Agenda Pack
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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A meeting of the IJB will be held on Wednesday 19th June 2024 at 9.30am-12pm 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: Cllr Anne McCrory 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 March 2024) For Approval Attachment Chair 4. Matters Arising/ Rolling Action List For Approval Attachment Chair 5. Chief Officer Update For Noting Verbal Ross McGuffie Strategic Planning & Development 6. Digital System Transformation - Mosaic For Noting Attachment Morag Dendy 7. Mental Health and Wellbeing Delivery Plan For Noting Attachment Ross McGuffie 8. Public Health Annual Report For Noting Attachment Dr Josephine Pravinkumar 9. Winter Planning Business Case Report 2024 For Approval Attachment Morag Dendy Performance & Finance 10. Unaudited North Lanarkshire IJB Annual Accounts 2023/24 For Approval Attachment Amanda Kilburn 1
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Governance & Policy 11. Membership Update For Endorsement Attachment Ross McGuffie 12. North Lanarkshire IJB Governance Document Update 2024 For Approval Attachment Stacey Anderson 13. Risk Management Report For Approval Attachment Stacey Anderson For Noting 14. 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 15. Date of Next Meeting 18th September 2024 2pm-4.30pm For Noting 2
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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 3
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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 4
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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. 5
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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. 6
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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. 7
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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 8
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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 9
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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 10
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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; 11
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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 12
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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 13
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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. 14
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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 15
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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. 16
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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 17
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1 ITEM 5 North Lanarkshire Integration Joint Board 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 – Planned for 13th November 2024 Liaison 3. Improving Cancer Journey R McGuffie Bring back a further update to the Board on the roll out of the programme and Paper on planner for 21st August 2024 PFA 4. 24.1.24 Item 7 National Care Service R McGuffie Table update for mosaic electronic records Review risk currently held for NCS Mosaic report on June agenda 18
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1 REPORT Item No: 6 SUBJECT: Digital System Transformation- Mosaic 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 Service Manager, Business Process Change & Improvement Service (BPCIS) Colin Sinclair, Project Manager (Mosaic) DATE: 19 June 2024 1. PURPOSE OF REPORT The purpose of the report is to detail the scale and scope of digital system transformation taking place across social work and social care and setting out the progress of the implementation and integration of the following digital products within North Lanarkshire. Mosaic – New Social Work & Social Care Case Management System CM2000 – Dynamic Scheduling System for Care at Home Services ELMS2 – Equipment Management System (Integrated Equipment & Adaptation Service) 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 19
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2 3. RECOMMENDATIONS i. Note the content of the report. ii. Acknowledge the progress made towards the implementation of new digital systems across the partnership, and their associated benefits. products. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 There is significant investment in digital solutions to support the management of social work and social care services across the partnership. This report provides an update on the implementation of three key products, outlining the current status of each project and highlighting the opportunities these products and systems represent for further system and data integration across the partnership. The three products/projects are: New Case Management System for Social Care/Social Work (Mosaic) Dynamic Scheduling System for Care at Home Services (CM 2000) ELMS2 Equipment Management System (Integrated Equipment & Adaptation Service) New Case Management System (Mosaic) 5.2 As part of the North Lanarkshire Council’s Digital NL programme of work and Digital and IT Strategy 2019-2024, the council carried out a cloud readiness assessment to determine which line of business system would be suitable for transitioning to a range of cloud-based solutions. The in-house social work management system, mySWIS, was rated against defined criteria such as system functionality, system maintenance, system usability, reporting capabilities and ability to migrate to the cloud. 5.3 mySWIS was considered not fit for purpose and could not be easily migrated to the cloud, typically due to legacy technology or complex point to point integration patterns. The council therefore agreed to procure a new social work case management solution and following a tender exercise, awarded the contract to Access UK Ltd (Mosaic) in September 2022 for an initial period of 60 months. 5.4 Mosaic, the new Social Care case management system, will be used across a wide range of services: Adult Health and Social Care – Including direct access with Health staff. Education & Families Justice Social Work Services Tackling Poverty Team Yes ☐ No ☒ N/A ☐ 20
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3 5.5 The introduction of a new digital solution for managing social work caseloads and workflows presents significant opportunities to improve worker access to relevant information, provide a single source for data on the people we support, improve data analytics and reporting to inform service improvement, and better opportunities for data sharing across the partnership. It is anticipated the investment in this system will yield many other benefits: More efficient use of social care staff time. Improved workflows for case management. Reduction in paper-based systems through the use of handheld/mobile devices. Improved statutory and legislative reporting and compliance. Improved quality assurance and key performance indicators. Improved customer satisfaction and contact with service users (including via customer Portal. More efficient use of staff time. 5.6 The development and implementation of Mosaic is supported by a project team, which has spent several months working with teams from across the partnership to configure the system to reflect our streamlined processes and workflows. The final configuration of the system is nearing completion to allow testing to take place in late summer, supported by a training programme for staff commencing in June 2024. 5.7 Migration of relevant data from mySWIS continues through to September 2024, and key integrations will be developed and tested, again by September 2024. Key integrations include: CM 2000 (dynamic scheduling – see below); ELMS 2 (Integrated Equipment & Adaptation Service – see below); and SEEMIS (Education management system). 5.8 The project is entering a critical phase with a planned go Live date of October 2024 and further details of the project timeline are detailed below: Stage Details Procurement Complete System Configuration On going scheduled to be completed by July 2024 Testing Scheduled to be completed by August 2024 Training June/July/August 2024 Data Migration September 2024 Integrations with other systems August/September 2024 Go Live October 2024 Post go Live support and Review September to December Phase 2 – Portal January 2025 21
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4 Dynamic Scheduling System for Care at Home Services (CM 2000) 5.9 The Home Support Service is currently engaged in a service redesign exercise as it seeks to increase focus on people’s choice and control, increase the quality of service, and equip frontline staff with the information they need to undertake their work most effectively. In relation to the latter point and within the context of the wider redesign activity, the service has procured a digital solution to ensure staff capacity is optimally utilised. 5.10 With a workforce of over 1,300 Home Support Workers supporting approximately 2,300 people at any given time, it is important to recognise the Home Support Service is a large and complex one, responsible for providing essential care and support to the most vulnerable in our communities. 5.11 Over the past eighteen months, the Home Support Service has developed a strong understanding of its requirements for a new scheduling tool, taking into account the day-to-day experiences within the service. These requirements include: Provision of over 6000 visits per day. 750 Home Support Workers on shift on a daily basis. Managing changes to the support we provide due to changes in people’s circumstances (e.g. hospital admission). Changing availability of Home Support Workers due to annual leave or other absence. Increasing number of people whose support requires multiple visits in a day, often involving two Home Support Workers to safely support with moving and assisting as well as personal care. Continuity of service and matching the right staff with the right skills to people at the right time, who require support, are essential to the quality of care and services provided. 5.12 In February 2024 a new dynamic scheduling tool was procured to replace the current product which comes to an end in October 2024. The contract awarded was awarded to The Access group for their CM2000 product. The contract is for an initial period of 48 months with the option of two additional single year extensions. 5.13 The introduction of this contract will support this service delivery by aiding back- office staff to schedule support and adapt quickly to changing needs efficiently and effectively. The contract provides an opportunity to explore additional benefits which would allow both service users and family members to access care notes via an application allowing real time updates. 5.14 There are a range of anticipated benefits associated with the project which will have an impact on staff (both front-facing practitioners and back-office staff), supported people and their carers and families. These anticipated benefits include: 22
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5 Ensure shift patterns reflect supported people’s needs – support is available at the right time and right place to support service demand, making more efficient use of resources. Accurate and transparent measurement and reporting of differential productivity/utilisation across the localities. Provision of management information to inform resource planning decisions. Increase workforce capacity through a more targeted and balanced allocation of resources across the home support teams. Greater transparency of locality resource allocation will enable greater flexibility and sharing of resource across locality boundaries. A more effective/efficient service delivery model resulting in a better consistency of service and an increase in satisfaction among the people we support. The ability for real time mobile workforce management and scheduling including minimising and optimising time spent travelling to visits. The ability to evaluate performance via workforce analytics and trend information. Increase staff morale through improved working practises and processes, resulting in better work life balance, and retention of staff. 5.15 The project team is progressing the configuration of the system with key service personnel. Testing, training and data migration will commence during the summer months, with an anticipated Go Live date of October 2024. ELMS2 – Equipment Management System (Integrated Equipment & Adaptation Service) 5.16 The Integrated Equipment & Adaptation Service has for many years used the MICES software platform supplied by Msoft which is no longer supported. The system manages the day-to-day demands of delivering independent living equipment services across both North and South Lanarkshire. This includes stock control and asset management. The legacy system has suffered from a lack of integration across other systems and applications resulting in a reliance on paper based systems and processes requiring significant double keying. 5.17 The Council has recently procured a new software solution, ELMS 2, provided by Ethitec Technology Ltd. The new solution will be implemented to meet the following service requirements: Direct ordering and tracking of orders technology providing delivery routes and times. A system that links directly to the stock control process, reducing administrative functions. Field staff provided with handheld devices which reduces the reliance on printed paperwork, provides real-time delivery information to the prescribers via email and route management based on current traffic conditions. 23
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6 Improved monitoring of equipment due for review and maintenance. Prescribers given direct access to equipment catalogues stock levels and service users equipment history. 5.18 ELMS 2 also offers interoperability and integration with Mosaic, the new social work case management solution and allows for direct access by NHS Lanarkshire staff to order equipment and view service users equipment history. Development work has been commenced to integrate with Morse, the community healthcare system used by NHS Lanarkshire. Project Timeline Stage Details Procurement March 2024 System Configuration April 2023 to May 2024 Testing June 2024 Training June/July 2024 Data Migration August 2024 Go Live August 2024 5.19 The project is in the testing phase with training commencing imminently. Service champions have been identified to support the roll out across the partnership, with the new solution planned to go live in early August 2024. 6. CONCLUSIONS 6.1 The digital system transformation activity taking place across the partnership is considerable and the key projects detailed within this report are all entering critical phases and will all go Live before the end of this calendar year. Each of the project teams continue to work with all stakeholders, including Senior Managers, front line staff and integrated teams across the partnership, to ensure a smooth transition as each produce goes live and to ensure the benefits outlined above are realised. 6.2 Implementing these systems presents not just a shift from legacy systems, some of which are end of life, but also a cultural shift in using digital platforms which allow the service to function differently. The ability to access and generate accurate and real time information to support practitioners, the ability for supported people to access their own data and the enhanced data quality and integration offered by these products will continue to support the service in enhancing staff’s digital skills across a range of settings. 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 ☒ 24
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7 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) The projects outlined in this report each have their own project boards. These are governed via the Council’s Digital Programme of Work Board. 7.3 FINANCIAL Each of the projects detailed within this report are part-funded via earmarked reserves which have been agreed for the lifetime of contracts. 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 Information and Data Protection RIA0000449 High Chief Officer (Planning, Performance & Quality Assurance) Failure to comply with legislation or regulatory procedures including SSSC regulations RIA0000451 Low Chief Officer (Adult Social Work Services) IT systems no longer fit for purpose RIA0000458 Medium Senior Manager (Strategy & Performance) Each of the projects manage their own risk registers. The project risk is linked to the service risks highlighted above. 25
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8 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 Regular stakeholder engagement takes place through project boards and various workshops and sub groups. ☒ Provide stakeholders with information on how to get involved Information is posted on Yammer and emails ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Discovery workshops carried out for every service area. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Service user engagement carried out as part of Home Support redesign. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Sub-groups/Stakeholder events and ongoing engagement with staff across North Lanarkshire ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Discovery workshops carried out for every service area. ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Communication and training plans. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Sub-groups/Stakeholder events and ongoing engagement with staff across North Lanarkshire 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIAs are ongoing and will be completed and approved prior to systems going LIVE. Yes No N/A EQIA added to website: 26
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9 Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. 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. 27
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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 28
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1 REPORT Item No: 7 SUBJECT: Mental Health and Wellbeing Delivery Plan To: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Ian Nicol, HSCP North and MHW Strategy Programme Manager DATE: 19 June 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 Ian Nicol, Programme Manager, Health and Social Care North Lanarkshire with advice and input from Kate Bell, Senior Manager, Strategic Change, NHS Lanarkshire. 3 RECOMMENDATIONS It is recommended that the IJB: (1) Acknowledges the process and timeline to develop a Lanarkshire Mental Health and Wellbeing Delivery Plan aligned to the National, Scottish Government/COSLA Mental health and Wellbeing Strategy and separate Delivery Plan, both published in 2023; (2) Agrees to receive the final draft Delivery Plan for approval at its next meeting in September 2024; 29
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2 (3) Agrees that Delivery Plan will subject to the endorsement of South Lanarkshire IJB; NHS Lanarkshire Board; North and South Lanarkshire Councils; and North and South Lanarkshire Community Planning Partnerships. 4 VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5 BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Getting it Right for Every Person (GIRFEP), a Mental Health and Wellbeing Strategy for Lanarkshire was launched in October 2019 to provide a shared vision and to drive significant shifts in culture (how we see and treat mental health and physical health), focusing on earlier intervention and prevention as well as the redesign and reconfiguration of services and development of new services. 5.2 The scope of the Strategy was not just about the mental health services delivered by the NHS, Integration Boards and Local Authorities but understanding how we, along with our wider community planning partners and society as a whole, contribute to the mental health and wellbeing of the people of Lanarkshire. 5.3 The joint strategic aims, aligned with partner organisations, of Getting It Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, were to: Improve healthcare and wellbeing; Strengthen effective leadership and governance for mental health services across all sectors; Reduce health inequalities and improve health and healthy life expectancy; Support people to live independently at home through integrated health and social care services; Provide comprehensive, integrated and responsive mental health and social care services and supports in community based settings; and Support all children and young people to live as full and healthy a life as possible and to realise their full potential. 5.4 The aspiration set out in the Strategy was that people in Lanarkshire live in a community where everyone understands that there is no good health without mental wellbeing, where we know how to support and improve our own and others’ mental wellbeing and act on that knowledge, and where our mental Yes ☐ No ☐ N/A ☒ 30
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3 wellbeing contributes to a healthier, wealthier, fairer, smarter, greener and safer Lanarkshire for all. 5.5 The delivery programme comprised of 4 main workstreams: Good Mental Health for All. Improving Access to Mental Health Support and Services. Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans. Specialist Mental Health Services. The Strategy also had in place a number of cross cutting interdependent workstreams. These included Communication and Engagement, Workforce and Finance. 5.6 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 5.7 Over the course of 2022, we were able to look forward, endeavouring to take advantage of the opportunities and experiences of working in different ways. All workstreams reviewed their delivery plans to ensure that they took account of the impact of Covid-19; build on our recovery plans and the new ways of working that have developed over the course of the pandemic, whilst retaining a focus on the vision and objectives set out in the original Lanarkshire Mental Health and Wellbeing Strategy. 5.8 This report outlines the progress made across all Strategy workstreams and sets out our progress in developing a Mental Health and Wellbeing Delivery Plan for Lanarkshire aligned to Scotland’s Mental Health and Wellbeing, the new national Mental Health and Wellbeing Strategy launched in 2023 by COSLA and the Scottish Government. 6 ACHIEVEMENTS Good Mental Health for All 6.1 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. 6.2 The Covid 19 Pandemic was stressful for many and threw a spotlight on the relationship between mental and physical health. The impact was not experienced equitably. Those least able to draw on protective factors (good health; financial wellbeing; affordable housing; employment; being able to work from home; support home schooling) were less equipped to deal with the impact. It exacerbated long-standing inequalities in being able to thrive in the face of adversity. 31
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4 6.3 The longer-term impact of the pandemic is likely to widen these inequalities further unless significant action is taken. This has taken on a new urgency with the emerging cost of living crisis, compounding the threat and further widening the gap. 6.4 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 6.5 The Good Mental Health for All Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Health Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and Common Mental Health Problems. 6.6 Key highlights include: Promoting a confident, diverse and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention Promoting a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports Delivering a programme of work to tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require Driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together Improving access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund Delivering an annual Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them Exploring robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. Improving Access to Mental Health Supports and Services (IAMHSS) 6.7 IAMHSS has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and through the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy, 2017. 32
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5 6.8 Primary Care Mental Health & Wellbeing Teams: PCMHW model developed with Mental Health Liaison Nurses now covering 91 GP practices supported by LAMH Mental Health and Wellbeing Workers providing a non-clinical role. Assessment Plus CBT based guided self-help intervention. now providing guided self-help intervention in 3 localities. A Task and Finish Group has now been established to: - review current Primary Care Mental Health (PCMH) service model to learn from our experience to date and ensure we make the most effective and efficient use of resources to provide a central point of referral for self & practitioner referrals of people experiencing mild to moderate mental health problems and divert patients from GP practice; - enhance and develop standard internal referral processes between the PCMH service, Primary Care Occupational Therapy (PCOT) and Community Link Worker (CLW) programmes, CMHTs, Mental Health Flow Navigation Centre & Community Addiction Services. 6.9 Transforming Mental Health in Emergency Departments (ED) Flow Navigation Centre (FNC) fully established in-hours providing an alternative to ED triage for a mental health assessment. Direct links with Psychiatric Liaison Nurse Service for Community Police Triage and Scottish Ambulance Service triage fully established in hours via FNC and Out-of-Hours at Douglas Street. Expanded in November 2021 to include British Transport Police. Out-of-Hours service expanded and fully embedded. Patients triaged and assessed via telephone, virtual platform, or face-to-face. Mental Health Advanced Nurse Practitioners now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. Overall reduction of 68% in police attendance at ED. 6.10 Custody Suites: We set out to develop a range of new ways of working within Custody Suites to deliver a person centred, safe and clinically effective healthcare for people detained in Police custody across the 4 Lanarkshire Custody Suites and develop a new Mental Health and Wellbeing Team staffing model, aligned to the Unscheduled Care Team, the Primary Care Team, and the Community Mental Health Teams who will continue to provide care for the most unwell people who need specialist input. Two Advanced Nurse Practitioners have been recruited through Action 15 funding in place and are providing a valuable mental health assessment resource to support people who present with mental health needs when detained for any period of time. Feedback has been positive. 33
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6 6.11 Prisoner Mental Health: Mental health Multi-Disciplinary Team staffing model for Shotts Prison developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. Prisoner population of HMP Shotts now has improved access to a wider range of mental health services – in particular psychological therapies and health improvement – through a match-stepped model of care. 6.12 Digital Solutions: Digital solutions explored to help provide services in new ways that make them more accessible and enhance patients’ experience. Near Me well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. MORSE transition completed for all previous Midis users. Work remains underway for migration of remaining services. Successful collaboration with Connecting Scotland to provide devices and support to service users. Digital champions identified Child and Adolescent Mental Health Services 6.13 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services (CAMHS) and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). 6.14 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by the more complex mental health problems, moving early intervention support to the Schools Counselling Model, Schools Nursing and the Community Wellbeing Framework. 6.15 In January 2021, the Specialist Children’s Health Services Unit (SCHSU) was formed bringing a centralised approach to the operational delivery of children’s specialist health services across Lanarkshire. In April 2021, Health and Social Care North Lanarkshire received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 6.16 Major achievements include: Choices and Partnership Approach (CAPA) embedded into CAMHS 34
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7 Recruiting and retaining staff who can provide the level of expertise required to enable us to deliver the national CAMHS specification fully by March 2026. Putting in place an electronic documentation system that will ensure children and young people who use CAMHS are visible across the system. New South Lanarkshire CAMHS facility within Udston Hospital, supporting CAMHS, the Eating Disorders team and the Neurodevelopmental Service opened to patients on 5th September 2022 and now fully operational. Refurbishment of Airbles Road and Coathill CAMHS outpatient and staff base planned to bring North Lanarkshire estate to same standard. Neurodevelopmental Service (NDS) Steering Group established to oversee development of the service and implement the NDS service specification for children and young people by March 2026. Children and Young People’s Community Mental Health and Wellbeing Support and Services 6.17 Delivering improvements for children and young people’s mental health and wellbeing is embedded in the North and South Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Robust progress has been made in offering a range of programmes of work with a focus on prevention/early intervention and promoting positive mental health and resilience. All practice is underpinned by The Promise, GIRFEC and UNCRC approaches. 6.18 Funding from the National Children and Young People’s Mental Health and Wellbeing Programme is being provided for the delivery of community mental health and wellbeing supports and services for children and young people. This is to support the development and provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government is clear that funding is to be used for new or enhanced services. Project officers have been recruited by both local authorities and gap analysis, benchmarking and co-production of services has been undertaken. 6.19 A range of services have been developed at universal and additional levels which complement and value to other service preventative services which address the children’s and young people’s wellbeing, examples include: 6.20 Key achievements include: Living Life to the Full – provided by NLC Community Learning & Development Family support for children impacted by neurodevelopmental difficulties – provided by Carers Together LIAM (Let’s Introduce Anxiety Management) – Educational Psychology Mentoring through sport – Active and Creative Communities Support and services commissioned by through Empowering Clusters, through the community solutions approach, based on local need 35
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8 Pilot of family wellbeing practitioners based on cluster to divert referrals from CAMHS – Education and Families Intensive Support for care experienced young people who have left care – Education and Families Implementation of a digital mental health and wellbeing platform, Kooth, which has now launched and is available for children and young people aged 10-18 years (up to 26 for care experienced young people). Launch of a public facing Children and Young People’s Mental Health Directory of Services and Resources in Lanarkshire. Following on from a successful collation and distribution of the Directory in an excel sheet format, we have taken on board the feedback we received and the Directory is now available to all on NHS Lanarkshire’s public facing website. Content and layout has been guided by children and young people as well as input for the design. Specialist Mental Health Services 6.21 Key achievements include: Dedicated specialised Community Perinatal Mental Health Team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. Multi-agency, multi-disciplinary Infant Mental Health team established. Maternity and Neonatal Psychological Interventions Service established. Review of Adult Rehabilitation Services completed. New referral form in place with a single point of referral; pathway to community rehab now live; planned date of discharge in place; new Community Rehabilitation Team nursing model embedded in practice; new Rehabilitation & Recovery Service Operational Policy in place. South Lanarkshire Community Mental Health Team (CMHT) funding and staff transferred from the previous hosted arrangements with North Lanarkshire to enable integration of Community Mental Health services within South Lanarkshire HSCP. Scottish Government funding for Dementia Post Diagnostic Support (PDS) Services utilised to create a single dedicated PDS service that focuses on those individuals not requiring secondary care input of an Older Adult CMHT. Adult Autism Assessment Service established as Phase 1 of a wider Adult Neurodevelopmental Pathway. 36
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9 7 MENTAL HEALTH AND WELLBEING DELIVERY PLAN Scotland’s Mental Health and Wellbeing 7.1 The new national Mental Health and Wellbeing Strategy recognises mental health as a cross-government priority, building on the partnership between the Scottish and Local Governments. 7.2 It recognises that underlying factors, inequalities and types of disadvantage affect certain groups of people who may suffer disproportionate impacts on their mental health. 7.3 We know that mental health does not just mean mental illness; it is a continuum that may include a range of needs, from having the right words to describe how we feel, through to everyday worries and feelings of distress or hopelessness. We must ensure that the right help is always available to those who experience severe and enduring mental health conditions and provide the wider support people may need to maintain good mental health. 7.4 In publishing the Strategy in 2023, the Scottish Government and COSLA acknowledge that all areas of Government will need to work together to achieve our shared vision and to make progress towards our outcomes, which are outlined below. The Strategy sets out a vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. 7.5 The Strategy describes a whole system model which very much aligns with the Lanarkshire Mental Health and Wellbeing Strategy 7.6 The Strategy sets out the following outcomes: Improved overall mental wellbeing and reduced inequalities. Improved quality of life for people with mental health conditions, free from stigma and discrimination 37
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10 Improved knowledge and understanding of mental health and wellbeing and how to access appropriate support Better equipped communities to support people’s mental health and wellbeing and provide opportunities to connect with others More effective cross-policy action to address the wide-ranging factors that impact people’s mental health and wellbeing. Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. Better access to and use of evidence and data in policy and practice. A diverse, skilled, supported and sustainable workforce across all sectors 7.7 It also identifies ten priorities which provide the structure for the first national Delivery Plan for 2023-25: 1. Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. 2. Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. 3. Better access to and use of evidence and data in policy and practice. 4. A diverse, skilled, supported and sustainable workforce across all sectors 5. Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk 6. Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies 7. Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery 8. Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk 38
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11 9. Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies 10. Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery Lanarkshire Mental Health and Wellbeing Delivery Plan 7.8 Given the close alignment between the 2019-2024 Lanarkshire and 2023 national strategies, the Integration Joint Board agreed at its Liaison Session on 8th November 2023, that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire Delivery Plan, aligned to the strategic actions set out in the national Delivery Plan, and clearly linking to local strategies and plans including both Health and Social Care Partnership Strategic Commissioning Plans, Our Health Together, Children’s Services Plans, the Plan for North Lanarkshire Community Plans and Local Outcome Improvement Plans. 7.9 Since then, work is continuing to: Assemble a final report on the work carried out over the 2019-2024 Mental Health and Wellbeing Strategy for sharing and publication Establish a programme sustainability plan- to identify any outstanding priorities and actions from 2019-2024 strategy to be carried forward into the new Lanarkshire Delivery Plan Undertake a self-assessment of where we are in Lanarkshire in relation to the strategic actions set out in the National Mental Health and Wellbeing Delivery Plan Consider contributions from stakeholders regarding existing and new priorities and actions (period of engagement and development) Engage with stakeholders both at Lanarkshire-wide and locality level, via the Community Boards in North Lanarkshire and with an equivalent engagement process in South Lanarkshire, to identify any further priorities and actions for the Lanarkshire Delivery Plan Agree future governance and leadership arrangements Prepare the final draft Lanarkshire MHW Delivery Plan for approval by the Integration Joint Board, subject to the endorsement of South Lanarkshire IJB, Community Planning Partnerships, North and South Lanarkshire Councils and the Lanarkshire NHS Board. Stand down current MHW Strategy Board, Executive group and associated workstreams and close 2019-2024 programme of work Establish governance structures and implementation process (embed in operational governance and supported by in-house enablers) 39
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12 7.10 The timeline to complete this process is set out in Appendix 1, the intention being to present a draft Delivery Plan to the Integration Joint Board in September 2024. 8 CONCLUSIONS 8.1 This section should draw the committee’s attention back to the key reasons and arguments in favour of the recommendations made within the report. 8.2 Conclusions can also inspire fresh concepts to address a problem highlighted within the report or presenting fresh perspectives on a subject. 9 IMPLICATIONS 9.1 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 ☒ 9.2 ASSOCIATED MEASURE(S) 9.2.1 An outcomes-focused Achievement Framework was developed (Appendix 2) for the Mental Health and Wellbeing Strategy that links the contributions made by projects and workstreams to outputs and the achievement of short and long term outcomes. 9.2.2 We noted in our strategy that as GIRFEP was implemented, people in Lanarkshire would see campaigns to promote ways of improving our mental wellbeing, changes and improvements to the way they access mental health support and services, new ways of working, observe new staff roles, a programme of work to tackle mental health stigma and discrimination, increased interventions to support prevention and early intervention as well as every effort to improve services for people with severe and enduring mental health conditions. 40
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13 9.2.3 Ultimately, the strategy set out with an ambition to change the culture in Lanarkshire and improve people’s physical wellbeing and mental health. A final report is being developed to report on what outcomes have been achieved over the period of the strategy. 9.2.4 A monitoring and evaluation framework is being developed to accompany the new national Strategy. This will set out how progress towards the outcomes will be measured. It will also take account of existing indicators and standards currently under development. 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The landscape in relation to additional funding streams, including Mental Health, released throughout the year by Scottish Government, is complex with continued uncertainty around the scale and timing of future funding. The costs and funding available for 2024/25 and future years will be closely monitored and reported. 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. This is currently no direct risk for the delivery plan. 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 Discussion at Lanarkshire Links quarterly meetings Engagement events involving Mental Health and Wellbeing Strategy Board and Comms & Engagement Group Presentation/discussion at Community Boards 41
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14 ☒ Provide stakeholders with information on how to get involved As above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs As above ☐ 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 As above ☐ 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 Presentation/discussion at Community Boards 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIAs were completed for the development of the 2019-24 Strategy and for most of the workstreams. These will be reviewed and will inform the completion of an EQIA for the Delivery Plan. EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, 2019-23 Scotland’s Mental Health and Wellbeing Mental Health and Wellbeing Delivery Plan, 2023-25 42
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15 9. APPENDICES Appendix 1 – Lanarkshire Mental Health and Wellbeing Delivery Plan - Timeline for Development Appendix 2 – Achievement Framework CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Maggs Thomson, HSCP North, Head of Health at Maggs.Thomson@lanarkshire.scot.nhs.uk 43
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16 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 44
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17 MENTAL HEALTH AND WELLBEING DELIVERY PLAN APPENDIX 1 45
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18 LANARKSHIRE MENTAL HEALTH AND WELLBEING STRATEGY ACHIEVEMENT FRAMEWORK APPENDIX 2 46
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REPORT Item No: 8 SUBJECT: Director of Public Health Annual Report TO: Integration Joint Board Committee Lead Officer for Report: Dr Josephine Pravinkumar, Director of Public Health and Health Policy Author(s) of Report Dr Josephine Pravinkumar, Director of Public Health and Health Policy DATE: 19 June 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: S Josephine Pravinkumar ☒ Reviewed By: Population Health Committee, NHS Lanarkshire ☒ Endorsed By: NHS Lanarkshire Board ☒ 47
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3. RECOMMENDATIONS The Integration Joint Board Committee is asked to note the following: (1) The lower life expectancy and higher premature deaths in Lanarkshire compared to Scotland, and inequalities in these figures across Lanarkshire, necessitates whole systems working as a key priority, applying multidisciplinary, interagency, and collaborative approaches to prevention, early intervention and ongoing care. (2) To support the delivery of the NHSL Anchor Strategic Plan, particularly taking a more inequalities focused approach to service delivery. (3) Strengthen opportunities to work with other anchors on common goals to support community wealth building which are evolving through working in partnership. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES Key points to note: 5.1 The estimated population of Lanarkshire from Census 2022 figures is 668,200, a 2.6% increase from 2011 Census. North Lanarkshire estimated population 341,000 (1% increase from 2011 Census) The latest projections available to us are based on estimates for 2018 and show the population of Lanarkshire as a whole is expected to rise about 0.5% between 2021 and 2032 and fall slightly between 2023 and 2042, making the expected overall change from 2021 to 2042 an increase of 0.2%. The projected age structure of Lanarkshire’ population between 2021 and 2042, demonstrated in figure 1.1.1, indicates an increase of the over 75 years age group will equate to 64% of the overall population. The report also gives a brief update on our health protection work, dental public health and screening services. 5.2 This year Dr Pravinkumar has taken the opportunity to reflect on key Public Health priorities which featured in the previous annual report 2021/22 and she has viewed this reflection through the “What we Said” and “What Happened” lens. Some of the things that we have made progress with are as follows: 48
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The cost of living plan actions has been incorporated into the NHS Lanarkshire anchor plan in order to ensure a streamlined approach. All oral health improvement programs and the National Dental Inspection Programme have been remobilised; NHS dental activity has continued to increase. Progress in the area of long-term conditions in 2023 in NHS Lanarkshire has included completion of a Test of Change (pilot) with regards to support for patients attending the respiratory laboratory to quit smoking, which has now been successfully incorporated into usual practice. 6. CONCLUSIONS The IJB is asked to note the report and identify opportunities as part of its work plan to provide ongoing support to the prevention and inequalities agenda and strengthen the approach even further. 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 ☒ 49
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7.2 ASSOCIATED MEASURE(S) Nil 7.3 FINANCIAL N/A This paper has been reviewed by Finance: Yes No N/A 50
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7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 □ 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 51
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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 DPHAR 2023 Statistical Info 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 Director of Public Health Annual Report 2023 Yes No N/A Yes No N/A 52
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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 53
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Acknowledgements I am grateful to the staff within the Directorate of Public Health for all their work over the year. I am also grateful for their continued commitment, and the commitment of NHS Lanarkshire and staff in other organisations, to public health in Lanarkshire. I would like to thank all the contributors to this report within the Directorate of Public Health, the Health Improvement Department and colleagues across NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. Finally, I would like to extend my thanks to all organisations who work with NHS Lanarkshire to protect, maintain and improve the health of the public. This includes North Lanarkshire Council, South Lanarkshire Council, North Lanarkshire University Health and Social Care Partnership and South Lanarkshire University Health and Social Care Partnership. You can contact us by emailing publichealthannualreport@lanarkshire.scot.nhs.uk. The Directorate of Public Health NHS Lanarkshire Headquarters Kirklands Fallside Road Bothwell G71 8BB Telephone: 01698 752952 www.nhslanarkshire.scot.nhs.uk © Lanarkshire NHS Board Published March 2024 We encourage the use by others of information and data contained in this publication. Brief extracts may be reproduced provided the source is fully acknowledged. Proposals for reproduction of large extracts should be sent to the address above. ISBN 978-0-905453-46-0 Cover image: Represents the role of an Anchor organisation, with the five dimensions from chapter 3, on a background featuring the ‘wave’ from NHS Lanarkshire’s logo. 55
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Contents Foreword 4 Reflections on the 2021/22 Annual Report 5 1. Health of the People of Lanarkshire 8 1.1 Population Profile and Key Health Measures 8 2. Health Protection 17 2.1 Health Protection Team Update 17 2.2 Lanarkshire’s Hepatitis C (HCV) Elimination Project 20 3. Anchor Themes 26 3.1 NHS Lanarkshire as an Anchor Organisation 26 3.2 Widening Access and Employability Opportunities 28 3.3 Monklands Replacement Project and Community Benefits 31 3.4 Service Design and Delivery 33 3.5 Environment, Sustainability and Assets 35 3.6 Being an Exemplar Anchor 37 3.7 Community Wealth Building 39 4. Healthcare Public Health 44 4.1 Strategic Prevention in Healthcare: Opportunities and Challenges in Lanarkshire 44 4.2 Population Screening 47 4.3 Scottish Dental Needs Assessment Report on Older Adults: Challenges and Recommendations 51 Statistical Appendix 54 56
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Foreword It is my pleasure and a privilege to present my second Director of Public Health annual report. It is a huge honour to serve the population of Lanarkshire and I'm very grateful to my team, the colleagues in NHS Lanarkshire, the health and social care partnerships and all our key stakeholders for their support and excellent whole system working that we are all committed to. This year I have focused the report on the theme of Anchor organisations. Anchor organisations are typically large local employers that can have a strong and positive influence on the health and well-being of their local communities. Organisations who are able to do this can make a difference to health and well-being outcomes and reduce inequalities by their work across the five pillars. Organisations can embed this thinking and be an exemplar employer, adopt good procurement practices, design services to suit vulnerable populations better, and also through managing their assets. NHS Lanarkshire and its partner organisations are very committed to the anchors in the local communities we serve. I have also included the usual valuable chapters on the health of the population and our health protection work, dental public health and screening services. Lanarkshire’s population is expected to slightly increase, however there is a change to population age structure; we have an ‘aging population’. Over the next 20 years we expect an increase in people aged over 75 and fewer people aged under 30 years. However, life expectancy in Scotland and Lanarkshire has started to decrease in recent years and there is huge variation between areas. Those living in the most deprived areas have fewer years of life than those living in the least deprived. In Lanarkshire, for men this difference is 11.3 years and for women 8.5 years. Over 40% of all deaths in 2022 were caused by cancer (25.8% of all deaths), coronary heart disease (11.5%), and stroke (5.9%). These are key issues that we would like to continue to tackle. In addition, respiratory diseases accounted for 10% of deaths and dementia and Alzheimer’s accounted for 9.6% of deaths in Lanarkshire in 2022. I am very grateful to the editorial team for being with me throughout this journey and for helping to collate this report. I’m indebted to all for their excellent efforts. I hope you find the report helpful and would be very keen to hear any feedback and also suggestions for themes for future reports. I have included a new section in this year’s report to give a brief update on some of the key population health priorities that we highlighted last year. Prof S. Josephine Pravinkumar, Director of Public Health & Health Policy Email: josephine.pravinkumar@lanarkshire.scot.nhs.uk 57
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Reflections on the 2021/22 Annual Report This is a new chapter to report on work undertaken over the last 12 months on key Public Health projects. Cost of Living What we said The cost of living crisis is likely to lead to adverse health impacts, widen existing health inequalities and increase demand on health and social care services. A NHS Lanarkshire cost of living action plan has been developed to mitigate the impact of the crisis on patients, carers and staff. This plan builds on the collaborative work already established through the Child Poverty action plans. What Happened The cost of living plan actions have been incorporated into the NHS Lanarkshire anchor plan in order to ensure a streamlined approach. Work is underway to develop a transport strategy for NHS Lanarkshire including the offer of online appointments where appropriate, in order to reduce unnecessary travel costs. The Health Improvement Team are leading a programme of work to embed raising the issue of financial wellbeing into patient assessments. This also includes asking staff who are on sick leave about their financial wellbeing via occupational health assessments. A Frequently Asked Questions resource has been developed for staff and managers to raise awareness of resources and supports available. A communications plan has been taken forward with key messages for staff and patients and a dedicated email address has been provided for staff to feedback experiences and ideas. Staff roadshows in hospitals have included benefit/debt advice and staff health initiatives within localities have also addressed cost of living issues. Children and Young People What we said Inequalities across a number of areas, including health, have been exacerbated for children, young people and their families following the pandemic. Child poverty remains. Child death review activity is an important tool to learn from and potentially prevent the unnecessary deaths of children and young people. Health outcomes for care experienced children and young people remain poorer and addressing gaps in access and support is a key priority. 58
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NHS Lanarkshire, alongside key partners, are working together to tackle these issues through The Children and Young People’s Health Plan and the local Child Poverty Action Plans for North Lanarkshire and South Lanarkshire among others. What happened The Children and Young People’s Health Plan for 2021-23 Annual Report details activity over the 2023 period. It shows progress and achievements have been made in many areas, however, there is some way to go in improving outcomes for children and young people experiencing the effects of the COVID-19 pandemic. Impact of COVID-19 pandemic across the Four Harms in relation to dentistry What we said The four harms are related: harms to health impact on society and the economy, just as the societal and economic effects impact on physical and mental health and wellbeing. The COVID-19 pandemic has had a sustained impact on the delivery of dental services, which are only recovering gradually. The disruption of oral health improvement programmes had primarily impacted on more socially disadvantaged groups, further widening health inequalities What happened All oral health improvement programmes and the National Dental Inspection Programme have been remobilised. NHS dental activity has continued to increase. The new dental payment reform has been implemented since 1 November 2023 and will both preserve the position of NHS dentistry and safeguard levels of access. Three local general dental practitioners have recently completed their training to become dentists with enhanced skills in domiciliary care. Health Promoting Health Service (HPHS) What we said Identifying the needs of each hospital site required a collaborative approach looking at the available evidence of need. The Holistic Needs Assessment (HNA) is a tool used to open up discussions with an individual that seeks to understand the issues they have. The HNA identifies the wider determinants of health and signposts to the support needed to help alleviate/ameliorate issues allowing individuals to support themselves. A partnership approach to undertaking an HNA as early as possible in the patient journey helps facilitate Discharge without Delay. What happened The HNA is being used within teams where a Test of Change (pilot) has been carried out when a Health Improvement Senior (HIS) is not available. However, due to 59
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staffing capacity, patients are normally referred to the HIS to undertake the assessment. Funding is in place to support one HIS per hospital site till the end of March 2025. One HIS has been recruited to deliver the Staff Health and Wellbeing agenda in North Lanarkshire University Health and Social Care Partnership with the contract ending in August 2025. These posts help support a holistic needs approach to care across the organisation. The work with the Scottish Ambulance Service (SAS) Pathways Hub has been extended to all three hospital sites. The Holistic Needs Assessment is completed by SAS staff and sent to HPHS when an individual is conveyed to hospital. The appropriate HIS will visit the individual whilst in hospital to complete the HNA process. Long Term Conditions What we said At least one in four people in Lanarkshire report having a minimum of two or more long term medical conditions. Mental health conditions, cardiovascular disease, and cancers represent significant long term problems for Lanarkshire residents. Compared to the rest of Scotland, these conditions are more prevalent in Lanarkshire. What happened Progress in the area of long term conditions in 2023 in NHS Lanarkshire has included completion of a Test of Change (pilot) with regards to support for patients attending the respiratory laboratory to quit smoking, which has now been successfully incorporated into usual practice. In addition, a Lanarkshire Pathways Framework was produced by the Long Term Conditions workstream. This resource will help support work on person-centred healthcare journeys for people with long term conditions. Prof S. Josephine Pravinkumar, Director of Public Health & Health Policy Email: josephine.pravinkumar@lanarkshire.scot.nhs.uk 60
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1. Health of the People of Lanarkshire 1.1 Population Profile and Key Health Measures Background This section describes the population of NHS Lanarkshire, and how it is projected to change over the next 20 years. The number of births and deaths registered in 2022, and data on life expectancy are reported. Mortality information for specific diseases is presented. Data on cancer registrations is also described. Detailed information on each area is included in the relevant section of the Statistical Appendix, which readers are referred to. This chapter also includes the latest Scottish Health Survey results for Lanarkshire. Census 2022 Initial Outputs (1) The first outputs from the Census in 2022 were published on 14 September 2023. This first release included population estimates by age and sex at Scotland and Local Authority level, as described in Table 1.1.1 below. The census release reports that estimates were individually rounded to the nearest hundred and therefore the sum of estimates may not exactly equal the total. North Lanarkshire estimated population: 341,000 (1.0% increase from 2011 Census). South Lanarkshire estimated population: 327,200 (4.3% increase on the 2011 Census). Adding the above estimates, the population of Lanarkshire is estimated to be 668,200. This is a 2.6% increase from the 2011 Census added Local Authority estimates of 651,557. Table 1.1.1: Estimated population structure of North Lanarkshire, South Lanarkshire and Scotland, Census 2022 Females Males 0–14 15–64 65 years and over North Lanarkshire 51.4% 48.6% 16.5% 65.6% 17.9% South Lanarkshire 51.6% 48.4% 15.8% 64.0% 20.3% Scotland 51.4% 48.6% 15.3% 64.6% 20.1% Data source: National Records of Scotland(1) Population projections (2) The latest projections of Lanarkshire’s future population are based on estimates for 2018, and show that the population is expected to rise about 0.5% between 2021 and 2032. The population is expected to fall slightly between 2032 and 2042, making the expected overall change from 2021 to 2042 an increase of 0.2%. The projected change in the age structure of Lanarkshire’s population between 2021 and 2042 is shown in Figure 1.1.1. Key components in the changing Lanarkshire population are as follows: There is a projected increase of 64.2% in the population aged 75 and over between 2021 and 2042. This would result in 34,494 more people in this age group. 61
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The largest fall in population will be in the under 30 year olds, with a projected decrease of 10.7% between 2021 and 2042. There is estimated to be 24,026 less people aged under 30 in the next twenty years, likely to be contributed by fewer births. Figure 1.1.1: Projected percentage change in the age structure of Lanarkshire's population, 2021-2042 Data source: National Records of Scotland(2) More details on population estimates and projections for Lanarkshire are provided in tables A2 and A3 in the Statistical Appendix. Births (2) There were 6,309 live births registered among NHS Lanarkshire residents in 2022, a slight decrease from 2021 of 1.5%. The number of stillbirths increased slightly from 24 in 2021 to 28 in 2022. The overall live birth rate per 1,000 women aged 15-44 was 52.2 for Lanarkshire, higher than the Scottish rate of 45.5. Over the three-year period 2020-2022, 99.6% of all babies born alive in Lanarkshire survived their first year. There was an average of 23 deaths per year, excluding stillborn babies. These deaths were similar to the level in Lanarkshire for the period 2019-2021. The infant death rate (deaths during the first year of life) in Lanarkshire was 3.7 per 1,000 live births – slightly higher than the Scottish rate of 3.5 per 1,000 live births. Due to the small numbers involved, death figures among children aged one year or younger fluctuate from year to year. Further information on births is shown in tables A4 and A5 in the Statistical Appendix. Life expectancy Life expectancy figures from National Records of Scotland (NRS)(2) are provisional for 2020- 2022. There is a decrease in life expectancy at birth in Lanarkshire between the time period 2010-2012 and 2020-2022. This decrease is 1.8 years for males (from 77.0 to 75.2 years) and 1.6 years for females (from 81.0 to 79.4 years). Over the same time period, 62
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Scotland life expectancy had stabilised, but has now started to decrease. UK life expectancy reported by Office for National Statistics(3) had been slowly increasing, and has now started to decrease. NRS figures(2) describe that females in Lanarkshire live on average 4.2 years longer than males. This gap between male and female life expectancy is similar to that for Scotland (4.2 years)(2) and the UK as a whole (4.0 years)(3). Life expectancy is below national levels; males in Lanarkshire live on average 1.3 years less and females 1.4 years less than in Scotland overall.(2) Compared to the UK as a whole, life expectancy in Lanarkshire is lower by 3.3 years in males and 3.2 years in females. (2,3) Within Lanarkshire, life expectancy in South Lanarkshire is higher than in North Lanarkshire; in the South males live 1.5 years longer and females 1.3 years longer on average than those in the North (see Figure 1.1.2).(2) Figure 1.1.2: Trends over time in life expectancy at birth in North Lanarkshire, South Lanarkshire and Scotland by sex F: Females; M: Males; North: North Lanarkshire; Scot: Scotland; South: South Lanarkshire Data Source: National Records of Scotland(2) Life expectancy in Lanarkshire also varies by Scottish Index of Multiple Deprivation (SIMD) quintile (ranking of area-level deprivation), as shown in data from 2017-2021.(4) Males living in the most deprived areas of Lanarkshire live on average 11.3 years less than males living in the least deprived areas; for females, life expectancy is 8.5 years less in the most deprived areas compared to the least deprived areas.(4) Further information on life expectancy is shown in table A12 of the Statistical Appendix. North M North F South M South F Scot M Scot F 82 80 78 76 74 72 70 2016-2018 2017-2019 2018-2020 Year 2019-2021 2020-2022 Life Expectancy at Birth (in Years) 63
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Deaths (2) There were 7,694 deaths registered in Lanarkshire in 2022, a decrease of 438 (5.4%) from 2021. Standardised mortality ratios (SMRs) were calculated for deaths in Lanarkshire, using Scotland as the standard population. SMRs show whether the number of deaths are higher or lower in Lanarkshire than would be expected based on Scotland’s mortality rates. Overall SMRs in Lanarkshire remain above the Scottish average for both sexes, both for mortality in those aged under 75 years and mortality in those aged 75 years and over. There is wide variation in SMRs between the different localities in Lanarkshire. From one locality with an SMR 20.4% below the Scottish rate for females aged less than 75 years, to another locality with an SMR 51.3% above the Scottish rate for females aged less than 75 years. Since 2012, the combined proportion of all deaths due to cancer, coronary heart disease (CHD) and stroke has accounted for less than 50% of all deaths and, in 2022, the proportion was 43.1%. Deaths from cancer decreased slightly this year from previous recent years, whilst for CHD they increased slightly and for stroke they remained relatively stable compared to previous years. In 2022, the ‘big killer’ diseases accounted for 3,316 deaths: individually cancer, CHD and stroke were responsible for 25.8%, 11.5% and 5.9% of all deaths in Lanarkshire, respectively. Respiratory disease was also a significant cause of mortality in 2022, accounting for 10.0% of all deaths in Lanarkshire. Another major cause of death in 2022 was dementia and Alzheimer’s, accounting for 9.6% of deaths. More detailed information on mortality is provided in the tables and charts in A6–A11 of the Statistical Appendix. 64
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Figure 1.1.3: Population Infographic (4-7) 65
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Cancer Registrations in Lanarkshire, 2021 (8) Number of cancer registrations is a measure of the number of cancers diagnosed in a given year. Cancer registration is a dynamic process therefore the figures presented here may differ from previously published information. The infographic below outlines key points derived from the detailed data in tables A13-A15 of the Statistical Appendix. Figure 1.1.4: Cancer infographic (8) 66
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Scottish Health Survey The Scottish Health Survey 2022 was published in December 2023.(9) A sample of households across Scotland were interviewed and data at Health Board level has been presented for 2018, 2019, 2021 and 2022 surveys combined.(9) The results from 2020 were excluded since these were experimental statistics.(10) The following infographic describes key results for Lanarkshire from this data, based on between 1002 and 1755 survey responses (varied depending on the question).(10) Figure 1.1.5: Scottish Health Survey infographic (10) 67
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Key Points The estimated population of Lanarkshire from Census 2022 figures is 668,200, a 2.6% increase from 2011 Census. The latest projections of Lanarkshire’s future population, based on estimates for 2018, show that the age structure of the population is expected to change between 2021 and 2042, with an increase in people aged 75 and over and fall in number of people aged under 30. There has been a decrease in life expectancy in Lanarkshire over the last 10 years. Life expectancy is lower in Lanarkshire than in Scotland overall and life expectancy is lower in North Lanarkshire than South Lanarkshire There were 7,694 deaths registered in Lanarkshire in 2022, a decrease of 5.4% from 2021. Overall standardised mortality ratios (SMRs) in Lanarkshire remain above the Scottish average for both sexes, both for those under 75 years and those 75 years and over. There is a wide variation in SMRs between the different localities in Lanarkshire. In 2022, the ‘big killer’ diseases accounted for 43.1% of all deaths – cancer (25.8% of all deaths), coronary heart disease (11.5%), and stroke (5.9%). In addition, respiratory diseases accounted for 10% of deaths and dementia and Alzheimer’s accounted for 9.6% of deaths. The highest number of cancer registrations in 2021 related to Trachea, Bronchus and Lung Cancer, Female Breast Cancer, Large Bowel Cancer and Prostate Cancer. The Scottish Health Survey Lanarkshire data describe that over 1 in 3 people experience a limiting long-term illness and nearly 1 in 4 people experience mental health symptoms. Priorities for Action Responding to the expected shift in population structure over the next 20 years, with fewer younger people and more older people, requires investment and preparation. The lower life expectancy and higher premature deaths in Lanarkshire compared to Scotland, and inequalities in these figures across Lanarkshire, necessitates whole systems working, applying multidisciplinary, interagency, and collaborative approaches to prevention, early intervention and ongoing care. An example of an initiative being undertaken through the Respiratory Speciality Improvement Group, is the ongoing work to develop a Respiratory Prevention Plan, which thereafter could be used as a blueprint for other long term conditions. An update to the Lanarkshire Long Term Conditions analysis is planned for 2024 and this will be valuable for the continued monitoring and assessment of the burden of disease in Lanarkshire. References (1) National Records of Scotland (NRS). Scotland's Census 2022 - Rounded population estimates – data. Scotland’s Census. Website. https://www.scotlandscensus.gov.uk/2022-results/scotland-s-census- 2022-rounded- population-estimates/ [Published 14 September 2023; accessed 23 January 2024]. (2) The statistics in this section were obtained from local analysis of data supplied by NRS or directly from NRS published online at https://www.nrscotland.gov.uk 68
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(3) Office for National Statistics. National life tables – life expectancy in the UK: 2020 to 2022. Office for National Statistics. Website. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lif eexpectancies/b ulletins/nationallifetablesunitedkingdom/2020to2022 [Published 11 January 2024; accessed 24 January 2024]. (4) Public Health Scotland. ScotPHO Online Profiles Tool. Public Health Scotland. Website. https://scotland.shinyapps.io/ScotPHO_profiles_tool/ [Accessed 9 February 2024]. (5) National Records of Scotland. Vital Events Reference Tables 2022. National Records of Scotland. Website. https://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/vital- events/general-publications/vital-events- reference-tables/2022 [Last updated 20 July 2023; accessed 21 December 2023]. (6) National Records of Scotland. Mid-2021 Population Estimates Scotland. National Records of Scotland. Website. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/population/population-estimates/mid-year-population-estimates/mid- 2021 [Accessed 21 December 2023]. (7) National Records of Scotland. Population Projections for Scottish Areas (2018- based). National Records of Scotland. Website. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics- by- theme/population/population-projections/sub-national-population-projections/2018- based [Accessed 21 December 2023]. (8) Tables A13-A15 of the NHS Lanarkshire Annual Report of the Director of Public Health 2023. (9) Scottish Government. The Scottish Health Survey 2022 – volume 1: main report. Edinburgh: Scottish Government; December 2023. https://www.gov.scot/publications/scottish-health-survey-2022-volume- 1-main- report/documents [Accessed 15 December 2023]. (10) Scottish Government. Scottish Health Survey dashboard. Scottish Government. Website. https://scotland.shinyapps.io/sg-scottish-health-survey/ [Last updated February 2024; accessed 9 February 2024]. Karen Lorenzetti, Principal Public Health Information Analyst Email: karen.lorenzetti@lanarkshire.scot.nhs.uk Lisa Maria Neil, Public Health Information Analyst Email: lisamaria.neil@lanarkshire.scot.nhs.uk Emma Baird, Locum Consultant in Public Health Medicine Email: emma.baird@lanarkshire.scot.nhs.uk 69
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2. Health Protection 2.1 Health Protection Team Update Background The Health Protection team are responsible for protecting individuals, groups and populations from infectious disease and non-infectious public health threats in the environment. During the winter of 2022/2023 there was a national increase in cases of group A Streptococcal infection and outbreaks of Scarlet fever in nurseries and schools. The team worked with colleagues in local education authorities to respond to these outbreaks and ensure staff and parents had the appropriate information. The winter also saw high levels of influenza activity across the community and a number of cases requiring admission to hospital. The summer brought the normal seasonal increase in cases of a range of gastrointestinal illness including Shiga toxin producing Escherichia coli (STEC), Salmonella and Cryptosporidium and cases of more exotic infections in residents returning from travel overseas including Salmonella typhi and paratyphi. Over the last year the Health Protection Team have supported the health of the population of Lanarkshire through a range of activities with two examples given below. Care Homes Within Care Homes across North and South Lanarkshire there are 4360 resident places. Care Homes came through challenging times over the COVID-19 pandemic years and are now looking to restore some routine and ‘business as usual’ approach to their services and to have a more settled environment for the lives of the residents in their care. The NHSL Health Protection Team work closely in collaboration with Care Home staff to help facilitate this. The team offers support and advice to Care Homes in line with local and national infection prevention and control guidance. Following the available guidance enables Care Homes to promote a protective, proactive environment for residents and staff. NHSL Health Protection Team have aligned Care Home Health Protection Nurses to localities. In addition, there is a Nurse Consultant Lead to provide overall co-ordination. With this specialist aligned support the Health Protection Team can ensure both one to one and locality input including visits to care homes to provide advice pertinent to their individual, person centred needs. During any outbreak situation a care home may have, the Health Protection Team will liaise daily with the care home staff to offer ongoing appropriate assessment and advice to minimise potential further spread of any infection. An outbreak is where two or more residents or staff have the same symptoms or diagnosis within the same time frame. This number of two is regardless of the size or population numbers of the Care Home. The Health Protection Team will advise use of the Care Home Infection Prevention and Control Manual (CH IPCM)(1) to adopt evidence based practice. 70
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During the COVID-19 pandemic there were frequent changes in national guidance for care homes to follow as more was learned about the new emerging virus. Guidance is now more stable and established. To assist and support care home staff in accessing the correct and most up to date guidance as part of preparing for winter 2023-2024 the Health Protection Nurse Team compiled a ‘one stop’ aide memoire to be used which contains a selection of links, guidance and information in one document. The aide memoire aims to help staff deliver effective care and have more time to do so, by providing faster access to information. This was sent to each care home manager at the start of winter 2023. The feedback from care homes has been positive with reports that the aide memoire is proving to be a useful tool to support quick access to guidance and information. Immunisation programme Over the last year there has been a significant amount of work taken forward by Public Health and partners to improve our immunisation coverage across the health board. We have set up an Immunisation Inclusivity Short Life Working Group which meets regularly and includes many different disciplines involved in immunisation, with representatives from across Lanarkshire. This group is working towards improving inclusivity for all immunisation programmes within Lanarkshire, with a particular focus at present on childhood immunisations. Measles elimination action plan There is ongoing widespread concern around the increase in measles cases throughout Europe and some parts of the UK. This resulted in the World Health Organisation (WHO) Europe branch calling for all countries to ensure there is sustained high measles, mumps, rubella (MMR) vaccination coverage, and for those who have previously missed doses of MMR vaccine to be offered vaccination, in order to prevent a resurgence of measles(2). In response to this, we are developing an up to date measles elimination action plan. This focuses on developing strategies within 3 main domains – before school entry, during school age and targeted groups (including groups within the population that may have lower vaccination uptake than the general population for various reasons). We have been in discussions with various stakeholders to gather qualitative information on potential barriers to vaccination and reasons for lower uptake within some populations. We are also looking at MMR vaccination rates by geographical area in Lanarkshire within the pre-school and school age populations which has helped identify areas with a disproportionately low uptake rate. This will help us develop effective targeted interventions for specific populations or areas in order to ensure that access to vaccination across the whole of Lanarkshire is as equitable as possible. Maximising MMR vaccination coverage in our health board will help give the population the best protection possible against measles. Tertiary education institutions It is also important that students entering tertiary education institutions are up to date with their vaccinations to help protect them against serious, vaccine preventable diseases. 71
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We have been working with the tertiary education institutions across Lanarkshire to encourage students to check that they are up to date with their MMR, Meningitis (MenACWY) and human papillomavirus (HPV) vaccines. If students have missed these during the routine childhood immunisation programme, or they are new entrants to Scotland and have not previously received any of these vaccines, we provide an opportunity to catch up with these vaccinations via an easily accessible on- campus vaccination catch up clinic. So far, we have successfully carried out one catch up clinic within South Lanarkshire College and have also linked many students into the generic vaccination service which runs across Lanarkshire. We are working with other tertiary institutions within Lanarkshire to implement similar catch up clinics in the new year. Key points The Health Protection Team are supporting care homes in the post COVID-19 pandemic era, in particular through advising on infection prevention and control guidance. A significant amount work has been undertaken to improve our immunisation coverage across the health board through a range of initiatives. Priorities for Action Continue to provide expert advice and input to care homes across Lanarkshire. Maximise uptake of immunisations across Lanarkshire and ensuring programmes are as equitable as possible. References (1) NHS National Services Scotland. National Infection Prevention and Control Manual: Care Home Infection Prevention and Control Manual (CH IPCM) [Internet]. 2023. Available from: https://www.nipcm.scot.nhs.uk/care-home- infection-prevention-and-control-manual-ch-ipcm/ (2) Chief Medical Officer for Scotland. Averting the Resurgence of Measles in Scotland 2023 [Internet]. Scottish Government; 2023 Aug. Available from: https://www.publications.scot.nhs.uk/publication/7931 Caroline Thomson, Health Protection Nurse Consultant Email: caroline.thomson2@lanarkshire.scot.nhs.uk Sophie El-Nahas, Clinical Fellow Email: Sophie.El-Nahas@lanarkshire.scot.nhs.uk Alison Smith-Palmer, Deputy Director of Public Health Email: Alison.Smith-Palmer@lanarkshire.scot.nhs.uk 72
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2.2 Lanarkshire’s Hepatitis C (HCV) Elimination Project April 2023 to March 2025 The initial phase of Lanarkshire’s 2 year HCV Elimination Project, including how using a broader model of community liver health/screening to deliver HCV awareness and testing has revealed a grave picture of liver health and health related behaviour in the Lanarkshire adult population. Background: Liver Disease – A Public Health Emergency in Scotland The British Liver Trust’s (BLT) report titled ‘Liver Disease: A Public Health Emergency in Scotland’ was discussed by members of the Scottish Parliament on 14 June 2023(1). The Cross-Party debate addressed the liver disease crisis in Scotland and highlighted Lanarkshire to be amongst the poorest in Scotland in terms of liver disease mortality and early detection. For nearly two decades NHS Boards across Scotland have contributed to the challenge of Scotland’s poor liver health and specifically hepatitis C (Hep C) related liver disease, via the delivery of the Scottish Government’s Hep C Action Plan (‘the Action Plan’). ‘Scotland’s Hepatitis C Action Plan: Achievements of the First Decade and Proposals for a Scottish Government Strategy (2019) for the Elimination of both Infection and Disease’(2) highlights achievements of the first decade of ‘the Action Plan’ and stresses the importance of the introduction of direct acting antivirals in 2014. These achievements for Scotland include: a decline in hepatitis C related decompensated cirrhosis (liver failure); a reduction in new presentation of hepatitis C related hepatocellular carcinoma; and a decline in hepatitis C related deaths. The final phase of the Hep C Action Plan has now moved to delivering Hep C elimination in Scotland(3), with a national target of 5000 Hep C treatment initiations required across Scotland by March 2025. From April 2023 to March 2025, NHS Lanarkshire requires a tripling of previous yearly HCV treatment initiations targets to meet their elimination target of 511 Hep C treatment initiations. Furthermore, the requirement to triple HCV treatment initiations number in Lanarkshire came with no additional resource, and so required a re-think on how the challenge would be met within the existing funding envelope and service provision. NHS Lanarkshire Hep C Elimination Project The Lanarkshire Blood Borne Virus (BBV) Network leads on all aspects of BBV related work in Lanarkshire and, in response to this HCV elimination challenge, developed the Lanarkshire Hep C Elimination Project (‘the project’). Pivotal to the development of the project was a review of all BBV testing across Lanarkshire; the who, where, when and what (types of tests), review of current evidence related to HCV elimination practice in Scotland and UK wide, and a re-allocation of available resources and negotiation of service involvement. The first six months of the project has resulted in an increase in HCV treatment initiations by 130% compared to the previous year, which is extremely positive. Whilst the core aim of the project is progressing well, the 10 locality ‘Love Your Liver Events’ held during the 73
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summer of 2023 have highlighted a grave picture of liver health and lifestyle behaviours in the adult population in Lanarkshire. The Lanarkshire BBV Network HCV Elimination Project focused on the development of 4 key work-streams. Work-stream 1: BBV Testing Finding and testing individuals who have been at risk of acquiring HCV is pivotal to achieving HCV treatment initiation targets and delivering HCV elimination in Lanarkshire and Scotland. A development session took place in November 2022 involving all Lanarkshire services who delivered BBV testing in the community. The three key outcomes from this session included: a. Establishing lead roles for each service within key settings to support better coordination and more efficient use of resources. b. Establishing a dedicated BBV Testing Team led by the Lanarkshire Harm Reduction Team and supported by Positive Support (BBV Network, Third Sector Service). BBV testing has been extended to Criminal Justice, Police Custody Suites, Pharmacy (Harm Reduction Team Pharmacy Development Worker), Mental Health Services, with continued work with all statutory and commissioned drug and alcohol services in Lanarkshire. c. 2024 will focus on business as usual, with an additional focus on HMP Shotts and opportunities for joint work with HMP Addiewell, as well as community Criminal Justice Services. Work-stream 2: New HCV Pathway A short life working group was established to review and develop a new HCV Pathway. The new streamlined pathway, with simplified criteria from testing to treatment, has been a significant factor in the 130% increase in HCV treatment initiations in the first six months of the project, compared with initiation numbers last year. Building relationships and developing new ways of working with staff across statutory and third sector drug and alcohol services, as well as the partnership between the Lanarkshire Harm Reduction Team and BBV Specialist Nurses have been pivotal to the increase in HCV treatment initiations. Work-stream 3: Implementing Public Health Scotland’s RECAST project The RECAST project will facilitate the reengagement and treatment of people with chronic HCV infection. Led by Public Health Scotland (PHS) and in partnership with NHS Boards, PHS has led an audit of the national HCV data held by PHS and supported the identification of individuals with chronic HCV infection. The CHI number was provided to enable follow- up. NHS Lanarkshire took part in the pilot exercise along with two other NHS Boards prior to the roll out across Scotland. This initial phase has identified approximately 500 individuals in Lanarkshire who will be followed up in Phase 2 of the project. A short life working group has been established to support the next phase of contacting and re-engaging with individuals. 74
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Work-stream 4: Love Your Liver Community Events (Summer 2023) NHS Lanarkshire, in partnership with the British Liver Trust (BLT), held ten ‘Love Your Liver’ roadshow events across North and South Lanarkshire between June and August 2023. The roadshow offered a unique chance for individuals to prioritise their liver health by receiving free liver health checks and gaining valuable information about various types of liver disease. Visitors to the unit had the opportunity to undergo a free fibro-scan, a non- invasive liver scan, and a swab test for hepatitis C if identified as being at high risk. These health checks are crucial as liver diseases, including hepatitis C, can often develop silently and lead to severe complications if left undetected. Nine in 10 cases of liver disease are preventable with the main causes being alcohol, obesity and viral hepatitis, including hepatitis C. Partnership The British Liver Trust approach to partnership working with statutory and third sector services, and their community engagement model (drop in, accommodated via a large trailer with 3 clinical rooms) has been used in England to support Hep C Elimination, raise awareness of liver health, including hepatitis C. The Lanarkshire BBV Network chose this partnership approach and model of good practice to support their wider community engagement work. The Lanarkshire Love Your Liver events were delivered by staff and volunteers from the British Liver Trust, NHS Lanarkshire’s BBV Network Support Team; Harm Reduction Team; Gastro/Liver Service based at University Hospital Hairmyres (UHH); BBV Network Third Sector commissioned services including Positive Support and Landed Peer Education Project: Phase 1: Planning • Appraisal, analysis and re-allocation of resources and leadership roles • Funding for Gastro/Liver Service to support additional referrals and to deliver the fibro-scanning during community events • Development of referral pathway directly into Gastro/Liver Service in UHH. • Limited advertising preceded each event via the British Liver Trust website and twitter account to facilitate opportunistic drop-in access. Phase 2: Delivery • 847 people attended 10 events delivered across Lanarkshire localities from June 2023 to August 2023. Venues included: Cumbernauld: Antonine Shopping Centre Airdrie: Morrisons Coatbridge: Main Street Cambuslang: Morrisons East Kilbride: Morrisons Hamilton: Morrisons Lanark: Morrisons Bellshill: Morrisons Motherwell: Shopping Centre Wishaw: Caledonian Retail Park 75
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Key Points Health Survey • 847 attendees - 627 (74% of attendees) completed the survey Liver Health • 431/627 (68%) received a fibro-scan • Overall, 52 of the 431 (12.1%) participants fibro-scanned in Lanarkshire had an E median of 8.0+, indicating a follow-up with primary care is recommended. • Of those, 16/52 had a fibro-scan score indicative of advanced damage. • 29/52 referred to Gastro/Liver Service UHH • 6/29 on the Hepatocellular Carcinoma (HCC) surveillance pathway HCV • Low HCV awareness • 170/611 identified HCV risk • When looking at only the under 50 yrs surveyed, this fraction increases to half (83 out of 165). • 162 HCV point of care test (POCT) • 9 POCT had positive (antibody) POCT • 3 individuals Dry Blood Spot Testing /3 positives Health Behaviours Diet • The majority of men and women under 40 yrs old who were surveyed had a takeaway twice or more per week (41 out of 75). • 2 in 5 people in Lanarkshire said they had processed foods three or more times per week, indicating a potential significant current and future impact on liver health across the population. • Men and women under 39 yrs represented the largest consumers of processed foods (men = 73.3%, women = 70.5%). • The majority of those surveyed admitted to snacking on crisps, chocolate, cake or biscuits between meals or in the evening (63.7%). • Over three quarters of women aged 40 to 59 yrs (76.5%) snacked between meals and in the evening Weight Of the 579 people whose BMI was calculated: • more than 70% were overweight or obese. • less than a third of women and less than a quarter of men had a healthy BMI. • 85.8% of participants had a diet categorised as caution or high risk for Non-Alcoholic Fatty Liver Disease (NAFLD) (n=611). • A third of participants were high risk 76
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Alcohol All 614 individuals who participated in the alcohol section of the survey were sorted into groups, based on whether or not they drank more than 14 units of alcohol per week. • When split by sex (332 women, 282 men), men were more than twice as likely to drink more than 14 units per week (women = 20.2%, men = 42.2%). • 67 women (19.8% of all women surveyed) drank more than 14 units of alcohol a week with an average of 29.9 units; more than double recommended maximum levels. • 119 men (41.3% of all men surveyed) drank more than 14 units of alcohol per week, their average was 35.7 units per week. • Further analysis of this data is in process. Reports will be shared with relevant stakeholders and partners of NHS Lanarkshire to shape ongoing work in this area. Referral to local services Information on local services was also provided to individuals who took part in the liver health check and to many individuals who stopped to chat to staff outside the BLT trailer. Information on a range of health issues was provided, as was information on and links to financial and welfare support services. Referrals were also made to local statutory and third sector alcohol and drug services. Priorities for Action At a time when we are expected to ‘do more with less’, strong strategic decision making, and utilising and re-focusing people, resources and expertise is key. We will continue with our focus on BBV testing in high risk settings, as well as continuing to promote the new Hep C pathway across local services. Phase 2 (2024) of the RECAST project will be pivotal to enabling NHS Lanarkshire to achieve Hep C Elimination by March 2025. The British Liver Trust model of community roadshow events provides clear evidence for more community health outreach work and has shown the benefit of community health checks as part of early detection and prevention. The findings from the Lanarkshire Love Your Liver events reflect the poor liver health status of the Lanarkshire population, as highlighted in the British Liver Trust and Scottish Governments cross party debate in June 2023(1). These events also demonstrate the significant role that community outreach/health checks can play in engaging with local communities and supporting early detection and prevention. References (1) British Liver Trust. Scottish ministers unite to address alarming liver disease crisis as deaths surge by almost 20% in two years [Internet]. 2023.Available from https://britishlivertrust.org.uk/scottish- ministers-unite-to-address-alarming-liver- disease-crisis-as-deaths-surge-by-almost-20-in-two-years/ (2) Coalition for Global Hepatitis Elimination. Scotland’s Hepatitis C Action Plan: Achievements of the First Decade and Proposals for a Scottish Government Strategy (2019) for the Elimination of both 77
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Infection and Disease [Internet]. 2019. Available from https://www.globalhep.org/tools- resources/action-plans/scotlands- hepatitis-c-action-plan-achievements-first-decade-and (3) Scottish Government. Sexual health and blood borne virus action plan: 2023 to 2026 [Internet]. 2023. Available from https://www.gov.scot/publications/sexual-health- blood-borne-virus-action-plan-2023- 2026/pages/2/ Trish Tougher, BBV Network Manager Email: Trish.tougher@lanarkshire.scot.nhs.uk Acknowledgements British Liver Trust Emma Bowering, Engagement and Events Manager, British Liver Trust Jonathan Worsfield, Project Delivery Manager, British Liver Trust NHS Lanarkshire Callum Buchanan, Information Analyst, Public Health Directorate Aileen Divers, Sister, Gastro/Liver Service, University Hospital Hairmyres (UHH) Dr Nick Kennedy, Consultant Infectious Diseases/BBV Network Lead Clinician Chris Kimber, BBV Network Development Officer Dr John Logan, Consultant Public Health Medicine (CPHM)/BBV Executive Lead Maureen Woods, BBV Testing Lead, Harm Reduction Team Third Sector Jaki Brown, Team Leader, Positive Support Lauren Kelly, Support Worker, Positive Support Laura McLean, Development Officer, Landed Peer Education Project Eddie Wilkie, Support Worker, Positive Support 78
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3. Anchor Themes 3.1 NHS Lanarkshire as an Anchor Organisation What is an Anchor Organisation?(1) Anchor organisations are typically large local employers with a strong local presence in an area like the NHS, local authorities, colleges and large local businesses. Figure 3.1.1: Anchor organisation Anchor organisations can have a sizeable positive influence on the health and wealth of communities as they employ large numbers of local people, spend substantial amounts of money, own and manage local land and buildings. Taking positive actions in these areas is known as community wealth building which is a new approach to local economic development which aims to mitigate inequalities. Community wealth building aims to direct financial resources back into the local economy and ensures local people are able to have control over, and benefit from, the opportunities these investments can bring. Anchor organisations also often deliver crucial services intrinsic to health and wellbeing and are rooted in the local community offering stability and support to communities, hence the term “anchor”. In addition, smaller local organisations, often in disadvantaged areas, can be community anchors through their ability to build trusted relationships with local people, offer local employment and community led activities, and connect their residents to opportunities that will support their health and wellbeing. How Can Anchor Organisations Make a Difference? The Health Foundation(1) identified five dimensions where anchors can have a positive influence. Taking intentional actions across these areas can affect social, economic and 79
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environmental change, contribute to positive health and wellbeing outcomes, and mitigate the impact of inequalities. Being an exemplar anchor – organisations can embed ‘anchors thinking’ across their culture, planning and actions, and work with other anchors to systematically share good practice and deliver enhanced positive impacts for their people and places. Employer – organisational policies on recruitment, pay and conditions, career progression and health can support inclusion goals and lower paid workers and help organisations to recruit and retain staff and fully tap the talents of their workforce. Procurement – organisations can adopt practices for buying goods and services which support local businesses and job opportunities, recirculate wealth and bring community benefits as well as improve supply chain resilience, responsiveness and relationships. Environment and assets – organisations can act to respond to the climate emergency, reduce energy, waste and pollution, use their assets for the benefits of communities and create better built and natural environments to support place making. Service design and delivery – public sector and community anchors can deliver their services in ways designed to help those facing poverty and disadvantage. Key Points NHS Lanarkshire has a long history of operating as an anchor organisation with a strong inclusive culture and many positive examples of working in partnership across these five areas. NHS Lanarkshire is committed to working with other anchors through more intentionally targeting opportunities and services to those who are most vulnerable and through shaping employability, procurement and asset strategies to be more inequalities focused. This ambition fits with national policy direction as the Scottish Government Health Inequalities: Place and Wellbeing Programme(2) now includes an anchors workstream and all Health Boards are required to have a 3-year strategic anchor plan in place. Priorities for Action In the following chapters we describe examples of work NHS Lanarkshire and partners are taking forward under our anchor ambitions. References (1) Reed S, Göpfert A, Wood S, Allwood D, Warbuton W. Building healthier communities: the role of the NHS as an anchor institution. The Health Foundation [Internet]. 2019. Available from: https://www.health.org.uk/publications/reports/building-healthier-communities-role- of-nhs-as-anchor- institution (2) Scottish Government. Health Inequalities: Place and Wellbeing Programme [Internet]. Available from: https://www.gov.scot/groups/health-inequalities-place-and- wellbeing-programme Elspeth Russell, Consultant in Public Health Email: elspeth.russell@lanarkshire.scot.nhs.uk 80
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3.2 Widening Access and Employability Opportunities Background NHS Lanarkshire recognises, as an anchor organisation and exemplar employer, the reciprocal link between health and work, and by widening access and employability, we enhance social mobility and life chances of our local communities. The right career with fair pay and conditions, improves people’s overall physical and mental health, supports quality of life and creates a positive and virtuous cycle leading to a reduction in health inequalities. Workforce NHS Lanarkshire is committed to putting in place a healthcare workforce which is representative of the communities we serve, with particular focus on widening access for those who are underrepresented within our existing workforce, from lower socioeconomic and deprived areas, or from minority backgrounds. Historically, individuals taking up work experience, apprenticeships and volunteering opportunities within NHS Lanarkshire have typically come from more advantaged communities. Widening access to these opportunities through inclusive recruitment practices and targeting to key populations, such as those affected by child poverty, is beneficial to both the individuals and the organisation as a whole as results in a wider and more diverse talent pool for staff recruitment. Figure 3.2.1: Impact of NHS Lanarkshire’s Demonstrator programme, 2022–2023 81
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Employability Programmes NHS Demonstrator Project The first Demonstrator Project was introduced under the Best Start, Bright Futures: Tackling child poverty delivery plan 2022–2026(1) focussing on those over 25 years old and unemployed. The project aims to increase participant’s confidence, learn new skills and develop skills for employment. Working in Partnership with both Local Employability Partnerships, NHS Lanarkshire has supported 26 individuals into paid placements, 17 (65%) of which achieved a positive outcome. Clinical Employability Programme In support of the No One Left Behind: Delivery Plan(2) NHS Lanarkshire has worked in partnership with New College Lanarkshire to support approximately 80 unemployed individuals annually into health care support worker roles. David Forbes-Nixon (DFN) Project SEARCH Project SEARCH is based on the most successful transition to work programme in the world and has been has recognised by the Scottish Government as a model of good practice within the national learning disability strategy The keys to life: Improving quality of life for people with learning disabilities(3). This project is aimed at young people with additional support needs, it is in its 13th year at University Hospital Wishaw and 11th Year at University Hospital Monklands and Hairmyres. To date, 160 young people have come through the NHS Lanarkshire programme, with approximately 70% going on to a positive destination in terms of employment or further study. Community outreach NHS Lanarkshire Employability team have been proactively engaging with partners with the aim of attracting and supporting individuals into health and social care careers. This has included attending events and client information sessions with partners such as Department for Work and Pensions, Prince’s Trust, and Remploy. In addition, the team have engaged with care experienced individuals and the armed forces talent programme Key Points The employability projects delivered by NHS Lanarkshire are making an impact on people’s lives by getting them back into the workplace. Targeting employment opportunities to key priority groups will contribute to the overall ambition of reducing inequalities. Priorities for Action Provide paid placements and work experience for individuals facing barriers to employment or those facing poverty. Provide outreach activities to our local community to promote NHS Lanarkshire as an exemplar employer. 82
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References (1) Scottish Government. Best Start, Bright Futures: Tackling child poverty delivery plan 2022–2026 [Internet]. 2022. Available from: https://www.gov.scot/publications/best-start-bright-futures-tackling- child-poverty- delivery-plan-2022-26 (2) Scottish Government. No One Left Behind: Delivery Plan [Internet]. 2020. Available from: https://www.gov.scot/publications/no-one-left-behind- delivery-plan (3) Scottish Government. The keys to life - Improving Quality of Life for People with Learning Disabilities Plan [Internet]. 2013. Available from: https://www.gov.scot/publications/keys-life-improving-quality-life- people-learning- disabilities Lorraine Scott, HR Business Partner Email: lorraine.scott2@lanarkshire.scot.nhs.uk 83
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3.3 Monklands Replacement Project and Community Benefits Background The Monklands Replacement Project (MRP) will deliver NHS Lanarkshire’s vision for a new acute hospital to replace the existing University Hospital Monklands as set out in NHS Lanarkshire’s strategic framework. The new hospital will be delivered on a new site at Wester Moffat Farm, east Airdrie and is being designed to support delivery of a new model of care that moves the focus of care away from long inpatient stays to one where day case, day treatment, outpatient and community care is the norm. Community Benefit All public sector contracting authorities are required to include community benefit requirements for all regulated procurements where the estimated value of the contract is equal to or greater than £4 million. The value of the MRP is significantly greater than that threshold therefore delivery of community benefits was a core part of the procurement strategy. The MRP has an established community benefit group which developed the community benefits plan and set the following key objectives: 1. To encourage the local community to be involved in the project by supporting local community initiatives. 2. To ensure community benefits are directed towards positive outcomes for disadvantaged and vulnerable groups that reflect what the community needs and contribute to reducing inequalities. 3. To facilitate opportunities for sustainable employment through the provision of skills, education and training programmes; apprenticeships; and new graduate job opportunities that are targeted to vulnerable groups including those who are unemployed or experiencing in-work poverty. 4. To promote economic growth through the involvement of small and medium-sized enterprises, Third Sector and Supported Businesses by facilitating awareness of the project, promoting contract and supply chain opportunities and related Community Wealth Building opportunities, while also ensuring these organisations are as ready to tender for opportunities as they can be. 5. To promote health & wellbeing through the inclusion of environmental and other initiatives that contribute to sustainable health & wellbeing outcomes. 6. To inform community benefits for future NHS Lanarkshire projects through measuring and reporting on community benefit targets and outcomes that highlight best practice, whilst seeking continual improvement and innovation. The Community Benefit requirements have been identified across five key themes as shown, below. Figure 3.3.1: Community Benefit Themes 84
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Key Points There is an opportunity for NHS Lanarkshire to harness wider opportunities through delivery of community benefits. Some of these opportunities include: Promoting NHS Lanarkshire’s role as an inclusive anchor organisation offering more targeted employment opportunities for local people, increasing procurement spend within the community, and being a role model for environmental sustainability through the hospital build process and ongoing policies and practices. Supporting Community Wealth Building through working with the local authorities and the local business base to identify opportunities to generate and keep money in the local economy. Positively contribute to the current Public Health Scotland priorities. Priorities for Action Develop the delivery plan. Develop the supporting communication plan. Establish the progress monitoring tool and reporting arrangements. Kathryn Henderson, MRP Senior Project Manager Email: kathryn.henderson2@lanarkshire.scot.nhs.uk 85
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3.4 Service Design and Delivery Background As part of our anchor approach, services should be designed and delivered in a way that support disadvantaged communities, working with partners and the community to help reduce inequalities and tackle poverty. Some examples of work within this area have included progressing a comprehensive cost of living action plan and ensuring that integrated Equality Impact Assessments (EQIA) are carried out and acted upon by our services. Cost of Living A range of initiatives this year have focussed on what we can do to enhance NHS Lanarkshire’s service delivery to support those at risk of, or experiencing, poverty within our communities and our own workforce. Tackling poverty is not the remit of specialist teams or any single organisation. Everyone can contribute to the collective effort to reduce poverty and this has been the message that we have been conveying this year, alongside our partners. An FAQ for managers on how to support staff who may be struggling with money worries has been developed. An FAQ for services on how to support patients who may be struggling with money worries has been developed. Working with partners, free period products have been made available in some of our sites. Workforce development sessions have taken place across services and teams with support to embed routine enquiry of finances. Support, in the form of a Welfare Rights Officer, from Money Matters Advice Service has been commissioned. A comprehensive communications plan has been developed and delivered. We have continued to work with partners to prioritise action on child poverty. Equality Impact Assessments It is widely documented that the COVID-19 pandemic has further exacerbated inequalities across our communities. The importance of embedding health inequalities across NHS Lanarkshire as part of COVID-19 Recovery has never more been at the forefront of policy making with the aim of ensuring equity of access for all Lanarkshire residents. Identifying inequalities and addressing these through service design and delivery, will enable services to be developed that focus on the needs of those who are most vulnerable. To ensure an inequalities focussed approach and compliance with the Equality Act 2010, NHS Lanarkshire undertakes a robust programme of integrated EQIAs across all work streams. There has been extensive work undertaken to ensure the assessment process complies with the Equality Act 2010, integrates the Children’s Rights Wellbeing Assessment and also pays (due regard) to reducing inequalities of outcome caused by socio-economic disadvantage. 86
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Key points NHS Lanarkshire has been taking forward a range of initiatives to mitigate the impact of the cost of living crisis on patients and staff. The development of the new NHS Lanarkshire healthcare strategy has provided an opportunity to embed an inequalities approach through the use of integrated EQIAs across all workstreams. Priorities for Action Supporting patients and staff with cost of living issues through a variety of actions, including addressing child poverty, is a key component of our anchor plan. Continue to ensure that integrated EQIA’s are carried out and our services are designed to reach and support our most disadvantaged communities. Ann McLaughlin, Senior Health Improvement Manager (South Lanarkshire HSCP) Email: ann.mclaughlin2@lanarkshire.scot.nhs.uk 87
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3.5 Environment, Sustainability and Assets Background Environmental sustainability is one of the pillars of the NHS as an anchor organisation and gives the opportunity to do environmentally sustainable work that has local impact on people’s health and inequalities as well as positively contributing to climate change. Our Natural Health Service provides benefits to physical, mental and social health(1-3) and can help to reduce inequalities in health through access to quality greenspace(3). There is a significant evidence base for the range of individual and wider social health and wellbeing benefits that can be achieved through outdoor activity and contact with nature. These benefits include: improved physical and mental health; therapeutic and restorative qualities enhancing recovery; reduced social isolation and greater community cohesion. There is overwhelming evidence to show that being physically active; including walking, has been shown to reduce a range of illnesses, reduce stress levels helping to reduce blood pressure and reduce feelings of depression and stress(4). Lanarkshire Green Health Partnership (LGHP) The Lanarkshire Green Health Partnership (LGHP), is integrated with weight management services and is partly funded via NHS Charities Together. The LGHP works to connect people with nature and maximise health inducing green assets. The partnership was formed, in 2018, as part of the national work ‘Our Natural Health Service’ and supports health sectors to embrace green health. It complements the NHS, to support the breadth of health and social care activity and see nature-based health programmes used as part of health improvement and encourage health behaviour change. As a partnership we recognise the importance of an integrated approach and developing opportunities and pathways to ensure individuals within our communities have access to engage in activities. The LGHP have taken approaches to help support specific areas of work and link to the outcomes of the partnership. Lanarkshire is rich in green spaces, including the NHS estate and the aim of the partnership is to coordinate and promote the use of all green spaces for health benefits and provide supportive green health programmes. Key priorities for 2023–2026 will be: Deliver an integrated model of leadership for LGHP Get Walking Lanarkshire Clydesdale Community Initiative – Therapeutic Garden Projects Voluntary Action South Lanarkshire/Voluntary Action North Lanarkshire – Green Health and Wellbeing Volunteer development. 88
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Key Points There is a broad range of partnership activity being delivered within Lanarkshire communities supporting adults, children and families to connect with nature and the positive impact on physical, mental and social health and wellbeing, especially for our most vulnerable groups. The contribution that these programmes make to the prevention agenda and tackling health inequality through targeted intervention and the offer of free local, health enhancing greenspace. Priorities for Action – LGHP Raise awareness and share the benefits of engaging with green health and promote engagement with activity. Support and build partnerships to inspire projects that help people connect to nature and be active outdoors. Empower health & social care and third sector staff to be confident to connect people to green health opportunities as appropriate. Seek and secure funding to enable contribution and continuation of evidence based practice. Priorities for Action – wider Environment, Sustainability and Assets anchor actions Enhance active travel and transport opportunities and ensure developments meet the needs of groups most affected by inequalities. Further develop community use of facilities and outdoor estates with a strong focus on engaging those most affected by inequalities. References (1) World Health Organization. Urban green spaces and health [Internet]. 2016. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO- 2016-3352-43111-60341 (2) Department for Environment, Food & Rural Affairs. Social Science Research Fellowship on the natural environment and human health - BE0109 [Internet]. 2017. Available from: https://randd.defra.gov.uk/ProjectDetails?ProjectId=19511 (3) Staatsen B, van der Vliet N, Kruize H, et al. INHERIT Exploring triple-win solutions for living, moving and consuming that encourage behavioural change, protect the environment, promote health and health equity. Chapter 4 Living – green space [Internet]. 2017. Available from: https://inherit.eu/baseline-review (4) NHS. Benefits of exercise [Internet]. 2021. Available from: https://www.nhs.uk/live- well/exercise/exercise-health-benefits Ann McLaughlin, Senior Health Improvement Manager (South Lanarkshire HSCP) Email: ann.mclaughlin2@lanarkshire.scot.nhs.uk Marie McKeown, Lanarkshire Weight Management Service Team Lead & Green Health Partnership Manager. Email: marie.mckeown@lanarkshire.scot.nhs.uk 89
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3.6 Being an Exemplar Anchor Background Being an exemplar anchor is about how organisations recognise the potential of their anchor role and intentionally embed anchor principles in their culture and values, corporate priorities, the day to day running of their services, and in how they work with, and learn from, other anchors. This involves reflecting on current practice and taking forward opportunities to further develop areas of good practice or to develop different ways of doing things that will benefit the local community. Development of NHS Lanarkshire Strategic Anchor Plan NHS Lanarkshire started their journey to more intentionally consider their role as an anchor back in 2021 as they began to recover from the pandemic and recognised the need to build back better with a stronger focus on inequalities. Seminars were held with senior leaders to gain their support for this agenda and from this initial work a strategic commitment was made to embedding anchor ways of working into the new NHS Lanarkshire Healthcare Strategy which is due to be published in 2024. To inform the development of the anchor plan, NHS Lanarkshire used a national anchor assessment framework(1) to assess their baseline position as an anchor and to identify priority actions across the five anchor dimensions. The actions that have been prioritised focus on further developing areas of good practice identified from the anchor baseline assessment or more intentionally applying an inequalities anchor lens to existing programmes of work. The actions aim to positively influence wider determinants of health through taking a public health prevention approach. The anchor action plan sets out milestones to be achieved annually for the next three years and high level performance measures have been proposed for each action. Working with Other Anchors NHS Lanarkshire are working closely with both local authorities, third sector organisations, and other local partners to align the anchor ambitions with partnership strategic priorities including Community Wealth Building, Child Poverty plans and Community Planning Partnerships. NHS Lanarkshire are also participating in regional, national and UK anchor networks in order to learn from others and identify opportunities for collaboration. 90
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Key points NHS Lanarkshire has developed a 3-year strategic anchor plan which outlines actions it will take to support community wealth building and a more inequalities focused approach to service delivery. Opportunities to work with other anchors on common goals to support community wealth building are evolving through working in partnership. Priorities for action Delivery of the strategic anchor plan requires leadership, ownership and support from across all services within NHS Lanarkshire. Communications to raise awareness of the anchor concept is a key priority for this programme of work. Maximising NHS Lanarkshire’s role as an anchor will require investing time to build on the local partnerships already in place with other anchor organisations to develop shared goals and to learn from each other. In November 2023, the Scottish Government issued a set of metrics for measuring baseline activity in relation to anchor activity. These will be incorporated into programme governance for 2024/25. Reference (1) Les Newby Associates, Wordfern Ltd. Harnessing the power of anchor institutions: a progressive framework for Scottish organisations. Public Health Scotland; 2023 Jun. Elspeth Russell, Consultant in Public Health Email: elspeth.russell@lanarkshire.scot.nhs.uk 91
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3.7 Community Wealth Building Background Community Wealth Building (CWB) is a practical approach to local economic development that supports the delivery of a wellbeing economy. The approach is based around five pillars: Inclusive Ownership Workforce Spending Land and Property Finance CWB seeks to redirect wealth back into local and regional economies and place more control over economic benefits in the hands of local people and businesses. CWB has a key focus on the role of anchor organisations and how they can use their economic levers to better support their local and regional economies. From a policy perspective, CWB forms part of the Scotland’s National Strategy for Economic Transformation(1) and the National Planning Framework 4(2). Building on the development of the approach across Scotland, the Scottish Government has committed to take forward a Community Wealth Building Bill in this Parliament, to enable more local communities and people to own, have a stake in, access and benefit from the wealth their economy generates. The Bill seeks to cement and augment the role public sector anchors play in supporting local economic development and advancing a wellbeing economy, legislating for them to consider their economic footprint within a wider place system. Figure 3.7.1: Community Wealth Building Adapted with permission from Economic Development Association Scotland and Scottish Government 92
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The North Lanarkshire approach The Commitment There is commitment across the North Lanarkshire Community Planning Partners to develop a shared approach to CWB that that can be applied across a number of policies, strategies and services for the benefit of local people, businesses and communities. This commitment will be realised through delivery of the following aims: Developing a common understanding of CWB. Understanding the breadth of work that contributes to CWB and identify further opportunities to enhance this. Developing a CWB statement to be embedded across several policy and strategy development areas. Ensuring that decision-making and practice is developed through a CWB ‘lens’. Developing the Approach A North Lanarkshire Partnership Working Group is in place with representatives from North Lanarkshire Council, NHS Lanarkshire, Voluntary Action North Lanarkshire, Police Scotland, and Scottish Fire and Rescue Service to drive forward the approach. An initial mapping document has been produced highlighting the many activities already happening which align to CWB across North Lanarkshire. The Partnership hosted a stakeholder session in August 2023. This included a presentation from the Scottish Government, an update on the North Lanarkshire Approach and five workshops around each pillar exploring: what is working well; gaps; what could we do more of; what assets are in place; and, any partnership/collaborative opportunities. The feedback from the event has been collated and circulated. An engagement plan is in place to consult and gather views from a wide range of internal and external stakeholders including Community Boards, elected representatives, businesses and young people. The consultation exercise will conclude by the end of February 2024. The findings of the consultation exercise, along with a review of best practise across Scotland, will form the basis for the development of the final statement and associated action plans and monitoring frameworks. Key Points Commitment is in place from the North Lanarkshire Community Planning Partners to develop a shared approach. The adopted approach will be embedded across several policy and strategy development areas. The approach will ensure that decision-making and practice is developed through a CWB ‘lens’. 93
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Priorities for Action Continued consultation and engagement on the approach. Adoption of the approach by the North Lanarkshire Strategic Leadership Board and partners by late summer 2024. References (1) Scottish Government. Scotland's National Strategy for Economic Transformation [Internet]. 2022. Available from: https://www.gov.scot/publications/scotlands- national-strategy-economic- transformation (2) Scottish Government. National Planning Framework 4 [Internet]. 2023. Available from: https://www.gov.scot/publications/national-planning- framework-4 Yvonne Weir, Enterprise Manager, North Lanarkshire Council Email: weiry@northlan.gov.uk Leanne Pollock, Community Partnership Manager, North Lanarkshire Council Email: pollockle@northlan.gov.uk The South Lanarkshire approach The Commitment The challenges of the last few years – the COVID-19 pandemic, soaring cost of living, and the war in Ukraine – have underlined the importance of local services rooted in local places and communities. It was therefore imperative to develop new ways of working which not only support the communities served by statutory services but also to contribute to making our services and our places stronger, more resilient and more sustainable. In March 2021, South Lanarkshire Council launched its Community Wealth Building Strategy(1). The strategy set out an aspiration to work in a new way for the people of South Lanarkshire, to use the power and influence of the council and other organisations to support communities and the South Lanarkshire economy 94
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Developing the approach From the start of the strategy development process, there was a strong recognition that CWB should be built into all areas of the Council’s business. There was a need to ensure that CWB became part of a new culture and way of working and to do this required the change in thinking to be led from the top. To facilitate this senior level support, a Community Wealth Building Commission was established which has cross-party political support within the council and engages senior officers from South Lanarkshire’s anchor organisations. These include NHS Lanarkshire, University of the West of Scotland, Voluntary Action South Lanarkshire (VASLan) and the business sector. By working together collaboratively across the five pillars of CWB, anchor organisations can multiply their effectiveness and deliver far-reaching transformational change. Turning strategic aspirations into action on the ground is the job of the CWB Progress Group. This multi-agency group is chaired by VASLan and aims to take the practical steps necessary to deliver the actions underpinning the CWB strategy. With the right structures in place and the key stakeholders involved from the start, results of our work are beginning to emerge across the five pillars of CWB. This strategic, whole- systems approach is beginning to bear fruit in what is a long-term aspiration to change our way of working for the benefit of the South Lanarkshire economy. Progress to date includes: Analysis of the council’s procurement spend; Changes to QuickQuote process to enable more local bids; A range of engagement events with local businesses to improve engagement with procurement processes; Development of Community Wishlists; Community benefits arising from council capital projects; Development of a Social Enterprise strategy and action plan; and, Development of a South Lanarkshire Community Wealth Building Charter. Key points South Lanarkshire Council and the South Lanarkshire Community Planning Partners are committed to improving the lives and prospects of everyone in South Lanarkshire through maximising opportunities for community wealth building. A Community Wealth Building Commission has been established to provide strategic leadership and support for this commitment and a CWB strategy has been developed along with a draft charter. There has been good progress made through proactive work on procurement practices and community benefit programmes. Priorities for action Work together to strengthen the collective role of key anchor organisations who deliver services across the area, in order to bring wealth into the area and generate real change across South Lanarkshire. 95
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Develop opportunities to share expertise and learning between local anchor organisations. Develop joint CWB indicators of progress and monitor these over time. Reference (1) South Lanarkshire Council. Community Wealth Building Strategy 2021 [Internet]. 2021. Available from: https://www.southlanarkshire.gov.uk/downloads/file/14909/community_wealth_buildin g_strategy_2021 Tom Little, Head of Communications and Strategy, South Lanarkshire Council Email: tom.little@southlanarkshire.gov.uk 96
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4. Healthcare Public Health 4.1 Strategic Prevention in Healthcare: Opportunities and Challenges in Lanarkshire Background Improvements in life expectancy have stalled in Scotland and is reducing in the most deprived areas (Figure 4.1.1, more discussion regarding life expectancy can be found in chapter 1.1 and appendix A12). Those living in the most deprived areas experience approximately 25 years fewer healthy years of life than the least deprived(1). Preventative healthcare in Lanarkshire, aligned with national healthcare directives, represents a pivotal shift in managing health and wellness that can reverse this trend. This strategic focus underscores the potential to transform the landscape of healthcare delivery and outcomes. Figure 4.1.1: Scotland all-cause mortality rate in men 0 – 64 years Source: Glasgow Centre for Population Health Opportunities for Lanarkshire Emphasising primary prevention through legislation, regulation, lifestyle support, vaccinations, and screening reduce chronic diseases, cardiovascular diseases, cancers, and diabetes(2) through service provision and advocacy, ensuring prevention is embedded into all areas of public sector service provision. Embracing targeted universalism, Lanarkshire can target resources whereby communities who uptake services least are supported and empowered to access those services in a focused manner(3): 97
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Secondary prevention efforts, including routine screenings for diseases like cancer and hypertension, facilitate early detection and treatment, improving patient outcomes. Tertiary prevention, managing existing conditions, can significantly reduce complications and improve quality of life. Preventative strategies can be cost-effective, reducing later need for expensive treatments and hospitalisations. Proactive health measures encourage community participation and awareness, fostering a culture of health and wellness. Figure 4.1.2: Lanarkshire mortality rate* in under 75s in the lowest and highest SIMD quintiles and overall Challenges to implementing a prevention mindset can be mitigated: Upfront dedicated proportionate spend on areas clearly defined as prevention can alleviate pressure against prioritising prevention in an environment with limited resources and an imperative to focus on deliver in the acute sector. Preventative healthcare must address inequalities to tackle disparities in mortality and life expectancy (see Figure 4.1.2 & chapter 1.1, Figure 1.1.2). The Inverse Care Law suggests that those most in need of medical care often receive the least(3). Structural change and investment in that change is required to successfully integrate preventative strategies requiring substantial effort, training, in that restructuring. Infrastructure to support individuals and patients to participate in prevention to ensure patient compliance and the effectiveness of interventions, can be built through a new vision of Primary Care reaching out and supporting personal change. Lanarkshire’s strategic leaning towards a preventative approach in healthcare presents significant opportunities to enhance health outcomes, reduce long-term costs, and further engage communities in their health and wellbeing. However, this approach also faces 98
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challenges, including resource allocation, addressing health inequalities, implementation complexities, variable effectiveness, and the prevailing focus on immediate treatment. Effective integration of preventative measures requires careful planning, community involvement, and a commitment to addressing these challenges head-on. Key Points Allocating funds specifically for prevention can reduce pressure in resource-limited settings. Prioritising prevention is key in delivering acceptable acute sector services. Effective preventative healthcare must tackle existing health inequalities. Structural changes and investments are vital for integrating preventative strategies. Preventative strategy integration demands considerable effort and training. Developing infrastructure is crucial for patient participation in prevention. A new Primary Care vision can support personal change and ensure intervention effectiveness. Priorities for Action Develop and promote in our own and partner organisations a prevention mindset at a strategic, tactical, and operational level. Restrict a proportion of budget for well-defined prevention infrastructure development. Develop a proportionate universalism framework of delivery to tackle inequalities. Develop anchor collaboration and infrastructure to support successful adoption of prevention by patients and communities. References (1) Walsh D, McCartney G. Changing Mortality Rates in Scotland and the UK - An Updated Summary. Glasgow Centre for Population Health; (2023). (cited 15/12/23). Available from: https://www.gcph.co.uk/publications/1083_changing_mortality_rates_in_scotland_an d_the_uk_an_up dated_summary. (2) Buck D, Baylis A, Dougall D, Robertson R. A vision for population health: Towards a healthier future. [London]: The King’s Fund; 2018. Available from: https://www.kingsfund.org.uk/publications/vision- population-health. (3) Tudor Hart J. The Inverse Care Law. Lancet. 1971; 297: 405–412. Dr Paul Nelson, Consultant in Public Health Email: paul.nelson@lanarkshire.scot.nhs.uk (or paul.nelson3@phs.scot) 99
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4.2 Population Screening Background NHS Lanarkshire provides all of the national population screening programmes available in Scotland. Table 4.2.1 shows the number of people in the target population, as well as uptake for each programme and a brief summary of our achievements against Healthcare Improvement Scotland standards Uptake Uptake rates for some screening programmes are improving (e.g. breast and bowel cancer screening) and others have levelled off (e.g. cervical cancer screening) over the last year. Uptake remains high in pregnancy and new-born screening programmes. Inequalities Activity to raise awareness of the benefits of screening and address the barriers to screening participation are being coordinated through an updated 3-year Screening Inequalities Action Plan. This includes allocation of the Scottish Government Cancer Screening Inequalities Fund to support a number of new areas of work, the continuation of an outreach approach to engage with people experiencing homelessness, community development work in areas of deprivation to encourage and support increased uptake of the cancer screening programmes and targeted messaging to support informed choice. All of the work to improve uptake in screening will now feature under the larger Detect Cancer Early programme of work across NHS Lanarkshire which aims to improve cancer outcomes through prevention, earlier detection and treatment. The national equity in screening strategy and action plan was published in the summer of 2023. Our local action plan will support the achievement of identified outcomes. National Cervical Exclusion Audit Following an incident in the national Scottish Cervical Screening Programme, an audit of patient records of those who have been excluded from the programme is being carried out to review the appropriateness of any exclusion applied. It has been identified that 13,199 records will require to be audited by NHS Lanarkshire. This National Cervical Exclusion Audit commenced within NHS Lanarkshire in April 2023 should take around 12 months to complete. The audit is progressing well and is on track to complete late spring of 2024. The audit has required close partnership working with primary and secondary care in Lanarkshire to ensure evidence is uploaded, reviewed and clinical management of patients, where appropriate, is in place. 100
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Table 4.2.1: Summary of Screening Programmes in Lanarkshire Target populati on Denomina tor and time frame Standard Uptake Outcomes(1) Bowel screeni ng All males and females aged 50 to 74 years 195,306(1) men and women May 2020 – Apr 2022 Nationally agreed KPIs, including the target uptake of 60.0%. 63.6 % All persons. Uptake varies across SIMD quintiles from 53.4% in SIMD 1 (most deprived) to 70.7%% in SIMD 5 (least deprived). 61.4% male 65.7% female Meets uptake standard for both sexes. Standards for pre assessment and colonoscopy waiting times continue to be a challenge following the introduction of the new bowel screening test called qFIT in 2017. Breast Cancer Screeni ng Females 50- 70 years 91,142(2) women Apr 2019 - Mar 2022 National ly agreed standar ds includin g minimu m uptake of 70.0%. 72.5% Uptake varies across SIMD quintiles from 63.7 % in SIMD 1 (most deprived) to 81.4 %in SIMD 5 (least deprived). Meets all standards except time to issue results and time to assessment from first adequate screen. Across Apr 2020 - Mar 2021, 136 invasive cancers were detected in women following breast screening: 31 were detected at the first screen (women aged 50- 52) and 105 were detected at subsequent screens in women 53-70 years old. Cervical screeni ng All women aged 25- 64 years 176,872 women Data from Apr 2021- Mar 2022 Nationally agreed standards including the target uptake of 80.0% in each Scottish Index of Multiple Deprivation (SIMD) quintile. 71.1%(3) 25-49 year olds 70.2 % 50-64 year olds 72.5% Uptake varies across SIMD quintiles from 63.7% in SIMD 1 (most deprived) to 79.0% in SIMD 5 (least deprived). Meets all standards apart from uptake and laboratory turnaround times for cytology. Sample to routine colposcopy referral are proving challenging to meet while NHS Lanarkshire deliver the National Cervical Exclusion Audit. Univers al Newbor n Hearing Screeni ng (UNHS) All newborn babies born to Lanarkshire residents or moving into Lanarkshire under the age of 12 weeks 6253 Apr 2022 – Mar 2023 98.0% of babies should have completed the hearing screen by 10 weeks. 99.8% of all newborn babies born to Lanarkshire residents, or moving into Lanarkshire under the age of 12 weeks in 22/23, have completed their hearing screening by 10 week 6 babies with moderate to severe permanent hearing loss were detected through screening. 101
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Newbor n Bloodsp ot Screeni ng All newborn babies born to Lanarkshire residents and babies with no bloodspot result moving into Lanarkshire before age 12 months 6156(4) Apr 2022 – Mar 2023 99.5% of infants who have undergone screening tests have a screening result available or are recalled for repeat testing by 20 days of age. 99.86% (standard ≥99.5%) of all babies born to Lanarkshire residents 2022/2023 have undergone bloodspot screening 11 babies were identified with four of the 9 conditions screened in the newborn blood spot programme. A further 29 babies were identified as carriers for Cystic Fibrosis or Haemoglobinopathi es (including Sickle Cell Disease) Diabetic Eye Screeni ng Patients with diabetes aged 12 years and over 44383 Nationally agreed Key Performan ce Indicators (KPIs), including minimum uptake of 80.0% uptake. 85.4% of those invited for screening attended for at least one screening test Currently unavailable as KPI data calculations are being validated AAA Screenin g Men aged 65 years 4184(5) men aged 65 who became eligible in year ending 31 March 2022 (based on provisional data) Nationally agreed KPIs, including minimum uptake of ≥75.0% uptake. 78.0% for those invited for screening. Uptake varies across SIMD quintiles from 72.1% in SIMD 1 (most deprived) to 76.6 % in SIMD 5 (least deprived). Highest is for SIMD 4(88.0%) 10 large aneurysms detected and referred for assessment by a Vascular Specialist for consideration of appropriateness for intervention. Key Points Screening can help prevent conditions (including cancers) developing as well as detecting conditions and cancers at an early stage, when treatment is more likely to be successful. Maximising uptake across the population, and targeting areas where uptake is lowest, will improve outcomes for those individuals and at a population level. Where members of the population make an informed choice not to participate in population screening programmes, awareness of the signs and symptoms of conditions, including cancer, is important, to improve outcomes and detect conditions earlier. Barriers to accessing services exist for screening tests and any required diagnostic testing or interventions. Identifying and addressing these barriers continues to be a focus within the work of the screening programmes 102
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Priorities for Action Continue work on the recovery of the Diabetic Eye Screening Programme; although, noting that significant progress has been made in addressing the backlog. Continue efforts to encourage engagement with, and participation in, population screening programmes in the most disadvantaged populations. Completion of the National Cervical Exclusion Audit across Lanarkshire to ensure all who have been excluded from cervical screening were excluded appropriately. References (1) Public Health Scotland. Scottish Bowel Screening Programme Statistics - For the period of invitations from May 2020 to April 2022 [Internet]. 2023. Available from: https://publichealthscotland.scot/publications/scottish-bowel-screening-programme- statistics/scottish- bowel-screening-programme-statistics-for-the-period-of- invitations-from-may-2020-to-april-2022/ (2) Public Health Scotland. Scottish breast screening programme statistics - Annual update to 31 March 2022 [Internet]. 2023. Available from: https://publichealthscotland.scot/publications/scottish-breast- screening- programme-statistics/scottish-breast-screening-programme-statistics-annual-update- to-31- march-2022/ (3) Public Health Scotland. Scottish cervical screening programme statistics - Annual update to 31 March 2022 [Internet]. 2023. Available from: https://publichealthscotland.scot/publications/scottish-cervical- screening- programme-statistics/scottish-cervical-screening-programme-statistics-annual- update-to- 31-march-2022/#:~:text=For%20the%20financial%20year%202021 (4) NHS National Services Scotland. Scottish Newborn Screening Laboratory. Data Report 2022/23. 2023 (5) Public Health Scotland. Scottish Abdominal Aortic Aneurysm (AAA) screening programme statistics - Year ending 31 March 2022 [Internet]. 2023. Available from: https://publichealthscotland.scot/publications/scottish-abdominal-aortic-aneurysm- aaa-screening- programme-statistics/scottish-abdominal-aortic-aneurysm-aaa- screening-programme-statistics-year- ending-31-march- 2022/#:~:text=The%20total%20number%20of%20initial Dr Cathy Johnman, Consultant in Public Health Email: cathy.johnman@lanarkshire.scot.nhs.uk Celia Briffa-Watt, Consultant in Public Health Email: celia.watt@lanarkshire.scot.nhs.uk Morag Nicholson, Public Health Screening Programme Manager Email: morag.nicholson@lanarkshire.scot.nhs.uk 103
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4.3 Scottish Dental Needs Assessment Report on Older Adults: Challenges and Recommendations Background The Scottish Dental Needs Assessment Programme (SDNAP) was tasked by the National Dental Advisory Committee to conduct a needs assessment of oral health and dental services for older adults. Given the demographic shift towards an increasingly aged population in Scotland(1), the needs assessment investigated the challenges and barriers associated with providing dental care for individuals entering their later years, often having received complex dental treatments in the past. The COVID-19 pandemic significantly affected the older population, increasing isolation and loneliness(2). The fieldwork for the SDNAP Report on Older Adults was conducted before the pandemic and serves as a crucial baseline for understanding the evolving challenges. Health Inequalities and Increasing Complexity of Care Despite the expectation of good health and well-being in later life, social determinants of health contribute to inequalities among older adults(3). Issues such as dependency, access to nutritious food, suitable accommodation, and timely healthcare interventions emerge as critical factors influencing oral health. Qualitative interviews conducted with general dental practitioners, hospital dental consultants and public dental service specialists and dental officers revealed the growing challenges in managing older adults, citing factors like increased medical complexity and changes in oral disease patterns. The need for specialised care, especially for patients with multiple comorbidities, was evident. Stakeholders recognised an overlap between challenging dental treatment and patient modifying factors. The Role of Prevention All stakeholders unanimously acknowledged the importance of prevention in maintaining oral health for older adults. Dentists called for a comprehensive, transparent, and fairly remunerated system that prioritises prevention across the life course. Patients valued preventative advice, highlighting the need for wider preventative education. The report acknowledges the challenges posed by an aging population, including multiple comorbidities and polypharmacy, underscoring the integral role of oral health in overall well-being(4). Training and Workforce Requirements Stakeholders also recognised the increasing complexity of care for older adults and the need for additional training opportunities. Dentists reported gaps in knowledge regarding the management of patients with two or more chronic conditions where each condition may influence the care of the other condition. The evolving demands on services, compounded by staff losses and shortages, underscored the importance of skill mix and utilising competencies effectively. 104
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Government Initiatives The Scottish Government has demonstrated a commitment to addressing the unique needs of older adults through various initiatives. The National Performance Framework, aligned with the United Nations 2030 Agenda for Sustainable Development Goals, emphasises healthy aging and equitable access to health and care services(5). Frameworks like A Fairer Scotland for Older People(6), and the Oral Health Improvement Plan(7) provide a strategic approach to tackle health inequalities and evolving oral health challenges. Key Points Dental care for older adults faces challenges due to complex medical histories, changing disease patterns, and increased patient expectations. Prevention is unanimously recognised as pivotal in maintaining oral health. Dentists advocate for a comprehensive prevention-focused approach across all age groups. Priorities for Action Policy Alignment: Ensure ongoing alignment of national policies with the evolving needs of older adults. Oral Health Improvement Programme Adaptation: Regularly review and adapt national oral health improvement programmes like Caring for Smiles to meet changing demographic needs. Education and Training: Prioritise education and training opportunities for the dental workforce to address the increasing complexity of care and patient expectations. System Review: Conduct a thorough review of the relationship between Public Dental Service, Hospital specialist dental service, special care dentistry, and General Dental Service to bridge the gap in service provision. References (1) Scottish Government. A Scotland for the future: opportunities and challenges of Scotland's changing population [Internet]. 2021 [cited 2023 Dec]. Available from: https://www.gov.scot/publications/scotland-future-opportunities-challenges- scotlands-changing- population/ (2) Age UK. Age UK research lays bare the drastic impact of the pandemic on our older population’s health and morale [Internet]. 2020 [cited 2023 Dec 11]. Available from: https://www.ageuk.org.uk/latest-press/articles/2020/10/age-uk-- research-into-the-effects-of-the- pandemic-on-the-older-populations-health/ (3) Age UK. Later Life in the United Kingdom 2019 [Internet]. 2019. [cited 2023 Dec 12]. Available from: https://www.ageuk.org.uk/globalassets/age- uk/documents/reports-and- publications/later_life_uk_factsheet.pdf (4) Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012 Jul;380(9836): 37-43. (5) United Nations. Transforming our world: the 2030 Agenda for Sustainable Development [Internet]. 2015. [cited 2023 Dec 13]. Available from: https://www.unep.org/resources/report/transforming-our- world-2030-agenda- 105
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sustainable-development (6) Scottish Government. A Fairer Scotland for Older People: framework for action [Internet]. 2019. [cited 2023 Dec 15]. Available from: https://www.gov.scot/publications/fairer-scotland-older-people- framework-action/ 106
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(7) Scottish Government. Oral health improvement plan [Internet]. 2018. [cited 2023 Dec 15]. Available from: https://www.gov.scot/publications/oral-health- improvement-plan/ Praveena Symeonoglou, Public Health Researcher/Programme Manager – Health Protection in Dentistry, based in NHS Lanarkshire Email: praveena.symeonoglou@lanarkshire.scot.nhs.uk 107
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Statistical Appendix List of tables A1 Sociodemographic summary: by locality/HSCP A2 Estimated population: by age group and locality/HSCP A3 Projected population: by age group and sex A4 Births: by year A5 Births, perinatal deaths, neonatal deaths and infant deaths: by HSCP A6 Deaths from all causes: by sex, age group and year A7 Deaths from all causes: by sex, age group and locality/HSCP A8 Deaths from malignant neoplasms: by sex, age group and year A9 Deaths from coronary heart disease: by sex, age group and year A10 Deaths from cerebrovascular disease: by sex, age group and year A11 Deaths from respiratory disease: by sex, age group and year A12 Expectation of life: by age and sex; trend by sex A13 Cancer registrations: by sex, age group and year A14 Cancer registrations: by year and site; standardised ratios by sex, age group and site A15 Cancer registrations: by locality/HSCP and site A16 Notifiable diseases – clinically notified cases: by year A17 Dental registrations and participation. Dental health of children: by Lanarkshire A18 Primary and booster immunisation uptake rates: by locality/HSCP General notes Lanarkshire has two Health and Social Care Partnerships (HSCPs) – North Lanarkshire and South Lanarkshire. The HSCPs cover the same geographical areas as North Lanarkshire Council and South Lanarkshire Council. There are ten localities within the HSCPs – six in North Lanarkshire (Airdrie, Coatbridge, North, Bellshill, Motherwell and Wishaw) and four in South Lanarkshire (Cambuslang/Rutherglen, East Kilbride, Clydesdale and Hamilton) – see map on page 2. On 1 April 2014, changes to NHS board boundaries resulted in NHS Lanarkshire becoming coterminous with the HSCPs and local authorities. The tables in the Statistical Appendix indicate whether information relates to the old or new NHS Lanarkshire boundary, the exception being where all data relate to April 2014 onwards. On 1 April 2019, changes to the Lanarkshire and Greater Glasgow and Clyde boundary at Cardowan by Stepps resulted in the following postcodes now being part of North Lanarkshire and NHS Lanarkshire - G33 6GZ, G33 6GX, G33 6GS, G33 6GY, G33 6GW, G33 6GT, G33 6GU, G33 6NS. 108
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Populations shown and used in rates calculations are, for NHS Lanarkshire, the HSCPs and Scotland, mid-year estimates produced by National Records of Scotland (NRS). Locality populations are from NRS small area population estimates at data zone level. Health Intelligence Team Email: karen.lorenzetti@lanarkshire.scot.nhs.uk 109
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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 ☐ 110
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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 111
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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 112
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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 113
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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. 114
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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 115
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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. 116
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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 117
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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. 118
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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 119
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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. 120
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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 121
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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% 122
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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 123
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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. 124
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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. 125
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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. 126
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1 REPORT Item No:10 SUBJECT: Unaudited North Lanarkshire IJB Annual Accounts 2023/24 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie NL Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 19 June 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 provides an overview of the unaudited North Lanarkshire IJB Annual Accounts for the financial year 2023/24, in line with the legislative requirements. 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) Approve the Annual Governance Statement and associated reports for inclusion in the statutory accounts; (2) Approve the unaudited North Lanarkshire IJB Annual Accounts 2023/24 at Appendix 1; (3) Approve the submission of the unaudited annual accounts to Audit Scotland; and (4) Acknowledge the arrangements for publications of the North Lanarkshire IJB Annual Accounts 2023/24 in line with the legislative requirements. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 was passed by the Scottish Parliament on 25 February 2014 and received Royal Assent in April 2014. This established the framework for the integration of health and social care in Scotland, to be governed by Integration Joint Boards with responsibility for the strategic planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements. 127
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2 5.2 The IJB is specified in legislation as a ‘Section 106’ body under the terms of the Local Government Scotland Act 1973 and as such is expected to prepare annual accounts in compliance with the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom and International Financial Reporting Standard (IFRS). 5.3 LASAAC (The Local Authority (Scotland) Accounts Advisory Committee) and CIPFA have produced additional guidance on accounting for the integration of health and social care. 6. CONCLUSIONS 6.1 This report provides the unaudited North Lanarkshire IJB Annual Accounts for the financial year 2023/24 in line with the legislative requirements. 7. NORTH LANARKSHIRE IJB ANNUAL ACCOUNTS 2023/24 7.1 The unaudited annual accounts are attached at Appendix 1 and have been prepared in line with proper accounting practice but remain subject to audit by Audit Scotland. 7.2 As prescribed by the Local Authority Accounts (Scotland) Regulations 2014 and in line with previous years, the unaudited annual accounts will be available for public inspection in the Council Office for a three-week period from Monday 1 July 2024 until Friday 19 July 2024 inclusive. The Regulations also require publication of the annual accounts on the North Lanarkshire IJB website. The unaudited annual accounts are therefore available online from Friday 28 June 2024 until the date the audited Annual Accounts are published. 7.3 The proposed sequence of events to approve the North Lanarkshire IJB Annual Accounts 2023/24 is summarised in the following table: Key Dates Items to be Approved IJB: 19 June 2024 Approve the unaudited annual accounts at Appendix 1 Approve the submission of the unaudited annual accounts to Audit Scotland. Audit Scotland: 20 September 2024 Issue of draft letter of Representation and proposed Independent Auditor’s Report Agreement of audited and unsigned annual report and accounts IJB: 25 September 2024 Approve the audited annual accounts. 8. IMPLICATIONS 8.1 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 ☐ 128
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3 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 ☒ 8.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 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 Very High Amanda Kilburn Prevention and Detection of Fraud, Bribery and/or Corruption Low Ross McGuffie 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 Low Ross McGuffie 8.5 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 129
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4 ☒ 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. 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 9. BACKGROUND PAPERS None. 10. APPENDICES Appendix 1 – Unaudited North Lanarkshire IJB Annual Accounts 2023/24 Chief Finance Officer Members seeking further information, please contact Amanda Kilburn on 07816 126362. 130
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5 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 131
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6 NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2023/24 UNAUDITED 132
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7 CONTENTS Management Commentary Page Purpose 3 University Status for Lanarkshire Health & Social Care Partnerships 3 The Role and Remit of North Lanarkshire Integration Joint Board 3 A Profile of North Lanarkshire 4 IJB Outcomes for the Year & Key Services Priorities & Outcomes 5 Key Challenges & Uncertainties 9 Measuring Performance Under Integration 10 Summary of Financial Performance 11 Reserves Strategy 13 Risk Management 14 Acknowledgements 15 Statement of Responsibilities 17 Remuneration Report 19 Annual Governance Statement 22 Comprehensive Income and Expenditure Statement 27 Movement in Reserves Statement 28 Balance Sheet 29 Notes to the Financial Statements Note 1: Significant Accounting Policies 30 Note 2: Critical Judgements and Estimation Uncertainty 32 Note 3: Events after Balance Sheet Date 32 Note 4: Expenditure and Funding Analysis by Nature 33 Note 5: Taxation and Non-Specific Grant Income 33 Note 6: Operating Costs 34 Note 7: Short Term Debtors and Creditors 34 Note 8: Usable Reserves: General Fund 34 Note 9: Related Party Transactions 35 Note 10: Hosted Services 36 Note 11: Additional Council Services Delegated to the IJB 38 Note 12: VAT 38 Note 13: External Audit Costs 38 Note 14: New Standards Issued but not yet Adopted 38 133
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8 Purpose MANAGEMENT COMMENTARY This publication contains the financial statements of North Lanarkshire Integration Joint Board (IJB) for the year ending 31 March 2024. The management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year 2023/24 and looks forward, outlining our future plans and the challenges and risks that we will face as we strive to meet the needs of the people of North Lanarkshire. Faced with continued financial challenges for the foreseeable future, the IJB recognise that we need to respond effectively to the future by exploring new and innovative solutions to support our community. By working with our partners, staff and communities, our services will continue to respond to these challenges by protecting lives and keeping people safe into the future. University Status for Lanarkshire Health and Social Care Partnerships Glasgow Caledonian University (GCU) granted university status to both North and South Health and Social Care Partnerships in November 2023. This has only been made possible by the long-standing commitment of delivering innovation, compassionate care and the excellent partnership relationships that have been forged in Lanarkshire over many years. This also highlights the existing contribution and future opportunities for community health and social care as engine rooms for education, training, research, and innovation. This is an exciting opportunity where are valued staff and partners will have a significant impact on community wellbeing by driving the vision and building on the exemplary care and professionalism that have made this opportunity for collaboration possible. The IJB and North Lanarkshire University Health and Social Care Partnership (UHSCNL) Senior Management Team would like to expend our gratitude for the magnificent work our staff continue to undertake despite the challenges they face on a daily basis, to ensure that service to those in need continue to be delivered safely and effectively. The Role and Remit of North Lanarkshire Integration Joint Board North Lanarkshire IJB, formally established on 1 April 2016, has responsibility for the strategic planning and commissioning of a wide range of health and social care services within North Lanarkshire. These functions delegated to the IJB, under the Public Bodies (Joint Working) (Scotland) Act 2014, are detailed in the formal partnership agreement between the two partner organisations, North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) referred to as the Integration Scheme.1 1 NL IJB Integration Scheme 2024 Our Purpose People of North Lanarkshire will achieve their full potential through: living safe, healthy, and independent lives in their communities; and receiving the information, support and care they need, efficiently and effectively, at the right time and in the right way. 134
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9 The IJBs primary purpose is to set the strategic direction for the delegated functions through its Strategic Commissioning Plan and the UHSCNL is responsible for the operational delivery of those strategic directions which include: accident and emergency services provided in a hospital; inpatient services related to general, geriatric, rehabilitation, and respiratory medicine; palliative care services; community health services; and social care services. The IJB comprises of eight voting members, made up of four Elected Members appointed by NLC and four Non-Executive Directors appointed by NHSL. Non-voting members include the Chief Officer, Chief Finance Officer, service professionals, third sector, service users, carers, and staff representatives. A Profile of North Lanarkshire There remains significant ongoing pressure in all health and social care systems across Scotland. High demand and patient acuity, coupled with increased winter pressures 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. Some of the multi-faceted factors that impact on the demand for health and social care services across North Lanarkshire include: North Lanarkshire is the 4th largest area in Scotland. It is also the 4th 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. There are approximately 14,000 unpaid carers known to carer support services and/or UHSCNL locally. However, the estimated true figure of unpaid carers locally is in the region of 50,000 to 60,000. 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 support, care homes, increases in demand for community-based healthcare, equipment and adaptations and an increased demand for GP services and medication. 135
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2 Strategic Commissioning Plan 2023-2026 9 IJB Outcomes for the Year and Key Service Priorities and Developments The Strategic Commissioning Plan 2023-20262 was approved and published in March 2023, sets out five key priorities: Support people through a whole family approach Develop and support a workforce for the future Strategic Commissioning Plan 2023/2026 Improve mental health and wellbeing The Programme of Work linked to these priorities, has been complied following consultation and engagement with stakeholders across the UHSCNL and beyond. It is aligned with the key strategic drivers across both NLC and NHSL, dovetailing with the developments associated with the NHSL Our Health Together and the NLC Plan for North Lanarkshire. The Programme of Work seeks to include those programmes and activities which are intended to help transform and reshape health, social care and social work services in North Lanarkshire and meet the ongoing and future needs of North Lanarkshire’s communities. During the three-year life of the plan, we will adopt a Learning Management Strategy approach, (often called Human Learning Systems), making learning and experimentation the key driving force of our work. By using our current understanding whilst experimenting with new ways of working, we aim to produce a different pattern of results and better outcomes. This new approach will then be developed and embedded as far as possible within each of the Programmes of Work to ensure we learn from our tests of change. The progress made by UHSCNL on the key strategic commissioning intentions and the key performance indicators are reported regularly to the IJB. The Annual Performance Report reflects on the improvements made and innovative practices achieved throughout the year. The key achievements are highlighted below: Hospital at Home Hospital at Home provides acute care within the clients own home, with a commitment to be in the clients house within an hour of referral. The service provides 72 virtual beds across Lanarkshire and supports on average 265 referrals per month. Average length of stay is around 5 days. We continue to develop the links between the Hospital at Home team, Primary Care and Localities as part of the integrated service offering in North Lanarkshire and are currently working towards extending working hours to allow patient admission to the service to continue until 10pm and further expansion of staff to accommodate a 7-day rostered service. Healthy Schools Developed by NHS Lanarkshire’s Healthy Lifestyle and Weight Management Service in conjunction with North Lanarkshire Council, as well as input from practitioners and learners, Healthy Schools is an example of health and education services working in partnership to support the future generations of Lanarkshire. Do the right thing first time Increased focus on prevention, early intervention and tackling inequalities 136
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10 The interactive website written by teachers from North and South Lanarkshire in conjunction with local NHS and UHSCNL staff, support children and their families to look after and improve their health and wellbeing by providing a health education framework which can be used by practitioners and teachers. Breastfeeding UHSCNL aim is to make North Lanarkshire a place where breastfeeding is the norm and build a supportive community and environment to encourage more women to feel comfortable breastfeeding for as long as they want, recognising both the short and long-term health benefits of breastfeeding for both mother and baby. UHSCNL support breastfeeding as the optimal infant feeding choice for all parents, in addition, each Community Board area in North Lanarkshire has a breastfeeding champion in place to support our commitment to improving breastfeeding rates. Community Nursing Community Nursing is a planned serviced that is delivered in all six localities and provides an at home service of person centred, safe, effective care for clients who cannot attend other care facilities due to disability, effects of long-term care conditions or illness or where being cared for at home is considered the most suitable environment. 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 clients and carers. It operates over seven days between the hours of 8am to 10pm. There is a separate overnight nursing service which operates between 10pm and 7am which predominately provides palliative care pain relief and unscheduled care. Engagement & Participation Community Boards are the foundation of the community planning process in North Lanarkshire. Nine Community Boards have been established and embedded in North Lanarkshire to support community leadership, involvement, and capacity building by focussing activity through a local outcome and improvement plan (LOIP). The Chief Social Work Officer is a Community Co-ordinator for one of the boards with the Head of Adult Social Work and Head of Planning, Performance and Quality Assurance providing a link to UHSCNL. Senior Social Work Managers also participate in area-based teams and sub-groups which support the delivery of the LOIPs. Living Well in the Community This is a multi-professional, cross-sector collaboration of Support Staff, Community Rehabilitation, Nursing, Health Visiting, Mental Health, Care at Home Teams, Equals Advocacy (Third Sector Advocacy Organisation), Frailty Specialists (Secondary Care), Information Technology, Pharmacy, Primary Care and Public Health Scotland. The team has a preventative approach for older adults in the community who are at high risk of deterioration. The overall aim of the approach is to improve outcomes and move away from crisis intervention as the only option for this cohort of patients. This approach is deployed across three Lanarkshire GP practices. Discharge Without Delay (DWD) DWD is a whole system approach which supports people to be cared for at home (or as close to home as possible) prevents avoidable admissions to hospital and, where hospital admission is necessary, supports timely discharge. This programme was introduced towards the end of 2021/22 and has continued as a priority for the partnership. 137
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11 The Home Assessment Team (HAT) was developed as a new team within North Lanarkshire and works collaboratively with hospital discharge hubs and clinical teams to support timely discharge from hospital to enable an assessment of each person’s immediate and long-term needs in their own home. This can include anything from signposting, to support from a statutory service and community care assessment. HAT take a multi-disciplinary approach to person centred care and consists of home support staff, health professionals, clinical responders, and social work staff to embed Home First principles to enable people to be supported to return home for a period of assessment. The team is receiving an increasingly greater volume of referrals, and a Home Assessment Development Plan is in place to streamline and reduce duplication of service from the teams working in this area. The development plan is currently focussed on services to support discharge; however, a second phase is planned to look at the interaction with Hospital at Home and other services placed to support admission prevention and avoidance. Technology Enabled Care Additional funding has been allocated directly to UHSCNL to support an increase in the use of Community Equipment and Technology Enabled Care (TEC). A dedicated team has been established to support individuals within their homes and communities with a focus on embedding technology into assessment and planning processes; providing training to all staff groups on technology and its use in care and support, supporting with risk assessments, ensuring technology support advice is embedded in Self Directed Support; and providing high level data on the technology being used within our communities. Our approach is aligned to the national guidance on the promotion of technology that can be an early intervention and helps prevent the need for supporting services to be put in place where a suitable TEC alternative exists. UHSCNL is actively promoting TEC through the team and the TEC flat, which is a demonstrator property for those interested in the potential solutions to meet their needs. Operation Flow: A New Model of Care The winter period is a challenging time for UHSCNL services, clients, and staff. In response to this, UHSCNL and our partners developed a clear plan to help redesign and rebuild services with the aim of increasing resilience within the service and the wider system, and also to provide a framework for a whole system improvement programme. Operation Flow was deployed which realised significant improvement across the health and social care system, including improved opportunities to support people to remain well at home, a reduction in hospital occupancy and length of stay and a very significant improvement in 4-hour A&E access, including an important reduction in ambulance waits. The second phase of this work has since been designed and launched as Operation Flow 2, which is a plan for a sustainable and resilient way forward with a clear focus on improving client and staff experience as well as key performance improvements. The new programme is focused at improving the system across the full client pathway from avoiding hospital admissions through to discharge and beyond. Community Solutions Established in 2012, Community Solutions is a successful, UHSCNL cross-sector health and social care investment and improvement programme for North Lanarkshire that is improving people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources, with a focus on prevention and early intervention. Community Solutions ensures a co-ordinated approach throughout North Lanarkshire, promoting local opportunities and solutions for and with people, avoiding the need for more formal services for longer periods of time. Community Solutions is an effective and active example of co-production: a true partnership between people, communities, and services. 138
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12 The range of achievements via the Community Solutions Programme Approach include significant development through local anchor organisations; Support in the Right Direction; Community Connectors and Improving Cancer Journeys. Self-Directed Support: Transformational SDS Agenda SDS was introduced to Scotland in April 2014 following the Social Care Self Directed Support Scotland Act 2013. Its introduction means that people receiving social care support in Scotland have the right of choice, control, and flexibility to meet their personal outcomes. Health and Social Care Partnerships are required to ensure that people are offered a range of choices on how they receive their social care support. Since implementation, the number of SDS users and their average budgets has been steadily increasing. This is reflected in the rate per 1,000 population of North Lanarkshire SDS users, which has steadily increased each year. A corresponding decrease in the number of care at home users has been observed and this is likely to be the transition from ‘traditional’ care at home towards SDS. Key priorities for the continued implementation of SDS include enhancing partnership working across the spectrum and an enhanced focus on Technology Enabled Care, in the deployment of assistive technology so that people can be supported at home as independently as possible, for as long as is appropriate, whilst minimising risk and reducing reliance on statutory services. Alcohol & Drug Partnership North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership established in 2019 focusing on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who use alcohol and drugs and those around them. ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives, including agencies that provide treatment and intervention for people experiencing problem alcohol and drug use. The North Lanarkshire ADP Strategy 2021-2024 draws on the successes, challenges and learning from previous activity. The strategy was informed by extensive consultation and engagement with service users, representatives groups and other key stakeholders to understand the needs, challenges, and innovative ideas for change, including many who have been in contact with services for support. Supporting Unpaid Carers To develop an alternative to traditional respite or a cash grant, which often had restricted eligibility criteria, a consultation was carried out with carers to put them at the heart of service design when considering alternative and creative ways to provide a short break. Carers fed back that service providers needed to think creatively and address the need for a break that did not only take the form of an annual short break, but that was easily accessible in the community, available on a regular basis and more flexible in terms of availability throughout the day. From these insights, the concept of the Carer Breather was established and funded projects were set up to offer activities such as art therapy, health and wellness activities, holistic support, and groups supporting people caring for loved ones with learning disabilities or living with long-term conditions. Carers can now access new services across North Lanarkshire that provide breaks from their caring roles and allow them to take some quality time out for themselves. 139
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13 Key Challenges and Uncertainties The key challenges and uncertainties below represent some of the areas highlighted in the Medium Term Financial Plan 2023-26, supported by the 10 year Long Term Financial Plan 2024-33: Recurring Financial Sustainability North Lanarkshire IJB Medium Term Financial Plan is subject to some non-recurring funding solutions which in the long term is unsustainable as the financial pressures increase year on year. Looking forward and as highlighted by Audit Scotland, the level of volatility, uncertainty and immediate financial pressures make planning and delivering sustainable change more difficult. Recurring funding solutions will require to be identified and implemented to secure recurring financial sustainability whilst ensuring services are delivered efficiently and effectively to our users. In 2024/25, UHSCNL will embark on a two-year programme targeted at service redesign, transformation, and financial management with the aim of releasing recurring funding to ensure future services and commitments remain sustainable. Demographic Growth and Demand Health and social care services are experiencing increasing demand due to demographic growth, an ageing population, complexity of care needs, and deprivation with the Feeley Report forecasting a yearly increase on social care demand until 2035 to be between 2.2% and 3.5%. This is an additional pressure which will need to be managed along with an overstretched health and social care service where waiting lists and referrals are continuing to cause some delays for our users. Staff Recruitment and Retention The wider health and social care sector have experienced challenges related to the recruitment and retention of staff for some time. The IJB has recognised the need to invest in the workforce through training and development by approving a ‘Grow Our Own’ staff training academy initiative in acknowledgement of the ongoing challenges in recruitment and retention and a national shortage of key skills. Receiving university status with GCU will provide opportunities for the younger workforce, adult recruitment, and employability, focusing on building capacity and resilience by supporting wellbeing, training, and development across the existing workforce. Young people will also have the opportunity to access health and social care vocational learning pathways allowing pupils to gain qualifications as well as work related learning experiences which will assist them in gaining employment in health and social care professions. Inflation and Rising Costs The volatility of the UK inflation, impacted by the global energy costs, will present a considerable challenge to the IJB for the foreseeable future. Currently inflation is higher than the long-term average of 2.82% and will impact on the sustainability of our external providers who are struggling to cope with the increased costs of goods and services, our service users as they battle with the concept of ‘heat’ or ‘eat’ and the IJB directly due to the rising costs from providers and increased demand on all services as we continue to help those most in need. Global price increases and the number of medicines being prescribed in Lanarkshire is also causing unprecedented pressure on our prescribing budgets. Projections for 2024/25 and beyond expect this pressure to increase and has resulted in a health board-wide efficiency measures coming into force in 2023/24, concentrating on drug switches and prescribing improvement projects. 140
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14 National Care Service The independent review of Adult Social Care recommended the creation of a National Care Service (NCS) and a system of care which took a human right based approach with a focus on incorporating the view of those with lived experience about what needs to change to make real and lasting improvements. The aspirations of the NCS represent a progression from the Scottish Government’s Health and Social Care Delivery Plan and supports their long-standing desire to shift the balance of care and support from hospital to a community care setting. The outcome of this review is currently subject to ongoing consultation and will be used to shape and develop the new legislation, with the intention that the NCS will launch in Spring of 2026 with local reform of Integration Authorities during 2028/29. This will impact on the delivery of services and over the next 5 years, proposed changes will have a direct impact on colleagues working in health and social care resulting in uncertainty and increased work challenges as we prepare for the implementation of the NCS. National Context Audit Scotland reports highlight IJBs are facing unprecedented challenges as they seek to balance the impact of the remobilisation of services after the pandemic, continuing rising costs and increasing demand. This is against a backdrop of financial uncertainty, workforce pressures, and social care reform. There remains a significant overall and recurrent budget gap across all IJBs in Scotland. Audit Scotland therefore advise that it is essential that IJBs identify significant recurring savings to maintain current levels of service provision at the same time as transforming the way services are delivered. Measuring Performance Under Integration Our Annual Performance Report was published in October 2023 and provides an opportunity to reflect on the past year and celebrate the accomplishments of UHSCNL, employees and partners. It acknowledges the ongoing collaborative work undertaken with service users, carers, families, and communities to improve on performance. Moreover, it recognises and acknowledges the existing and future challenges that the partnership faces, many of which are influenced by the long-lasting effects of the pandemic. Since 2016, Integration Authorities have been required by legislation to report on the Core Suite of Integration Indicators. These indicators were developed to help IJBs review their progress towards achieving each of the National Health and Wellbeing Outcomes, which focus on improving how services are provided and the difference health and social care services should make for people. The most recent reporting period available is mainly 2022; this ensures that the findings are based on the most complete and robust date currently available: Title North Lanarkshire Scotland UHSCNL Trend Scotland Trend Emergency admission rate (per 100,000 population) 14,765 11,155 Emergency bed day rate (per 100,000 Population) 120,073 113,134 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharge) 114 102 Proportion of last 6 months of life spent at home or in a community setting 89% 89% 141
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15 Title North Lanarkshire Scotland UHSCNL Trend Scotland Trend Falls rate per 1,000 population aged 65+ 19 22 Premature mortality (per 100,000 population) 580 466 Proportion of care services graded 'good' or better in Care Inspectorate Inspections 77% 75% Percentage of adults with intensive care needs receiving care at home 71% 64% Number of days people spend in hospital when they are ready to be discharged (Per 1,000 population) 970 919 Performance is better than previous reporting period Performance is worse than previous reporting period Summary of Financial Performance The financial year 2023/24 has brought a fresh set of challenges including continued recovery from the pandemic, the cost of living crisis, a changing demographic profile, pressures attributable to hospital discharges, staffing shortages, rising costs and increased demand for services. Through regular updates to the board from the Chief Finance Officer (CFO) and by ensuring decisions made throughout 2023/24 were taken to support financial sustainability, the IJB has successfully managed to deliver year on year financial balance. This has been achieved through a combination of actions: flexible use of recurring and non-recurring funding; creation and use of reserves for specific commitments; delivery of approved savings through efficiency measures and redesign; focusing on workforce planning and the Strategic Commissioning Plan Programme of Work; and effective governance and audit controls. 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 NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations grant settlement from Scottish Government. The combined recurring and non-recurring budgets available to the IJB in 2023/24 to take forward the commissioning intention in line with the Strategic Commissioning Plan, is circa £821m. Included within this funding is a ‘Large Hospital Service’ (Set Aside) budget totalling £74.575m. This budget is in respect of the functions delegated by the Health Board which are carried out in a hospital setting. The Set Aside budget 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 by postcode. Also included is £40.641m which represents a number of delegated services which 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. 142
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16 Throughout 2023/24 the CFO financial monitoring reports to the IJB projected an underspend, prior to the transfer of year end balances to general and earmarked reserves at the financial year end. This included the transfer of specific ring-fenced monies (including Scottish Government funding for: Mental Health Services, Alcohol & Drug, Hospital at Home, and nursing) in line with Scottish Government guidance. Care Group Budget 2023/24 £m Actual 2023/24 £m Variance 2023/24 £m Health Care Services Locality and Other Services 67.471 59.671 7.800 Addiction Services 7.551 3.954 3.597 Medical and Nursing Directorate 4.639 4.105 0.534 Prescribing 76.661 78.442 (1.781) Out of Area Services 4.318 4.585 (0.267) Area Wide Services 8.054 7.621 0.433 Hosted Services 195.779 190.715 5.063 Family Health Services 126.015 126.015 - Set-Aside Budget 74.575 74.575 - Total Health Care Services 565.063 549.684 15.379 Care Group Budget 2023/24 £m Actual 2023/24 £m Variance 2023/24 £m Social Care Services Social Care Services 252.796 249.465 3.331 Housing Services 2.599 2.599 - Transport Services 0.551 0.551 - Total Social Care Services 255.946 252.615 3.331 Total Health & Social Care Services 821.009 802.299 18.710 Note: The figures differ to that in the Comprehensive Income and Expenditure Statement (CIES) due to differences in the presentation of in year adjustments between the partners. The year end underspend totalled £18.710m. Drawdown of reserves in 2023/24 totalled £41.132m leaving a deficit on the provision of services of £22.422m as shown in the CIES on page 27 and Movement in Reserves on page 28. North Lanarkshire IJB Financial Outturn 2023/24 £m Underspend as at 31 March 2024 (18.710) Drawdown of Reserves 41.132 Deficit on Provision of Services (Page 27) Movement in Reserves (Page 28) 22.422 143
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17 The following provides a high-level summary of the key pressures and the main reasons why the IJB’s final outturn resulted in an underspend against its budget in 2023/24: Locality and Other Services net underspend of £7.800m is in relation to ongoing challenges in terms of recruitment and retention of staff across all mainstream service areas. This underspend also includes Scottish Government funding of £4.277m allocated to help address the current staffing pressures. This funding will be carried forward into 2024/25 within specific ring-fenced reserves to be used in 2024/25. North Lanarkshire Hosted Services combined net underspend totalling £5.063m. This is due to additional funding received from Scottish Government (£4.457m) which will be carried forward into 2024/25 and allocated against approved spending plans within Mental Health. The remaining underspend is in relation to vacant posts across the service. Addiction Services net underspend of £3.597m. The total underspend is in relation to Scottish Government ring-fenced funding which will be carried forward for use in 2025/26. Social Care Services net underspend of £3.331m is in relation to ongoing challenges in terms of recruitment and retention of staff across all service areas. Prescribing net overspend of £1.781m is attributable to the continued increase in costs associated with the number of medicines being prescribed. Medical/Nursing Directorate and Area Wide Services combined net underspend totalling £0.967m is due to additional Scottish Government funding (£1.034m) which will be carried forward into 2024/25 and allocated against approved spending plans within Pharmacy, Frailty and District Nursing. As demand continues to rise, the costs of providing health and social care services across Lanarkshire have also been increasing year on year. The table below shows the cost of our services incurred over the last three years, as presented in the Comprehensive Income and Expenditure Statement: North Lanarkshire IJB Services 2021/22 £m 2022/23 £m 2023/24 £m Social Care Services 202.610 236.972 261.848 Health Care Services 74.073 74.527 78.950 Family Health Services 109.652 115.625 126.015 Delegated Services 2.207 2.437 3.150 Hosted Services 149.126 159.642 189.595 IJB Operating Costs 0.214 0.247 0.308 Prescribing Costs 68.739 71.332 78.442 Covid-19 Costs 13.412 7.072 0.227 Set-Aside 65.164 69.120 74.575 Income (3.800) (4.717) (5.303) Cost of Services 681.397 732.256 807.807 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 reserve strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The IJB Reserves Strategy 2023/24 allows for the flexibility in terms of potential fluctuations. This allows the IJB to increase contingency reserve balances significantly where resources permit providing future financial resilience for those years where the level of resources available to the IJB may be significantly constrained and will require a drawdown from these reserves in order to deliver financial balance. 144
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18 To protect the financial resilience of the IJB in the context of an increased financial risk profile, the IJB transferred £4.821m from the 2023/24 in year underspend to contingency reserves. This provides a total contingency reserve of 5.2% of our mainstream financial envelope. The IJB has also committed actions attached to the Strategic Commissioning Plan Programme of Works and funding is therefore earmarked to specific projects to allow spend to be managed in a way that represents best value for the IJB to achieve its national outcomes. It is also important that in year funding available from government priorities are able to be ring-fenced and carried forward into the following financial year. As these funding allocations are to meet specific commitments, they must be carried forward to meet the conditions attached to their receipt. The table below shows the breakdown of the underspend transferred to reserves at year end: Analysis of Underspend Transfer to IJB Reserves at Year End 2023/24 £m Ring-Fenced Reserves 13.365 Earmarked Reserves 0.524 Contingency Reserves 4.821 Total Underspend Transferred to Reserves 18.710 Risk Management The IJB Risk Management Strategy complements the existing risk management processes within each partner by ensuring risk reports form a substantial item of business at all IJB and PFA Committee meetings. There are three main risk registers across the partnership: IJB risk register outlining the strategic risks to the IJB; Health operational risk register, hosted within the NHS Lanarkshire system; and Social Work operational risk register, hosted within North Lanarkshire Council system. Strong ties have been maintained with the corporate risk managers in both partner organisations and the IJB Risk Management Strategy, has been developed in conjunction with these leads, linking closely to both the NLC and NHSL Risk Management Strategies. At time of writing, there are currently seventeen open risks identified within our North Lanarkshire IJB Risk Register with two of these risks rated as very high and seven rated as high. The table below shows a summary of these: Category Summary of Risk Current Risk Level Financial Strategic Financial Challenges: There are a range of financial challenges which will impact on the IJB’s ability to deliver the Strategic Commissioning Plan with the financial envelope available. Very High Financial Reputational 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 internal controls. Low Financial Strategic Set-Aside Budget: There is a risk that the resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care. High Financial Strategic Hosted Services: There is a risk of dispute between the North and South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services budgets. Medium 145
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19 Category Summary of Risk (Continued) Current Risk Level Financial Operational Prescribing Activity and Costs: The risk is cost of prescribing could impact on the availability of medicines, healthcare techniques and technology and in respect of supply of medicines and medical devices, additional checks are now required at ports and EEA before goods can cross the border. Very High Financial Strategic Third and Voluntary Sector: There is a risk our third sector organisations are vulnerable because of the lack of certainty in respect of long-term funding security. Low Financial Strategic Ineffective Governance Arrangements: There is a risk that the intensity of the required response to Covid-19 could result in a failure of governance impacting on the effectiveness of the IJB decision-making. Low Performance Oversight of Performance Activity: There is a risk the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role. Low Performance 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 sickness absence, and redeployment. High Performance Care Homes: Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placements and closure of care homes. Medium Strategic & Performance 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 post and challenges recruiting. Medium Strategic & Performance 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. High Strategic 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 on the impact of change. High Strategic & Performance Unscheduled Care: There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand, workforce capacity, delays in onward movement of patients and care at home capacity. High Strategic & Performance 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. Medium Performance Service Sustainability: Due to competing service priorities and workforce and financial challenges, there is a risk that the IJB will be unable to implement the strategic plans. High Performance Workforce Sustainability: It is becoming increasingly difficult to recruit to particular roles across Health and Social Care as gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. High Acknowledgements We would like to acknowledge the significant effort required to both produce the annual accounts and successfully manage the finances of the IJB and to record our thanks to the Finance teams in both North Lanarkshire Council and NHS Lanarkshire and colleagues in other services for their continued hard work and support. 146
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20 Cllr Anne McCrory Chair Date: Professor Ross McGuffie Chief Officer Date: Amanda Kilburn FCCA Chief Finance Officer Date: 147
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21 STATEMENT OF RESPONSIBILITIES Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire Joint Board is required to: Make arrangements for the proper administration of its financial affairs and to ensure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Finance Officer. Manage its affairs to secure economic, efficient, and effective use of resources and safeguard its assets. Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with the legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). Approve the Annual Accounts. I confirm that these Annual Accounts were approved for signature at a meeting of the North Lanarkshire Integration Joint Board on xx September 2024. Signed on behalf of the North Lanarkshire Integration Joint Board Cllr Anne McCrory Chair Date: 148
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22 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the Integration Joint Board’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: Selected suitable accounting policies and then applied them consistently. Made judgements and estimates that were reasonable and prudent. Complied with legislation. Complied with the Local Authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: Kept proper accounting records which were up-to-date. Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that these Annual Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2024 and the transactions for the year then ended. Amanda Kilburn FCCA Chief Finance Officer Date: 149
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23 REMUNERATION REPORT The Local Authority Accounts (Scotland) Regulations 2014 (SSI No.201/200) require local authorities and IJB’s in Scotland to prepare a Remuneration Report as part of the annual statutory accounts. The information in the tables below is subject to external audit. The explanatory text in the Remuneration Report is reviewed by Audit Scotland to ensure it is consistent with the financial statements. Voting Board Members Voting IJB members constitute councillors nominated as board members by constituent authorities and NHS representatives nominated by the NHS Board. The voting members of North Lanarkshire IJB were appointed through nomination by North Lanarkshire Council and NHS Lanarkshire. The regulations require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant’ person in relation to the Remuneration Report includes a senior officer holding office with associated authority, whether on a permanent or temporary basis, in the financial year to which that Remuneration Report relates. The Board Members do not receive remuneration or expenses directly from the IJB. Any remuneration or reimbursement of expenses for voting board members is governed by the relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs by the partner. The details of the Chair and Vice Chair appointments held during 2023/24 are outlined in the table below: Name Post Held Nominated by Cllr Ayeshah Khan IJB Chair (1 April 2023 to 30 June 2023) North Lanarkshire Council Cllr Martin McCulloch IJB Chair (1 July 2023 to 20 Jan 2024) North Lanarkshire Council Cllr Michael McBride IJB Chair (21 January 2024 to 31 March 2024) North Lanarkshire Council Brian Moore IJB Vice Chair (1 April 2023 to 31 March 2024) NHS Lanarkshire The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlement of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or the Vice Chair. There were no exit packages payable during the financial year. 150
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24 Officers of the IJB The IJB does not directly employ any staff in its own right however specific post-holding officers are non- voting members of the Board. The Chief Officer and the Chief Finance Officer are appointed by the North Lanarkshire IJB and employed by North Lanarkshire Council. Both posts are seconded to the IJB in line with the local arrangements. The senior officers received the following remuneration in the period: Total Earnings * 2022/23 £ Name and Post Title* Total Earnings 2023/24 £ 112,098 Ross McGuffie Chief Officer 1 April 2022 to 31 March 2024 124,425 45,844 (FYE 74,370) Amanda Kilburn Chief Finance Officer 22 August 2022 to 31 March 2024 81,854 3,645 (FYE 38,004) Marie Moy Chief Finance Officer 1 April 2022 to 6 May 2022 - *Total Earnings 2022/23: Full Year Estimate includes an estimate of the full year salary for Amanda Kilburn who started as Chief Finance Officer on 22 August 2022 and for Marie Moy who left post on 6 May 2022. Pay band information is not separately provided as all staff pay information has been disclosed in the information above. Pension Benefits In respect of officers’ pension benefits the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pension liability reflected on the IJB balance sheet for the Chief Officer or the Chief Finance Officer. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The table also shows the total value of the accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. 151
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25 Name and Post Title In Year Pension Contribution* Accrued Pension Benefits For Year to 31/03/2023 £ For Year to 31/03/2024 £ Description As at 31/03/2023 £ As at 31/03/2024 £ Ross McGuffie Chief Officer 21,635 24,014 Pension 12,476 16,236 Lump Sum - - Amanda Kilburn Chief Finance Officer 8,848 15,798 Pension 14,821 16,902 Lump Sum - - Marie Moy Chief Finance Officer 365 - Pension - - Lump Sum - - *In Year Pension Contribution for Marie Moy relates to 1 April – 6 May 2022. Cllr Anne McCrory Chair Date: Professor Ross McGuffie Chief Officer Date: 152
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26 ANNUAL GOVERNANCE STATEMENT The Annual Governance Statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance and meets the requirements of the ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE in 2016. Scope of Responsibility The IJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. The IJB also aims to foster a culture of continuous improvement in the performance of the IJB’s functions and to make arrangements to secure best value. To meet this responsibility, the IJB has established arrangements for governance which includes a system of internal controls. The system is intended to manage risk to support the achievement of the IJB’s policies, aims and objectives. Reliance is also placed on the NLC and NHSL systems of internal control which support compliance with both organisations’ policies and promotes achievement of each organisations aims and objectives, as well as those of the IJB. This system can only provide reasonable and not absolute assurance of effectiveness. Purpose of the Governance Framework The governance framework comprises the systems and processes, and culture and values, by which the IJB is directed and controlled. It enables the IJB to monitor the achievement of the objectives set out in the IJB’s Strategic Commissioning Plan. The governance framework is continually updated to reflect best practises, new legislative requirements, and the expectations of stakeholders. The system of internal control is based on an ongoing process designed to identify and prioritise the risks in the achievement of the IJB’s objectives, to evaluate the likelihood of those risks being realised, the impact should they be realised, and to manage them effectively. Governance Framework and Internal Control System The IJB comprises of eight voting members, with one from each partner organisation assuming the role of Chair and Vice Chair. Four are Council Members nominated by NLC and four are Non-Executive Members appointed by NHSL. The term of office is for a period of three years. There are also a number of non-voting professional and stakeholder members on the IJB board. Stakeholder members currently include third sector, carers, staff representatives, service users and professional members including the Chief Officer and Chief Finance Officer. The IJB, via a process of delegation from NLC and NHSL, has responsibility for the planning, resourcing and operational delivery of all delegated health and social care within its geographical area. The main features of the governance framework are: Principles The IJB follows the principles set out in the Convention of Scottish Local Authorities (COSLA) and the Accounts Commission in 1996 Code of Guidance on Funding External Bodies and Following the Public Pound for both resources delegated to the IJB, and resources paid to its Local Authority and Health Service partners. 153
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27 Formal Frameworks The IJB is formally constituted through the Integration Scheme agreed by NLC and NHSL and approved by Scottish Ministers. The IJB operates within an established procedural framework. The roles and responsibilities of board members and officers are defined within standing orders, scheme of delegation and financial governance arrangements which are subject to regular review. The IJB Code of Corporate Governance3 was approved by the IJB on 18 July 2017, and is subject to ongoing updates as required. Board members adhere to an established Code of Conduct and are supported by induction and ongoing training and development. Staff ‘Personal Development Plan’ (PDP) schemes are also in place, the aim of which is to focus on performance and development that contributes towards achieving service objectives. UHSCNL has robust structures which are based on service delivery, care and interventions that are person centred, timely, outcome focused, equitable, safe, efficient, and effective. Reports are presented to the IJB throughout the year which provides evidence to demonstrate the delivery of our core components within our framework and the Clinical and Care Governance principles specified by Scottish Government. Strategic Planning The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic Commissioning Plan which sets out the key outcomes the IJB is committed to delivering with its partners. The Strategic Commissioning Plan Board sets out the IJB’s approach to engage with stakeholders. Consultations on the future vision and activities of the IJB is undertaken with its Local Authority, Health Service partners and stakeholders. The IJB regularly publishes information regarding its performance. The financial plans outline the financial challenges and opportunities the UHSCNL faces in the medium to long term and provides a framework which will support the IJB to remain financially sustainable. It complements the IJB Strategic Commissioning Plan, highlighting how the financial plans will support the delivery of the IJB’s strategic objectives and priorities. Oversight Effective scrutiny and service improvement activities are supported by the formal submissions of reports, findings and recommendations by Inspectorates and the appointed Internal Audit Service to the IJB’s Senior Management Team, the main IJB board and the Performance, Finance and Audit Committee, as appropriate. Performance management, monitoring of service delivery and financial governance is provided by the UHSCNL to the IJB, who are accountable to both the Local Authority and the Health Board. It reviews reports on the effectiveness of the integrated arrangements including the financial management of the integrated budget. This ensures there is a regular scrutiny at senior management, committee, and board level. Information on performance can be found in the Annual Performance Report published on our UHSCNL website4. Risk Management In line with the continued and ongoing review of the IJB Risk Register, new and emerging risks or changes in risk level are agreed at each Senior Management Team, IJB and PFA meeting as appropriate. The current risks at time of writing are summarised in the Management Commentary. 3 IJB Code of Corporate Governance 4 UHSCNL Website 154
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28 Financial Control Responsibility for maintaining and operating an effective system of internal financial control rests with the Chief Finance Officer. The system of internal financial control is based on a framework of regular management information, Financial Regulations and Standing Financial Instructions, administrative procedures, including segregation of duties, and management and supervision including delegation and accountability. Development and maintenance of these systems is undertaken by managers within the UHSCNL supported by NLC and NHSL in relation to the operational delivery of health and social care services. Transformational Change The IJB financial plans and the Strategic Commissioning Plan recognises the need to transform the way in which the UHSCNL delivers services to ensure the sustainability of health and social care services going forward. Together with the IJB Reserves Strategy, these plans are regularly reviewed over their lifespan, and amended as necessary to reflect the current challenges and pressures the partnership face. Review of Adequacy and Effectiveness Due to the nature of the IJB membership, a conflict of interest can arise between individual board and committee members and the responsibilities they have to the IJB. It is the responsibility of board and committee members to declare any potential conflicts of interest, and it is the responsibility of the Chair of the relevant board or committee to ensure sure declarations are appropriately considered and acted upon. The IJB has responsibility for conducting an annual review of the effectiveness of the system of internal control and the quality of data used throughout the organisation. The review is informed by the work of the Senior Management Team, who have the responsibility for the development and maintenance of the internal control framework, the work of the internal and external audit teams and other independent inspectorates. Internal Audit undertake an annual programme following an assessment of risk completed during the strategic audit planning process. The appointed NHSL Chief Internal Auditor in conjunction with the NLC Chief Officer (Audit and Risk), provide an annual report to the IJB PFA Committee giving an independent opinion of the adequacy and effectiveness of the governance framework, risk management and internal controls. Based on the audit work undertaken directly on behalf of the IJB and being informed by internal audit, work undertaken independently by each respective internal audit function within NLC and NHSL, the NHSL Chief Internal Auditor and the NLC Chief Officer (Audit and Risk) are able to conclude that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls. Roles and Responsibilities The Chief Officer is the Accountable Officer for the IJB and has day to day operational responsibility to monitor delivery of integrated services, with oversight from the IJB. The IJB complies with the CIPFA statement on ‘The Role of the Chief Finance Officer in Local Government 2014’. The IJB Chief Finance Officer has responsibility for the UHSCNL financial arrangements and is professionally qualified and suitably experienced to lead and advise the IJB finance functions. 155
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29 The IJB complies with the requirements of the Public Sector Internal Audit Standards and the approved Internal Audit Charter for the IJB. The appointed NHSL Chief Internal Auditor has responsibility for the IJB internal audit functions and is professionally qualified and suitably experienced to lead and direct internal audit staff. The Internal Audit Service operates in accordance with the CIPFA ‘Public Sector Internal Audit Standards 2017’. Board members and officers of the IJB are committed to the concept of sound internal control and effective delivery of health and social care services. The IJB PFA Committee operates in accordance with CIPFA ‘Audit Committee Principles in Local Authorities in Scotland and Audit Committees Practical Guidance for Local Authorities’. The committee core function is to provide the IJB with independent assurance on the adequacy of the risk management framework, the internal control environment, the integrity of the financial reporting and governance arrangements. Action Plan To ensure continual improvement of the IJB’s governance arrangements, the following action plan has been agreed. Also included are improvement areas identified by Audit Scotland within their Annual Audit Report. Regular updates on progress of the agreed actions will be presented to and monitored by the IJB PFA. 2022/23 Ref Improvement Area Agreed Action Responsible Person Date 1 Service Level Agreement (SLA) To agree an SLA with Children, Families and Justice for future hosting arrangements following the budget disaggregation exercise. Work is currently underway to agree, approve and implement the new SLA in partnership with Children, Families and Justice Services. Chief Officer Ongoing 2 National Care Service To develop a sound understanding of the impact for the UHSCNL of the National Care Service legislation. Paper presented to the IJB in January 24 giving an update on timescales for implementation. Further updates will be presented to the board as details are released. Chief Officer Ongoing 2023/24 Improvement Area Agreed Action Responsible Person Date 1 Financial Performance Reports To ensure that financial performance reports retain a holistic view as a whole and continue to align to the reserves strategy and financial strategy. Additional information added to the IJB financial reports including movement of reserves. Annual and quarterly performance reports include financial performance. Individual detailed reports including priorities and outcomes presented to the IJB via the programme of works reporting cycle. Chief Finance Officer Performance Manager Complete 2 Longer Term Financial Plan (LTFP) To develop a LTFP to demonstrate the longer term financial sustainability and help support longer term planning. LTFP approved by the IJB in March 2023. Chief Finance Officer Complete 156
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30 Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the partnership conducts its business in a manner that has due regard to the principles of good governance. Overall, the results of work undertaken to provide assurance include reports produced by Audit Scotland and a range of governance reports undertaken jointly with the partner organisations to help to inform an opinion on whether the internal controls for UHSCNL have in place are adequate. The joint internal audit opinion is that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control. Conclusion and Opinion on Assurance It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements. The IJB has adhered to the stated principles of good governance, acted in the public interest, and been committed to continuous improvement. The scrutiny and oversight of the IJB PFA Committee contributes effectively to these arrangements. There were no significant control weaknesses, issues, or failure in the expected standards for good governance, risk management and internal control. We consider that the internal control environment provides reasonable and objective assurance that any significant risks impacting on the IJB’s principal objectives will be identified and actions taken to avoid or mitigate their impact and are consistent with the recommendations of the CIPFA/SOLACE Framework (2016). Cllr Anne McCrory Chair Date: Professor Ross McGuffie Chief Officer Date: 157
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31 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2024 This statement shows the actual cost of providing services in accordance with generally accepted accounting practices. It includes, on an accrual basis, all expenses and related income. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. 2022/23 North Lanarkshire University Health & Social Care Partnership Integration Joint Board Note 2023/24 Gross Expenditure Gross Income Net Expenditure Gross Expenditure Gross Income Net Expenditure £m £m £m £m £m £m 236.972 (2.280) 234.692 Social Care Services 261.848 (2.153) 259.695 74.527 74.527 Health Care Services 78.950 78.950 115.625 115.625 Family Health Services 126.015 126.015 159.642 159.642 Hosted Services 10 189.595 189.595 1.886 (1.886) 0.000 Housing Services 2.599 (2.599) 0.000 0.551 (0.551) 0.000 Transport Services 0.551 (0.551) 0.000 0.247 0.247 Corporate Services 6 0.308 0.308 71.332 71.332 Prescribing 78.442 78.442 69.120 69.120 Set Aside for Hospital Acute Services 74.575 74.575 7.072 7.072 Covid-19 Costs 0.227 0.227 736.974 (4.717) 732.256 Total Cost of Services 813.110 (5.303) 807.807 (710.750) (710.750) Taxation and Non-Specific Grant Income 5 (785.385) (785.385) 736.974 (715.467) 21.506 (Surplus) or Deficit on Provisions of Services (Movement in Reserves) 813.110 (790.688) 22.422 158
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32 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. North Lanarkshire University Health & Social Care Partnership Integration Joint Board Total Reserves General Fund £m Movement in Reserves during 2022/23: Opening Balance at 1 April 2022 (119.452) Total Comprehensive Income and Expendiutre (Increase) or decrease in 2022/23 21.506 Closing Balance at 31 March 2023 (97.946) Movement in Reserves during 2023/24: Opening Balance at 1 April 2023 (97.946) Total Comprehensive Income and Expendiutre (Increase) or decrease in 2023/24 22.422 Closing Balance at 31 March 2024 (75.524) 159
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33 BALANCE SHEET AS AT 31 MARCH 2024 The balance sheet shows the value of the IJB’s assets and liabilities as at 31 March 2024. The net assets of the IJB (assets less liabilities) are matched by the reserves held by the IJB. 31 March 2023 North Lanarkshire University Health & Social Care Partnership Integration Joint Board Notes 31 March 2024 £m £m 97.946 Current Assets Short Term Debtors 7 75.524 - Current Liabilities Short Term Creditors 7 - 97.946 Net Assets 75.524 97.946 Usable Reserves: General Fund 8 75.524 97.946 Total Reserves 75.524 The Statement of Accounts presents a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2024 and its income and expenditure for the year then ended. Notes to the Financial Statements numbers 1 to 14 found on pages 30 - 38, form part of the financial statements. The unaudited accounts were authorised for issue on 19 June 2024. Balance Sheet signed by: Amanda Kilburn FCCA Chief Finance Officer Date: 160
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34 NOTES TO THE FINANCIAL STATEMENTS Note 1. Significant Accounting Policies General Principles The financial statements summarise the transactions of the IJB for the financial year 2023/24 and its position at 31 March 2024. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between NLC and NHSL. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. Each partner complies with their accounting policies as appropriate. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: Expenditure is recognised when goods or services are received, and their benefits are used by the IJB. Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income and receipt of the income is probable. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. Where debts may not be received, the balance of debtors is written down. Funding The IJB is primarily funded through contributions from its statutory funding partners, NLC and NHSL. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Lanarkshire and service recipients in South Lanarkshire for services that are delivered under hosted arrangements and on a pan-Lanarkshire basis. The funding relating to the year under review is recognised as income in the CIES and will normally be income added to the General Fund. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by partners. The movement in General Fund balance is therefore solely due to the transactions shown in the CIES. Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. All transactions are settled on behalf of the IJB by the funding partner. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. 161
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35 There is therefore no requirement for the IJB to produce a cash flow statement. The funding balance due to and from each funding partner as at 31 March 2024 is represented as a debtor or creditor on the IJB’s balance sheet. Employee Benefit The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its balance sheet. The IJB has a legal responsibility to appoint a Chief Officer. A Chief Finance Officer has also been appointed to the IJB. More details on these arrangements are provided in the remuneration report. The charges for the employing partners are treated as employee costs. Where material, the absence entitlement at 31 March is accrued, for example in relation to annual leave earned but not yet taken. In the case of North Lanarkshire IJB any annual leave earned by the Chief Officer and Chief Finance Officer, but not yet taken is not considered to be material. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation on 31 March due to a past event, settlement of the obligation is probable, and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the CIES and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31 March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s balance sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31 March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s balance sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. Indemnity Insurance / Clinical and Medical Negligence The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). NLC and NHSL have responsibility for claims in respect of the services for which they are statutorily responsible for and that they provide. Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material, the overall expected value of known claims taking probability of settlement into consideration, is provided for in the IJB balance sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and where material, presented as either a debtor or disclosed as a contingent asset. 162
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36 Debtors and Creditors Financial instruments are recognised in the balance sheet when an obligation is identified and released as that obligation is fulfilled. Debtors are held at fair value and represent funding due from partner bodies that was not utilised in year. There are no creditor balances. Reserves A reserve is the accumulation of surpluses, deficits, and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2024, the usable reserve balance totals £75.524m. There are no unusable reserves. Specific Service Income Income may be received from individuals as a contribution towards the cost of their social care service. The amount collected is allocated to the relevant expenditure category and the net cost is reported in the CIES. This is the basis upon which the 2023/24 Annual Accounts have been prepared. Note 2. Critical Judgements and Estimation Uncertainty In preparing the 2023/24 financial statements, the IJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. The critical judgements made in the annual accounts are: Hosted Services Within Lanarkshire, each IJB has operational responsibility for the service which it hosts on behalf of the other IJB. In delivering these services each IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such the IJB is considered to be acting as ‘principal’, and the full costs are reflected within the annual accounts for the services which it hosts. This is the basis on which North Lanarkshire IJB accounts have been prepared. The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the North Lanarkshire IJB on the basis of 52% of the total expenditure, 48% of the services relating to the South Lanarkshire IJB are also included as the North Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the Annual Accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service. Note 3. Events After the Balance Sheet Date The Chief Finance Officer authorised the unaudited annual accounts for issue on 19 June 2024. Events after the balance sheet date are those events that occur between the end of the reporting period and the date when the statements are authorised for issue. Where events take place before the date of authorisation and provide information about conditions existing as at 31 March 2024, the figures in the financial statements and notes would be adjusted in all material aspects to reflect the impact of this information. There have been no material events since the date of the balance sheet which require revision to the figures in the Annual Accounts. 163
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37 Note 4. Expenditure and Funding Analysis by Nature The following table shows the gross expenditure and funding for North Lanarkshire IJB against subjective headings: Expenditure and Funding Analysis by Nature 2022/23 2023/24 £m £m Social Care Services 236.972 261.848 Health Care Services - Localities 58.422 66.933 Health Care Services - Area Wide 11.189 7.621 Health Care Services - Out of Area 4.917 4.396 Family Health Services 115.625 126.015 Housing Services 1.886 2.599 Transport Services 0.551 0.551 Hosted Services - Led by North IJB 125.402 148.954 Hosted Services - Led by South IJB 34.240 40.641 IJB Operating Costs 0.247 0.308 Prescribing Costs 71.332 78.442 Covid-19 Costs 7.072 0.227 Set Aside 69.120 74.575 Income (4.717) (5.303) Total Cost of Services 732.256 807.807 Partners Funding Contributions and Non-Specific Grant Income (710.750) (785.385) (Surplus)/Deficit on Provision of Services 21.506 22.422 Note 5. Taxation and Non-Specific Grant Income The following table shows the funding contribution from the two partner organisations: Taxation and Non-Specific Grant Income 2022/23 2023/24 £m £m Funding Contribution from NHS Lanarkshire (523.649) (590.418) Funding Contribution from North Lanarkshire Council (187.101) (194.967) Total (710.750) (785.385) The funding contribution from the NHS Board shown above includes £74.575m in respect of ‘Set Aside’ resources relating to acute hospital services. These are provided by NHSL which retains responsibility for managing the costs of providing these services. The IJB however has responsibility for the consumption and level of demand placed on these resources. Excluded from the funding contribution from the partners above is any specific service income contributions from clients towards the cost of their social care services. In 2023/24 this income totalled £2.153m and is presented as gross income in the Cost of Services within the CIES on page 27. 164
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38 Note 6. Operating Costs NLC and NHSL provide a range of support services for the IJB including finance, personnel, planning, audit, payroll, debtor, and creditor services. There is no charge to the IJB for these support services. The costs associated with running the IJB are shown in the following table: IJB Operating Costs (Corporate Services) 2022/23 2023/24 £m £m Staff Costs 0.213 0.272 Audit Fees 0.031 0.033 Administration Costs 0.003 0.003 Total 0.247 0.308 Note 7. Short Term Debtors and Creditors At 31 March 2024, North Lanarkshire IJB had short term debtors of £75.524m relating to the reserves held in the Balance Sheet. There were no short term creditors. Amounts owed by funding partners are stated on a net basis and are classified as short term debtors on the basis that these reserves could be utilised at any time. Short Term Debtors 2022/23 2023/24 £m £m NHS Lanarkshire 62.180 50.719 North Lanarkshire Council 35.766 24.805 Total 97.946 75.524 Short Term Creditors 2022/23 2023/24 £m £m NHS Lanarkshire - - North Lanarkshire Council - - Total - - Note 8. Usable Reserves: General Fund The purpose of the General Fund is detailed in the IJB Reserves Policy and summarised below: Funding received for a specific purpose and not yet spent will be allocated to a ring-fenced reserve. Funding for future expenditure needs and key financial risks will be allocated to earmarked reserves. A contingency reserve is required to cushion the impact of unexpected events or emergencies. At 31 March 2024 the IJB transferred funding to ring-fenced reserves to enable the IJB to deliver on specific Scottish Government funded programmes and earmarked reserves to support the delivery of programme of works. In addition, the contingency reserve has been increased as part of the IJB financial strategy. This will be used to manage the risk of any future unanticipated events and support service provision that may materially impact on the financial position of the IJB in later years. 165
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39 The following table shows the movement of reserves during 2023/24: USEABLE RESERVES Balance as at 31 March 2023 Net Transfers during 2023/24 Balance as at 31 March 2024 £m £m £m Alcohol and Drug Partnership Funding 3.348 0.249 3.597 Blood-Borne Viruses Services 0.171 0.023 0.194 Children and Adolescent Mental Health Services 4.101 (1.252) 2.849 Community Living Change Fund 1.298 (0.134) 1.164 Long Covid Pathways Funding 0.771 (0.537) 0.234 Hospital at Home Services 0.621 0.341 0.962 Mental Health and Learning Disability Services 11.290 (4.252) 7.038 North Planning Band 2-4 Posts & Pharmacy Training 1.106 1.786 2.892 Nursing Funding 0.376 1.010 1.386 Ring-Fenced Reserves - Other Services 4.495 (0.696) 3.799 Total Ring-Fenced Reserves 27.577 (3.463) 24.114 Adult Social Care Winter Preparedness Fund 1.941 (0.941) 1.000 Carers Act Support 2.643 (0.047) 2.596 Children and Adolescent Mental Health Services 0.346 (0.078) 0.268 Digital and IT Strategy 5.630 (0.377) 5.253 Earmarked Reserves - Other Services 5.263 (2.671) 2.592 Home Support Resilience 3.498 (2.842) 0.656 Integrated Authority Support 4.926 (4.926) 0.000 IJB Financial Plan 2023/2026 8.947 (4.276) 4.671 Long Covid Contingency 1.949 (1.949) 0.000 Minor Repair and Replacement Programme of Works 3.390 (1.579) 1.811 Prescribing Fund 4.361 4.361 Social Care Services 5.216 (4.407) 0.809 Winter Funding Business Case 5.608 (4.289) 1.319 Total Earmarked Reserves 53.718 (28.381) 25.337 Total Contingency Reserve 16.651 9.423 26.074 TOTAL USEABLE RESERVES 97.946 (22.422) 75.524 Note 9. Related Party Transactions The IJB has related party transactions with NLC and NHSL. In particular the nature of the partnership means that the IJB may influence and be influenced by its partners. Non-voting board members are not directly employed by NHSL however, a contribution of 50% of the cost of the Chief Officer is made by NHSL along with the full cost of the Chief Finance Officer. This payment is included in the IJB Operating Costs (Corporate Services) in the CIES and detailed at Note 6. 166
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40 The financial information contained in the IJB Annual Accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double accounting. The following transactions and balances included in the IJB Annual Accounts are presented to provide additional information on related party relationships. There are elements of expenditure which are shown against NLC but where the resource is provided by NHSL. Resource Transfer which includes the Social Care Fund are therefore part of the NHSL budget but are used to deliver social care services supplied by NLC. Income Received 2022/23 2023/24 £m £m NHS Lanarkshire - - North Lanarkshire Council (4.717) (5.303) Total (4.717) (5.303) Expenditure on Services Provided 2022/23 2023/24 £m £m NHS Lanarkshire 496.010 547.613 Resource Transfer to North Lanarkshire Council 52.993 54.266 NHS Lanarkshire Total 549.003 601.879 North Lanarkshire Council 240.964 265.497 Resource Transfer from NHS Lanarkshire (52.993) (54.266) North Lanarkshire Council Total 187.971 211.231 Funding Contributions Received 2022/23 2023/24 £m £m NHS Lanarkshire (523.649) (590.418) North Lanarkshire Council (187.101) (194.967) Total (710.750) (785.385) Debtors 2022/23 2023/24 £m £m NHS Lanarkshire 62.180 50.719 North Lanarkshire Council 35.766 24.805 Total 97.946 75.524 Note 10. Hosted Services North Lanarkshire IJB act as the lead for a number of delegated services on behalf of South Lanarkshire IJB. It therefore commissions services on behalf of South Lanarkshire IJB and reclaims the costs involved. Since North Lanarkshire IJB is acting as ‘principal’ in these transactions, the total gross expenditure and the consequential reimbursement is included in the CIES even though 48% of the hosted budget is consumed by South Lanarkshire. 167
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41 Host: North Lanarkshire North Lanarkshire Services 2022/23 Consumed by South Lanarkshire 2022/23 Service North Lanarkshire Services 2023/24 Consumed by South Lanarkshire 2023/24 £m £m £m £m 1.535 0.764 Blood Borne Virus Services 1.667 0.833 11.127 7.193 Children and Adolescents Mental Health Services 13.648 6.975 12.220 6.035 Childrens Services 14.482 6.410 2.452 1.177 Continence Services 3.465 1.187 3.753 1.996 Dietetics Services 4.152 2.115 2.166 1.277 Hospital at Home 3.367 1.773 2.473 0.940 Immunisation Services 5.815 2.721 - 0.278 Integrated Equipment and Adaptation Store - 0.272 74.366 41.490 Mental Health and Learning Disability Services 84.074 43.706 4.434 2.250 Podiatry Services 4.873 2.405 1.908 0.874 Prisoner Healthcare Services 3.047 0.982 2.974 1.541 Sexual Health Services 3.569 1.661 5.994 3.195 Speech and Language Therapy Services 6.796 3.426 125.402 69.010 Total Services Hosted by North Lanarkshire IJB 148.954 74.466 Similarly, South Lanarkshire IJB acts as the lead for a number of delegated services on behalf of North Lanarkshire IJB. The value consumed by North Lanarkshire equates to 52% of South Lanarkshire IJB hosted budget. As this expenditure is incurred for the residents of North Lanarkshire, it is included in the CIES. Host: South Lanarkshire Consumed by North Lanarkshire 2022/23 South Lanarkshire Services 2022/23 Service Consumed by North Lanarkshire 2023/24 South Lanarkshire Services 2023/24 £m £m £m £m 4.007 7.081 Community Dental Services 4.288 7.422 1.396 1.856 Brain Injury Unit 1.477 2.773 2.649 5.113 Diabetic Services 2.395 4.633 0.024 0.047 Improving Cancer Journey - - 4.350 7.909 Occupational Therapy Services 4.669 8.739 4.806 9.003 Out of Hours Services 5.227 9.991 3.738 7.412 Palliative Care Services 3.941 7.507 5.536 10.427 Physiotherapy Services 6.103 11.581 0.362 0.319 Telehealth - - 0.452 0.810 Primary Care Services 0.467 0.790 6.920 10.973 Primary Care Improvement Fund 12.074 23.220 34.240 60.950 Total Services Hosted by South Lanarkshire IJB 40.641 76.656 The table below shows the total of hosted serviced included in the CIES: 2022/23 £m Hosted Services 2023/24 £m 125.402 Total Services Hosted by North Lanarkshire IJB 148.954 34.240 Total Services Hosted by South Lanarkshire IJB and Consumed by North 40.641 159.642 Total Included in Comprehensive Income and Expenditure Statement 189.595 168
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42 Note 11. Additional Council Services Delegated to the IJB The following table shows the costs of NLC services delegated to the IJB. Under the Public Bodies (Joint Working) (Scotland) Act 2014, the IJB is accountable for these services however, they continue to be delivered by NLC. UHSCNL monitor the delivery of these services on behalf of the IJB. 2022/23 £m Council Services 2023/24 £m 1.886 Housing Services 2.599 0.551 Transport Services 0.551 2.437 Gross Expenditure 3.150 (2.437) Income (3.150) - Net Expenditure - Note 12. VAT The IJB is not VAT registered and does not charge or recover VAT on its functions. The VAT treatment of expenditure and income within the accounts depends on which of the partners is providing the service as these bodies are treated differently for VAT purposes: Where NLC is the provider, income and expenditure exclude any amounts related to VAT, as collected VAT is payable to HM Revenue & Customs and all VAT paid is recoverable from it. On a very limited number of items that NLC are not entitled to fully recover VAT, expenditure for these specific items will include the full cost to the IJB. Where NHSL is the provider, expenditure will include the full cost to the IJB as generally, NHSL cannot recover VAT. The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime. Note 13. External Audit Costs Fees payable to Audit Scotland in respect of external audit services undertaken in accordance with Audit Scotland’s Code of Audit Practice in 2023/24 are £33,360. Audit Scotland did not undertake any non-audit services. Note 14. New Standard Issued but Not Yet Adopted The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts. 169
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1 REPORT Item No: 11 SUBJECT: Membership Update TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Stacey Connor Governance Support Manager DATE: 19 June 2024 1. PURPOSE OF REPORT This paper is coming to the IJB: To advise of the replacement of 2 Non-Executive Directors from NHS Lanarkshire and 1 elected member to the IJB and to confirm the appointment of a new IJB chair. For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ Ross McGuffie, Chief Accountable Officer 170
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2 3. RECOMMENDATIONS 3.1 The integration joint board is asked to note the update of its membership with 2 new Non-Executive Directors from NHS Lanarkshire to the committee and to confirm a change of 1 elected member who has also been appointed the new IJB chair. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The rules about IJB membership are contained in statutory instruments and reflected in the Integration Scheme. These state that Board members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. 5.2 The Chair of the IJB should alternate between the voting representatives of North Lanarkshire Council and NHS Lanarkshire. 5.3 The rules around IJB membership applies to all members with the exception of the Chief Accountable Officer, Financial Officer and the Chief Social Work Officer who remain on the Board as long as they hold their respective posts. 5.4 The following summary represented the current position with a note of appointments and reappointments that require to be endorsed by the IJB; Elected members – North Lanarkshire Council All of the current elected members have been appointed within the three-year term of office. Furthermore, at the meeting of North Lanarkshire Council held on Thursday, 28 March 2024, it was agreed that Councillor Anne McCrory would replace Councillor Michael McBride on North Lanarkshire Health and Social Care Integration Joint Board taking effect from 28th April 2024. In addition to this Councillor McCrory has also been nominated as Chair. Non- Executive Directors – NHS Lanarkshire The NHS Lanarkshire Board reviewed its Non-Executive Directors portfolios and formally proposed the replacement of Mr Ally Boyle and Mr James Muir with Mr Nauman Dar and Ms Siobhan White. Mr Phillip Courser will remain a Yes ☐ No ☒ N/A ☐ 171
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3 member of the board and Mr Brian Moore also, in addition to being the Vice Chair of the committee. 6. CONCLUSIONS The foregoing proposals have been agreed by both the NHS Lanarkshire Board and North Lanarkshire Council and there has been no adverse comments. The membership of the IJB has been updated in line with the guidance contained within the Statutory Instruments and Scheme of Integration with reference to the rules around reappointment following a three-year term of office. A number appointments /reappointments have been confirmed and should be endorsed but 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: 172
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. No related risks 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 N/A ☐ Provide stakeholders with information on how to get involved N/A ☐ 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 N/A Yes ☐ No ☒ N/A ☐ 173
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5 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 None. Please include a glossary of terms if not already included. 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 ☒ 174
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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 175
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REPORT Item No: 12 SUBJECT: North Lanarkshire IJB Governance Document Update 2024 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Stacey Anderson Support Services, Project Manager Stacey Connor Governance Support Manager DATE: 19 June 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: Stacey Anderson and Stacey Connor, NL H&SCP Governance Team ☒ Reviewed By: ☐ Endorsed By: ☐ 176
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3. RECOMMENDATIONS It is recommended that the IJB: 3.1 Review the updated IJB Governance Report. 3.2 Acknowledge that the Code of Conduct and Declaration of Interest Forms have been issued to IJB members for completion for 2024- 2025. 3.3 Approve the recommendation to include a Directions summary as a standing item on the IJB and IJB PFA Agenda. 3.4 Note the review of the Records Management Plan of North Lanarkshire Integration Joint Board as part of the IJB Governance work plan for 2024-25. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 The report provides an overview of the recently reviewed/updated governance documents in regards to reporting for the North Lanarkshire Integration Joint Board. 5.1.2 It is a requirement of the Integration Joint Board to ensure that they are compliant with The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014). 5.1.3 A continuous review of the IJB governance documents/policy will commence across the financial year with updates regularly being provided to the IJB. 5.1.4 The report focuses on the governance surrounding the Code of Conduct and Declaration of Interest, Directions and Record Management. 5.2 Code of Conduct and Declaration of Interest 5.2.1 As part of the risk measure for risk associated with fraud, a review of the IJB Code of Conduct took place in April 2023 with the main change to the code of conduct being around how declarations of interest are submitted to the IJB. 5.2.2 It was agreed at the IJB meeting on the 17th May 2023, that all members would 177
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be asked to submit an annual IJB declarations of interest form, with the form having a clearer focus on the nine categories that are listed within the Code of Conduct. 5.2.3 The Code of Conduct and Declaration of Interest documents were circulated to all IJB members at the start of April 2024, with a request to complete and submit to the NL H&SCP Governance Team. 5.2.4 The completed declarations of interest forms will be uploaded to the IJB website North Lanarkshire Health and Social Care Partnership (https://hscnl.org.uk/) and a register of interests including gifts and hospitality received by members will be held by the NL H&SCP Governance team on behalf of the IJB. 5.3 Directions 5.3.1 In January 2020, the Scottish Government issued Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. 5.3.2 The North Lanarkshire Joint Board must issue a direction in respect of every function that has been delegated to it by NHS Lanarkshire and North Lanarkshire Council which must provide relevant budget information. 5.3.3 Directions are the means by which the IJB informs the Health Board and the Local Authority what is to be delivered using the integrated budget and for the IJB to improve the quality and sustainability of care, as outlined in its strategic commissioning plan. Directions are also the legal basis on which the Health Board and Local Authority deliver services that are under the control of the IJB. 5.3.4 To help ensure that the North Lanarkshire Integration Joint Board implements the Statutory Guidance on Directions, a North Lanarkshire Integration Joint Board Directions Policy was created in 2023 and approved at the IJB meeting on 17th May 2023. 5.3.5 The policy details what directions are, how and when directions should be issued and how directions should be implemented and monitored. The policy also includes a Directions template for the IJB to use which has been added to each paper when directions are issued. 5.3.6 For the financial year of 2023- 2024, the North Lanarkshire Integration Joint Board issued Directions on a total of 86 reports, with the main themes of the directions issued including requesting further updates or information, approving finance and reports and identification of risks. 5.3.6 To further support the implementation of Directions and to help monitor the progress of issued direction, it is recommended that a summary overview of the Directions issued by the IJB be added as a standing item to the IJB and IJB PFA agenda. 5.4 Records Management Plan 5.4.1 The Public Records (Scotland) Act 2011 (‘the Act’) came into force in January 2013. The Act obliges the IJB and other public authorities to prepare and implement a Records Management Plan (“the Plan”). The Plan set out proper arrangements for 178
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the management of records within the IJB. 5.4.2 The Records Management Plan of North Lanarkshire Integration Joint Board was developed in 2020 and demonstrates the commitment of the IJB to continuous improvement in the way in which it manages and uses its records. 5.4.3 The plan is due for renewal by July 2025, therefore a review of The Records Management Plan will be undertaken as part of the IJB Governance work plan for 2024-25. 6. CONCLUSIONS 6.1 The North Lanarkshire Integration Joint Board continues to strengthen its governance with the use of the Code of Conduct and Declaration of Interest Policy and Directions Policy. 6.2 The recommendation to include a summary report of Directions as part of the agenda of IJB and IJB PFA will further strengthen the oversight of IJB Directions and assist in the monitoring of Directions being implemented. 6.3 The review of the Records Management Plan as part of the IJB Governance work plan for 2024-25 will ensure that the IJB continues to comply with The Public Records (Scotland) Act 2011. 179
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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 ☒ 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 Choose an item. 180
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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 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ 181
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EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS Code of Conduct Directions Policy Records Management Plan of North Lanarkshire Integration Joint Board. 9. APPENDICES Appendix 1 Declaration of Interest CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk 182
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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 183
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Appendix 1 Received Date Entered Code of Conduct for Members of the North Lanarkshire Integrated Joint Board Register of Interests Note: If you have no interest in a category, please state “None”. The descriptions provided below are in summary form. For full details refer to the Code of Conduct. Board members must register their registrable interests within one month of becoming a board member and register any changes to those interests within one month of those changes having occurred. Name: Position on Board: Category One: Remuneration Remuneration from Employment Name (Registered name if different) of Employer and Post Held Nature of Business and regularity of remunerated work Additional Comments Details of Employment held Additional Employment held 184
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Remuneration from Self-employment Name of Business Nature of Business and regularity of remunerated work Additional comments Details of Self- employment held Additional Self- employment held Remuneration as Holder of an Office Nature of Office held Organisation and any allowances received Additional comments e.g. Frequency Details of Office Held Additional details of Offices Held Additional details of Offices Held 185
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Remuneration as a Director of an Undertaking Name of Undertaking Nature of Business and any allowance received Additional comments Details of first Directorship held Details of second Directorship held Details of third Directorship held Remuneration as a Partner in a Firm Name of Partnership Nature of Business and any allowance received Additional comments Details of first Partnership held Details of second Partnership held Details of third Partnership held 186
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Remuneration from appointment or nomination by North Lanarkshire Integration Joint Board to another body Name of Body Nature of Business and any allowance received Additional comments Details of first appointment held Details of second appointment held Details of third appointment held Remuneration from a trade, profession vocation or any other work Nature of work For whom undertaken and Frequency Additional comments Details of remuneration from trade, profession or other work Additional instances of remuneration from trade, profession or other work 187
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Category Two: Other Roles This applies to any unremunerated directorships where the body in question is a subsidiary or parent company of an undertaking in which the member holds a remunerated directorship. Name and registered number of subsidiary, parent or other organisation Nature of business and relationship to company or other undertaking where remunerated directorship under Category One Additional Comments Details of non- remunerated directorship Additional instances of non- remunerated directorship 188
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Category Three: Contracts Applies to a registerable interest where the member (or a firm in which they are a partner, or an undertaking in which they are a director or in which they have shares of a value as described in paragraph 4.20 of the Code) have made a contract with North Lanarkshire Integration Joint Board: a) under which goods or services are to be provided, or works are to be executed; and b) which has not been fully discharged. Description of Contract (excluding value) Duration of Contract Additional comments Details of contracts entered into None Additional instances of contracts entered into Additional instances of contracts entered into Category Four: Election Expenses If a member has been elected to North Lanarkshire Integration Joint Board, then they will register a description of, and statement of, any assistance towards election expenses relating to election to North Lanarkshire Integration Joint Board. Source of Assistance towards Election Expenses Description of any Allowance received Additional comments Details of election expenses 189
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Additional instances of election expenses 190
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Category Five: Houses, Land and Buildings Requirement to declare land/housing ownership or any other right or interest in houses which may be significant to, or of relevance to, or bear upon, the work of North Lanarkshire Integration Joint Board Description of interest Description of approximate location Additional comments Details of interests in houses, land and buildings Additional instances of interests in houses, land and buildings Additional instances of interests in houses, land and buildings Category Six: Shares and Securities A description of the shares is required if (a) a member owns or has an interest in more than 1% of the issued share capital of the company or other body; or (b) where, at the relevant date, the market value of any shares and securities (in any one specific company or body) that they own or have an interest in is greater than £25,000. Description of undertaking Description of nature of holding (value need not be disclosed) Additional comments 191
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Details of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB 192
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Additional instances of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB Category Seven: Gifts and Hospitality Members should understand the requirements of paragraphs 3.12 to 3.20 regarding gifts and hospitality. As members will not accept any gifts or hospitality, other than under the limited circumstances allowed, they understand there is no longer the need to register any. Date Description of Gift Received from 193
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Category Eight: Non-Financial Interests Members may also have other interests and they understand it is equally important that relevant interests such as membership or holding office in other public bodies, companies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. In this context, they understand non- financial interests are those which members of the public with knowledge of the relevant facts might reasonably think could influence their actions, speeches, votes or decision-making in North Lanarkshire Integration Joint Board (this includes its Committees and memberships of other organisations to which they have been appointed or nominated by North Lanarkshire Integration Joint Board). Description of interest Additional comments Details of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB 194
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Category Nine: Close Family Members Members will register the interests of any close family member who has transactions with North Lanarkshire Integration Joint Board or is likely to have transactions or do business with it. Relationship Nature of transaction Additional comments Details of interest Additional instances of interest Additional instances of interest Date of Preparation: Number of Continuation Sheets: Signed: 195
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REPORT Item No: 13 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: 19th June 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. 196
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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 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. 5.1 BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.1.1 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.1.2 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. 5.1.3 Following on from the risk report presented at the IJB meeting on the 27th March 2024, alongside the financial update report, it was agreed by the board that the Financial Challenges risk rating would increase from High to Very High. 5.1.4 At the IJB PFA meeting on 22nd May 2024, the following risk rating changes were approved: 197
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Delivery of CAMHs service, risk rating reduced from High to Medium Ineffective Governance arrangements, risk rating reduced from Medium to Low. Unscheduled Care, risk rating reduced from Very High to High. 5.1.5 Following these changes there are currently two other risks rated as Very High on the IJB risk register. 5.1.6 IJB 06/21 – Prescribing Activity and Costs 5.1.7 IJB 17/22 – Unscheduled Care 5.1.8 There are six high rated risks on the IJB risk register. 5.1.9 IJB 04/21 - Notional Set Aside Budget 5.1.10 IJB 12/21 - Staff Health & wellbeing 5.1.11 IJB 15/22 – Cost of Living 5.1.12 IJB 16/22 – National Care Service 5.1.13 IJB 19/23 – Service sustainability 5.1.14 IJB 20/23 – Workforce sustainability 5.1.15 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). . 198
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6. CONCLUSIONS 6.1 The IJB currently has 17 risks identified on its IJB risk register with 8 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 ☐ 199
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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 1. 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 200
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1. 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. 201
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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 202
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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 203
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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 2. 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. 3. Bed modelling and capacity planning arrangements are in place. 4. Effective working relationships between both partners and the IJB have been established. 5. 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 28.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Jan 2024 Reviewed May 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 28.08.2024 Reviewed Jan 2024 Reviewed May 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. 1. Prescribing Management Board functions and membership. 2. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 3. Locality Pharmacist input. 4. Earmarked reserve established to address prescribing costs. 5. 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. 6. 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. 7. 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. 8. 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 28.08.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated (risk increased) October 2023. Reviewed Jan 2024 Reviewed June 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 30.06.24 Previously IJB16. Reviewed April 2024. 204
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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 a t i o n a l N e t w o r k s a r e LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.10.24 Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. Reviewed and risk level lowered June 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 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. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. LOW LOW Ross McGuffie Morag Dendy SLT, IJB PFA, IJB 31..10.24 Reviewed May 2024. 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 Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). Rest & Recuperation areas identified. Peer Support Networks established Well established Occupational Health supports available to support staff sickness. Actions 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. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. Managers supporting & encouraging staff to take planned leave/use full leave allocation Audits of adherence to sickness absence policy being undertaken HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.08.24 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed May 2024. 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 Establishment of Care Home Assurance Team. Escalation Process in place. National protocol to support discharge of Covid 19 patients in place. Actions Public Health teams providing guidance on infection control. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 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 medium medium Ross McGuffie Trudi Marshall IJB, PF&A, SLT, SC&SC, A H &SC 28.08.24 Reviewed and updated Oct 2023 Reviewed May 2024. . R 205
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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 ‐ Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised 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 Secured significant national investment to fully implement new service model Active review of skill mix to utilise medical staff only when required for highly complex patients Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 Continuous review and validation of the waiting list Action Incremental implementation of the new service model CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion Refurbishment of North Lanarkshire facilities commences early summer 2023 Medium medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and risk level lowered May 2024. 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 NLC Silver command group stood up focused on cost of living NHSL commenced review through CMT Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 ACTIONS Survey of NLC hybrid workers to see if home working remains financially viable Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 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 30.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed May 2024. 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 NLC establishing NCS working groups Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA ACTIONS IJB response submitted on proposed Bill Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups 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 31.08.24 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 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 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. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision NHS CMT and Covid response group oversight of performance Daily PDD meetings to review every planned supported discharge and delayed discharge Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges ACTIONS Expansion of Home Support service Roll out of Home Assessment Teams across all 6 Localities by Feb New CSW roles in District Nursing teams to proactively support Care Managed patients Additional Nursing capacity in District Nursing Teams Expansion of Equipment and Adaptation Service to support rapid access in community Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed bySept 23) High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.08.24 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024. Reviewed and risk level reduced May 2024. 206
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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 Working group established to coordinate all activity Oversight through Home Support Programme Board Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB ACTIONS NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Communication out to all community alarm service users Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational 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 28.07.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. Reviewed April 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 IJB PFA Committee. IJB Chief Officer is a member of each partner's key decision‐making forums. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Regular budget meetings with Chief Executives and Directors of Finance. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Capacity plans in place to maximize efficiency. Consultation and involvement with key stakeholders including service users and carers. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions Sustainability plans to be reviewed regularly Re‐introduction of scrutiny panels Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. Review of reporting process into IJB to ensure continuous review of services/ service developments. Development of the programme of work to ensure regular reporting structure in place for service review. 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. Reviewed April 2024. 207
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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.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 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. 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. Development of the Care Academy Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 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 28.07.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24 Reviewed April 2024. IJB21. 24 Financial Pharmacy Pressures within Prison Service Pharmacy costs have traditionally been the highest area of non‐pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. High CONTROLS Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS Prescribing Action Group re‐established to try and manage the number of items prescribed Development of pain and medicine management pathways Review of prescribing habits High Low Ross M cGuffie Ross M cGuffie IJB PFA, IJB 30/07.24 Added to register May 2024. 208
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NL H&SCP Risk Overview Report Meeting Name – IJB PFA Reporting Period: IJB PFA Risk Register – May 2024 Appendix 2 209
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NL HSCP IJB Risk – Dashboard February 2024 Executive Summary Risk Register Number of Risks IJB 17 NL Council NHS Lanarkshire 21 Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 4 3 2 10 Risk Score Trend IJB06/21 PrescribingActivityand Costs VH IJB 17/22 Unscheduled Care VH IJB.01/21 Financial Challenges VH IJB Highest Scoring Risks NL H&SCP Risks Reported to Assurance Committees Service risks‐ Service level Level 3‐ North Health Professional/ Operational Group and Support Care and Clinical Governance IJB Risk Register – IJB and IJB PFA Level 2‐ Core Risk Overview Process NL H&SCP 210
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Level 3‐ Very High and High Risks ‐Summary IJBID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel (Current) Risklevel (Target) RiskOwner RiskRegister Lead Assurance Source NextReview Date ClosedDate IJB.01/ 21 Financial Strategic 01/04/2021 FinancialChallenges 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 settlementfrom the Scottish Government. 2. The IJB is dependent on funding from bothpartners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. NewScottish 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. Eachpartner may be unable to maintain theirfinancial contributions to the IJB in future yearswhich would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns arenot implemented in full and in line withthe original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Futuresavings targets will continue to be challenging and are likely to impact on essential coreservices. 13. The IJB Financial Plan cannot be adhered toand 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 VERY HIGH MEDIUM AmandaKilburn AmandaKilburn SLT, IJB PFA,IJB 28.06.2024 Previously IJB2, IJB7, IJB10and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and Updated Jan 2024. Reviewed and risk increased March 2024. 211
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IJB ID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate IJB04. 21 Financial Strategic 01/04/2021 NotionalSet‐AsideBudget 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 tosupport maintaining people athome e.g.transitional care models. VERYHIGH HIGH MEDIUM RossMcGuffie AmandaKilburn SLT, IJB PFA,IJB 28.026.2024 Reviewed and Updated May 2023. Reviewed Oct2023. Reviewed Dec2023 Update being provided to IJB in Jan2024. ReviewedMay 2024 IJB06. 21 Financial Operational 01/04/2021 PrescribingActivity and Costs The cost of prescribing is growing due toissues in supply chains driving increased wholesaler costof medicines, advance treatment developments resulting in the need formore 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 portsin the UK and the EEA before goods, including medical products, can cross the border. New customs checks arerequired when moving medicines between the EEAand the UK. Medium VERYHIGH LOW RossMcGuffie AmandaKilburn SLT, IJB PFA,IJB 28..06.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024 212
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IJB.12. 21 Performance 30/08/2021 StaffHealth & 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 forfurther staff redeployment due to winter planning contingency arrangements. medium HIGH low RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB, SC&CG,AH&SC 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec2023. Report on Staff Health and Wellbeing due to IJBin March 2024 Reviewed and updated May 2024 213
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IJB ID Category Opened Date Description of Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date Closed Date IJB.14. 2022 Strategic& Performance 30.04.22 CAMHS‐ There is a risk that the CAMHS servicecannot 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 isimpacting 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 Medium medium RossMcGuffie MoragDendy IJB,PF&A, SLT 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec2023. Reviewed and updated March 2024 Reviewed and risk reduced May 2024 IJB.15. 2022 Strategic& Performance 05.09.22 Costof Living There is a risk that the IJB's StrategicCommissioning 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 oflife 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 High Medium RossMcGuffie RossMcGuffie SLT, IJB 30.06.2024 Reviewed and Updated May 2023. Reviewed Oct2023. Reviewed and updated March 2024. Reviewed and updated May 2024 IJB.16. 2022 Strategic 05.09.22 NationalCare Service There is a risk that the ongoing workaround a National Care Service could destabilise currentservice delivery due tosignificant 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 High Low Diane Fraser RossMcGuffie SLT, IJB PFA,IJB, ASWC&WB 31.06.24 Reviewed and Updated May 2023. Reviewed and Updated Oct2023. Updated being provided Jan 2024. Reviewed and updated May 2024. IJB.17. 2022 Strategic& Performance 05.09.22 UnscheduledCare There is a risk that we cannot sustain whole system patient flow through peak winter pressuresdue to increased frontdoor demand; hospital workforce capacity; delays inonward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading toreduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High High Medium RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.026.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024. Reviewed and risk lowered May 2024 214
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IJBID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate IJB.18. 2022 Strategicand Performance 05.09.22 CommunityAlarms There is a risk that the community alarmsystem will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarmusers not getting a response when required. High Medium Low Diane Fraser RossMcGuffie SLT, IJB PFA,IJB, ASWC&WB 28.06.2024 Reviewed and updated June 2023. Reviewed Oct2023. Reviewed Jan 2024. Reviewed May 2024 IJB.19. 2023 Performance 27/02/2023 ServiceSustainability 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 High Low RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.06.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024. IJB.20. 2023 WorkforceSustainability Itis becoming increasingly difficult to recruit toparticular roles across Health and Social Care. Gaps in the workforcecan result in reduction of service provision, increase in staff workload and inability to deliver the strategicplan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving fromthe EEA and non‐EEA countries are subject tothe same immigration rules. The new points‐based immigration system makes exceptions forthe majority of health care professionals with an NHSjob offer and for qualified social workersvia a new fast‐track visa route, known asthe Health and Care WorkerVisa. There are however no exceptions made for other social care roles, such as careworkers. The Mutual Recognition of Professional Qualifications Directive isan EU‐wide directive that allows professional regulatorsin 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 High Medium RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.06.24 Reviewed and Updated May 2023 Reviewed and updated Oct2023. Reviewed and updated Jan 24 Reviewed and updated May 2024 215
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Delivery of CAMHS Service 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 andchallenges recruiting to new posts identified through the national recovery and renewal fund. This isimpacting 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 andreputation of the IJB. RMc MD Current Controls 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals seen 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 recurring investment to fully implement new service model 4. Completed 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 50% of gap by end of May 2022 ( 53% achieved) 6. Continuous review and validation of the waiting list 7. Waiting list validation exercised completed in April 2022 with reduction in list by 16% 8. New SL CAMHS facility at Udston Hospital became operational in June (this is a vital development to create physical capacity for implementation of the new CAMHS model) 9. Established programme board to oversee both incremental implementation of the service model and performance 10. All workstreams in train 11. Dedicated Recruitment Team Actions 1. Incremental implementation of the new service model 2. Performance monitoring through the programme board 3. CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals 4. Waiting list initiative commenced 5. Udston opened for patients September 2022 6. upgrade to North physical infrastructure agreed. Update 28th December 1.CAMHS WLI now embedded. 2. Monthly monitoring at board ongoing. 3.CAPA be introduced AND will be on trakcare to go live March 2023. There will be a concurrent WLI as above. 4.Close working with health improvement and GP reps Risk Trend Risk Level Reduced A range of controls, actions and mitigations have been put in place since the risk was initially created in April 2022. On creation the risk was originally provided with a risk level of very high. The risk level was reduced to high in May 2023 following implantation of a range of actions by the service. Following further implementation of regular report, reviews by the scrutiny panel and further actions being implemented it is for consideration by the IJB for further risk rating reduction. Current –High Target – Medium 216
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted ina 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. Newor amended legislation and Scottish andUK Government guidance may not be adopted effectively and timeously. 3. Ineffective information governance controls could lead to databreaches and an impact on the General Data Protection Regulations. 4. Communications with employees, patients and service users maybe ineffective. 5. There will require to be changes to theworking environment including remote working and working from home. 6. There is a reduced ability to protect the wellbeing of employees, patients and service users. There may be adverse media coverage locally, aloss of public confidence and reputational damage. RMc AK Current Controls 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 forthe use of MSTeams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Riskregisters are in place for the IJBand each partner. Each partner has aspecific 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'sWorking 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 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 carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse events. 3. IJB Governance reporting reviewed and associated documents updated. Risk Trend Risk Level Reduced and details updated The risk was originally created in April 2021 and detailed concerns around the ineffective governancearrangements following the Covid Pandemic. The risk was updated in Dec 2023 to review the mention of Covid. Following implementation of a range of actions and a review of the governance processes across the H&SCP it is for the IJB to consider if the risk level can be reviewed. Target ‐ low Current medium 217
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Unscheduled Care There is a risk that we cannot sustainwhole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays inonward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading toreduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. RMc RMc Current Controls CONTROLS 1. CareHome Assurance Group and associated supports forcare homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Careat Home Assurance group and associated activityto try to support and sustain independent sectorprovision 3. NHSCMT and Covid response group oversight ofperformance 4. DailyPDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole systemapproach to unscheduled care/delayed discharge challenges Actions ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. NewCSW roles in District Nursing teams toproactively 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 aswell as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all sixLocalities to support rehab in the community and reduce long‐term service demand 8. 5Task and Finish groups now established toroll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) 9. Firebreak implemented Jan 2024. Risk Trend Risk Level Lowered The risk was created in Sept 2022, due to a concern regarding sustaining flow during peak winter due to increasing patient demand. The risk was originally provided with a Very High Risk Rating. Since the creation of the risk a range of mitigations and actions have taken place including Operation Flow, increase resource and service development of key areas including frailty, H@H, discharge support. It is for the IJB to consider if the implementation of these actions now reduced the risk rating for this risk. Target‐ Medium Current –VH 218
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Risk in Focus – Review Risk Description Risk Owner Risk Lead Service Sustainability Dueto competing service priorities and workforce/ operational and financial challenges there is a risk thatthe IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategicaims of theIJB poses a risk on operational service delivery and the achievement of financial balance andpatient safety RMc RMc Current Controls 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 NHSFinance Departments. 4. Regular budget meetings with Chief Executives and Directorsof 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 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. Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Target‐ Low Current – High 219
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Risk in Focus – Review Risk Description Risk Owner Risk Lead Workforce Sustainability Itis becoming increasingly difficult to recruit toparticular 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 strategicplan. 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 tothe same immigration rules. Thenew points‐based immigration system makes exceptions for the majority of health care professionals with an NHSjob offer and for qualified social workers via a new fast‐track visa route, known asthe Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. TheMutual Recognition of Professional Qualifications Directive isan 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 theEEA for at least two years after thetransition period ends. This however is nota reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. RMc RMc Current Controls CONTROLS 1. Allsuccessful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, aone‐off charge levied against arrivingmigrant 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 rulesare in law as part of the Immigrationand Social Security Co‐ordination (EU Withdrawal) Act2020. As such, from 1 January 2021,they apply to all workersarriving to work inthe 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 SettlementScheme which will guarantee their right towork in the UK indefinitely. 2. Inrespect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to reviewfuture 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 NLCto support key priority areas of recruitment such as Mental Health and Home Support Actions ACTIONS 1. Annual workforce plan being prepared 2. NHSLprogramme underway to support international recruitment 3. Onthe day recruitment events being trialed inHome Support 4. Useof university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 5. Recruitment of 15 Modern Apprenticeships within the H&SCPworking within Business Admin, Comms and Health CareSupport. Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Target‐ Low Current – High 220
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Risk in Focus – National Care Service Risk Description Risk Owner Risk Lead NationalCare Service There is a risk that the ongoing workaround a National Care Service could destabilise current service delivery due tosignificant change activity, time demands around theco‐design process, staff uncertainty and partner organisations having to focus inwardly due to theimpact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved bythe IJB and the Strategic Commissioning Plan for 2023‐26. RMc RMc Current Controls CONTROLS 1. NLCestablishing NCS working groups 2. KeyHSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA Actions ACTIONS 1. IJBresponse submitted on proposed Bill 2. Strongpartnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLAworking groups being established ‐ local reps nominated for each Risk Trend Risk Review Thisrisk was initially created in September 2022. Although the North Lanarkshire IJB has little control over the National Care Service, work is ongoing to ensure NL IJB is involved in the decisions has much as possible. NL IJB received an update paper on the National Care Service on the 24/01/24., with a recommendation for the IJB to review the current National Care Service risk to ensure it fit for purpose. Target‐ Low Current – High 221
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Risk in Focus – Pharmacy Pressure within Prison Service Risk Description Risk Owner Risk Lead Pharmacy costs have traditionally been the highest area of non‐pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. MT RMc Current Controls CONTROLS • Reviewof the dispense processes within the prison • Implementation of guidelines • Improved communication with pharmacy provider Actions ACTIONS • PrescribingAction Group re‐established to try and manage the number of items prescribed • Development of pain and medicine management pathways • Review of prescribing habits Risk Trend New Risk Following the Prisoner Healthcare Report presented to IJB PFA on the 22nd May 2024. The IJB PFA recommended that a Pharmacy Pressure within Prison Service Risk was added to the risk register. Target‐ Low Current – VeryHigh 222
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Risk in Focus – Adult Care Staffing Risk Description Risk Owner Risk Lead Currently being developed MT RMc Current Controls ActionsRisk Trend Target‐ Low 223