ITEM 4 - Minute - Integration Joint Board Performance, Finance & Audit Committee - 21 August 2024
North Lanarkshire Council · 25 September 2024
Back to Health and Social Care Integration Joint Board — 25 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st August 9.30am-12pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Nauman Dar (Left 11.05am) NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Anne McCrory North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Siobhan White (Left 11am) NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Elizabeth Seaton (Left 9.55am) Carers Together John Watson (Joined 9.40am) Unison Rep In Attendance: Andrea Breen (Observer) Senior Manager Adult Social Work Stacey Connor (Minutes) Governance Support Manager Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Sharon Murray Interim Nurse Director North HSCP Sharon Simpson (Observer) General Manager NE Sector Maggs Thomson Head of Health NHSCP Karen Workman (Observer) Senior Manger Adult Social Work Apologies: Stacey Anderson Support Services, Project Manager Paul Carey Audit Scotland Diane Fraser Head of Adult Social Work Services Margaret Gibb Interim Chief Exec, VANL Third Sector Rep Cathy McGinty NHSL Partnership/Staff Side Rep
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2 Dr Lucy Munro Medical Director North HSCP Harry Robertson Carer Representative ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA (22nd May 2024) The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Ross McGuffie updated the committee on the action log as follows: Future Meeting-Working with Chryston to identify a space big enough for December meeting to be hosted here. Also considering using meeting room 10 (new meeting room at Kirklands) for face to face meetings in 2025. 5. Community Alarms Service The Community Alarm Service operates 24 hours per day, 7 days a week, 365 days per year. When the individual activates the alarm, a signal is sent via the telephone line to the alarm receiving centre in North Lanarkshire which is staffed 24 hours a day, 365 days a year. A Response Advisor (call handler) speaks directly to the person to find out what kind of assistance is required. Within the last report to committee the service was planning to conduct a wide-ranging service review, however following feedback from various stakeholders and improved Care Inspection grades it was evident that the service was effective, staff were committed, and service users satisfied with the support provided therefore the scope of the review was adjusted, to focus on the staffing element of the service. The service has already changed around 3000 analogue alarms to a Hybrid digital ready unit which do not use the analogue telephone line, with a further 1000 planned to be exchanged by November 2024. Housing have undertaken an upgrade of all Sheltered Housing developments to a new Warden Call system that will be fully digital ready when the Digital ARC is implemented and are installing equipment in the
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3 remaining developments (which were upgraded a few years ago) to have a Digital connection available in readiness for the move to Digital. During the course of the financial year 23/24 £325,000 had been spent purchasing 1500 hybrid alarms. It is anticipated that £1,275,000 will be available to continue with the purchase of hybrid digital alarms in this financial year. There is a projected increase in cost therefore a funding gap for future years that requires to be sourced. The charge for the community alarm service increased to £3.57 per week 51p per day) from the 1st April 2024, despite the slight increase being applied the charge for the community alarm service within North Lanarkshire remains one of the lowest when compared to all other local authorities across Scotland. A benchmarking exercise was undertaken to further understand charging across the country. This report gave an update on the Community Alarm Service. It highlighted the work undertaken for the transition of analogue to digital; both the challenges and progress were noted. Additionally, the positive Community Alarm Service gradings from the Care Inspectorate were recognised. From engagement and consultation, it is agreed that the service staffing resource requires review. Finally, it noted the service charging position. Phillip Couser queried is the scale of uptake where we would want it to be. Ross McGuffie advised there is a stable position, throughout all the changes we have not seen a change in use pattern. Cllr Barclay questioned for those on the new system has it been a smooth transition or has there been any issues. Ross advised that the early stage of the transition was where the challenges were, as not sure where the changes were taking place now have been linking with telephone providers directly. Moving the hybrid alarms is allowing us to be ahead of the moves. Karen Workman added we are receiving roughly 130 alarm requests a month. The service has worked closely with the technology and housing teams to reduce any disruptions. Cllr Burgess asked do we have figures on loss of units over time. Ross McGuffie replied numbers are roughly static for active users- reduction is due to patients going into care or deaths in the community. Brian Moore queried will the fire alarm compatible issue be resolved in the future. It was advised that this would be resolved naturally though the digital programme. The IJB PFA agreed the following recommendations: (1) Acknowledged the contents of this Community Alarm Service update report. (2) Acknowledge the ongoing work being undertaken to support the transition from analogue to digital and the work completed to date. (3) Acknowledged the progress and challenges of progressing the move to the new digital ARC platform and the extensive work completed to date in preparation for this. (4) Acknowledged the positive Care Inspectorate grading that the service received from the Care Inspectorate.
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4 (5) Acknowledged the position with current and future charging for the service. 6. Home Support Service The report informed on the progress on the implementation of the redesign of the Home Support Service which was approved in 2018. It outlined the work that has been undertaken following the recovery from the pandemic focusing on areas such as demand, complexity of support, workforce challenges, new models of delivery from acute setting and changing demographics. This demonstrates that the model approved in 2018 remains fit for purpose and aligns with the current aims and objectives of the Strategic Commissioning Plan. The model was based on the outputs of the Cross−Party Working Group, the advice from support officers and wider officer research, the proposed new model focuses on five major elements: • Integrated Model (Discharge to Assess in Localities) • Same Day Response/Reablement/First Support (Intensive and time limited) • Specialist Teams (e.g. supporting people with frequently changing needs and end of life / Palliative Care) • Ongoing Paid Support (allocation of an individual budget to deliver individual outcomes as part of SDS) • Quality Assurance (improving standards of care) The plan outlined that the Home Support Service was to be a functional model based on two elements; assessment and planning (overall assessment and planning activity or the service) and long-term service delivery which will be referred to as the Living Well Service (providing support to those with complex health and social care needs). The impact of change detailed showed improvement of the quality and consistency of care and support, improved recruitment and retention, addressed impaired staff morale, improved Care Inspectorate grades and maximise efficiencies and capacity within the service. This will be supported by good governance, clear infrastructure, a skilled workforce and improved culture and environment. This has been an incredible amount of work undertaken to ensure that the operating model is fit for purpose and can adapt into the future as we respond to whole system changes. A further update will be provided with the finalised operating model and associated workforce establishment to the committee. Key areas of focus for the work include: Assessment and Planning Living Well Service Dynamic scheduling system Engagement particularly with other boards
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5 Quality Assurance Demonstrator sites are operational in Airdrie and Wishaw which will be rolled out further and updates will be brought back to the committee as the work progresses. John Watson noted concerns around the volume of care commission inspections and the impact this has on the staff. Ross McGuffie advised Diane Fraser and Alison Gordon are picking up discussions and raising these concerns formally with the lead inspector. In North have had 19 inspections comparted to 1 in South so looking to seek more of a balance. Some of the members asked were there particular reasons for North receiving this amount of inspections. Ross McGuffie advised there are different lead inspectors so it can be down to individual approach. Some areas have been received grades 2 inspections with areas for improvement identified which are being addressed; care inspectorate are aware of improvement processed taking place. This has been raised at the national whole system group as a concern and will be raised again. Cllr Kelly asked will the new dynamic scheduling be included as part of staff training plans. It was confirmed a training team has been identified to support staff and linking with the provider of the new system directly to offer ongoing support. Have also identified champions for the system. Phillip Couser queried are trends determined by demographics for those with complex needs. The response advised that there is an increased complexity in some cases and clear that we are currently over providing packages so should see a reducing number as reviews take place but increased complexity of cases. Looking at up skilling workforce to ensure staff are as skilled as they can be to be able to provide more complex care for patients. Cllr Burgess asked regarding more complex patients and is there more care time being allocated to staff to undertake tasks. Karen Workman advised new dynamic scheduling will assist in allocating the required time in real time and taking into account feedback from staff around this. Cllr Barclay enquired are we comparable to other Health authorities for the amount of inspections undertaken. Ross McGuffie replied we have not looked at this data yet until we try to manage this locally but will consider this in future. Brian Moore commented that despite the number of inspections there will be opportunities for learning from the findings and further reports from the Care Inspectorate on this service area should be brought back to the committee. The IJB PFA acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model.
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6 7. Home Assessment Team/ Discharge without Delay Programme Update In September 2021 the IJB approved the establishment of a Change Fund to create additional capacity and support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire Health and Social Care Partnership, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan. North Lanarkshire’s Home Assessment Team, (HAT), is a multi-disciplinary social work, health and social care resource which applies a whole system approach to planning and preparation for hospital discharge and admission avoidance by facilitating both assessment and intervention within each person’s own home. HAT will support by adjusting the balance of care both at the front door and back door of hospitals. The report presented provided an update on the establishment of HAT in North Lanarkshire, which includes background, progress to date, plans, recruitment update, successes, risks and next steps. The delivery of high-quality support is critical to support individuals who are at risk of admission to a hospital or who have complex discharge needs. The improvement work to establish the Home Assessment Team (HAT) is critical to the delivery of the Plan for North Lanarkshire and the University Health and Social Care North Lanarkshire Strategic Commissioning Plan. HAT provide assessment at home with a focus of complementing established practice and supporting service redesign and streamlining of other key areas of work including the longer-term vision of the development and implementation of an enabling hub approach across the North Lanarkshire Health and Social Care Partnership. Cllr Kelly requested some feedback around links for HAT with health services. Morag Dendy advised working on a video to capture the enthusiasm of the staff and promote the service. This work is being done as it’s what’s right for people and want staff to feel they have done a good day’s work. Have no direct control with Acute colleagues but lots of platforms to link in for a whole system approach. Also working with South colleagues to develop on a Lanarkshire process. The IJB PFA Committee: 1. Acknowledged the report. 2. Endorsed the strategic direction of HAT and the implementation of HAT across North Lanarkshire. 3. Acknowledged the significant development in HAT practice across North Lanarkshire 8. Self-Directed Support Update The report provided an update on the progressive implementation of Self- Directed Support SDS) nationally and the position locally with reference to
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7 the Self-Directed Support Framework of Standards updated by Social Work Scotland in May 2024. The report reinforced the whole system approach to continuing to promote maximum choice and control for people living in North Lanarkshire. Self-directed support is the approach threading through all of the work of the Health and Social Care partnership. The ability to respond to people uniquely and continue to individualise responses including where an individual budget supports choice and control will remain the route to mitigate the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. The priority of work over the next 12 months, informed by the completion of a Self-Evaluation will be building resilience and sustainability: • In communities – helping people to help themselves first, ensuring the best information, advice and access to self-assessment / self help • In the Sector – recognising the importance of partnerships with all stakeholders, articulating that through good market facilitation and a focus on community wealth building In the workforce – training and development, fully using the care academy and developing the role of Scottish Care Cllr Barclay noted some concerns –between discharge from hospital and funding allocations being sorted is the patient linked in with. Morag Dendy noted assessment of someone in crisis is the not the best time to establish long term need to trying to balance short term support and longer term capacity so constantly link with patients during the process to ensure needs are met. Brian Moore referred to a Care Solutions annual report from September 2021 which contained a section on the Self Directed Support Network which has negative comments on the experience of SDS and he requested that the self-evaluation capture the views of individual users. The IJB PFA: 1. Acknowledged the progress made in North Lanarkshire to promote choice and control through Self-Directed Support 2. Noted that a future report will be brought to detail the findings of a Self-Evaluation and associated Action Plan 9. Improving The Cancer Journey In June 2021 the North Lanarkshire IJB endorsed Phase 1 of a two-part application to the fund to scope the local approach in partnership with VANL. In March 2023 Phase 2 of the application was approved supporting access to funding of £2m to improve the cancer journey across Lanarkshire, the paper offered an update of progress since the launch of the service in March 2024.
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8 The Improving Cancer Journey (ICJ) approach aligned to Community Solutions, Improving Lives mobilising the community voice around cancer as well as wider long-term conditions to complement the national approach to inclusion, promote successful engagement with more deprived communities and facilitate volunteering models. The Phase 2 Application outlined the resource provided by Macmillan, which was equivalent to employ 3.5 whole time equivalent staff, which was matched against the funding within the Improving Lives Initiative (ILI) of £412,800 to employ a combined team of 10 Community Connectors. This approach was designed to ensure everyone in North Lanarkshire diagnosed with cancer can easily access the support they need, when they need it to enable them to live as well and as independently as possible. The committee appreciated the presentation of the data and the use of graphics. Comments were made on the referrals gender split and the percentage of referrals by SIMD area. The IJB PFA noted the progress in the provision of support for people with a cancer diagnosis and those affected by a diagnosis to improve the cancer journey for individuals, their carers, their families and friends. 10. Our Health Together A report was shared with the committee to present the new NHS Lanarkshire healthcare strategy ‘Our Health Together Living Our Best Lives in Lanarkshire’ 2024-2031. Our Health Together (OHT) sets out the NHS Board’s strategy for the period dating from 2024 to 2031. The strategy was developed following an extensive stakeholder engagement programme that ran from April to August 2023 and involved patients, carers, our staff and local communities, including children and young people. OHT provides the overarching strategic direction and is aligned to the Transformation and Reform programme that is already underway. The strategy also reflects both local and national priorities. The four reform groups referenced as the priority areas of focus within the document will become the delivery arm of ‘Our Health Together’ going forward. These groups will develop implementation plans for the short to medium term and will continue to engage and involve key stakeholders in their work. There was a long engagement exercise to pull this work together. There are key themes within the document around: Primary Care, Mental Health, Urgent Care and Planned Care. This will be considered for future discussion at an IJB liaison session. Can also consider linking to updates around the SCP.
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9 The IJB PFA endorse the ‘Our Health Together’ strategy. 11. North Lanarkshire ADP Annual Reporting Survey 2023/24 The Alcohol and Drug Partnership (ADP) Annual Reporting Survey is designed to collect information from all ADPs across Scotland on a range of aspects relating to the delivery of the National Mission during the financial year 2023/24. The data collected is used to better understand the challenges and opportunities at the local level and the findings will be used to help inform the following nationally: • The monitoring of the National Mission; • The work of a number of national groups including the Whole Family Approach Group, the Public Health Surveillance Group and the Residential Rehabilitation Working Group, amongst others; and • The priority areas of work for national organisations which support local delivery. Once the data is analysed and findings are published at an aggregate level as Official Statistics on the Scottish Government website The detail in the Annual Reporting Survey reflects the positive work reported through the IJB in March 2024 and through the PFA in October 2023. National drug death figures have increased in 2023- there has been 1072 deaths reported. There were 103 deaths in 2023 for North Lanarkshire compared to 65 in 2022 which is an increase of 38 from the previous year. Each death is reviewed and considered to identify any learning going forward. The committee expressed concern about the increase in NLC and requested that further information be brought back to the IJB PFA. Work has been done with HIS across Scotland to look at learning from the differences in drug related deaths in partnerships. There is a refresh of ADP leads and strategic leads in September which should lead to different information sharing across Scotland. The IJB PFA approve the following recommendations: (1) Noted the content of the report (2) Approved the Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 for submission 12. Internal Audit Annual Report 2023 24 The Internal Audit Annual Audit Report for 2023/2024 provided a high-level overview of the activity undertaken by the Internal Audit teams during the year, as reflected in the annual opinion.
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10 Based on the work undertaken directly on behalf of the IJB and being informed by internal audit work undertaken independently by each respective internal audit function within North Lanarkshire Council and NHS Lanarkshire, it is concluded that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management, and internal controls for the year ending 31 March 2024. Internal Audit will, as part of the agreed 2024/2025 workplan, develop and agree arrangements to undertake follow-up work on the implementation of actions agreed in response to relevant audit recommendations and report on this work to the PFAC during 2024/2025. It was noted the overall opinion is ‘reasonable assurance’ but when you look at the definitions at the end of the paper, there is no ‘reasonable assurance’ instead the definitions are: substantial, adequate or limited. The committee would like clarity of which one ‘reasonable assurance’ would fall into. The committee also noted comments on the timing of this report as the committee would have preferred to have received it prior to the 2023/24 unaudited annual accounts being published in June so the governance statement could include the internal audit opinion for the year. A request to internal audit for 24/25 and future years would be to have this information before the statutory publication of the unaudited accounts in June. Amanda Kilburn will feed both points noted above to the internal audit on behalf of the committee. The IJB PFA endorse the opinion of the Chief Internal Auditors that Reasonable Assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control for the year ended 31 March 2024. AK 13. Q4 Performance Report The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. Areas identified as red and require improvement this quarter are: • Cervical screening • Childhood Immunisations
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11 • 6-8 week reviews • Reablement and rehabilitation • Adult mental health • SLT • Dietetics • Complaints • Smoking cessation • Adult social work Brian Moore asked is there any work planned to review health visitors similar to district nursing reviews. Sharon Murray advised considering a review as there is significant different in caseloads across areas need to look at boundaries. Testing a HV app to improvement communication between staff and patients. There was also discussion regarding the over reliance on paper based systems. The current performance regarding SLT was also noted. The IJB PFA noted the contents of the report and the appendix. 14. Supporting Unpaid Carers- Carers Support Allocation Previous reporting to the IJB outlined the planned approach to strengthen supports to unpaid carers. The report identified a number of carers led and carers informed initiatives introduced over the past year, highlighting our wider approach to engagement with, and the participation of, carers and carer organisations. The report shared provides an update on the current financial position and the budget allocated to carers support. A previous report to the IJB in May 2024 provided details of support arrangements in place for unpaid Carers and progress with the implementation of the Carers Act. In addition, the response to a Freedom of Information request (released March 2024) on the Analysis of Carers (Scotland) Act 2016 funding 2022- 2023 was included and noted the unallocated spend in North Lanarkshire stood at £1,032,017. This figure was based on caring related spend reported to Committee in 2022. Since then, there has been further investment in the carer support aligned to approaches and developments outlined in our Carers Strategy 2024-2027. The report also included details of the position with Ear Marked Reserves related to the implementation of the Carers Act Support Act. The financial position reported as of 28 February 24 was £2.596m. The position as of Feb 24 on Ear Marked Reserves related to the implementation of the Carers Support Act has changed slightly with £188,000 utilised, leaving a balance of £2.408m. As this value is non- recurring, this will be used to support shorter term initiatives that improve outcomes for Carers. The IJB PFA: (1) Endorsed the approach to supporting Carers in North Lanarkshire
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12 (2) Noted the current financial position and budget allocation in relation to carers support. 15. A Shared British Sign Language Plan for Lanarkshire 2024- 2030 The British Sign Language (Scotland) Act 2015, required certain public bodies including Health Board and Local Authorities to develop a BSL plan every six years. A Shared BSL Plan for Lanarkshire 2024-2030, is the second shared BSL local plan for Lanarkshire covering the work of NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. The plan for Lanarkshire sets out actions around ten priority areas which will be monitored through equalities forums, these are: • Delivery the Lanarkshire BSL Local Plan 2024-2030 • BSL Accessibility • Children, Young People and their Families • Access to Employment • Health and Wellbeing • Celebrating BSL Culture • BSL Data • Transport • Access to Justice • Democratic Participation The IJB PFA note the contents of the report. 16. Risk Register The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. The IJB currently has 19 risks identified on its IJB risk register with 11 risks rated as high or very high. Very High Risks • IJB 06/21 – Prescribing Activity and Costs- Sitting at 38% of target achieved, this is for polypharmacy reviews rather than prescription switches which means the target will continue to rise over the year. • IJB 01/21 – Financial Challenges High Risks • IJB 04/21 - Notional Set Aside Budget • IJB 12/21 - Staff Health & wellbeing • IJB 15/22 – Cost of Living • IJB 16/22 – National Care Service • IJB 19/23 – Service Sustainability • IJB 20/23 – Workforce Sustainability
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13 • IJB 12/22 – Unscheduled Care Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. The Pharmacy Pressures within the Prison Service is a new risk that has been added to the IJB Risk Register as per IJB approval in June 2024. Costs associated with this has risen substantially meaning it is an area of concern. Following recent performance reporting that has been presented to the IJB focused around Speech and Language Therapy, it is recommended that a risk relating to the performance of the Speech and Language Therapy Service is added to the IJB risk register as detailed in the IJB Risk Overview Dashboard. The group were in agreement that this should be added as a risk to offer some assurance/oversight. Brian Moore noted previously got a list of Health and Council risk which may impact on the committee; to consider potentially including going forward. Recommendations agreed: 3.1 The IJB PFA noted the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 The IJB PFA noted the inclusion of one new risk to the IJB Risk Register regarding Pharmacy Pressures within the Prison System. 3.3 The IJB PFA is asked to consider the addition of a risk relating to the Speech and Language Therapy Service to the IJB Risk Register following recent performance reports. 17. Risk There were no new risks identified. 18. Date of Next Meeting 23rd October 2024 2pm-4.30pm