IJB Agenda Pack - 4 December 2024
North Lanarkshire Council · 4 December 2024
Back to Health and Social Care Integration Joint Board — 4 December 2024 and its agenda
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A meeting of the IJB will be held on Wednesday 4th December 2024 at 9.30am-12pm via MS Meetings If anyone would like to join this meeting, please contact Rose Walker by email at NLHSCPGovernance@lanarkshire.scot.nhs.uk for the relevant information. Chair: 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 (25th September 2024) For Approval Attachment Chair 4. Minutes IJB PFA (23rd October 2024) For Approval Attachment Chair 5. Matters Arising/ Rolling Action Log For Noting Attachment Chair 6. Chief Officer Update For Noting Verbal Claire Rae Strategic Planning & Development 7. Strategic Commissioning Plan Progress For Approval Attachment Morag Dendy 8. Chryston Update For Noting Attachment Maggs Thomson 9. Whole System Winter Planning For Approval Attachment Morag Dendy Performance & Finance 10. Financial Monitoring For Approval Attachment Claire Rae Governance & Policy 11. Support, Care and Clinical Governance Update For Noting Attachment Lucy Munro 12. Climate Change Reporting For Noting Attachment Stacey Anderson
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13. Terms of Reference For Approval Attachment Stacey Anderson 14. Risk Register For Approval Attachment Stacey Anderson For Noting 15. 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 16. Date of Next Meeting IJB – 22nd January 2025 For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 25th September 2024 at 2.00pm – 4.15pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Nominated Councillor 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 Anne McCrory (Chair) North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non-Exec Director Non-Voting Members: Ross McGuffie Chief Officer, North Lanarkshire HSCP Cathy McGinty NHSL Partnership/Staff Side Rep Harry Robertson Carer Representative OFFICER IN ATTENDANCE: Stacey Anderson Support Services Project Manager Morag Dendy Chief Officer Planning, Performance & Quality Mark Dell Communications Manager Peter McCrossan Director of AHPs Des Murray Chief Executive NLC Joanne Jenkins Interim Nurse Director NLHSCP Dr Josephine Pravinkumar Director of Public Health Dr Tyra Smyth General Practitioner (GP) Claire Rae Dr Lucy Munro Head of Health South HSCP Medical Director NL APOLOGIES: Paul Carey Audit Scotland Nauman Dar NHS Lanarkshire Nominated Non-Exec Director Dr Kenneth Dagg Secondary Care Medical Practitioner Jann Gardner Chief Executive NHS Lanarkshire Alison Gordon Head of Children & Families & Justice Services CSWO of NLC John Watson Employee Representative NLC Unison Siobhan White NHS Lanarkshire Nominated Non-Exec Director Maria Williamson Senior Manager, Quality Assurance
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2 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 (19th June 2024) The previous minutes were agreed as an accurate reflection of the discussion. 4. 5. Minutes of IJB PFA (21st August 2024) The previous minutes were agreed as an accurate reflection of the discussion. Matters Arising/ IJB Action Log Matters Arising There were no matters arising. IJB Action Log Ross McGuffie updated the committee regarding the below actions: IJB Self-Assessment Report – Audit Scotland have re started the self- assessment work so looking to start this again, due to the changes in membership it is planned to discuss this at the liaison session in November to give new members some time to settle in. 6. Chief Officer Update Ross McGuffie provided the committee with a verbal update as follows: • NHS Lanarkshire are currently in the process of running a Firebreak activity. Previous firebreaks have focused on Covid recovery, whilst the aim of this Firebreak is sustainable change and safer care. A range of work has been undertaken across the whole organisation, with new projects and developments across sites to improve services and deliver the best care possible. • Performance during firebreak has improved with 65 delays in Lanarkshire and 15 in Glasgow, which is below the target range for delayed discharge. • FNC + Plus continues to build and develop across Lanarkshire, with NHS Lanarkshire Board Members having the opportunity to visit FNC+Plus
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3 during firebreak, learning how the centre manages unscheduled care, guiding patients to the right service quickly to improve outcomes and reduce strain on hospital resources. Cllr Barclay commended the work that has been carried out and expressed thanks to the teams. Phillip Couser also highlighted that he has witnessed the huge amount of work being done during the walk rounds that he has been involved in, with consideration of lessons learnt, and how we standardise processes being included within the evaluation of firebreak. Phillip also considered the potential positive impact on bed occupancy if we could have systems running 7 days. Ross McGuffie agreed and noted that there is a system push at the end of the week to make capacity for the weekend, we need to consider how we balance this over seven days. It is for the whole system to combine focus to improve performance across 7 days. 7. Mental Health Hospital Based Complex Care (HBCCC) Since the last update to the IJB, the contract with Cumbernauld Care Home came to an end on 31st July 2024. 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 has been in place to coordinate individual patient reviews, engagement with families and the development of a new in-house model for HBCCC services. A new in-house unit for HBCCC will be opened at Udston Hospital, with a projected date of March 2025. Engagement continues with the families affected to ensure a positive co-design of the new space. Cllr Barclay asked about the numbers of beds being made available within Udston Hospital compared to bed base within Hatton Lea for HBCCC patients and if there is scope to scale up the bed numbers at Udston if required. Ross McGuffie replied that all patients have had an assessment and that the capacity for HBCCC patients at Udston has been based on the outcome of these assessment and on the scoping and planning work that has been carried out. Cllr Barclay asked what the public perception/ feedback has been regarding these changes. Ross McGuffie explained that the feedback from the public has been mixed and therefore it has been important to ensure that we have offered wide engagement with all families involved in this process. Cathy McGinty highlighted from the engagement meetings that she has attended, there is mixed feelings, however the engagement sessions being supported by Social Care are a continued support to patients and their families.
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4 Brian Moore noted that a lot of work had been done within the short timeframe to ensure continued support for patients and asked regarding the contract with HC One and if this will be renegotiated considering these changes. Ross McGuffie replied that as reductions are made within HC One, the contract will be reviewed as appropriated. The IJB committee: I. Note the content of the report. II. Note the ongoing engagement programme with families to ensure a co- design approach to the new facility. III. Request further updates to show the finalised site plans and costings once complete. 8. Primary Care Transformation Dr Munro presents the Primary Care Transformation report, highlighting that the legacy of historical primary care investment in Lanarkshire over the last 30 years - with Lanarkshire is now 12% below the National Resource Allocation Formula share of Scottish GP practice spending - has resulted in it now having the lowest primary care capacity in Scotland (whole time equivalent number of GPs 30% below national average). This has resulted in challenges for patients in accessing General Practice, both: • Being able to contact their GP practice. • Getting a consultation with an appropriate clinician once they have contacted the practice. The Primary Care Improvement Programme (PCIP) has delivered significant additional resource, with a pharmacotherapy service available to every practice, Treatment rooms delivering Community Treatment and Care services available across every locality and responsibility for vaccination having been taken from General Practices and moved to delivery by a central service. In addition, new roles such as Community Link Workers have been made available to all practices. However, these interventions have not succeeded in fully mitigating the challenges posed by the mismatch of GP supply and demand (either nationally or locally), with the key national deliverables not well aligned with drivers for General Practice access. The focus for 2024/25 an action plan is in place targeting four key areas of work: • Maximising the productivity and effectiveness of existing PCIP resource. • Development of a programme of work to ensure that the existing capacity of General Practice is used optimally, and exploration to identify technology which could assist and can be deployed across all practices. • Utilising the infrastructure of the new NHS Lanarkshire Interface Directorate to drive the whole system change required for the codesign of new pathways into secondary care and ensure that community resources,
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5 such as Community and Treatment and Care facilities are easily available to Secondary Care without the necessity to involve General Practice. • A programme, working with third sector groups, to codesign new (managed service) first contact services which are comprehensive, co-ordinated and provide continuity of care for patients where appropriate. Oversight of the delivery of this action plan sits with the Primary Care Strategy Board, chaired by Director of Health and Social Care, South Lanarkshire University HSCP. Supporting workstreams will undertake a communications and engagement exercise across primary and secondary care and ensure that future Digital plans align with Primary Care strategic goals. A Joint North and South Primary Care Vision Session will be held on 6th November 2024 at 3pm to further discuss the improvement plan. Brian Moore asked around the status of the funding of the Primary Care Improvement Plan (PCIP). Claire Rae explained that the PCIP budget had not yet been baselined and this was likely to happen 2026/27. Brian also inquired regarding awareness and support for “at risk” GP practices. Dr Munro explained that NL HSCP Senior Leadership Team regularly meet to discuss struggling practices and offer support to these practices, working closely with the locality lead GPs. Councillor Barclay asked if there was anything that could be done to make Lanarkshire more attractive to GPs as a place to work. Dr Munro explained that Lanarkshire has seen an increase in the number of GP trainees and work to support these GPs is underway including placement reviews, support groups and mentoring. Dr Smyth also added that there is other work that could be done to further support GPs, including funding and improved IT systems. The IJB Committee: I. Recognise the challenges facing General Practice and the current measures in place to support. II. Acknowledge the whole system change required to ensure sustainable Primary Care provision for the population of Lanarkshire. 9. Integration Joint Boards Finance and Performance Report This report presented by Ross McGuffie builds on previous audits and shows that Integration Joint Boards are managing in a complex landscape of unprecedented pressures, challenges and uncertainties. In particular, the demand for services continues to increase whilst funding decreased by 9% in real terms in 22-23. In order to support the IJBs in addressing the challenges outlined within the report, it is recommended within the report that Integration Joint Boards should:
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6 • Ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges • Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability • Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: -Service redesign focused on early intervention and prevention • Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches • Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. Phillip Couser highlighted that the report was similar previous years, with the content of the report being as expected which is disappointing, being data driven is key to support change and development and there is a need to consider how we can further embed this into the work. Brain Moore requested that the recommendations made within the report are included as part of the IJB action log, as locally we have done a range of improvement work within these factors that we will be able to evidence. The Integration Joint Board Committee noted the following: I. The recommendations outlined with in the report. II. The request to add these recommendations to NL HSCP action plan. 10. Audit Scotland Annual Report Audit Scotland AAR on the IJB Annual Accounts extends across several subjects, as follows: • IJB Annual Accounts 2023/24; • Financial management and sustainability; and • Governance, transparency, and best value. The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2023/24 give a true and fair view of the net expenditure for the year and have therefore issued an unmodified independent report. An action plan on has been agreed by both the Chief Officer and the Chief Finance Officer and will now be implemented across the IJB.
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7 The IJB noted thanks to John Boyd and Amanda Kilburn for their continued support during the audit process. The IJB committee: I. Acknowledge the Audit Scotland AAR in advance of the approval of the IJB Annual Accounts 2023/24; and II. Approved the management response to the action points which is highlighted at pages 23 to 25 of the annual audit report, attached at appendix 2. 11. Audited IJB Annual Accounts 2023/2024 The annual accounts are tabled within the report shared and have been prepared in line with proper accounting practice and have been subject to audit by Audit Scotland. The IJB Annual Accounts 2023/24 were prepared in accordance with the requirements of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable, and prudent judgement were made, and proper accounting records were maintained. The preparation of the unaudited annual accounts also met the statutory deadline of 30 June 2024. The External Auditor has concluded that the 2023/24 financial statements of the North Lanarkshire IJB give a true and fair view of its net expenditure for the year and have therefore issued an unmodified independent audit report. The IJB Committee: I. Acknowledge the External Auditor’s opinions; II. Approve the IJB Annual Accounts 2023/24 for signature; and III. Acknowledge that the signed audited IJB Annual Accounts will be available to view electronically on the UHSCNL website. 12. Financial Monitoring Ross McGuffie provided a summary of the financial position of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the period 1 April 2024 to 30 June 2024, highlighting that the IJB projected outturn position, is an underspend of £1.429m, assuming the current trajectory of spend continues until the end of this financial year. Currently there is no ring-fenced funding included in this reported position.
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8 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. CORE management team and various sustainability and value groups have been meeting on a regular basis to discuss and monitor the management actions reported in the financial plans to progress savings and redesign of services to help support future years budget planning. This includes the following areas of work: • Review of financial planning assumptions for 2024/25. • Review of all current vacancies including length of time left vacant. • Review of discretionary spend and supplementary staffing. • Updates on saving planning in significant areas of budget pressures. • Various service reviews across the partnership. • Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. The current IJB savings position at the end of June 2024, show total savings achieved of £6.331m Cllr Burgess asked about the saving elements and queried if there were any large projects that would help meet most of the saving targets or if it is likely to be smaller projects across a range of service areas. Ross McGuffie explained that it would be a mix, with larger scale projects such as Mental Health and HBCCC work providing some savings with smaller scale projects at locality level also contributing to the savings plans, it was highlighted that the importance of these projects are ensuring individual consideration, patient care and safety. Brian Moore questioned the reserves currently held by the IJB and if this would likely be clawed back or have a negative impact on funding received by the IJB moving forward. Ross McGuffie described how there has already been a significant decrease to some of the funding bundles received by service areas such as Mental Health and that discussions with Scottish Government around these reductions are ongoing. Dr Munro provided an overview of the work that has been undertaken by colleagues to achieve 46% of the prescribing target to date, with positive projections for year end. The IJB agreed the following recommendations: I. Acknowledge the contents of the report; and II. Acknowledge the projected outturn for 2024/25 is an underspend of £1.429m. 13. Annual Performance Report Morag Dendy provided an overview of the Annual Performance Report detailing the focus on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators).
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9 The Annual Performance Report 2023/24 presents the performance in relation to these metrics, alongside performance information relating to inspections carried out by the Care Inspectorate and additional local performance information in the form of the Chief Executive’s scorecard. Progress against the National Health & Wellbeing Outcomes is also described in the report. A section has been dedicated to presenting and describing financial performance for 2023/24. Stephen Forrest via presentation provided an overview of the performance of NL HSCP showcasing that progress has been made against a challenging position for Health and Social Care nationally, which is reflected in the performance in some of the metrics presented in the report. In order to comply with the requirements to publish the APR by 31st July 2024, a draft version has been available on the IJB website since that date, pending approval by the IJB. This was required due to the timescales imposed on the partnership to produce and publish an Annual Performance Report by 31st July using Public Health Scotland data that is not published on their website until 04th July 2024, as previous publications of the data set are provided to the Integration Authorities for management use only. Cllr Barclay asked how NL HSCP compare to other partnerships. Stephen Forrest explained performance in North Lanarkshire is broadly comparable with similar authorities and the Scottish average in many areas, however there is variability across areas. Philip Couser noted the difference in figures between the Finance Report and the Performance Report. Stephen Forrest explained that this was due to the timings of when each report was written and the availability of data sets. Action to check the data across the finance and performance reports to align both reports. The IJB committee: I. Reviewed the content of the draft Annual Performance Report 2023/24 - University Health & Social Care North Lanarkshire, which is appended to this report. II. Approved for publication the content of the draft Annual Performance Report 2023/24 - University Health & Social Care North Lanarkshire. SF 14. Risk Management Report There are currently two other risks rated as Very High on the IJB risk register. • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges There following risks are rated high on the IJB risk register.
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10 • 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 • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy The IJB 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. 15. Registered Social Landlords Morag Dendy provided an overview of the report providing detail that the contracts with Registered Social Landlords (RSLs) expired in 2016/17, prompting a review of the services being provided. The review has been significantly delayed due to the impact of the Covid-19 pandemic. The purpose of review was to ensure that people had the freedom to choose who provides the care and support they receive. We recognise it is vital that any support tenants receive are focused on their needs and are unique to them. The decision to remodel Registered Social Landlord Provision (RSLs) was approved within the March 2020 IJB financial plan, which received cross party support. The plan detailed that the current RSL services would transition to become Retirement Housing in line with the council’s in-house model. It was noted that this change would result in future support costs being absorbed by housing benefit. This current review commenced in June 2023. Following discussions with providers and the collation of data and impact assessments outlining the needs of tenants, North Lanarkshire Council informed all providers within the scope of the review of the initial proposal to withdraw all housing support funding. The review of Registered Social Landlord provision will be completed, with all new arrangements in place by 01 April 2025. With plans to continue to engage with Trust as the transfer to the new arrangements takes place with continued engagement with Hanover Scotland re implementing the recommendations made following the independent review of the fire evacuation strategy, with the recommence of the review of Hanover Scotland also planned. It is expected that the completion of this review will achieve the intentions as set out in the March 2020 IJB financial plan.
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11 The IJB committee: I. Recognises the progress of this review, which when completed will further embed the principles of Self-Directed Support – Social Care (Self Directed Support) (Scotland) Act 2013. II. Acknowledge the change in provision delivered by both Link Housing Association and Blackwood and note a review of this provision is no longer required. III. Acknowledge the concerns raised by Trust and their representatives and note agreement has been reached following a positive meeting between North Lanarkshire Council and Trust Housing Representatives. IV. Acknowledge the approval by Aspire management committee to progress to a Retirement Housing model at, Law View Housing development. V. Note the delay in progressing the review with Hanover Scotland due to fire safety concerns and following an independent fire audit, endorse the recommencement of that review. VI. Agree a notice period to 31 March 2025 to enable transition planning with providers and individual tenants. 16. Appointment of New Chief Officer Professor Ross McGuffie will step down from his role as Chief Officer of North Lanarkshire Health and Social Care on Thursday, 26th September 2024. Over the past five years, he has provided valuable support, leadership, and guidance to both the North Lanarkshire Health and Social Care Partnership and the Integration Joint Board. Following a recruitment process conducted in collaboration with representatives from NHS Lanarkshire, North Lanarkshire Council, and the Integrated Joint Board, Claire Rae has been appointed as Chief Officer for the North Lanarkshire Health and Social Care Partnership, with the appointment effective from 1st October 2024, pending completion of reference checks and other formalities. Members of the IJB committee expressed thanks to Ross for his leadership, commitment and guidance over the years. The IJB Committee: Acknowledge the departure of Professor Ross McGuffie from the position of Chief Officer and the appointment of Claire Rae as the new Chief Officer for the North Lanarkshire Health and Social Care Partnership. 17. Risk There was no new risk identified.
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12 Date of Next Meeting 4th December 2024 9.10am - 12pm
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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 23th October 2024 14:00-16:30 Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Paul Kelly Siobhan White North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Claire Rae Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together Liz Seaton Partnership for Change User Rep John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Rose Walker (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Margaret Flavell Joanne Jenkins Nurse Director (interim) North HSCP Thomas Moan Dr Lucy Munro Medical Director North HSCP Maggs Thomson Head of Health NHSCP John Watson Maria Williamson Senior Manager, Quality Assurance David Wood Harry Robertson (Guest) Dawn Wright Management Team Secretary, North HSCP Apologies: Nauman Dar NHS Lanarkshire Nominated Non Exec Director Diane Fraser Alison Gordon Head of Adult Social Work Services
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2 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 21st August 2024 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Brian Moore referenced the discussion from previous Integration Joint Board (IJB) meeting around the numbers of Care Inspectorate reports that some services were subject to, and asked if there was any feedback to the frequency and numbers undertaken. Claire Rae, Chief Officer, North Health and Social Care Partnership agreed will pick this discussion up and feedback to members of the group. Noted that the Audit Scotland report was recently discussed within an IJB meeting, and suggestion made that the recommendations within report be incorporated on the IJB Action log. It was noted on review there is a number of actions remaining. To review recommendations within a liaison session in the context of medium term financial planning arrangements. Claire Rae advised update will also be provided at the IJB meeting scheduled 4 December 2024. 5. Getting It Right For Everyone (GIRFE) Morag Dendy presented the Getting it right for everyone (GIRFE) paper highlighting is a national piece of work supporting Adults in a much more person centred way. The paper outlined a proposed multi-agency approach to support and services from young adulthood to end of life care which the Scottish Government is co-designing with place-based pathfinders. Health and Social Care North Lanarkshire North Lanarkshire is a place-based pathfinder for older people and frailty.
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3 The Pathfinder programme began in January 2023 and is underpinned by a co-design approach including: • GIRFE Design School - a support model which can help teams to come together, get ready for co-design work, and engage people with lived experience on a specific policy area, problem exploration or redesign challenge. • GIRFE Learning Networks to support a national practice model. There are eleven place-based pathfinders across Scotland aligned to five thematic areas: 1. People in prisons. 2. People in addiction services. 3. People registered at Deep end GP Practices. 4. Families with multiple and/or complex needs and young people in transition from GIRFEC to GIRFE. 5. Older people and frailty. The North Lanarkshire pathfinder was geared towards a focus on frailty given the population projections of North Lanarkshire and a need to reduce demand and pressure on health and social care services. The North Lanarkshire pathfinder work sought to achieve three main things. 1. To understand people’s experiences of accessing health and social care services in a range of different settings, across thematic areas and focused geographically on Wishaw (although wider engagement took place). 2. To embed their expertise and knowledge into the final version of the principles and elements of a national toolkit that would support the approach at a local level. 3. To ensure, through the governance structure adopted, continued alignment with the Strategic Commissioning Plan programme of work and delivery plan for Back to Basics, that adopts the Human Learning Systems (HLS) approach. Morag Dendy added that a lot of the work nationally fits with priorities locally in relation to how we help people to help themselves first; to how it is influenced locally and influence on a national context. Phillip Couser asked what confidence do we have; that we have this access to the data; to properly assess the impact and performance of this? Morag Dendy advised that benefits have been realised from the collaborative work undertaken with colleagues in Airdrie and Wishaw locality which had also provided the opportunity to test, explore and identify areas of improvement. Margaret Flavell added that one of the Pathfinders is meeting with some of the operational staff involved in the Wishaw demonstrator and is speaking with people with lived experience. The team have linked closely with the performance team to analyse and interpret the data.
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4 Brian Moore referred to the following highlights within the report and sought clarity in relation to: 1. The development of digital requirements; asked has this been advanced? 2. Did we get the toolkit in September 2024? 3. The sticky person; who do we envisage in fulfilling that role? 4. In terms of the Governance framework; the IJB is not mentioned 5. Under 6.4.1 the risks that are outlined makes reference to finance; trying to get a sense of the timeline and the process for rolling this out across different localities. What are the financial implications? 6. In terms of the demonstrator sites, Airdrie and Wishaw and its reference to community nursing. How does that overlap with the next paper on the agenda where reference is made to a single point of access for community district nursing? Morag Dendy replied; in terms of the digital requirements, the Scottish Government, share the frustrations by the slowness and progress in relation to how a national digital approach would assist the work “It's an area that we continue to feed into”. The tool kit, this is a bit more of a practical document. What we aim to do, is to embed in to our operations and not to make this feel like it's something different and additional. The focus is on how does this fit with a wider approach which helps us to be able to test the content broadly, but not necessarily adhering to the format that the Scottish Government have shared. Additionally, in relation to sticky person, the enabling approach encourages a place based opportunity to think about the people resources and wider community resources within a locality is encouraging us to really identify a lead that makes sense for each person in that context. A sticky person could be anyone in relation to people employed through statutory organisations, third sector partners, and the Community connector roles. Morag Dendy added in regard to the financial implications, it is about streamlining current operations into a more whole system way of working. With robust reviewing processes in place, to ensure we are doing things right first time. This will allow us to refine the way of operating for efficiency and effectiveness from the start, with not over-supporting or dealing with the impact of under-supporting. The single point of access from community nursing is about no waits, . how do we respond quickly, considering how do we do that in a way that takes from the lessons learnt from the work that Podiatry and CAMHS have done. It's our responsibility to consider how we undertake these streams, and get the right response in place for people to join in a locality based approach. We have structures in place that will help us learn collectively. Cllr Barclay commented on looking at Lanarkshire as a whole; referring Airdrie, Wishaw, and with Cumbernauld the point was made that there can be differences between areas sometimes and statistical outliers; is the GIRFE model flexible enough to take into consideration all of this?
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5 Morag Dendy advised the focus has been on Airdrie and Wishaw. The back to basic work has included all of the localities, however we are confident that we will get to a model that will respond to the uniqueness of the different localities. Margaret Flavell commented around the question raised regarding Governance; that the IJB was not specially mentioned. To note the Programme Board Governance structure was being refreshed at the time of the report, referred to the new Getting it right for everyone (GIRFE) board, sub groups below and pointed out this work would report in to that. IJB PFA Committee note and agreed the following recommendations: I. Endorse the GIRFE Pathfinder journey and approve the next steps. II. Endorse the testing of prototypes in multidisciplinary operational practice, through: III. The provision of and deployment of existing resources to ensure capacity, providing support and challenge via the Back-to-Basics governance structure to measure the learning IV. Embedding the GIRFE principles and subsequent practice and ways of working underpins the Back to Basics/enabling approach. V. Have requested to receive future reports with the national pathfinder learning. 6. Community Nursing Review Joanne Jenkins presented an update on the progress of Community Nursing Review. Community Nursing is a planned service that is delivered in all six localities and provides nursing care to people who cannot attend other care facilities or where being cared for in their home is considered the most suitable environment. This service was last reviewed in 2006 therefore a review of community nursing within North Lanarkshire HSCP was commissioned by the Nurse Director, Health & Social Care North Lanarkshire on 20th August 2023 with the aim to develop a model which meets the needs of our changing demographics and also to support improved workforce planning with clear career progression pathways. The Community Nursing review has now been completed and the implementation stage is ongoing. Demand for our health and social care services is ever increasing as people live longer but are often now living with multiple long term conditions and increasingly complex needs for health care and social support. Planned Project Objectives and Process • Develop a Vision for Community Nursing in Lanarkshire. • Map demography, local need and current service provision. • Develop a stakeholder engagement to ensure that we engage the community, staff and service users.
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6 • Develop a revised clinical model. • To develop a workforce plan – utilising the 6-step methodology of workforce planning. • To develop a training and development plan to support the new staffing model. • Review Governance for Community Nursing. • Implement recommendations of review and monitor impact on patient outcomes. Phillip Couser asked is there comparative data, to other areas, to see how the service is performing or is that still an area where this is general weakness. Joanne Jenkins advised that the project have found this to be a general weakness. Nationally conversations are being had as there is a drive for this; but don’t have the data at this time. Siobhan White asked around the training for newly qualified nurses coming in at different points; has there been lessons learned from new qualified staff; and shared practice to their experience? Joanne Jenkins advised this has been looked at for newly qualified nurses within development days, and try to take a consistent approach across North and South Lanarkshire. Brian Moore commented it is interesting to see the planned work with care homes and the benefits that may arise with same. Brian also referred to the social care issue and some of the tasks that might be transferred; social care as a reference to catheter bags and stoma care and asked how this is progressing? Joanne Jenkins advised is progressing well with positive feedback received. IJB PFA Committee note and agreed the following recommendations: I. The progress of the Community Nursing review. 7. CAMHS and NDS Recovery and Renewal Programme Board Dr Lucy Munro presented detail of scope and scale of modernisation that has been delivered by the CAMHS and NDS Recovery and Renewal Programme Board to facilitate delivery of a CAMHS and an NDS model aligned to the individual national specifications. The Lanarkshire CAMHS and NDS Programme Board has been in place since 2021. The Programme Plan articulates how the National CAMHS Service Specification – as well as associated Scottish Government directives – will be locally implemented. The purpose of this programme was to assess, evaluate and where appropriate redesign Child & Adolescent Mental Health services ensuring a whole systems approach based on children and young people’s rights and relationships.
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7 There have been 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery: - • Neurodevelopmental Service – all work completed. All neurodevelopmental requests for assistance are now channelled via established Neurodevelopmental Service. This combined 3 previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. • Choices & Partnership Approach (CAPA) Implementation within CAMHS- all work completed. This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. • HR & Workforce – all work completed. A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. • Communication and Engagement- all work completed. An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. • eHealth- all work completed. Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. • Capital/Strategic Planning- ongoing. Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same. Dr Munro reported the financial instability continues to challenge workforce stability. Claire Rae added in relation to the funding; there has been a significant reduction in the mental health bundle funding allocation that would cover CAMHS. The reduction will have a significant implication on our trajectories and performance. Claire provided assurance that both herself and the Director of Finance NHSL were in discussions with Scottish Government regarding the funding and further updates will be provided to the IJB. Cllr Barclay acknowledged compared to where we were, it seems work is moving in the right direction, and asked is it having an effect on the waiting time for people getting an appointment? Dr Lucy Munro answered yes. Have seen that improvement trajectory. Had seen a recent dip to 66% to 18 weeks, but expecting with the changes that have been made and the projections that we have from a Public Health Scotland analyst to be at 90% at 18 weeks for that first appointment. Added waiting lists are still too long; workshops are being held for people on these waiting lists; to offer support.
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8 Dr Munro outlined some of the diagnostic issues and challenges in relation to NDS and increasing demand for assessments. It was confirmed that lead civil servants share the views expressed at the meeting. Dr Munro added that Stephen MacLeod the Scottish Government advisor for CAMHS and NDS; brings this to the board. Brian Moore referred to the final recommendation; the remit of Programme Board will expand to include financial planning for workforce resilience. Brian Moore requested that an update to the IJB is required following the Scottish Government meeting to see what the short term and long term impact will be if of any financial reduction. IJB PFA Committee note and approve the following recommendations: I. The contents of report and progress made to date. II. Robust reporting is now available as an electronic patient management system with aligned electronic patient record is now in place. Performance is monitored and managed within the unit and formally reported via IQPR III. All work streams have completed work initially advised with exception of capital planning. However, this work is in progress and can be managed locally with support from planning colleagues. Additionally, the information available to us, due to improvements in robustness of data capture is capable of informing redesign in a way that was not possible in first phase of capital investment. IV. Ongoing work of the Board will focus on NDS and the interface of NDS with CAMHS. V. Remit of Programme Board will expand to include financial planning for workforce resilience 8. Paediatric Modernisation Board Maggs Thomson provided an update on the Paediatric Modernisation Board which was established in current form, formally, in February 2023. The Paediatric Board is focussed on modernisation of service delivery and clinical activity generated via acute hospital and aligned community based paediatric services. The delivery of the services within scope of board, inclusive of in-patient care are the responsibility of the Specialist Children’s Health Services Unit, and hosted on behalf of NHS Lanarkshire within North Lanarkshire Health and Social Care Partnership. The Board forms part of NLHSCP Strategic Commissioning Plan and reports to North Lanarkshire CORE, North Lanarkshire Integration Joint Board, South Lanarkshire Integration Joint Board and NHS Lanarkshire. The agreed remit of Board is: - • Ensure a collaborative, inclusive approach to the design and delivery of a programme of work to implement the Paediatrics Modernisation Programme Plan;
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9 • Monitoring the financial position across the Programme, including the use of Scottish Government funding for specific areas of work; • Encourage and strengthen links between the Programme, North and South Lanarkshire Paediatrics Services Plans and other relevant strategies of all key partners; • Approve Programme documents and deliverables; • Monitor the progress of Programme and delivery plans; • Approve significant changes to the Programme scope, objectives, deliverables, funding and timescales; • Provide assurance that outputs are operationally fit for purpose and implemented satisfactorily; • Identify and manage risks and issues ensuring mitigating actions; • Agree and track benefits realisation and achievement of outcomes; • Approve Programme closure following implementation and ensure that any end project reports, issues, lessons learned and risks are documented and passed on to the appropriate body. A three Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: - Horizon 1- covers current issues that require quick response. • Nursing Care Assurance • Review of Continence Services Horizon 2 -covers emerging issues that are likely to be faced in the next one to three years. • Sustainability of medical rota Horizon 3 - covers issues that might come into play in the future. • New clinical model Brian Moore asked for further clarification on the statement that elements of this work being impacted by current service level agreements with partners and sensitive discussion via regional planning. He noted there is a big emphasis on regional planning within the national system at the moment; do you know what the implications are for this service? Maggs Thomson informed that the paediatric wards provide a District General Hospital level of care; currently in negotiations with our Glasgow colleagues to provide our tertiary level care and that's afforded through the SLA with Glasgow. It was noted the progress is still at early stages and assurance offered to members that work is being undertaken in these areas. Phillip Couser commented; the paper doesn't have any sort of hard timelines against which this work is progressing to deliver on and asked is there any risk that might change? Maggs Thomson advised the primary emphasis and focus in the first year was to start the shift in thinking and to get the right stakeholders around the table to build that level of confidence and trust, and to have plans on the table to see what could be delivered.
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10 Action/ Direction to service: Brian Moore asked when report comes back with an update, that additional information be provided to get a better understanding of the staff numbers working within the service as well as the budget and number of patients, inpatient and community supports. IJB PFA Committee note and agreed the following recommendations: I. the contents of the report and progress of work achieved to date. II. the scale of challenge to delivery of sustainable transformational change. The success of programme delivery will require clinical modelling and clinician support. This has to be balanced proportionately with safe delivery of care whilst transformational work progresses. III. that elements of this work are impacted by current service level agreements with tertiary partners. This requires sensitive discussion via regional planning process. 9. Speech and Language Therapy Service Improvement Maggs Thomson provided an overview of the scope and span of improvement work being delivered via Speech and Language Therapy (SLT) Service. The Speech and Language Therapy service is hosted within the Specialist Children’s Health Services Unit of North Lanarkshire HSCP and delivered pan Lanarkshire. The service is funded by NHS Lanarkshire and via service level agreement arrangements with north and south education departments. The service offers support to children and young people and separately, to adults. The service improvement work is focussed on delivery of improvements required to support improved access to speech and language therapists and interventions for children and young people. A Speech and Language Service Improvement Group was established at request of NLHSCP Chief Accountable Officer. The first scoping of service model and setting of priorities was undertaken in April 2023. As a result, areas of priority were agreed, and work streams established to progress work to date: - • Waiting List- This work is progressing well in a testing phase following review and standardisation of the processes that support patient pathway and inform digital plan. Agreeing, refining and developing core clinical offerings at Universal, Targeted and Specialist level. Ensuring workforce have the confidence, resources and knowledge to deliver the core service model • Digital - This work has progressed well. The service had no digital footprint. Trakcare has been implemented since September 8th, 2024.
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11 • Comms and Engagement - This work has progressed well. Colleagues within the service had already well-established social media platforms and information and education via YouTube that was used to support children and young and their parents and carers. • HR and Workforce -This work has progressed well. Review of all posts across the service has been undertaken. Brian Moore commented in terms of paediatrics and CAMHS; the benefits of making connections with district nursing review and particularly the reference in the performance report to restrictive locality working arrangements, there needs to be a fundamental rethink of how we structure and deliver the service going forward. Maggs Thomson clarified whilst delivering in localities the services are reviewed on a Lanarkshire wide basis. IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report and progress of work achieved to date. 10. An update on Care Academy Morag Dendy provided an update on the Care Academy which is a collaborative initiative between NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. It reports through both North and South Lanarkshire Council’s committee structure. The Academy is authorised to work with partners such as local councils, education departments, colleges, universities, the independent sector and third-sector organisations to attract and recruit staff to the health and social care workforce. The overall vision for the Care Academy is to develop a robust, sustained, vibrant Care Academy attracting and developing a diverse workforce for health and care services in Lanarkshire and promoting the sector as a rewarding choice for careers”. There have been four work streams now established, with specific actions within each being developed by the work streams themselves. A further update on progress on each of the work streams will be brought back to IJB in 6 months. Progress and updates are also provided through: • Brighter Futures Programme Board - North Lanarkshire • Social Work Resource and Finance and Corporate Resources (Personnel Services) – South Lanarkshire • Core management team of both HSCP’s – NHSL Cllr Paul Kelly commented, I think it's a really important piece of work around recruitment of new people into social care; one of the challenges that may be required was to identify is around the funding aspects, the different wage elements of care from your local authority, private third sector? and in terms of how we manage it.
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12 IJB PFA Committee note and agreed the following recommendations: I. The progress with Implementation of the Care Academy Pan Lanarkshire. II. a further update on progress with the work streams in 6 months’ time will be submitted to the IJB. 11. Performance Update – Quarter 1 (April – June 2024) Morag Dendy gave an overview of the Quarter 1 performance report detailing the areas for improvement identified in Appendix 1 and progress made to date. Noted the areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. Phillip Couser commented on the broader societal issues that sit outside Lanarkshire that impact some of the metrics, asked whether or not a peer group review might help focus on areas where there is room for improvement. Brian Moore pointed out we have that covered in terms of the annual performance report where we are part of a cohort, and there was some benchmarking information. Claire Rae mentioned in terms benchmarking; this is something that we constantly strive to do in terms of looking and implementing learning from other boards and local authorities in terms of performance. Acknowledged in terms of annual performance report, going forward that we will include recognition of areas of success. Cllr Barclay referred to the referrals and the figures from adult protection concern reports; asked regards the dip in the number of cases, and wondered what are the reasons behind this? Morag Dendy advised very often the referral numbers can relate to good work being done, it is not so much of a lack of reporting. Note there is also a lot of work done through the Adult Protection Committee and the reporting there, which gives a lot more detail and feed through this forum. Brian Moore asked when looking at alcohol and drug services, do we know what the impact, of all the activity is and how we capture it? And suggested a more fundamental review of how we tackle smoking cessation. Cllr Barclay referred to sickness absence- In relation to COVID and asked is there stats being kept to say this relates to COVID and is that causing some sort of fluctuation within this, or is it is like the other organisations in that COVID has just been taken as part of absence reporting? Brian Moore informed the understanding is that this is now just part of absence reporting and Maggs Thomson re-iterated this is not reported separately and is just managed along with any other sickness absence.
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13 IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report and the appendix. 12. Tackling Poverty- Cost of Living Helpline Morag Dendy provided an update on the Tackling Poverty service. A key role of the Tackling Poverty Team is to support the income maximisation service through the First Point of Contact Team to residents, Support Services for fieldwork staff, supporting specialist Social Work Services, Education Services and Housing Services and the Resolution Team representing clients at tribunals and hearings. Successful welfare rights intervention, where individuals are awarded extra benefit, frequently mean that, as a result of increased income, they are better able to manage their own affairs and may not require further health and social work services. The Tackling Poverty Team monitors and records activity of the helpline, in number of people assisted, reason for referral, income generated, advice given, outcomes, number of people/referrals signposted to other services/agencies. Siobhan White asked is there some of this work being undertaken by other bodies anywhere ie. welfare officers helping people in one capacity and then the housing associations also. Morag Dendy advised that this work has a whole system focus in relation to the joint work with housing colleagues, including housing associations, and that the collaborative approach is fundamental in the tackling poverty approach. In the report there is reference to some maybe not to others, but they are actively involved in the overall approach and work with their housing colleagues in North Lanarkshire Council which gives us good routes into those wider links. Cllr Barclay added from an elected members point of view the one door approach has been phenomenal. Action / Direction to service - Brian Moore noted that post June 2025, to support the continuation of the of the helpline; an exit strategy or alternative funding will need to be identified by the service IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report. II. Endorse the report and note the impact of the funding of the Cost-of- Living helpline for residents III. Approve the request to extend the use the already earmarked funds (£600,000, from April 2023 to March 2025) to support the enhanced service to June 2025.
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14 13. Quality Assurance Annual Report Morag Dendy gave overview, of the Quality Assurance activity over the period April 23 to 31 March 2024 detailing Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Market Facilitation, In House Monitoring, Safer Staffing & Communications; highlighting the progress made within these key activities noted in the last reporting period, and advising of the developments in progress which are planned for the period 2024/25. There's lots of progress in relation to people who have experience of a need and support being involved directly. The activity in relation to regulatory contact through the Care Inspectorate is all captured. The report is reported through the Adult Care and Social Work Committee and through the Education, Children and Families Committee. Brian Moore commented on safe staffing; noting in terms of future work going forward the Quality Assurance team is going to look at this in more detail; highlighted an annual report to be submitted by April 2025. Suggestion made that members of the IJB PFA would benefit from having an understanding of safe staffing and some of the elements of it in terms of real time reporting and escalation. Pointed out it will be useful to bring an explanatory note to the IJB as there has been ongoing work on the health side, but it's also applicable to social care. It was noted there was zero findings of duty of candour this year and Brian Moore asked for comment regarding the absence of reports. Maria Williamson added that in previous years, have reported commissioning services duty of candour; there has been activity externally, just not internally. External organisations are required to publish their own reports. Going forward the duty of candour report that we publish will refer to our own services in terms of social care. IJB PFA Committee note and agree the following recommendations: I. Note and endorse the contents of the report. II. Remit the report to Adult Care and Social Work Committee. III. Request that an explanatory note to the IJB on safe staffing is provided at an IJB Liason session. 14. Community Solutions Annual Report Community Solutions is a successful, cross-sector health and social care investment and improvement programme for North Lanarkshire established in 2012 – aims to improve 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.
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15 The Community Solutions Programme is a North Lanarkshire partnership initiative involving: • University Health and Social Care North Lanarkshire’s (UHSCNL) public sector partner organisations – North Lanarkshire Council (NLC) and NHS Lanarkshire. • Voluntary Action North Lanarkshire (VANL) - the programme’s host organisation. • The Community and Voluntary Sector (CVS) funded organisations and projects. Brian Moore mentioned in relation to Community transport; this may be an area where there could be future developments and asked around mental health and well-being funding; is there any indication as to the future, allocations in in the coming year? Thomas Moan replied seems to be very positive. On phase four, which will be allocated in the last quarter of this year for projects being delivered in 2025 from April 2035 to March 2026. Mental health and well-being is still a major issue. One of the areas that we're working closely with colleagues in NHS Lanarkshire, is to see how people with more severe mental health support needs, how we can complement from the Community voluntary sector. Philip Couser raised question in relation to funding; do we feel confident that we are able to demonstrate and defend the value that we're getting from these investments? do we have that sort of evidence? Do we have a framework by which we can judge the value that we are getting from these investments? Thomas Moan answered; have a quite a robust performance, measurement, evaluation, learning and improvement framework in place named Pemeli. The focus is on how can inform service redesign. IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report. 15. Whistleblowing Report North Lanarkshire Council’s Whistleblowing Procedure (attached at Appendix 1) has been reviewed and no amendments requiring approval are considered necessary at this time. In NHS Lanarkshire no new whistleblowing cases were raised during April, May and June 2024. One case raised in Q4 of 2023/24 was withdrawn, and one case initially raised in Q1 of 2023/24 continued to be assessed to determine if it met the criteria for Whistleblowing. One new potential case was raised in May 2024 and after further consideration the member of staff decided not to pursue the Policy. No new concerns were raised which were deemed appropriate for investigation under HR policies. Brian Moore commented in terms of where we are, is still early days and the fact that we have low numbers is something that we need to reflect upon. In
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16 terms of raising awareness and training; as an IJB will be seeking assurance that staff and managers are aware of the whistleblowing policy. Noted will continue to monitor on an annual basis. Maggs Thomson commented although we do not see a lot of whistle blowing numbers; one of the things we do see coming through is a fair number of anonymous complaints. When the party isn't known to anyone, and asked is this something we need to do to look at. Brian Moore added is a very valid point because the whistleblowing legislation doesn't cover confidential concerns, it does give guidance that it should be investigated as best you can under the circumstances. IJB PFA Committee note and agreed the following recommendations: I. note the update and the content of each Whistleblowing report and are assurance that whistleblowing standards are being followed and learning shared. 16. Risk Report 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 risk rated as high or very high. Noted no changes to risks this period. Very High Risks • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges • IJB 21/24- Pharmacy Pressures within Prison Services 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 • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy A comparative review was conducted of the corporate risk registers for North Lanarkshire Council and NHS Lanarkshire. the review also encompassed the Adult Health and Social Care Risk Register as well as the NL H&SCP Core Risk Register. Highlighted was that all four risk registers had the following risk themes detailed: • Financial Risks/ Financial Sustainability
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17 • Prevention and Detection of Fraud, Bribery and/or Corruption Cllr Barclay gave thanks to Stacey Anderson for hard work and displaying in this format for ease of reference. Brian Moore commented that the adult protection one is part of performance reporting and questioned the submission of a report from the Adult Protection Committee to the IJB in terms of understanding those processes. Noted for the next meeting, to discuss the potential inclusion of climate change in the risk register. Noted agency is currently not included in the IJB risk register, may need to be addressed. Lucy Munro added there’s a sustainability and value group which is led by looking at all of the agency staffing from a medical perspective and advised their maybe also be work being undertaken from a nursing perspective. IJB PFA Committee note and agree the following recommendations: I. 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. II. noted the inclusion of an overview of the corporate risk registers across parent organisations within North Lanarkshire. III. Have considered the inclusion of climate change and public protection risks to the IJB risk register to align risk sharing across parent organisations. With Climate Change risk being added to the register and further discussions to be held regarding the inclusion of a public protection risk at further IJB sessions. 17. Risk No other emerging risks identified to be added to the risk register. 18. Date of Next Meeting 27th March 2025, 14:00-16:30
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 18. 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 Nov Liaison 25. Future Meeting R McGuffie Host a future meeting face to face in Chryston hub Looking at Dec IJB –confirming arrangements. Unfortunately, there is not a meeting room large enough for committee, however in process of arranging a walk around and meet and greet. 26 25.09.24 Item 9 Integration Joint Boards Finance C Rae Ensure that their Medium-Term Financial Plans are up to date
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2 and Performance Report 2024 and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: -Service redesign focused on early intervention and prevention. -Approaches focused on improving the recruitment and retention of the workforce. 29 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve
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3 outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. 30. 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people.
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4 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 June 2021 November 2021 – deferred to IJB Complete Reserve strategy
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5 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding December 2021 deferred to March 2023. presented to IJB PFA on 16th Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported September/December 2020 Deferred to March 2021 – deferred to September 2021 – Original Action complete with further update on hosting arrangements presented to
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6 to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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7 Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete
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8 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Complete Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IJB PFA Further update on October PFA agenda
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9 5. 19/6/24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19/6/24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 1. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove
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10 Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete.
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11 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update provided after year-end figures. Combined report linked to community alarms on
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12 August PFA agenda Complete 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; • Cost of Living Pressures • Urgent/Unscheduled care • Community Alarms (Analogue to digital) • National Care Service September 2022 Complete 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 On agenda Tabled at June PFA
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13 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie Reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute and also review current risk register Update planned for March 2023 IJB Liaison session planned to review Complete 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda Update on October agenda
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14 Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT paediatrics and speech and language On April 2023 agenda Complete 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore Topic at 8th Nov Liaison session Complete 23 18.10.23 Item 5 Risk Register R McGuffie Ross to provide briefing document to offer the committee assurance that risk are reviewed against other boards November 2023 Liaison Session Complete 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report Tabled @ May PFA Complete
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1 REPORT Item No: 7 SUBJECT: Strategic Commissioning Plan 2023-26 and Programme of Work Update TO: Integration Joint Board Lead Officer for Report: Chief Officer, Planning, Performance & Quality Assurance Author(s) of Report Senior Manager, Strategy & Performance DATE: 04 December 2024 1. PURPOSE OF REPORT The purpose of the report is to provide the board with a mid-cycle update on the implementation of the Strategic Commissioning Plan 2023-26 and its associated Programme of Work. 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 the Chief Officer, Planning, Performance & Quality Assurance and has been reviewed by the Strategic Leadership Team. 3. EXECUTIVE SUMMARY
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2 The report provides the board with a mid-cycle update on the implementation of the Strategic Commissioning Plan 2023-26 and its associated Programme of Work. Each item within the Programme of Work is included in the appendix with a summary position on its current status and a RAG assessment. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report. (1) It is recommended that the IJB approve the current status of the Programme of Work, as contained within Appendix 1 of this report. 5. VARIATIONS TO DIRECTIONS? 6. BACKGROUND 6.1 The Integration Joint Board approved the final version of the Strategic Commissioning Plan 2023-2026 at its meeting on 22 March 2023, setting out how the Health & Social Care Partnerships plans and delivers services for North Lanarkshire over the medium term and how these arrangements help to contribute towards achieving the national health and wellbeing outcomes. 6.2 Subsequently, a more detailed Programme of Work was approved by the Board at its meeting on 27 September 2023, setting out in more detail the programmes and activities intended to help transform the health and social care system. 7. SUMMARY OF KEY ISSUES 7.1 The Board has been kept informed of progress for each of the items within the Programme of Work, with specific reports considered by either the Board or the Performance, Finance and Audit Committee since September 2023. 7.2 Now that we have reached the mid-point of our planning cycle, this report has been compiled to take stock of progress and achievements to date across the entirety of the Programme of Work (PoW). Each of the PoW items are included in Appendix 1 with a summary of the current position and a Red/Amber/Green status assessment. 7.3 As previously reported, the partnership has been adopting a learning as management strategy (also known as Human Learning System) approach, working with partners from Healthcare Improvement Scotland to make learning and experimentation the key force driving our work. This approach to Yes ☐ No ☒ N/A ☐
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3 has been promoted across the range of programmes and redesign activity as part of this overall Programme of Work. 7.4 A key element of our learning approach has been the development of a Whole System Enabling Approach, often referred to as Back to Basics, which is helping us systematically understand and consider how all parts of the Health & Social Care system interact and influence each other. This approach is referred to throughout the report and is central to our efforts in supporting people to thrive by providing targeted services that are tailored to reflect their diverse needs. Keeping people central to the decisions that affect them helps us plan actions that support positive outcomes for those who access our services. By adopting a “sticky person” approach, which is to identify a lead person not only to assess need but to engage others to ensure the right response where needed, rather than pass on, we can safeguard against long waits, by waiting well and getting to the right response quickly. 7.5 The overall ambition of our Programme of Work and of our Whole System Enabling Approach is to have a system that is streamlined, supports fewer repeat actions and touch points/onward referrals for people and makes best use of resources by using them in a more effective and productive way. This will ensure that not only are we offering people the right support, at the right time and so increasing their quality of life, we are also increasing the quality of experience for staff in work satisfaction. To achieve this across the whole system, each locality will be responsible for their local population, which means decisions will be made closer to people. This approach will help support robust connections across all local stakeholders to Locality Planning Groups (LPGs), Local Outcome Improvement Plans (LOIPs) and Community Boards (CBs). 8. CONCLUSIONS 8.1 This report offers a mid-cycle stock-take of the partnership’s progress against the commitments made in its Programme of Work. Significant progress has been made and is recognised within the appendix attached to this report. Further work will continue over the next eighteen months to ensure momentum is sustained and key milestones continue to be delivered. 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 ☒
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4 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) None 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 ☐ 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
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5 ☐ 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 9.6 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 No N/A 10. BACKGROUND PAPERS None. 11. APPENDICES Appendix 1 - Programme of Work Status Update (October 2024)
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6 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Graeme Cowan cowang@northlan.gov.uk
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7 Appendix 1 – Programme of Work Status Update (October 2024) 1. Getting It Right For Everyone (GIRFE) The GIRFE Pathfinder is working with staff in localities to take forward the learning from the co-design process and progress the prototypes ensuring these are deployed and embedded within the Whole System Enabling Approach (Back to Basics). The North Lanarkshire Pathfinder will focus on the following prototypes during the next phase of testing: • My plan – a means by which people can record their own information and share with agencies when required. The aim of My plan is to remove any need for people to retell their stories and their circumstances multiple times. This includes living well, ageing well and dying well. • Work is ongoing to embed the GIRFE principles across a variety of approaches that deliver preventative and early intervention approaches and activities. The aim is to improve access to appropriate supports and services by ensuring there are good conversations with people and their families from the first point of contact. Through an enabling approach, we will embed multidisciplinary teams (My team) around the person and their plan. • Our approach to improving the co-ordination of people’s support involves a sticky person as a trusted point of contact who supports people with the coordination of their plan and appointments as an integrated member of a multi-disciplinary team, including when someone receives support from a variety of teams. Areas for further development and design include determining how the sticky person for each person is allocated and how the role might be undertaken by a family member or other non- professional. • Clarity of vision for a community hub involves principles which will support the development of Hubs ensuring they reflect local needs and where people can connect with public services and with local people involved in both service delivery and decision making. The Council has an approved set of hub guiding principles so the we are building upon active work being undertaken in Newmains and St
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8 Brigid’s Community Hub, Riverbank and Chryston community hubs. Further development of this prototype includes identifying what community supports and services can be delivered through the hub, in reach and outreach, as well as the development of performance indicators to determine the impact of support on the health and well-being of the communities they serve. • Dementia practice - Additionally, we have agreed to consider staff competencies in supporting people with dementia post diagnosis. We understand that families can sometimes have extended wait on supports and this can be a challenging time so can we consider ‘waiting well’. We will work with staff across Home Support and Integrated Day Services in gathering data re training/development and competencies and whether this meets expectations as required in the Dementia Strategy. • GIRFEC to GIRFE (Moving On) - Working with our Education and Families colleagues to consider this important transition stage in a young person’s life. In what way can this transition be seamless with the right support at the right time. As outlined earlier we require to consider what the prototypes mean in real time. There has been extensive engagement and communication across the HSCP regarding the need for the workforce to get back to basics, have meaningful conversations with people about what is important to them. 2. Frailty Strategy The Lanarkshire Strategy for Preventing and Managing Frailty 2023 – 2028 was approved in November 2023. The implementation of the strategy is ongoing with a particular focus on the establishment of frailty networks, which commenced in November 2023 with the aim of providing a collaboration between the multi-disciplinary teams on our acute sites and the partnerships who have experience in frailty work. This has led to richly informed conversations which has been at the forefront of driving realistic and patient- centred change for the people living in North Lanarkshire. With continued engagement with both North and South Health and Social Care Partnerships, including GP localities, District Nurses and Third Sector organisations, there has been an understanding on how staff work with frailty patients and the challenges around this. It has also ensured more joint working between acute and community teams.
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9 3. Home Support Redesign The Home Support Redesign programme continues to focus on the following key elements: Assessment and Planning The development of an integrated approach through the establishment of Home Assessment Team working closely with Reablement and Integrated Rehabilitation Team builds on the work to deliver discharge to assess and same day response. This aligns the home support workforce with locality health and social work teams and will provide a range of resources to facilitate assessment and planning. By adopting this approach, it will ensure that when someone needs longer term support it is based on thorough assessment and support planning. This will be for people whose needs are more complex, including end of life care, within their own home. Following assessment and support planning, individuals will have the option of NLC home support delivered by the Living Well Service. Supported people can consider how their support is delivered through the 4 options as outlined in the self-directed support legislation. At the point of review, options will be discussed including individual budgets or direct payments which can be used flexibly to meet identified outcomes. The home support workforce in North Lanarkshire, provides essential support and care to individuals, carers and families. The Living Well Service will continue to provide care and support to individuals who require longer term, planned support. Due to the changing demographics and complexity of individuals requiring support, the workforce will be able to provide a responsive, flexible approach to those with fluctuating needs. The workforce establishment and structure need to be finalised to allow for the model to be fully operational. This work will be ongoing with business partners and trade unions. Workforce The recruitment of staff to assessment and planning has been prioritised to support the operational model. The service has invested in dedicated staff to support learning and development through training, including
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10 refresher cycles, and investment in workforce development to provide high quality care. An overall training plan has been created and has been made available to managers within the service. The plan ensures key activity is progressed including monitoring mandatory training for Home Support Workers as well as highlighting registration requirements for all staff to deliver quality driven service offering flexibility and focused on service user outcomes. Dynamic Scheduling The tool will improve consistency, reduce missed visits, and incorporate travel time accurately. For the first time, the service will be able to monitor care delivery in real-time and monitor quality indicators such as punctuality, continuity and service duration. The tool will demonstrate how person-centred support improves quality of life and measures the effectiveness of care delivered. Engagement An important aspect in the review of the service model was to involve both staff and individuals who use the service by offering opportunities for them to shape the service by active participation. Consultation with the workforce and stakeholders was undertaken through a series of events including face to face meetings across all locality areas and surveys to capture views and experiences of the current and future model. During each consultation event operational issues were captured and addressed which included ‘You Said, We Listened’. The engagement with supported people and their cares/ families highlighted recurring themes and included the need for continuity of care with consistency of carers and timing of visits however many reported that carers were respectful and courteous. Following consultation with the workforce and stakeholders, benchmarking was undertaken with eight local authorities including Renfrewshire, East Dunbartonshire, South Lanarkshire, Inverclyde, Falkirk, Fife and Glasgow to gain a more in-depth knowledge and understanding of other Health and Social Care Partnerships, how they operate and manage Care at Home and Home Support provisions. This included gathering data across key areas of service delivery including preventing hospital admissions, facilitating hospital discharge, managing demand, cost and system.
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11 The information collated has allowed the service to identify best practice and useful learning from others to develop a structure for the Home Support Workforce. A workforce plan is being finalised. Improving Quality The proposed changes will ultimately ensure people have a high quality, safe and compassionate care and support, which is sustainable and maintained across all localities 4. Carers Strategy The partnership’s new Carers Strategy 2024-27 was approved and published in May 2024 and the approach continues to be based on the principles of the Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013, promoting a whole system approach that enables people to have more choice and control in their lives. The development of the Carers Strategy gave us the opportunity to undertake extensive engagement and participation activity with carers and supported people. This has resulted in a carer led and carer informed strategy, co-produced with carers and carer organisations locally. The sense of “joint ownership” that has emerged is something that carers, carer organisations and UHSCNL can be proud of. The aspiration is to offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them. Through these initiatives, carers can lead full and meaningful lives, and ensures that people can engage in, participate in, and contribute to the local economy and wider society, should that be their choice. The wider approach also encompasses the principles of Getting it Right for Everyone (GIRFE) and Community Wealth Building. Carers, carer focused organisations and University Health and Social Care North Lanarkshire (UHSCNL) have, over time, developed a very robust carer support infrastructure, and our Carers Strategy 2024-2027 seeks to utilise this to best effect. 5. Care Home Assurance Team In 2021-22, My Health, My Care, My Home (Healthcare Framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for
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12 adults living in care homes across Scotland. The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes. To ensure a collaborative approach with implementation of the Healthcare Framework an engagement session took place in April 23 with all key stakeholders including care home staff, care home managers, care home providers, Care Inspectorate, Scottish Care, Health, Social Work and Social Care Staff. Subsequently, a Project Plan was developed and agreed with key stakeholders and Short LifeWorking Groups (SLWGs) were established covering all six core elements: Nurturing Environment The collaborative visit programme has shifted from “doing to” to “doing with” and new initiatives such as the MDT and Hand Hygiene Improvement projects have been built using a collaborative approach. There have been improvements in encouraging and listening to feedback. An example of this has been in working together to address the needs of care home staff training, which resulted in the development of the recently completed 6-month training programme. The newly appointed Practice Development Educator for care homes is currently engaging with staff to collaboratively develop the next programme based on the care homes identified needs and the HSCP’s priorities. This includes enabling routes for care home staff to access planned NHS training has begun. Multi-Disciplinary Team (MDT) We work collaboratively with the care home staff, assisting with care planning and introducing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). The team have now joined up with Social Work to attend the residents’ 4–6-week review in the care home. Prevention The application of Infection Prevention Control (IPC) standards in care homes is well supported. The dedicated IPC team is available for advice, education and guidance. The MDT approach will support the contents of care plans to be reflective of the individuals care needs taking into account health needs, which is often a role that carers complete. The support from CHL will therefore ensure the best start for residents entering care homes ensuring a more comprehensive proactive, preventative approach.
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13 Anticipatory and Future Care Planning There is a need to raise awareness of ACP’s and to provide education and training for care home staff. A training package is currently being developed by palliative care consultants and the Care Home Practice Development Educator Palliative and End of Life Care We promote various tools to aid residents’ palliative and end of life care needs and provide training to support their use. Urgent and Emergency Care The Flow Navigation Centre (FNC) appropriately refer care home residents to Hospital at Home from 09:00hrs- 17:00hrs. This approach has successfully supported care home residents to remain in the care homes. These hours will be extended over the next few months. 6. Hospital @ Home During 2023, a rapid review of the Hospital at Home service was undertaken, taking into account the immediate plans for expansion and the future vision for Hospital at Home in line with Scotland’s national strategy Horizon 1 (complete) • Extended operating hours to include evening and weekend working • Enhanced interfaces between community nursing, hospital based specialities and more understanding of capabilities across the system. Increased reporting of agreed KPIs • Increased professional to professional advice via consultant connect • Captured learning from Heart Failure Test of Change to inform speciality developments across the service • Explored Flow Navigation Centre being the single point of access for escalation and deescalation Horizon 2 (complete) • Refocused service to admission avoidance • Clearly defined step down criteria for complex cases
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14 • Move from medical delivered model to a medical oversight model • Rapid access to diagnostics • Developed and implemented recommendations from Heart Failure learning Horizon 3 – to be implemented by March 2025 • Finalise workforce model for service • Connect Hospital at Home to locality teams (urgent response and nursing) • Agree model for multiple Responsible Medical Officers when the service expands into other specialties • Clarify system wide governance arrangements • Ensure a de-escalation and escalation framework is in place • ANPs undertaking differential diagnosis 7. Home Assessment Team (HAT) The Home Assessment Teams are operational in all localities and are fully embedded within the enabling approaches developed in each locality. Service Model • Standard Operating Procedure agreed and in place. • Workshops held to map pathways, review and agree pan-Lanarkshire referral criteria with all key stakeholders including transfers of care into reablement, mainstream/longer term home support and integrated rehabilitation services. • HAT staff accommodation secured in university hospitals and community. • Induction programme established. Data and measurement • Data spreadsheet developed to record activity and enable monitoring of performance and outcomes. This continues to be revised according to activity and developments. Recruitment
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15 • Recruitment to HAT ongoing to build capacity across all localities. The pressures within the system regarding workforce are widely acknowledged and adjustments continue to be made to skill-mix. • Several recruitment campaigns have been progressed across health and social care to recruit across the team including Home Support, Physiotherapy and Occupational Therapy staff. • It is the intention for existing staff to be able to work flexibly across sectors as required to meet demands. • Interim operational management of HAT has been delegated to two Locality Social Work Managers, aligned to the 2 hospital sites of University Hospitals Monklands and Wishaw, and an NHS Service Manager, working closely with the discharge arrangements and the hospital social work teams. This will be rolled out across the six localities. • Strategic management is also undergoing a review to ensure integration into the new GIRFE/Enabling Approach arrangements. As HAT has developed, further synergies have been identified with other key programmes of work to improve our prevention and early intervention response. This includes Getting It Right for Everyone (GIRFE), the Frailty Strategy, Home Support Refresh, the Whole System Enabling approach and the Operation FLOW Optimal Discharge Planning Target Operating Model. The interface with other parts of a person’s journey is critical. Whilst some individuals will not require any statutory support, there will be those who would benefit from further intervention. Therefore, while we ensure FLOW through the acute hospital sites, this is also required within community settings and timely access to reablement, and rehabilitation will be critical to enable people to maximise their potential and ensure that they receive the support that is right for them. Weekly meetings have been established between relevant staff in HAT, Home Support, Reablement and Integrated Rehabilitation Teams to facilitate effective communication regarding individual service users and reablement activity and subsequent goal setting supported by a standard operating procedure. Taking a Whole System Enabling Approach, each locality is developing a multi-disciplinary enabling approach to ensure an effective and timely response that taps into community resources, where appropriate, through our recently appointed third sector community connectors.
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16 8. Self Directed Support Transformation A learning and development plan is in place to support new and existing practitioners, team leaders and seniors, managers and wider stakeholders. Practitioners, people who have support arrangement in place, family carers, independent sector providers and third and voluntary sector providers are also actively involved in the delivery of more formal training as well as in the ongoing refresh of the plan Work is ongoing with colleagues involved in the delivery of both local authority and independent sector care at home services to increase choice and control through individualising arrangements and planning with people to meet changing needs flexibly and responsively, understanding the focus on frailty. In keeping with a place-based approach to empowering localities and facilitating decision making closest to the person, changes to the authorisation of individual budgets within an enabling approach to localities has been introduced. This approach has increased the speed of decision making, empowered practitioners and leaders, and increased the creativity and flexibility that underpins self directed support. 9. Community Alarm Service The plan for North Lanarkshire Council’s community alarm service is to transition to a new digital service, this will ensure that the Alarm Receiving Centre (ARC) is fully digitised and will meet the digital requirements of our service while minimising the risks to analogue failures as the decommissioning of these old analogue lines progress. This will allow the Partnership to adopt a new Digital Solution that will meet future requirements and can be customised to our specific operational requirements. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. At the time of writing several local authorities have successfully transitioned over to the new digital ARC that will be supported by Chubb and Sky Response. The transition to digital has required the service to review all alarm devices that are in place within homes in the community and sheltered house residences and replace these current analogue devices with digital ready alarm devices. There will also be a requirement for digitally enabled peripherals such as falls detectors, door contacts etc, to be thoroughly tested to ensure that they are compatible with the new digital
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17 alarm receiving centre and alarm device. The ability to connect existing interconnected fire/smoke detectors via the digital alarm is currently not available. The Scottish Government are working with manufacturers on solutions to connect these devices to remove the need for multiple detectors to be in the same room. 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. The service also issued a questionnaire seeking service users feedback on the Community Alarm service, 124 questionnaires were returned. The findings of the questionnaire were that service users were satisfied with the service provided and that staff were helpful, polite and treated people with dignity and respect. The service recently held an awareness day for Health and Social Care staff, stakeholders and third sector organisations over a 2-day period to provide more information and insight into the Community Alarm Service and how the service operates and functions. Several focus groups were held with community alarm staff over a number of weeks in late 2023, each focus group was provided with an open platform to share their feedback, views, knowledge, and insight into the community alarm service. The feedback was grouped into themes and further analysed to identify several important issues. Overall staff were incredibly positive about their roles/responsibilities and proud of the impact that their service had on individuals needing support from the community alarm service. The service recognises that the staffing resource has not been reviewed within the community alarm service since its inception, however given the service growth as well as prioritising the move from an analogue to digital solution as well as the introduction of new digital technology it is evident that a review of the staffing structure is required. 10. Community Nursing Review The new Vision & Model for Community Nursing was launched in October 2024. Caseload Complexity
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18 New complexity descriptors have been developed using a collaborative approach with the community nursing teams. All staff have received training to ensure a consistent approach to measuring complexity of patients within caseloads. These are now used on a daily basis to describe workload demand and support safe staffing. An audit tool was created to review the overall complexity of caseloads which will be used to aid the fair distribution caseloads and support a review of skill mix within the community nursing teams. Practice Assessors have been allocated to each locality to support the teams. They are working with District Nurses and trainee District Nurses to support improvements in caseload management Care Management & Referral Criteria A collaborative approach to managing patients with complex care needs is being currently taken with nurses working as part of a wider multidisciplinary team in localities. This approach ensures that everyone works together and can quickly respond to complex often unscheduled demand for services. In line with our strategy for preventing and managing frailty, frailty scoring is being introduced to community nursing assessments. Identifying frailty at an early stage will enable staff to plan and coordinate care, support wellbeing and optimise independence. We are also reviewing future care planning and will work in conjunction with GP’s to ensure we proactively plan and coordinate care using realistic medicine principals to achieve the aims of Healthy Ageing and Living Our Best Lives in Lanarkshire. A Community Nursing Referral Centre (CNRC) was established in February 2024 and now takes calls for Wishaw, Motherwell, Airdrie and Bellshill. The other two localities are currently recruiting call handling staff to join the CNRC and hope to be in all localities by November 2024. Roles, Responsibilities and Training An internal District Nursing trainee pathway was developed and has been successfully supporting the training and registration of staff. A review of this training pathway took place to ensure it reflects the new Nursing Midwifery Allied Health Professional (NMAHP) Competency Framework and Queens Nurse Institute Scotland (QNIS) standards. Concerns around a gap in leadership is being addressed by encouraging Team Leaders to attend Leadership and Quality Improvement courses.
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19 11. Alcohol & Drugs Partnership Strategy A programme of extensive and competitive commissioning activities took place via the North Lanarkshire Alcohol & Drugs Partnership (ADP) in 2023, with five key services tendered to support the delivery of the National Mission Priorities, including: • Early intervention, prevention and education – awarded to Landed • Individual Placement Support – awarded to SAMH • Adult and Whole Family Support service – awarded to Phoenix Futures • Recovery Community Development – awarded to Recovery Scotland • Crisis, overdose response and assertive outreach service – awarded to Turning Point Scotland North Lanarkshire ADP Board made the decision to commit to three year funding for all new and continuing services from 2023 onwards. This recognised feedback from stakeholders citing challenges faced with previous year on year funding arrangements that impacted on staff recruitment and retention, longer term planning and service stability. A number of test of change projects have been funded/initiated via NLADP, including: • Arrest referral pathways via Police custody centres • Contextual safeguarding for children and young people • Alcohol and Drug Solutions Courts, and; • Extended Youth Work Provision and Diversionary Activities via Community Learning and Development (CL&D). Drug Death Prevention Work to refine drug death prevention efforts in 2023 included a full review of the Drugs Death Prevention Group (DDPG) operational workstreams with a full membership update and work plan now in place. Reducing Alcohol Harms The Reducing Alcohol Harms group has been meeting for the last 18 months and is a multi-agency group with broad representation from the ADP partners. There is a detailed work-plan linked to the RAHG that cuts across whole population measures and targeted local interventions from Licensing, Alcohol Brief Interventions, Health Needs Assessment, education and training and work to target higher risk groups.
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20 Residential Rehabilitation An extensive programme of work was led by the ADP support team and the Scottish Recovery Consortium to offer training and support to staff to ensure residential rehab is available to anyone who wishes to be assessed. Residential rehab is now offered more consistently as part of the treatment and care offer in North Lanarkshire Whole Family support NLADP continues to invest in family support linked to the decisions reached via the Whole Family Approach sub-group, led by the national holistic framework, local evidence of need and linked to ADP strategic objectives. MAT Standards 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. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. 12. Prisoner Healthcare The Adult Health Services Unit (AHSU), in collaboration with Scottish Prison Service (SPS), and on-site staff, successfully undertook a Service Model Review to implement an improved Prisoner Healthcare service to the population of HMP Shotts. This included stabilised staffing models, improved staff training plans, and improved patient centred care for all patients, in particular those with identified existing health needs. Originally commissioned in January 2022, the review covered the following 8 standards: • Standard 1: Effective Management of Resources & Staff Governance • Standard 2 Primary Care & chronic disease Management • Standard 3: Mental Health & Addictions
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21 • Standard 4: Medicines Management • Standard 5: Infection Prevention and Control • Standard 6: Person Centred Health and Care • Standard 7: End of Life Care • Standard 8 : Deteriorating Patient The action plan produced from the review made 31 recommendations, all of which are now complete and signed off. A scheduled Healthcare Improvement Scotland inspection took place in May 2022. Several recommendation sfor improvement were categorised under Standard 9: Health and Wellbeing: The prison takes all reasonable steps to ensure the health and wellbeing of all prisoners. The AHSU management team worked well in collaboration with the prisoner healthcare team, and SPS to ensure these actions were addressed in a timeously manner. The team met with HIS a further twice between the initial inspection and August 2023 to review the progress made. In September 2023, HIS officially signed off the plan as complete with no further review required until the scheduled inspection in 2027. Commendations were made at the efforts made to address the recruitment, retention, and overall staffing issue in the prison. Currently, 20 of the 22 recommendations are 100% complete, with the remaining two actions ongoing as part of a pharmacy review. 13. Mental Health & Wellbeing Strategy The success of the Lanarkshire’s Mental Health and Wellbeing Strategy, 2019-2024 is the result of co- production, ongoing engagement, robust planning, trusted collaboration and joint implementation of a system-wide approach to mental health and wellbeing in Lanarkshire, with all partners considered equal. The key achievements of the 2019-24 Strategy have been reported to the Board in a separate report. 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, agreed with the proposal that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire
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22 Delivery Plan. The Lanarkshire delivery plan will be aligned to the strategic actions set out in the national Delivery Plan, and link clearly to local strategies and plans including both Health and Social Care Partnership Strategic Commissioning Plans, NHS Lanarkshire’s Our Health Together strategy, Children’s Services Plans, the Plan for North Lanarkshire Community Plans and Local Outcome Improvement Plans. Since then, work has been undertaken to: • Establish a sustainability plan to identify any outstanding priorities and actions from 2019-2024 strategy to be carried forward into the new Lanarkshire Delivery Plan; • Assemble a final report on the work carried out over the 2019-2024 Mental Health and Wellbeing Strategy, a Review report of the MHWS 2019-2024 for sharing and publication; • Carry out 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; • Engage with stakeholders both at Lanarkshire-wide, including a self-assessment workshop with all stakeholders, presentations and discussion at Lanarkshire Links Quarterly meetings and locality level, via the Community Boards in North Lanarkshire, to identify any further priorities and actions for the Lanarkshire Delivery Plan; • Prepare a draft Lanarkshire MHW Delivery Plan for adoption 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; • Propose future governance and leadership for the implementation of the MHW Delivery Plan – set a draft plan and Terms of Reference for Lanarkshire MHW Delivery Board • Stand down current Mental Health and Wellbeing Strategy Board, Executive Group and associated workstreams and close the 2019-2024 programme of work; 14. Speech & Language Therapy The Speech and Language Service Improvement Group was established in 2023 and undertook a scoping exercise with a view to developing a new service model. As a result, areas of priority were agreed, and work streams established: Waiting List This work is progressing well in a testing phase following • review and standardisation of the processes that support patient pathway and inform digital plan.
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23 • Agreeing, refining and developing core clinical offerings at Universal, Targeted and Specialist level. • Ensuring workforce have the confidence, resources and knowledge to deliver the core service model Digital Previously, the service had no digital footprint. Trakcare has been implemented since September 2024 and the service is at an early stage of being able to gather evidence from the robust data it can provide. However, early indicators are that this will provide necessary evidence to better understand recording of interventions, where barriers or bottlenecks can occur in pathway. Communications and Engagement Colleagues within the service had already well-established social media platforms and information and education via YouTube that was used to support children and young people and their parents and carers. Support has been provided to extend SLT website to include adult services. This will coordinate all SLT information to one defined space. Members of group are also contributing to development of an app that will support children and families who are supported by local health visitor colleagues. HR and Workforce A review of all posts across the service has been undertaken. Focus of future work is on continued development of relationship with higher education. This will support opportunities for students in training as well as provide development for opportunities for career development of both unregistered and registered roles. Administration and Accommodation This work is at an early stage and will be appropriately informed by evidence now available due to implementation of Trakcare. 15. CAMHS There have been 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery:
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24 Neurodevelopmental Service All neurodevelopmental requests for assistance are now channelled via the established Neurodevelopmental Service. This combined three previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. This is a highly skilled workforce and maximum efficiencies within resource are assured. Time limited commission of an external provider has provided additional capacity that facilitated assessments of young people before they graduated to adult service referral routes. Demand for assessment continues to exceed capacity. This has been highlighted nationally and is common across all health board areas. It is advised that national work will influence next steps with neurodevelopmental services. Choices & Partnership Approach (CAPA) This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. HR & Workforce A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. Communication and Engagement An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. eHealth Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. Capital/Strategic Planning Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same.
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25 The objectives initially set by Programme Board have been realised and have now progressed to a stage of sustainability of performance and quality assurance that is aligned with national specification. The performance trajectory is positive. 73.91% against an RTT of 90% was delivered in July 2024. Objective analysis by Public Health Scotland colleagues has assured that full delivery of 90% RTT should be realised by October 2024. This is reliant on continuance of funding aligned to a workforce that is responsible for delivery of trajectory. Additional modelling is taking place to provide assurance of patient review list care provision. Whilst not a government recorded or formally reported target, it is a good indicator of patient experience and shifts balance of care from responsive crisis management to planned intervention. Additionally, we continue to work with West of Scotland colleagues to deliver a standard of care provision capable of managing care locally and consistently to facilitate equity with other health board areas. This has included expansion of our unscheduled CAMHS (UCAMHS) model. It has combined the expertise of CAMHS Duty Team, Intensive Treatment Team and Nurse Team. Hours of service delivery will be further expanded in October. This additional capacity and expertise will support avoidance of admission care planning, support safe hospital discharge and manage risk appropriate to environment. The UCAMHS response model is available to all children and young people on both CAMHS and NDS lists who experience deterioration in mental health whilst waiting to be seen or awaiting specific treatment. This service is also open, by referral, to any child or young person previously unknown who has presented with an acute deterioration in mental health with aligned escalation of risk 16. Paediatrics Review In order to deliver the Paediatrics Review programme, five working groups were established: • Communications and Engagement • Accommodation • Transition and Interfaces • eHealth (now Digital) • HR and Workforce • Regional and National Links
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26 All are at various stages of progress and have been prioritised according to acuity of clinical challenges that have arisen. Additionally, a sixth group has been established to ensure the modernisation plan is aligned with current financial challenges and potential for saving realisation as well as transformational change. A 3 Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: Horizon 1 • Nursing Care Assurance • Review of Continence Services Horizon 1 work is progressing well. The nursing care assurance work has been led by the Associate Director of Nursing and been supported by NHS Lanarkshire Quality Improvement Team. The standards agreed have been inclusive of contributions made by nurse colleagues who work within paediatric in- patient environment and of community based nurses who support specialist care for children within a clinic, their home and/or school environment(s). The Review of Continence Service has been led by Clinical Lead for Community Paediatrics. This has been more challenging to progress due to clinical demands on colleagues involved, changes within continence aligned workforce and assurance work identified that required address prior to full commencement of work. Despite these challenges, a literature review has been undertaken and review of current service model undertaken with a plan to test new model soon. We expect further projects to be undertaken subject to availability of clinical staff. Further examples of work already being considered is the development of a supported palliative care pathway and review of current acute pharmacy colleague support and its interface with primary care. Prioritisation of work to be undertaken in future will be informed by release of capacity of colleagues who are completing initial Horizon 1 work and colleagues who can be released from clinical activity. Horizon 2 • Sustainability of medical rota
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27 This Horizon 2 focus of work emerged quickly as a clinical risk due to unsustainability of Tier 1 and 2 medical rotas that require to be in place to ensure safe function of in-patient care. Tier 1 is junior trainee doctors who provide the foundation of medical intervention within ward. Tier 2 trainees are higher trainee doctors who are working towards becoming a consultant within paediatrics. This is an important trainee rota to fill as it provides a pathway for interested trainees to return in the future as consultants. If numbers are not coming through and/or they do 5 not have a good trainee experience whilst with us, it will have a negative impact on long term recruitment of these specialist colleagues to Lanarkshire. Tier 3 is our consultant level rota. All rotas are inextricably linked and cannot be separated without negative impact on wider system, and at times on individuals. This fragility of rota is due to a culmination of factors which include less availability of trainees being provided by deanery and increasing numbers of trainees who want to work less than full time. This has resulted at times, in increased pressures resulting in use of locums and of requests generated to consultants to act down into senior trainee roles. This negatively impacts on planned community care assessment and review and places an additional burden of stress on an already tired workforce. Due to level of risk identified, additional support was approved by Core management team. Additionally, our Medical Director continues to have dialogue with deanery to assure that we are receiving an equitable offer of trainees. Horizon 3 • New clinical model Clinical capacity will need to be realised from completion of ongoing Horizon work to facilitate taking forward this larger piece of work. Meantime, informal discussions have commenced between nursing and medical colleagues with their respective professional leads. Health and well-being of colleagues during times of significant change have been recognised as a potential barrier and risk to further progression of work. Organisational development colleagues are supporting professional leadership and operational management to appropriately support staff throughout and beyond this programme of work by involving them in “stay conversations” which can also contribute and inform to modernisation plans.
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28 The pace of transformational change has been slowed by limited capacity of clinicians to commit time to service improvement work. This is due to clinical demand, which can be variable throughout seasons of year. This will be factored into plans for spring and summer 2025 that will aim to progress work towards delivery of new clinical model, Horizon 3. 17. Community Solutions The Community Solutions Strategy and Investment Plan 2022-25 was approved in 2022 and continues to deliver a range of programmes activities within the third sector, supported by a range of programme evaluation and accountability arrangements. During 2023/24, VANL managed the provision of funding awards to Community and Voluntary Sector (CVS) organisations to deliver services to local people on a range of priority issues: • Anticipatory Care Support • Befriending Support • Carer Breather Fund - Phase Two • Children, Young People and Families Mental Health and Wellbeing Fund - Phase Four • Community Mental Health and Wellbeing Fund - Phase Two • Community Transport • Hospital Discharge Support A future review of funding arrangements will explore the following areas and develop updated investment proposals, which will improve health, wellbeing, and inclusion, whilst reducing demand on public services: • Our Community Connectors’ pilot scheme • Continuation of our effective support for people discharged from hospital provided by the CVS. • Support for unpaid carers – especially short breaks from caring • Strengthening CVS support for physical activity given the significant benefits to health that can be achieved through physical activity and the potential for the CVS to provide further support. • Strengthening volunteer driver support for people attending health and social care appointments, to support access and inclusion more cost-effectively.
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29 • Review of anticipatory care and befriending will be supported through a separate complementary process Achievements to note from 2023 and 2024 include: The focal point of the Improving Lives Initiative is a pilot of Community Connectors using the “three conversations” approach to assist people in crisis to help them find support from community and voluntary groups and, if appropriate, refer them to sources of support from the public sector. This includes people with a diagnosis of cancer. Ten connector posts are funded for two years and are employed by North Lanarkshire Disability Forum, which has considerable relevant experience having previously employed advisors to assist people with self-directed support for over six years with national funding. Capacity Building • Carers’ capacity building – North Lanarkshire Carers Together supporting empowerment and engagement of carers • Community & Voluntary Sector Capacity Building – VANL supporting the provision of specialist guidance to CVS organisations that assist children, young people and families. • Volunteering capacity building – VANL continue to promote volunteering within health and social care support roles and liaise with volunteer-involving organisations to improve their volunteer management and support 18. Digital Technology & Systems The digital system transformation activity taking place across the partnership is considerable and the key projects such as Mosaic (the new social work case management system) and Dynamic Scheduling Tool are critical phases and will go Live before the end of this financial 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 product goes live and to ensure the benefits outlined above are realised.
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30 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. As part of the review of the oversight groups for the programme of work, a new Digital & Technology Group has been established for the partnership and will be tasked with pursuing a range of programmes and projects which will introduce and embed a range of new digital systems, technology and equipment across a range of health and care settings. An important part of this work will be ensuring appropriate alignment with the digital developments already in progress within the other programmes of work highlighted in the report, e.g. CAMHS, Mental Health & Wellbeing Delivery Plan, etc. 19. Engagement & Participation Strategy Over recent months a focused effort has been directed towards refreshing the Engagement & Participation Strategy that will serve as the foundation across all areas of our work. The final version of the Engagement & Participation Strategy 2024-27 was approved in May 2024. In the development of the Strategy, we actively engaged with stakeholders; representatives of community- based organisations, supported people, carers, and staff teams. Learning from these sessions has highlighted what is considered good engagement and participation and provided confirmation that the refreshed strategy should: • Be short and user friendly. • Be an overarching strategy that can guide communication and action planning across all areas of services and supports. • Build from the current strategy, including what we have learned and what people have told us. There has been good progress to increase the resource and capacity across community-based organisations to strengthen the voice of supported people, including those harder to reach e.g. BAME, LGBTQI+ and those in more rural communities.
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31 We recognise the importance in ensuring that engagement and participation is meaningful and not tokenistic, so the principles of engagement and participation are now included in the Staff Induction programme, both as written information and as a direct input to programme for new social work and social care practitioners. A wide range of stakeholders have been actively engaged in the development of the Strategy through consultation and direct involvement. Promotion to implement the Strategy will be a shared responsibility and will include awareness raising and the development of practical tools to support: • An evidence base on how people experience services and how their experience shapes and improves future development of services and supports. • The voice of supported people in our communities • Increased capacity for early intervention and prevention. • Two-way communication and a strengthened feedback loop back to decision makers • Increased feedback and the role of lived experience in improvement of services and supports. • Increased connections with supported people and communities that are harder to engage with. • Increased awareness about what is important to supported people and their communities. The refresh of our Locality Planning Group arrangements and alignment with the Locality Planning Teams and Community Boards is underway. Once finalised, this will provide sector, locality, and thematic forums, which can be influenced and shaped through engagement and participation with our Communities, Carers and Supported People. 20. Academic Partnerships 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
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32 to develop this approach 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. There is a mutual desire to explore many more projects and areas of innovation that often require short notice decision making associated with modest sums of fixed term investments, though there has also been significant external funding identified over the year. More recently, the University of Strathclyde has signed Memorandums of Understanding with both Lanarkshire councils – consolidating the formal, multi-agency collaboration and continuing to develop the relationships and opportunities for the HSCP and local authorities. 21. Care Academy The Care Academy is a collaborative initiative between NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. The Academy is authorised to work with partners such as local councils, education departments, colleges, universities, the independent sector and third-sector organisations to attract and recruit staff to the health and social care workforce. Four workstreams have been established: Workstream 1 – Attraction, recruitment, retention and wellbeing Developing recruitment strategies to attract prospective candidates to the sector. Engaging and focusing on employee safety, well-being motivation to enhance employee retention. Workstream 2 – Pathways to care for young people Strengthening the reach and impact into the health and social care sector through a vocational education model, aiming to grow a future talent pipeline.
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33 Workstream 3 – Adult pathways to care Improving prospects for working-age adults entering the health and social care sector, addressing poverty, and inequality, attracting passive candidates, and facilitating career change opportunities Workstream 4 – Funding and procurement Continually review and assess current and upcoming funding streams and identify potential gaps and opportunities. Explore the potential of community benefits opportunities. It was agreed at the most recent Board meeting to put this workstream on hold until the others are all well established. Incomplete and unlikely to be delivered against agreed timescales – remedial action required. Incomplete and but within acceptable thresholds. Complete or on-track for completion against agreed timescales
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1 REPORT Item No: 8 SUBJECT: Progress Update: Development and Delivery of Chryston Community Health Clinic TO: Integration Joint Board Lead Officer for Report: Maggs Thomson, Head of Health Author(s) of Report Maggs Thomson, Head of Health Contact details for Author(s) of Report Maggs.thomson@lanarkshire.scot.nhs.uk DATE: 4th December 2024 1. PURPOSE OF REPORT This paper is coming to the IJB to provide an update on the development and delivery of Chryston Community Health Clinic For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed Prepared by Maggs Thomson, Head of Health in consultation with both Chryston Community Health Clinic Mobilisation Group and the Northern Corridor Service Repatriation Group. 3. RECOMMENDATIONS The IJB is asked to: 1) Note the completion of the capital programme.
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2 2) Note the ongoing progress with the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and their associated Health and Social Care Partnerships (HSCP’s) 3) Note the current identified financial gap and reflect on work to date to progress towards final conclusion. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. 5.1.2 This boundary change aimed to facilitate the development of integrated services across all areas of Scotland. The change resulted in the Northern Corridor (covering the areas of Moodiesburn, Muirhead, Chryston, Stepps, Gartcosh and Auchinloch) being transferred into the NHS Lanarkshire (NHSL) boundary. 5.1.3 This geographical area has one health facility located within Muirhead (Muirhead Clinic), which is small and at the time of transfer, dilapidated and not fit for function. The facility required backlog maintenance and asbestos work to be undertaken which was completed. 5.1.4 Despite the upgrade and refurbishment which improved compliance with healthcare standards, the facility could still not support the provision of all services for the local population. 5.1.5 Consideration was given to providing a new build facility on the existing site, however the footprint and parking limitations would not allow for the size of centre required to meet the clinical ask. 5.1.6 Due to the limited capacity of this facility, NHSL was unable to fully repatriate services from NHSGG&C, resulting in northern corridor residents having to travel significant distances across Glasgow to access some health services, with teams and clinics based in a range of areas including Shettleston, Kirkintilloch, Easterhouse and Bridgeton. 5.1.7 The services identified below continue to be delivered via a Service Level Agreement (SLA) with NHSGG&C and the associated HSCP’s. • Community Diabetic Service Yes No N/A
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3 • Community Mental Health Teams • Dietetics • Physiotherapy • Sexual and Reproductive Health Services • Substance Misuse 5.1.8 An opportunity emerged with the development of North Lanarkshire Council’s (NLC) ‘The Plan for North Lanarkshire’ which set out an ambitious estates strategy that looked to develop Community Hubs / Campuses. Further to consideration of this approach, NHSL working in partnership with NLC, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. 5.1.9 There was extensive engagement with all stakeholders including NLC and NHSL project teams which resulted in the optimum design being developed to the satisfaction of all the stakeholders. The agreed design went through wide- ranging routes of engagement with key stakeholders including NHSL staff, H&SCP staff, teachers, support staff and pupils at Chryston Primary School. This process also included joint engagement with representatives of the Parent Council and elected members, culminating in an online public consultation to inform residents of the design outcome. 5.1.10 The business case for the Development of Chryston Community Health Clinic was considered by the NHSL Board on December 2021 at a cost of £3.65M and signed off with all legal agreements completed in January 2022. 5.1.11 The build programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. 5.1.12 In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. 5.1.13 A Service Level Agreement (SLA) continues to be in place and as of 31st of July 2024 a notice of cessation is now formally lodged with NHSGG&C. This is a changed position since previous time of reporting. This has exposed UH&SCNL to a £52.5k financial gap if services where to be delivered with the known funded establishment and skill mix of the NHS Lanarkshire service model. 5.1.14 The financial gap appears to be an improved position since last report however this is with utilisation of the £212k in reserves for contingency of double running costs. This will need to be factored into any mobilisation processes in the coming months.
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4 Update 5.2 Chryston Community Health Clinic 5.2.1 The build programme experienced a delay and handover completed to NLC in late September 2023. To support school term and safe transfer of equipment it was agreed to open the school for business on 25th October 2023 following the mid-term break. 5.2.2 UH&SCNL mobilisation group progressed their operational plan in line with the school timeline and worked towards mid-November transfer of Muirhead clinic. Unfortunately, due to some critical snagging and IT challenges this further delayed to December 2023 with the first patient being received on the 18th. 5.2.3 All Muirhead Clinic services have transferred to Chryston Community Health Clinic. 5.2.4 Midwifery and CAMHS have also been supported to provide services in the new health clinic 5.2.5 Chryston Community Health Clinic and Chryston Primary School was officially opened on 30th May 2024 5.2.6 The intention was to decommission Muirhead Clinic, however NHSL has offered this accommodation to another service and the site responsibility transferred to SLUH&SCP at the end of January 2024. 5.3 Repatriation of Services 5.3.1 This process has proved challenging due initially to build delays and agreements with NHSGG&C to repatriate services from 1st April 2024. 5.3.2 All new Physiotherapy referrals have been allocated to NHSL since July 2024 with NHSGG&C continuing to see patients from the waiting list. 5.3.3 At time of reporting Dietetics was moving over to be delivered in Chryston. 5.3.4 Since time of last report, the notice process has been in dispute with NHSGG&C and there is now formal agreement that the SLA will terminate on 31st January 2025. 5.3.5 Finance has now been agreed and recruitment is progressing to repatriate all services identified above.
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5 6. CONCLUSIONS 6.1 In conclusion, this paper confirms that Chryston Community Health Clinic was delivered for service provision from 18th December 2023. 6.2 All services have transferred from Muirhead Clinic and are being delivered in Chryston Community Health Clinic with the addition of Midwifery and CAMHS 6.3 Muirhead Clinic will not be decommissioned and site responsibility was handed over the SLUH&SCP on 31st January 2024. 6.4 The IJB has already approved additional funding (£212K) to support double running costs for one quarter to allow safe transition of repatriated services. This position has now changed due to movement in SLA cessation date and this funding will be required to support the current positon with an additional gap of £52.5k. 7. IMPLICATIONS Noted within the content of the paper 7.1 NATIONAL OUTCOMES The repatriation of services will support improvements in a range of service performance measures, particularly around mental health and substance misuse. 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL Yes No N/A At this time the £212k non-recurring allocation will still be required to support the extended notice period and the expectation of a further £52.5k required. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks around the repatriation of services, including the transfer of complex treatment packages, ongoing recruitment challenges and the funding gap already identified and will be built into the operational risk register. 7.5 PEOPLE A significant programme of engagement has taken place as part of the development of the business case.
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6 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A Developed as part of the business case. 8. BACKGROUND PAPERS NHS Lanarkshire Chryston Community Health Clinic Business Case https://www.nhslanarkshire.scot.nhs.uk/download/2021-december-20-board- papers/ Maggs Thomson Head of Health
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7
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1 REPORT Item No: 9 SUBJECT: Whole System Winter Planning 2024/25 TO: Integration Joint Board Committee (IJB) Lead Officer for Report: Claire Rae, Chief Officer, North HSCP Author(s) of Report Report content was developed by Craig Cunningham, Head of Commissioning and Performance, South Lanarkshire Health and Social Care Partnership Refreshed for North Lanarkshire IJB by Morag Dendy, Head of Planning, Performance and Quality Assurance Contact Details for Author(s) of the Report Craig.cunningham@lanarkshire.scot.nhs.uk DendyM@northlan.gov.uk DATE: 04 December 2024 1. PURPOSE OF REPORT This paper is coming to the IJB to provide an update on and confirm support for the planning arrangements being put in place to ensure Health and Social Care Services are prepared as reasonably as they can be for the coming winter months with particular recognition of the uncertainties and potential impacts that still remain relating to inclement weather, influenza and other respiratory illnesses, norovirus and other winter viruses, financial pressures, cost of living issues and other concurrent risks against the backdrop of major pre-existing system-wide pressures. For approval ☐ For endorsement ☐ To note ☒
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2 2. ROUTE TO THE BOARD This paper has been prepared by Detail has been reviewed by Prepared By: The multi- agency, multi- disciplinary winter planning group. ☐ Reviewed By: The North Lanarkshire HSCP Strategic Leadership Team. ☒ Endorsed By: ☐ 3. Executive Summary The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). The four winter planning priorities include: • Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. • Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. • Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. • Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting Scotland’s unpaid carers. A range of implementations and reviews have taken place to ensure the right conditions for the success of the winter plan. Preparation have included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation to support continuous patient flow and care.
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3 4. RECOMMENDATIONS 4.1 The IJB is asked to: • Note the plans in place to mitigate the impact of winter 5. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 6. BACKGROUND/SUMMARY OF KEY ISSUES 6.1 Background 6.1.1 Annual whole system planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Lanarkshire Health and Social Care system, in common with that across Scotland, continues to face significant challenges. 6.1.2 Planning for Winter 2024/25 commenced in August 2024 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). 6.1.3 Given the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as, and should be understood to be, a dynamic plan and one that is highly likely to be subject to change over the coming months as it reacts to any emergent issues. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific exercise took place on 14 November 2024 to test system-wide planning. Additionally, work undertaken in previous years by NHS Lanarkshire to take account of the increasingly likely eventuality of several concurrent risks which may well align to create increased system pressure has also been utilised as part of the wider winter planning process. These risks include, inter alia, increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages across a number of sectors and grades across the Health and Social Care sector;
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4 public health impact of cost-of-living crisis/fuel costs and subsequent demand on health and care services; inclement weather and available finances. 6.2 National Guidance / Scottish Government Correspondence 6.2.1 National guidance was published on 24 September 2024 and is attached as Appendix 1. The guidance sets out the national expectations for those areas that local winter plans would be expected to address. 6.2.2 The four winter planning priorities outlined follow a journey through the health and social care system. 6.2.2.1 Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. 6.2.2.2 Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. 6.2.2.3 Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. 6.2.2.4 Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting Scotland’s unpaid carers. 6.2.3 Thereafter there was a request that a winter preparedness self-assessment be prepared which was also undertaken by the multi-agency group and duly submitted to Scottish Government by the due date of 16 October 2024. The self-assessment is attached as Appendix 2. 6.2.4 Some funding has been made available centrally in 2024/25 to support winter planning as well as some monies managed internally as part of the respective financial plans to anticipate winter pressures. Following discussion between the NHS Lanarkshire Director of Finance and the two Chief Financial Officers of the IJBs, funding to manage the impact of winter and ongoing pressures has been identified and further detail is set out at item 7 below. 6.3 Approach to Winter Planning 2024/25 6.3.1 Whilst the winter plan will be a Lanarkshire wide plan, it is structured in two main parts. This is to recognise the significant work underway as part of Operation Flow, which is aimed at maximising flow through acute hospitals and associated care pathways. Continuation and emphasis of aspects of this work will form the basis of the winter planning for acute hospital services. 6.3.2 All other aspects of the Lanarkshire wide winter plan, including the input of Flow Navigation Centre +, have been undertaken via the multi-sectorial/multi-agency winter planning group. Representation from acute services/Operation Flow/FNC+
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5 forms part of the wider group to ensure all necessary synergies are recognised and planning is appropriately integrated. 6.3.3 As well as the national guidance referred to at 3.4, there was also a debrief of the Lanarkshire winter plan for 2023/24 and that has also been considered as part of the planning for winter 2024/25. 6.4 Operation Flow: NHS Lanarkshire’s Whole System Unscheduled Improvement Plan Supporting Winter Planning 6.4.1 The key objective for Operation Flow remains that patient safety is enhanced, and staff wellbeing improved through a reduction in hospital occupancy and maintaining sustained improvement across all key performance metrics. This remains a commitment during the winter period. This will be achieved by: o Managing demand across the system o Maintaining a positive admission and discharge balance o Maximising outflow 6.4.2 Creating the right conditions for the success of the winter plan is essential. Consequently, preparation has included reviewing and finalising Target Operating Models (TOMs) and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation. System readiness is also underpinned by the delivery and implementation of the detail of the site and HSCP level action and improvement plans. 6.4.3 The specific actions agreed include: 6.4.3.1 Delivery of the Acute Sites Minors Improvement Plan to maintain sustained performance of 90% daily across the Flow Group 1. 6.4.3.2 Implementation of the Front Door TOM across all 3 Acute sites. This will ensure consistency across all Front Door processes and pathways and a reduction in unnecessary waits / delays for patients. The actions for the TOM implementation include: operationalisation of REACT to maximise streaming of patients to the right part of the system (including direction to other locations of care); scheduling of minors and ambulatory care patients; and appropriate referral to other hospital based specialties within the agreed timescales as outlined in the TOM. 6.4.3.3 Improving flow at the Front Doors is also dependant on maintaining a positive admission and discharge balance across the acute and non-acute bed base. Work continues to embed the NHS Lanarkshire flow foundation bundle which includes achieving ward beat, setting PDDs, maximising pre- noon discharges, x 3 times daily structured board rounds to support discharge planning and using criteria led discharge when a Senior Clinical Decision maker is not available. This improvement work has been further enhanced by the development of an Optimal Discharge Planning TOM that outlines which discharge planning pathway (1 – 4) a patient should be allocated to. This supports the ward staff to identify at an earlier stage if patients will require assessment from social work and social care teams to ensure their safe discharge. Significant work has been undertaken to raise
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6 awareness of the key principles of the TOM, however further training and education is required to support implementation. 6.4.3.4 Refresh of the Operation Flow Handbook – to provide further clarity across all disciplines, roles and responsibilities in relation to flow improvement across our system 6.4.3.5 Weekly review, using a ‘criteria to reside’ methodology for all patients not in delay with a LOS of 14 days plus, to determine the discharge planning actions required. 6.4.4 There will be continual oversight of the delivery and implementation of the actions through the Core Oversight Board and Executive Flow Oversight Board, alternating on a weekly basis, utilising all appropriate data as well as multiple daily reviews of system operating issues and actions being reviewed and revised as necessary. 6.5 Discharge Without Delay 6.5.1 Work continues in embedding the Discharge Without Delay programme and its related aspects, e.g. Planned Date of Discharge; consistent roll out of Home Assessment services North and South; increased numbers of people being supported to die at home via ‘pathway 4’ and further work with third sector providers. 6.5.2 These elements have also been incorporated into the Optimal Discharge Planning TOM. 6.5.3 Both of North and South Lanarkshire HSCPs have seen a reduction in the number of delayed discharges and in turn, there is an increase in the number of people who are being supported to be rehabilitated at home. This is often to a level of being able to manage their own care independently or, in some instances, with a reduced level of care than may have been originally assessed when in the hospital or first referred. 6.5.4 Both HSCPs also work closely with ‘Lanarkshire Carers’ as well as a range of voluntary organisations such that increased levels of support are available to carers to support them to be able to continue to undertake their caring roles. 6.6 Flow Navigation Centre + Plus (FNC+) 6.6.1 The work of the FNC will play a major role as part of the wider system response to managing winter pressures in 2024/25 and as part of the preparation for winter, the service has moved to larger accommodation in Kirklands Headquarters. This has allowed the expansion of the team and further collaboration with partners. 6.6.2 A dynamic multi-disciplinary team is now in place to support clinical decision making. The team consists of registered nursing staff, consultant geriatricians, emergency department consultants and SAS Advanced Nurse Practitioners (ANPs). This will ensure good coverage to manage all calls received and to thereafter be able to support patients to receive the right care as timely as possible with a positive experience. Plans are being developed to expand this team further to include pharmacists, Allied Health Professionals and palliative care services.
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7 6.6.3 This also includes maximising the use of systems such as ‘Consultant Connect’ and ‘Near Me’ such that as far as possible, there can be shared approaches agreed to the management of patients between NHS 24, SAS, primary and secondary care services. 6.6.4 A range of other supports is also available to manage specific patient groups, e.g. access to frailty services, expanded Hospital at Home (H@H) and Outpatient Antibiotic Therapy (OPAT). 6.6.5 The tendering process for virtual ward capacity has now been completed and plans are underway to introduce the capacity for up to 400 virtual beds, building on the success of the existing Frailty H@H service in Lanarkshire. This virtual system will enable electronic patient records to be accessed and shared by all involved in a patient’s care; update patient reported outcomes; wearable technology for continuous and intermittent monitoring; ability to engage via telephone; messaging and video calls directly with patients. 6.6.6 The initial focus of these beds will be to reduce occupancy across the acute sites, swiftly moving to admission avoidance across specialties such as respiratory, cardiology and gastroenterology. 6.7 Social Care Provider Sustainability 6.7.1 Independent providers of social care in Scotland, notably care homes and care at home providers, have highlighted the continued difficult operating environment in which they operate. There are increasing numbers of jobs in the ‘unqualified’ sector that means care jobs are not as attractive as they once were and accordingly, vacancy pressures continue to be a concern for several providers. 6.7.2 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider environment and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care workforce challenges) and statutory/legal parameters. On a Lanarkshire-wide basis, support for Care Homes is overseen by the pan- Lanarkshire Care Home Assurance and Support Board (CHASB). The Care Home Collaborative Group reports to the CHASB. Its purpose is to support quality improvements to enable the implementation of the “My Health, My Care, My Home- healthcare framework for adults living in Care Homes”. The Care Inspectorate participate in both of these meetings. 6.8 General Practice and Pharmacy opening 6.8.1 As in previous years, a local enhanced service to support general practices over the peak winter period has been agreed. This will see up to 74% of the GP practices in Lanarkshire opening at some stage over the Public Holidays on 26 December 2024 and 2 January 2025 as well as Saturday 28 December 2024 and thereafter on all the Saturdays during January 2025. The practices involved have been supported in communicating this to their respective patient lists. Similarly, the respective details will be shared with NHS 24, the Primary Care Out of Hours Service (PCOOH) and FNC+ such that as many people as possible can be diverted
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8 to their own GP practice during these typically very busy times for the wider ‘unscheduled care’ system. 6.8.2 There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, PCOOH Service, FNC+ and Emergency Departments where possible. 6.9 General Practice sustainability 6.9.1 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. 6.9.2 This was the subject of previous presentations to the NHS Lanarkshire Board which included describing the work ongoing to address capacity and demand, most notably, through the Primary Care Improvement Plan (PCIP). 6.9.3 As part of the regular reporting to Scottish Government on system pressures through the winter period, there are weekly updates on the numbers of practices that are unable to provide the full range of services that they would under ‘normal’ working conditions. 6.10 Primary Care Out of Hours Service (PCOOH) 6.10.1 The new clinical model operating in the Lanarkshire PCOOH service has assisted the Service to move to a more multi-disciplinary workforce and competency-based model of care, thereby reducing the number of occasions when alternative arrangements require to be introduced. 6.10.2 This multi-disciplinary team will be enhanced over the winter period to ensure additional staff are available to manage the increased demand that can be anticipated across the peak activity periods in winter. 6.11 Contingency Arrangements for Additional Deaths 6.11.1 Whilst there is no reason to assume that there will be above average mortality rates when compared to other winters, as part of the routine contingency planning required every winter, additional mortuary capacity will be available over the winter period. 6.11.2 As part of the Lanarkshire LRP arrangements, there is also scope to work with local undertakers to increase the frequency of funerals, burials and cremations should the need arise. 6.12 Flu and Covid 19 Vaccine Programme 6.12.1 Following final advice on the winter flu and Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), vaccines are being offered to the following groups: Flu and Covid vaccines The groups below are eligible for both COVID-19 and flu vaccines this winter:
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9 o Residents in care homes for older adults o Those aged 65+ o 6 months-64 at COVID clinical risk o Staff in care homes for older adults o Frontline health and social care workers o Pregnant women at any stage of pregnancy (first, second or third trimesters) Flu vaccine only The groups below are eligible for their flu vaccines this winter: o 18-64 years with an eligible flu-only clinical risk condition o Carers (including unpaid and young carers) o Non-frontline NHS workers o Household contacts of those with immunosuppression o Asylum seekers living in Home Office hotel or B&B accommodation o Those experiencing homelessness o Those experiencing substance misuse o All prisoners within the Scottish prison estate o Those living in long-stay residential care homes or other long stay care facilities 6.12.2 The programme is well advanced and this year is utilising a range of ‘pop-up’ clinics in health centres, clinics and various local community facilities; local pharmacies for the >75s; hospital outpatient departments at weekends and three ‘mass vaccination centres’ at Muirhead Clinic, Braidfute retail centre (Lanark) and Eddlewood Community Centre in Hamilton. (Venues previously available for mass vaccination centres have largely been given back to their original use and no longer available.) In addition to this, there is a range of services designed to offer vaccines to any who are in geographical areas or part of a thematic/ethnic group where take up of vaccine may be lower than for the general population. 6.13 Carers Support 6.13.1 Funding from the Carers (Scotland) Act 2016 allocation 2024/2025 has been used to enhance operational services for carers across both Partnerships. This included monies from this funding being directed to support ongoing work with carers, with a particular emphasis on the Self-Directed Support (SDS) agenda; and a strengthened internal capacity within the HSCPs to enable frontline staff in managing increasing demand with regards to supporting carers. This has seen a sharp increase in the number of carers being identified and therefore able to be signposted to the respective supports. 6.14 Staff Wellbeing 6.14.1 NHS Lanarkshire’s Health and Wellbeing Strategy will form an integral part of the system wide winter plan. The emphasis will be on providing a working environment in all areas across Health and Social Care where staff are able to enhance and
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10 maintain their personal and professional wellbeing and to reach their full potential in a culture that provides space, time and support for self-care. 6.14.2 The ‘Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded fully and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to manage the dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 6.14.3 Council employees can also access a range of materials to support health and wellbeing through the respective employee programmes. 6.15 Adverse Weather 6.15.1 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both North and South Lanarkshire Councils have policies in place in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 6.15.2 A series of actions is open to the organisations, individually and in collaboration, in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations. 7. CONCLUSIONS A range of implementations and reviews have taken place to ensure the right conditions for the success of the winter plan. Preparation have included finalising new care models and ensuring that the full workforce is engaged in all elements of the plan and understand their role in its implementation to support continuous patient flow and care. 8. IMPLICATIONS 8.1 Concurrent Resilience Planning and Risks 8.1.1 As highlighted above, there is a potential of concurrent risks aligning to have a significant impact on the wider health and social care services. 8.1.2 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. A ‘Winter Breach’ event was held on 14 November 2024, organised by the Lanarkshire
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11 LRP and focusing on the potential disruption that can occur in the winter period. 8.1.3 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. 8.2 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 ☒ 8.3 ASSOCIATED MEASURE(S) N/A 8.4 FINANCIAL • A number of funding sources are being utilised to cover the cost of the additional services being introduced to support enhanced staffing and services across the peak winter period. For the majority of services, they will operate from mid-December through to mid-March. • Funding sources include nationally provided Unscheduled Care monies and financial plans of the NHS Board and the two H&SCPs. • In total, it is anticipated that circa £4.0m will be utilised in funding all the additional services which will be provided and this can be funded from the available budgets.
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12 This paper has been reviewed by Finance: Yes ☒ No ☐ N/A ☐ 8.5 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Noted below Very High Claire Rae • Learning from recent months and years has underscored the need for continued multi-disciplinary team working to better meet service demands; and the need for a cohesive whole system approach to delivering health and social care going forward. The experience of recent years has emphasised the interdependencies between primary care (including independent contractor services), community care, secondary care, and social care; and shown that one component of health and social care delivery being overwhelmed with demand can have consequential knock-on effects on the other component parts of the system. • Given the foregoing, even with mitigations in place, there is a significant risk that the systems across NHS Lanarkshire and beyond will be under extreme pressure over the winter period. This risk has been moved from ‘medium’ to ‘very high’ on the IJB risk register.
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13 8.6 ENGAGEMENT & PARTICPATION • Work is well underway at both local and national levels on the public messaging in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. North and South Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. • There has also been an expansive series of communications to seek to support as many people as possible take up the offer of vaccines – whether flu, Covid or both. This has also been accentuated for frontline health and social care staff. • The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment.
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14 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 8.7 INEQUALITIES & FAIRER SCOTLAND DUTY • This report does not introduce a new policy, function, or strategy, rather a strengthening of existing systems, therefore, no Equality Impact Assessment is required. EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website:
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15 Yes / Date added ☐ No ☐ N/A ☒ 9. BACKGROUND PAPERS 9.1 none 10. APPENDICES 10.1 Appendix 1 National guidance, published 24 September 2024 Appendix 2 Self-assessment Morag Dendy Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following: Morag Dendy – dendym@northlan.gov.uk
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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
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Appendix 1 Health and Social Care Winter Preparedness Plan 2024/25
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2 Contents Joint Foreword by the Cabinet Secretary for Health and Social Care, Neil Gray and COSLA Spokesperson for Health and Social Care, Councillor Kelly ........... 3 Learning from Last Winter ....................................................................................... 8 A Continued Approach .......................................................................................... 10 Working in Partnership ...................................................................................... 11 Improved Data Collection and Reporting.......................................................... 12 Winter Engagement ............................................................................................ 12 Winter Preparedness Checklist ......................................................................... 12 Our Priorities for Winter 2024/25 ........................................................................... 14 Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care ................................................................ 15 How we will jointly deliver this priority ............................................................. 15 Protecting people through the delivery of vaccination programmes that reduce serious illness, hospitalisation and mortality ...................................... 19 How we will jointly deliver this programme ...................................................... 20 Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate ................................................................................................. 22 How we will jointly deliver this priority ............................................................. 22 How we will support this plan with effective communications ....................... 23 Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, and social care and social work services, protecting planned and established care, to reduce long waits and unmet need ........................................... 24 How we will jointly deliver this priority ............................................................. 24 Protect planned care with a focus on continuing to reduce long waits ......... 26 How we will jointly deliver this priority ............................................................. 26 Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting ............................................................................................ 27 How we will jointly deliver this priority ............................................................. 27 Additional Resources ............................................................................................ 30 Summary and Escalations ..................................................................................... 31
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3 The value and importance of our health and social care services has never been public services. Most if not all individuals across Scotland will interact with health and social care services at some point in their life, and we are committed to ensuring that everyone experiences consistently high-quality care when they do. This plan sets out how we as COSLA and Scottish Government will jointly seek to address the exceptional pressures facing our health and care services over the winter, to support local systems to deliver quality services. However, we cannot understate how challenging the environment is for our health, social care, and social work services, with the demand on the system rising, and the complexity of support many people require increasing. Last year we committed to moving from annual winter planning to year-round surge time and are increasingly sustained. , we talked about how we had started the planning process earlier than ever before. Now we have gone a step further, moving towards this as a continual process in which our key partners including in the independent, third and voluntary sectors are equal partners who can shape this planning activity. We have engaged more widely than ever before as part of this process. This is not simply a one-off change, but a commitment to more effective partnership working; a process where we listen and respond year-round, building and adapting our plans to ensure they most accurately reflect diverse needs and facilitate preparedness for whatever surges we may face. To those who have contributed to this goal and this plan, a genuine heartfelt thank you, we hope that you can see your contributions and your voice reflected within this document. Ultimately, what we have heard is important, and what this plan is about, is people. The people who access our health, social care and social work services but also the people who work tirelessly to ensure that those services deliver the best possible standard of care. mental health, as well as their right to live independently in their community, has been the overarching focus in the development of this plan. Despite this planning now being a continuous process, we are clear that winter is a specific period of increased pressure, in which people require additional support from our health, social care and social work services. Increases in respiratory illnesses, such as flu, covid and RSV, as well as weather-related injuries from falls and accidents, make what is already a challenging environment in which to deliver services even more difficult. As we have outlined, this plan is about people, and it could not be realised without our incredibly dedicated and hard-working workforce. We know that those who work in the NHS, our local authorities, care homes and care at home services, and community based organisations work incredibly hard year-round, but particularly in
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4 winter, to make sure that everyone gets the safe, timely care they need in the appropriate setting. This workforce protects, cares for and nurtures the wellbeing of the people of Scotland, and it is right that this plan outlines actions taken to support these individuals so they can continue to care for our population. unpaid carers, ensuring that those who provide critical care to their loved ones are appropriately cared for. A key element of this winter plan is ensuring that people are cared for in the right place at the right time. This begins with the prevention work to keep people well, and keep them from needing hospital care, this includes work underway in our social care system, the hard work of volunteers and unpaid carers, our extensive vaccination programme and utilising our primary care system effectively. Within our hospitals, this plan targets key priorities critical to an efficient and resilient system, such as admission, a steady and consistent flow through the system and the joint efforts of our health, social care and social work systems to ensure timely discharge. Our hospitals provide specialist high quality, safe, clinical care, and while the vast majority nearly 97% of people are discharged without delay, some people remain in hospital after it is clinically necessary. People who will not sleep in their own bed tonight and who will have poorer outcomes as a result. We must do everything in our power to ensure that people receive the support that is right for them, in the right place, at the right time, and that there is strong collaboration and leadership across health, social care, and social work to ensure a timely and safe discharge from hospital. Beyond the hospital setting, this plan clearly articulates our priority of supporting possible. This may be in a care home, through our dedicated care at home services or through self-directed support, all of which play a vital role in seeing this priority realised. Whilst we should not underestimate the additional challenges that winter can bring to our increasingly pressured health, social care and social work services, the priorities set out in this plan support systems to ensure that appropriate preparations are in place. By working together as a whole system, we can continue to deliver safe, timely and high-quality care for people across Scotland, supporting them to live healthy happy lives.
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5 Introduction This Winter Plan represents a whole system approach to addressing a surge in demand for health, social care and social work services. Whilst it is recognised that over recent years there has been increasing and sustained pressures on our health and social care system, there are also periods, such as winter, where demand increases even further. Winter is not the only period this can occur and surge pressures can happen at any time; therefore we are transitioning to year-round surge planning and the measures outlined in this plan are applicable throughout the year as well as the winter months. However, we also recognise there are unique challenges for health and social care services throughout the winter period that result in increased pressure on our services, including increased respiratory infections, higher risk of slips and falls, and staff absence. Insofar as is possible, systems should adopt a preventative approach to managing pressures and to mitigate and reduce harm by ensuring people who need health, social care and social work services are receiving the right care, in the right place, at the right time. We also recognise that pressures on the system are not confined to increased demand but are increasingly exacerbated by the position of public finances. Our partners across health boards, local authorities, Integration Joint Boards and the third and independent sector are all facing extremely challenging financial pressures, and it is within this context that we are setting out a national approach to supporting local systems to address some of these challenges, whilst recognising the impact that the current financial position has on our ability to achieve sustained improvements. has been on enhancing partnership working across health and social care, going further in our engagement, with a particular focus on working alongside our independent, third and voluntary sector partners, recognising the significant contribution they make within our communities. plan enabled us to save more than 50,000 unnecessary ambulance journeys for individuals. By the end of 2023/24 we had created 495 older people and acute Hospital at Home beds across Scotland, which supported over 14,400 people without them needing ambulance attendances, emergency care or to spend time in hospital. This service provides additional support for the system at periods of peak pressure, for example last winter more than 1,700 individuals were supported by older people / acute adult hospital at home in January 2024 alone, providing them with critical care when it was needed most. This represented a 54% increase on provision in January 2023. We also know the crucial role that community supports play in keeping people well and enabling people to live independently, preventing many individuals from requiring hospital care in the first place. Public Health (PHS) Care at Home statistics tell us that in 2022/23, 89,620 people received 37.7 million hours of care which was an increase from the year before. We have strengthened and embedded a person-centred and person-led approach to the development of this Plan as well as our work at a national level, with the aim of equipping our health and social care services to deliver safe, timely and high-quality care by working collaboratively with all parts of the system. This focus on people is
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6 critical to ensuring that individual s human right to the highest attainable standard of mental and physical health and their right to live independently as part of a community are upheld and that every person in Scotland can continue to expect high quality care, despite the incredible pressures on the system. Whilst this plan provides a national overview, it also seeks to address the specific operational pressures experienced and support our local partners to continue to provide the specific services required by their local population and deliver the high- quality care that individuals rightfully expect. We know that the delivery of these services requires close partnership working across multiple agencies and organisations. We and our partners work hard to include delivery partners, including those in the third and independent sectors, in the planning and preparedness activity but there is always more we can do to ensure that all partners are active members of this process. From dashboards created last year, we are using data to better understand local variations, to determine local and national actions and target interventions where there is greatest need. Our approach to surge planning incorporates ongoing improvements and continues work to maximise capacity and improve flow through all parts of the system. It also utilises effective monitoring of enhanced data to bolster our understanding of the resilience of the system. Key components of our approach towards a more resilient health and social care system and, in turn healthier communities: An approach that is whole system, prioritising prevention, improving system flow and embedding a home first approach. Leadership at all levels, both nationally and locally, supported by appropriate governance arrangements. Preparedness checklist for local systems. Community capacity and surge capacity planning. Continued use of and development of the data and dashboard to inform improved surge reporting and modelling work year-round. Winter vaccination programme including roll out of the new Respiratory Syncytial Virus (RSV) vaccination programme for older adults aged 75-80 and infant protection via maternal vaccination. Continued monitoring of performance of Primary Care system. Protecting planned care through increased use of day surgery units. Reducing the time people spend in hospital by delivering optimal discharge planning based on Centre for Sustainable Delivery (CfSD) evidence. Reducing delays through the delivery of our Hospital Occupancy and Delayed Discharge Action Plan and actions under our Joint Mission to Reduce Delayed Discharges. Working together, through our Joint Statement of Intent Commitment, to overhaul the current mechanism of eligibility criteria to ensure an approach to social care support that is based on human rights and needs, whilst also recognising that community waits for care and support and assessment are inextricably linked to challenges with workforce and finances.
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7 Supporting our vital workforce in both health and social care, as well as unpaid carers across Scotland. Supporting people to live well in the community, through the provision of high- quality care, in care homes and care at home services and through investment in care and support, including self-directed support and support for unpaid carers.
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8 As in previous years, we undertook a comprehensive exercise to understand the lessons learned from last winter, which focused on the development, delivery, and governance of the published actions. This work has informed and shaped our planning this year. We have met with valued partners from across the NHS, Local Authorities, Health and Social Care Partnerships (HSCPs), the third, independent and voluntary sectors to listen to their concerns and identify gaps in last winter plan. We have implemented many of the requested changes and will continue to work alongside those most affected by the plan, to make necessary improvements, so that our plan can best reflect the current context and support our system. Local systems, and the individuals and organisations that work within it to deliver health and care to our most vulnerable individuals, worked hard to meet high levels of demand and ensure people received care when they needed it most. However, we know that complex challenges remain and there is still work to be done to ensure people can access the timely care they need in the appropriate setting. Last winter and in previous winters, we have seen unacceptable waits for ambulances, assessments and care packages, long ambulance queues and delays in A&E departments, and hospitals more broadly. We have experienced high levels of hospital occupancy, delayed discharge and unmet need within our communities, as well as increased demand for GP appointments and for social care packages and assessment. We know that all aspects of our health and social care system are interconnected. Increased pressure in one part of the system is not isolated but impacts more widely across the whole system. Increased occupancy within our hospitals for example can increase length of stay and impact on levels of delayed discharges. This also leads to poorer outcomes for individuals which in turn can have a knock on impact on the demand for social work assessment and, in particular if an individual has a prolonged hospital stay, the level of care they require when they do leave hospital. It is important to recognise the significant impact longer lengths of stay have on individuals, causing deterioration, reducing independence and in some cases resulting in life-changing decisions such as admission to institutional care. We have also seen that these are not limited to the winter period with increased pressure on our health and social care system at all times of the year. This has, since the Covid-19 pandemic, regularly continued throughout the summer months and we have, this year, seen delayed discharges remain at peak levels long after they would normally begin to reduce. It is also important to note that Covid has not gone away, but simply added to the pressures experienced, at points this summer we have seen over 600 hospitalisations from Covid, Scotland wide. These pressures are only exacerbated by challenges with workforce availability, demographic and population issues, and budget constraints.
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9 This all indicates that we will enter this winter with a health and social care system under more extreme pressure than ever before. This has provided the context for the development of this plan and the initiatives contained within. Critically, the report highlighted that to be effective, planning for periods of surge should be a year-round and not limited to the winter months. That is why this year, we have a dedicated team responsible for working across the health and social care system to determine actions to be implemented and delivered throughout the year, to build resilience and capacity in our systems.
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10 Despite these challenges, the feedback received did highlight several key strengths of the planning process in 2023/24. The improvements to the data available to local systems and new dashboards were highlighted as particular assets, which provided an overview of the performance of both the health and social care systems throughout winter. This also provided the Scottish Government and COSLA with key oversight data to identify where support could be most effectively targeted. Actions driven by our Whole System Oversight and Planning Group such as our Delayed Discharge and Hospital Occupancy Action Plan were also welcomed, and this work has been embedded and built upon by the new Joint Mission to Reduce Delayed Discharges. Similarly, increased monitoring through the winter preparedness checklist and local self-assessments ensured partners were better informed and prepared than in previous years. The quarterly self-assessment returns from local systems provided a national overview of whole system discharge planning that required focus. Assurances were also provided by local systems in relation to service delivery, resourcing and business continuity over winter. Given the pressures experienced within the system and the increasing levels of delayed discharges, there has been enhanced scrutiny and assurance of local areas progress in relation to their performance against national objectives, with a focus on supporting those local areas experiencing the most challenge. Over a third of areas now have delays per 100,000 which are below their pre-pandemic levels and many more are on track to deliver this goal by October. We will continue to work closely with local systems to maintain this positive progress and will target improvement activity in those areas that are struggling to replicate this trajectory. At the heart of these efforts is a collective need to improve the experience and outcomes of individuals who access health, social care and social work services across the entire patient journey. Partners referenced the international recruitment pilot undertaken in social care as providing vital support for employers and critical learning. Although this has not been without its challenges with previous Home Office changes presenting barriers for the sector. Moving forward, the Scottish Government have committed to further funding which will enable the Centre for Workforce Supply Social Care (CWSS), in NHS Education for Scotland (NES) to continue to support Adult Social Care Organisations in Scotland in their efforts to recruitment internationally by continuing the universal support offered through the established networks12. We continue to build and develop upon lessons learned, maintaining the key benefits and approach to planning from previous years in the following key areas: 1 2
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11 To deliver on our commitment that people receive the right care, in the right place at the right times and have access to high quality services, we have continued to strengthen our joint governance and assurance mechanism between the Scottish Government and COSLA, working closely with Chief Executives from health boards, local authorities and Chief Officers represented through Health and Social Care Scotland. We continue to work with local systems to support them to make necessary changes to drive forward improvement programmes such as the work of the CfSD around over-14-day hospital stays as well as the Delayed Discharge and Hospital Occupancy Action Plan, and to monitor the resulting impact. These programmes and actions are vital to free up capacity as we head towards a period of higher demand, ensuring people and families are seen to when they need it most. The Collaborative Response and Assurance Group (CRAG), co-chaired by the Cabinet Secretary and COSLA Health and Social Care Spokesperson, provides assurance and escalation for joint decisions on the deployment of options that support the resilience of health and social care. This membership and frequency of the group has recently expanded to support increased activity under the joint mission to reduce delayed discharge, engaging system leaders from across health, social care and social work and supporting improvements in performance and practice around discharge. The Whole System Oversight and Planning Group has made a significant contribution to tackling delayed discharge and supporting the health and social care system to be better prepared for surges, such as winter. Throughout the year they have supported planning for anticipated surges and peak leave periods, driven the Action Plan and promoted best practice in Discharge without Delay principles, such as setting a planned date of discharge. They continue to play a vital role as part of the expanded CRAG mechanism. In order to progress the medium- and long-term improvements the work of the Whole System Strategic Improvement Group and the Joint Social Care and Social Work Workforce Taskforce are both driving change in the resilience of the social work and social care sector, working closely with our statutory, third sector and independent partners. Local leaders and services have already begun their planning for winter and are maximising the capacity of systems to meet the increased pressures experienced over this period. We will continue to work closely with NHS Health Boards, Local Authorities and HSCPs to support them in this planning and preparedness activity, and to ensure those that require care and support whether that be at home, in a community health setting or a GP practice, a hospital or a care home are able to access it. It is also vital that effective partnership working extends beyond our statutory partners to effectively involve our independent and third sector partners, who play a critical role in supporting people across Scotland. We will work to ensure that their
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12 expertise, leadership and knowledge is valued, trusted and respected and that they are engaged in national and local planning and delivery in an open and transparent way. The contribution that they make should never be underestimated and the specialist support and advocacy they provide must be recognised within our response to surges. Last year a whole systems dashboard was developed, in partnership between PHS, National Services Scotland (NSS) and Scottish Government, which has improved oversight and knowledge of health and social care. The dashboard is being used routinely for situational awareness and has been a key component of planning for periods of high demand In addition, to support winter and surge planning. To further support local systems a Social Care Dashboard has also been developed which provides a more granular level of detail on various elements of social care. Work was undertaken and published on how these products were received and how to improve them for winter 2024/253 with an aim to merge the two dashboards. Recent changes to the TURAS Care Management have reduced the data burden on Care Homes, providing a picture of available beds, occupancy and the pausing of some duplicate data collections, standardising data on care homes within the Care Home data review framework. Through the WSOPG, local areas have also been undertaking regular self- assessments against the key standards contained within the Delayed Discharge and Hospital Occupancy Action Plan, supporting whole-system benchmarking. Critical to whole system surge planning is better engagement with systems, providers and key stakeholders. They can offer rich intelligence and insight to help shape the plan and actions based on lived experience and knowledge of what works well. We have strengthened stakeholder engagement and partnership working to ensure we incorporate that expertise into improvements for this year. The Winter Preparedness Checklist aligns with the priorities set out in this Winter Plan and covers four key areas against which we asked Health Boards and HSCPs to provide an assessment of preparedness for their local systems: Section 1: Overview of Preparedness and Business Continuity Section 2: Urgent and Unscheduled Health and Social Care, and Planned Care Section 3: Primary Care, Mental Health and Social Care Section 4: Health and Social Care Workforce and Staff Wellbeing We will be using the outputs of this checklist along with the Hospital Occupancy and Delayed Discharge Action Plan self-assessment returns, dashboard data and other 3
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13 factors to create a holistic system assurance overview and provide targeted and tailored support to those areas identified as having scope to improve and increase resilience. This approach also encourages benchmarking across and within the system, and identification and sharing of best practice between areas.
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14 We have continued to develop upon the priorities winter preparedness plan, to strengthen our approach to whole system planning and delivery. In keeping with our commitment that the focus of this plan is people, we have adjusted our priorities this year to reflect how people experience our health and social care system. This approach recognises that pressures in one system area can have a knock-on effect on other parts of the system, and meaningful action should consider how services are interdependent on each other. At the heart of our four priorities for winter, are three key principles which ensure we retain our focus on the individual. These are: 1. Person centred and person led care as embodied through the Getting it Right for Everyone Principles, which aim to ensure a personalised way to access care and support. Ensuring that people are at the centre of decisions that affect them. 2. Strong leadership and partnership working across the whole system. 3. Implementing local and national actions we know work to improve the patient journey, and ultimately which improve outcomes for individuals, such as Discharge Without Delay principles The four winter planning priorities outlined follow a journey through the health and social care system. Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and
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15 Social care and support services, social work and Unpaid Carers, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated approach is critical year-round but particularly over winter. Health and social care professionals operate in numerous community settings, operated by public bodies, independent providers and third sector organisations. These professionals work with thousands of people across Scotland, helping them to stay well, flourish and live independent lives year-round and particularly in the winter period, reducing the pressure on our health and social care system and ensuring that individuals continue to receive the best possible care in challenging circumstances. Proactively support people at highest risk in our communities to keep well and prevent the need for hospital care, supporting the community services which deliver this critical work. This includes: Supporting the health and social care professionals working in every care home and care at home service, who maintain the health and wellbeing of thousands of people across Scotland by taking forward activity under the Joint Social Services Taskforce (JSST) which has the most valuable impact on the social care and social work workforce in partnership with NES, the Scottish Social Services Council (SSSC), Social Work Scotland, Coalition of Care and Support Providers in Scotland (CCPS) and unions. Enabling the delivery of high quality, effective and personalised care in care homes across Scotland, with dedicated health and social care professionals providing a safe and nurturing environment. We ensure that the best care is provided through a range of improvement activity, and the Healthcare Framework. The Health and Social Care Standards set out what should be expected when using health, social care or
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16 social work services in Scotland and these underpin the Care Inspectorates inspection frameworks456. Providing excellent care for individuals in their own homes through dedicated care at home services, which provide care tailored to the needs of almost 90,000 people across Scotland7, enabling people to live as independently as possible in their own homes. Ensure there is clear communication at a national level that a care package may be - home care, either long term or to support reablement, or it could be a mix of home care; digital technology and aids and adaptations or in some situations, just digital or aids and adaptations. Supporting individuals to live their lives in ways that are meaningful to them, maintaining their own and their carers health and wellbeing through self-directed support and support for unpaid carers COSLA and Scottish Government recently published the Self Directed Support (SDS) Improvement Plan to support progress of implementation of SDS so that people consistently experience choice and control over their care. The provision of free personal and nursing care payments to over 10,000 adults across Scotland8. Critical to this is the strong partnership working between Integration Authorities and local providers and third sector interface. Writing to all local areas in advance of winter to reassure them of the flexibility available in the statutory guidance, when considering the employment of a family member as personal assistant under SDS option 1. This will support local decision making and development of processes which will mitigate, manage or reduce risks when it is in the best interests of the supported person to employ a family member with Power of Attorney (POA) / guardianship as a personal assistant. Ensure that existing programmes of work being progressed by Digital Health and Care (DHAC) and COSLA are utilised fully to support system pressures, including Maximising the benefits of the shared Alarm Receiving Centre (ARC) - the shared ARC is now live with several HSCPs and 7 more to be onboarded over the next few months. The shared ARC is a cloud- based common platform for ARCs across Scotland supports the required shift towards more proactive and preventative approaches to supporting citizens, including the integration of Telecare data to support assessment, anticipating need, and supporting early interventions. With standardised data, telecare providers can anticipate citizen needs and tailor interventions, accordingly, ensuring timely and targeted support. 4 5 6 7 8
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17 Use data more effectively to support early intervention using the Telecare Information Framework (TIF). Through the adoption of this data set, telecare service providers will gain access to valuable insights that support early intervention and preventive measures. By leveraging data analytics, providers can proactively identify individuals at risk and intervene promptly, ultimately improving outcomes and enhancing citizen wellbeing. Through the Mental Health and Wellbeing Strategy we will ensure we have the right activity in place to meet changing need this winter and in coming years, with a strong focus on prevention and early intervention, to allow people to access care in the most appropriate setting or pathway. Through the Mental Health and Wellbeing Delivery Plan, continue to build on work underway to improve unplanned and urgent mental health care, including for those in mental distress, by utilising a multi-agency response and alignment with the national rollout of the Distress Brief Intervention (DBI) programme and; Support Boards providing access to a mental health clinician 24 hours a day, seven days a week. Embed the Time, Space, Compassion principles. Increase access to existing and developing services by developing a mental health unscheduled care resource pack by Autumn 2024. Continue to increase awareness of available pathways into support and care through developing tailored messaging for specific population and equalities groups in 2024. Continue to invest in the Enhanced Mental Health Pathway and promote partnership working to increase Police Scotland and Scottish Ambulance Service (SAS) access to local clinical support. Take an evidenced based approach to improvement work to better understand how people are accessing and receiving unplanned mental health care, ensuring that improvements to unplanned and urgent care are underpinned by robust data, including person demographic data. published in Autumn 2023, and the subsequent Police Scotland actions on mental health. Through the multi-agency Partnership Delivery Group (PDG) on mental health and policing established to drive forward activity aimed at improving outcomes for people in mental health need, as well as those experiencing distress or crisis, publish a Framework for Collaboration supporting partnership working at a local level for police, health, social work, social care services and across public and third sectors, in the Autumn, as well as a cross-sector Action Plan before the end of 2024, which will detail how long-term ambitions are to be achieved. A national review of Psychiatric Emergency Plans by the Mental Health Unscheduled Care Network by November 2024, followed by the development of national guidance in 2025 to ensure reasonable consistency across 14 Health Boards. Maintain consistent engagement with Boards, sponsored bodies and key groups such as Primary Care leads, National Out of Hours (OOH) oversight
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9 19 group, SAS and NHS 24 to continually monitor the performance of the Primary Care system through regular performance reporting on: GP capacity and resilience OOH availability SAS and NHS 24 performance Report on-going performance to Ministers and highlight any issues through CRAG, escalating and taking any action as appropriate. Provide ongoing support through the Scottish Dental Access Initiative (SDAI) to facilitate the opening of new or expansion of existing General Dental Services (GDS) dental practices to register new NHS patients for care, by engaging with boards to understand local issues and facilitate local solutions, such as Public Dental Service (PDS) providing alternative care to patients who cannot access GDS. Ensure the Primary Care system is as resilient as possible heading into winter and that people are able to access the care they need, in their community, where appropriate. One such example is the SAS Integrated Clinical hub, which helps to direct patients to the most appropriate point of care, without automatically directing them to A&E. Build resilience in social care through the invaluable work of our Local Authority and Health and Social Care Partnership resilience leads and existing Resilience Partnerships to facilitate effective business continuity planning, emergency preparedness and development of our resilience infrastructure. Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and OOH. Health Boards ensure that there is adequate provision of NHS Pharmaceutical Care services and support to local health care needs, including winter. Health Boards and local contractor committees continuing to work collaboratively to address any pressures across local community pharmacy networks such as cluster working. Community pharmacies continue to provide appointment free access to pharmacists and the wider pharmacy support team for advice and treatment for minor ailments and every day common clinical conditions. Ensuring that patients continue to have access to the prescribed medicines and services such as NHS Pharmacy First and a range of Public Health Services. Work to embed the Getting It Right For Everyone (GIRFE) principles through our , which has been co-designed with partners and people with lived experience. This will support Health and Social Care professionals to provide holistic support to people, alongside the My Health, My Care, My Home healthcare framework for adults living in care homes9.
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10 19 DHPs are made by local authorities to eligible individuals where they need help with their rent or housing costs. Eligible individuals can find out how to apply by visiting mygov.scot or contacting their local authority.10 Protecting people who may be most impacted by severe illness, hospitalisation or death from RSV, Covid-19 and flu, through vaccination, is a key means of reducing demand on our health and social care systems. The new RSV programme, launched in August 2024, demonstrates the value of vaccination. This programme will be offered to pregnant women to protect babies and to older adults aged 75-80 RSV is the leading cause of emergency respiratory admissions to hospital in Scotland in infants, with 1,516 children aged under one hospitalised with the virus last year. There were also over 1,000 cases of RSV recorded in adults aged 75 and over in Scotland between October 2022 and September 2023, with more than half (535) having to spend time in hospital as a result. It is therefore anticipated that a successful programme will help to reduce these numbers. We also want to see as many eligible people as possible protected from Covid-19 and flu this winter. Our eligible cohorts continue to be guided by independent advice from the Joint Committee on Vaccination and Immunisation (JCVI) who assess who is most at-risk from these viruses, and therefore would benefit from vaccination. Our adult Flu and Covid-19 vaccination programme will launch for winter, with all those over the age of 65, residents in care homes for older adults and all those in a clinical risk group, eligible for both vaccines. Both vaccines will be offered at the same appointment for efficiency. This winter, the JCVI does not advise an offer of Covid-19 vaccination for frontline health and social care workers, staff working in care homes for older adults, unpaid carers and household contacts of people with immunosuppression. However, they do say that Health and social care service providers may wish to consider whether vaccination provided as an occupational health programme is appropriate, and ahead of such considerations, health departments may choose to continue to extend an offer of Covid-19 vaccination to frontline health and social care workers and staff working in care homes for older adults in winter 2024. Under this flexibility, Scottish Government has decided to offer frontline health and social care workers, including all staff working in care homes for older adults, Covid-19 vaccination this winter. important that we do everything we can to ensure those who are eligible for the vaccine, including frontline staff, take it up if they wish. We will work with partners including Public Health Scotland to promote and encourage uptake.
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20 Unpaid carers and household contacts of the immunosuppressed will remain eligible for flu vaccination this winter, but will not be offered Covid-19. The primary aim of the national Covid-19 vaccination programme remains the prevention of severe illness (hospitalisations and deaths) arising from Covid-19. As currently available Covid-19 vaccines provide limited protection against mild and asymptomatic disease, the focus of the programme is on offering vaccination to those most likely to directly benefit from vaccination, particularly those with underlying health conditions that increase their risk of hospitalisation following infection. transmission of the infection and support the resilience of the health and care system, particularly during the winter months. Alongside this, it will be important for us to continue to closely monitor rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required. In addition to vaccination and infection prevention, social connections, exercise and meaningful activity are vital for the wellbeing and quality of life of everyone, but in particular those living in a care home. It therefore remains fundamentally important that people living in care homes remain connected to their loved ones even in infectious outbreak situations in line with PHS Covid-19 Guidance. Work with Boards to introduce the new year-round maternal RSV vaccination programme from 12 August 2024 to protect infants. Offer the flu vaccination to all school age children in Scotland, including secondary school pupils as part of the seasonal child flu programme. Promote child flu vaccination uptake, especially in children aged 2-5 years, to ensure they receive the earliest protection to help stop the virus spreading. To have maximum impact, early completion of vaccination amongst this group is essential. Work with Boards to vaccinate all cohorts as advised by JCVI as part of the seasonal flu and Covid-19 vaccination programme. Frontline health and social care workers will be eligible for both Covid-19 and flu vaccination, but we will work with PHS and Boards to assess a return to peer-to-peer flu vaccination delivery models in clinical settings. Boards will continue to offer frontline Health and Social Care Workers the opportunity to drop into any community clinic, without the need to book, but workers can also book via the online portal and the national vaccination helpline if they would prefer. Although frontline Health and Social Care Workers are eligible for both Covid- 19 and flu this winter, they will be more active promotion of flu vaccination uptake in that group, as well as non-frontline NHS worker groups, to help build resilience within the health and social care system. Continuing to encourage high vaccination uptake for both Covid-19 and flu, within care homes and care at home providers specifically is vital.
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21 Focus on key messaging to encourage uptake of the winter vaccination programme, with a focus on the individual properties and benefits of each vaccine, to target vaccine hesitancy and inclusion: There will be no national Flu Vaccine Covid Vaccine (FVCV) marketing campaign in winter 2024 and no paid for media or marketing activity Instead, PHS Comms will develop an inhouse creative for a predominantly digital campaign for all eligible groups. There will be specific focussed assets designed to reach those who support vaccination but are hesitant or are not prioritising getting vaccinated11. PHS will develop more clinical flu and Covid-19 messaging for the frontline Health and Social Care Worker group. All PHS FVCV assets and toolkits will be distributed via established stakeholder networks. There will be a PHS led seasonal child flu programme updated national marketing campaign - . Replenishing covid test stocks at regular intervals to meet projected demand. As a positive test is required to access Covid-19 treatments for those eligible, additional orders of new tests can be placed in line with demand. Continue to work with partners such as PHS, to ensure the delivery of a robust respiratory surveillance programme that quickly identifies signals or trends that are of concern and provide infection prevention and control advice and guidance as required. Continue to work with Executive Board Nurse Directors, and other professional leads, such as Chief Social Work Officers, Chief Officers and Care Homes to collaborate on the delivery of person-centred safe care and support to Improve the health and wellbeing of people living in care homes in line with the Healthcare framework for adults living in care homes.12 Continue to work with local partners to support people living in care settings to remain connected to their loved ones. 11 12
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22 For many, Emergency Departments may not be the best place for their healthcare needs and our Urgent and Unscheduled Care Collaborative improvement approach is not only better for people but reduces pressure on acute and primary care services too. This includes maximising admission avoidance through initiatives such as reducing conveyance of people from care homes where it is clinically appropriate, expanding hospital at home services and discharge to assess. The principle of right care, right place, right time does not just apply to health care however, we know that it is also important to apply this principle to social care and social work assessments, as assessments are most effective when completed in a own home. Occasionally during period of exceptional demand, individuals it is also important for people with lower or moderate levels of risk to be signposted to lower level support. Everyone in need of emergency mental health care must receive that support quickly, and wherever possible, close to home. People presenting with stress and/or distress are often conveyed to hospital when there can be community-based alternatives that support the patient as well as the system as a whole. This will also ensure that people seeking mental health support receive the right care, in the right place, at the right time, regardless of where, or what time of day they present there should be no wrong door. To ensure that people receive the most appropriate care and are empowered to support themselves and those they care for, the Scottish Government and HSCPs are continuing to deliver communications programmes to increase awareness of high-quality accessible healthcare information. A multi-agency communications group provides an expert forum to agree key messages and develop national and local communications plans to ensure the public is well informed. Continue to work with Healthcare Improvement Scotland and Boards to expand the Hospital at Home Older People's service to improve the resilience and efficiency of services that will enable people to be treated at home, where appropriate. Providing alternatives to hospital attendance and admission through the enhancement of local Flow Navigation Centres which provide virtual access to the A&E team to support patients to be seen in the right clinical care setting. Reduce ambulance turnaround times by improving front door processes and optimising services such as Flow Navigation Centres and the Integrated Clinical Hub which provide care for patients at or near home, reducing pressure on A&E departments. Produce a scoping report in summer 2024 on the feasibility of implementing an additional safe space as an alternative to people being conveyed to an
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23 Emergency Department when in a mental health crisis and the use of Emergency Departments as a legal place of safety. Develop and optimise accessible and effective pathways and referral routes to enable OOH services to redirect as appropriate. Ensuring appropriate public messaging such as the NHS 24 winter messaging campaign as well as up to date information on NHS inform is delivered throughout the winter period so that people know how and where to access all primary care services. Increase awareness of the key sources of information that will support the public with their care needs, whether that information is delivered in person (for example, through social workers, care home and care at home providers, community pharmacists or local GPs), via the telephone (NHS 24 on 111 for physical or mental health concerns) or digitally (nhsinform.scot, the NHS 24 online app, Care Information Scotland or local council websites).1314 Resources developed by Scottish Government, PHS and NHS 24 will be available online for any stakeholders to use through their own communications channels such as social media accounts, e-newsletters or in- venue signage to support local activation. Increase awareness of the role for Home First and delivery of services (such as Hospital at Home or assessments for longer-term care needs) at home through media relations, social media and operational communications. Collaborative working across Boards, Local Authorities, Primary Care Contractors, providers, carer centres and Partnerships to consistently redirect and signpost people to the appropriate service for their needs, whether through national, regional or local communications. 13 14
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24 Both COSLA and Scottish Government recognise that actions and improvements to maximise capacity are best and most sustainably delivered in an integrated and co- ordinated way across the whole system. Local Authorities, Boards and Integration Authorities, together with the voluntary and independent sectors, and indeed with our communities, integral to the successful integration of health and social care to deliver better experiences and outcomes for the people who access services. We recognise the challenge in increasing capacity across the system during periods of sustained pressure and are committed to working with all partners to do everything we can to support local systems to meet demand and deliver high quality services. We have maintained our national focus on addressing pressures across the whole system and reducing levels of delay from hospital, with enhanced oversight and assurance arrangements to ensure targeted support where systems need it most. Behind every delayed discharge, is a person who will not sleep in their own bed tonight. Critically our focus on these delays is centred around ensuring the best possible care for that individual. Each delayed discharge has been clinically assessed, and a determination made that hospital is not the best place for them to receive the ongoing care that they may need. If a person is kept in hospital longer than clinically necessary, their outcomes and overall health will be affected. lack of discharge planning, awaiting an assessment, to difficulty in ensuring a suitable care package is in place, or to legal challenges that may be experienced where an individual does not have the capacity to make decisions for themselves. There is also significant variation across the country. Our new mission to reduce delayed discharge is focusing in on this variation, supporting local systems to improve their performance and ensuring that good practice is replicated to give each person the best experience possible. This also requires us to focus attention to the 6000 people awaiting a social care assessment, highlighting the significant challenge ahead in addressing levels of unmet need in our community which inevitably impacts on levels of delay in hospital. Support the First Minister and COSLA Mission to Reduce Delayed Discharges: Continue to deliver a whole system approach in improving system flow and reducing delays in services for mental health, learning disabilities and adults with incapacity. Support people to live well in the community, only being admitted as an inpatient when necessary and discharged in a timely manner.
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25 Embed good practice discharge processes, such as the Discharge without Delay principles, as set out in the Hospital Occupancy and Delayed Discharge Action Plan. Deliver effective discharge planning for patients admitted to acute or community hospitals to protect established care at home packages, allowing discharge without further delay for assessment. As part of the CRAG, work in partnership with Health Boards, HSCPs, Local Authorities, the third sector and people with lived experience to reduce mental health, learning disability and adults with in-capacity delays and improve system flow. This will be delivered through a dedicated multi-agency working group, which will focus on deploying targeted improvement and performance support to local systems to reduce delays, as well as generating an evidence base regarding the medium and longer term interventions required to address systemic challenges. The group will also consider approaches to reducing inappropriate out of area placements identified through the Coming Home work. Continue to work with Health Boards to deliver improvement and implementation of key actions to ensure improved A&E performance. A focus on reducing length of stay over 14 days for non-delayed patients and increasing short stays less than 72 hours to improve occupancy and flow. This will be delivered through the work of CfSD, Urgent and Unscheduled Care Collaborative Programme, actions include: Increased senior decision makers at front door, which will support prompt decision making. Strengthening the patient discharge processes. Discharge without Delay through daily, or twice daily where appropriate, ward-rounds with senior-decision-makers. Daily multi-disciplinary team (MDT) board rounds with a plan for every patient, every day. Whole-System MDT reviews of long-stay patients. Continue to make progress on delivery of commitments within the Joint Statement of Intent, with our shared aim continuing to be to improve the experience and outcomes of people who access social care support and those who work within the sector. Continue to drive forward wider system improvement through the Scottish Learning Improvement Framework, with joint political oversight through the Whole System Strategic Improvement Group. Monitor performance and delivery of social care response and improvement measures and provide assurance to Scottish Ministers and COSLA on the actions being progressed to improve local performance, our management of winter pressures and sector viability. Design and deliver a programme of improvement work targeted at embedding home first approaches in health and their intersection, in the short and medium-term. Involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, this means engaging with the patient, their families, and carers in hospital discharge discussions to ensure their needs and wants are central to decision-making.
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26 Use of home-based assessments such as discharge to assess for all Home Support packages to ensure accurate person-centred assessments, in familiar and homely environments. Over the past few years, Boards have tried, where possible to protect planned care, however they sometimes have had to take the difficult decision to step down planned care in order to deliver emergency treatment. Given the impact this has had on waiting lists, and on patients themselves, we are committed to protecting planned care throughout this winter. Long waits are regrettable, but we are determined to provide Health Boards with the support necessary to drive improvements and will continue to target resources to reduce waiting times, particularly for those waiting longest for treatment. In addition, we are working closely with Health Boards to implement alternative pathways and new models of care which will support patients to be seen more quickly and increase capacity and sustainability. Despite an exceptionally challenging winter period last year, new outpatient activity was up by 2.9% in the quarter ending March 2024 when compared to the previous quarter, and inpatient/day-case activity for the quarter to March 2024 was the highest since the start of the pandemic; the 9th quarterly increase in a row with 63,900 patients seen. We will continue to work closely with the Boards to maximise planned care capacity and where the majority of long waits in some specialities remain, ensure we continue to work hard to reduce these as quickly as possible. Strive to protect cancer care with a focus on continuing to prioritise new urgent suspicion of cancer patients and protect theatres for cancer operating. Work with Boards to maximise capacity, to reduce waits prior to winter 2024/25. Maximise capacity through regional and national working: Maximise theatre capacity including National Treatment Centres through expanded sessions in evenings and weekends. Support Boards, including through the National Elective Coordination Unit (NECU), to maximise clinical validation of waiting lists to identify, where appropriate, alternative forms of treatment. Continue to support Boards in the adoption of Active Clinical Referral Triage (ACRT) and Patient Initiated Return (PIR) to improve patient care and reduce waiting times by eliminating unnecessary face to face attendances. Deliver the actions contained in the Endoscopy and Urology Diagnostic Plan. Encourage the optimisation of digital solutions and standardise pre-operative assessment to reduce the need for unnecessary appointments and cancellations, thereby releasing capacity. Protect planned care through maximising the use of day surgery units including increasing the proportion of procedures converted to day case surgery.
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27 Our highly skilled and committed workforce is the cornerstone of our response every winter. We understand the continued pressures that our health and social care workforce, including volunteers and unpaid carers, are performing under, now more than ever. In order to meet demand, we must continue to focus on supporting workforce capacity and retention of staff, unpaid carers, and our third sector partners, and ensuring that we support the wellbeing of staff through challenging periods of high demand. We are pursuing a range of different strategies to nurture the workforce in both health and social care over the long term. Within our health workforce, for example, this includes supporting the expansion of trainee doctor posts, to reflect the changing demands on our health and social care system. IMPACT have recently completed a literature review looking at what best supports wellbeing for personal assistants and their employers, this offers provide useful insight for future planning to support this key social care workforce. The JSST was established to ensure that further meaningful progress can be made in partnership to address pressures, and with a focus on delivery of outcomes which workforce. A key objective of the Taskforce is to identify collective and individual organisational actions required to address the challenges facing the professions through focusing on improvement opportunities across the workforce journey, and identifying where practical changes to practice, working across boundaries, can enable a step change in the delivery of integrated care and service delivery. It is estimated that between 700,000 and 800,000 people provide unpaid care for a relative or friend at home and within other community or residential supports, and so hugely valued unpaid carers, as well as enabling carers to participate in education, training or employment alongside their caring responsibilities, ensuing that carers are able to sustain their caring role with positive wellbeing. We must also continue to support the effective implementation of SDS for people who access support and their carers as the default approach to social care, ensuing people have choice and control over their care and support. Progressing workforce activity through the JSST, including development of paid college placement project which aims to develop and socialise a national paid college placement blueprint for adult social care employers such as Local Authorities, independent sector and third sector. It focuses on expanding successful practices to increase the availability of paid placements for adult social care students during their qualifications. The blueprint is currently being developed and will be implemented in future college academic sessions from 2025. Through Scottish Government funding to NES, fund the CWSS which supports Adult Social Care Organisations in Scotland in their efforts to recruit
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28 internationally by establishing network platforms for sharing best practice, networking and discussion within the social care sector. Scottish Government is committed to working with the sector to look at options to improve rates of pay and terms and conditions for the social care workforce and we are currently working with stakeholders to develop sectoral bargaining for the sector to advance this. However, public finances are under unprecedented pressure, and we must balance the fiscal position while the demand for government support and intervention continues to rise. Supporting any retiring staff who wish to continue in employment suitable to them and to the service through the Retire and Return provisions outlined the NHS Scotland Retirement Policy. Supporting staff throughout their career, to manage demands on their time options to help them to balance their lifestyle whilst maintaining and promoting the best possible service to our patients and service users. These include a Flexible Work Location and Flexible Work Pattern Policy. Encouraging Boards to promote part-time work opportunities to their health, social care and social work students, who can help to build short-term capacity as required. Our NHS Scotland Flexible work location and NHS Scotland Flexible work pattern policies provide staff with a range of flexible working options to help balance their lifestyle whilst maintaining and promoting the best possible service to patients and service users. Provide essential wellbeing support to staff across health, social care and social work suffering poor mental health through: Availability of confidential mental health care and treatment for registered staff through the Workforce Specialist Service, as well as psychological therapies and interventions for all staff, supporting staff to treat anxiety, depression and improve issues like difficulty sleeping Additionally the National Wellbeing Hub continues to offer a range of self-service resources for staff15. Further, NHS 24 deliver the National Wellbeing helpline, offering a 24/7 compassionate listening service. These wellbeing provisions provide important intervention options for staff suffering poor mental health, improving the likelihood of these staff returning to, or remaining in work for the longer term, and improving the quality of care they are able to provide. Ensure people who provide unpaid care are supported in their caring roles and supported to look after their own health and wellbeing alongside engaging in education, training and/or employment. We are implementing our National Carers Strategy to drive forward long-term changes to improve the lives of unpaid carers across Scotland. It sets out a cross-government approach to carers issues, including through social care, social security policies and supporting carers in employment and education. 15
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29 Supporting local carer centres and young carer services to build capacity and ensure all carers can access consistent and up-to-date information. We will work with stakeholders to improve the availability and range of short breaks. We will continue to work with local service commissioners, Shared Care Scotland and others to promote greater availability and choice of short break support in different areas. Continue to explore how volunteers can provide support in both discharge from hospital, in assisting people to attend appointments, and consider appropriate use of established local and national volunteer partnerships. We will also explore how the National Volunteering Hub can be best utilised to support the health and social care system to manage pressures over the winter period.
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30 The Warmer Homes Scotland scheme, delivered by Warmworks, was re- launched on 02 October 2023 with more funding and help for households to receive a climate-friendly heating system. People can contact Home Energy Scotland to check their eligibility and receive advice on additional support. Applications are assessed by Home Energy Scotland (HES) against the eligibility criteria. For more information, visit the Home Energy Scotland website or telephone 0808 808 2282 (Monday to Friday 8am-8pm and Saturday 9am-5pm). Cost Of Living website has a range of resources including how to get in touch with your local council for help with energy and bills, and has specific advice for older people or those who are disabled, including links to support organisations and information about the benefits that they may be entitled to. The Care Information Scotland website summarises unpaid carers rights to information, advice and support, alongside details of social work departments and local carer centres to find out more about what is available locally. My Power of Attorney website provides information on the importance of POA
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31 This Winter Preparedness Plan sets out the actions being implemented across the health and social care system in order to prepare for the increase in demand and pressure we expect to see over winter 2024/25. These actions are being adopted as part of a business as usual approach to local planning for surges in demand and complement local surge/escalation and capacity plans. To support this, we have put in place a national governance system with strategic oversight across health and care to recognise and mitigate evolving risks (including system pressures) and maintain a flexible response covering whole-system winter pressures. Working on a local basis, monitoring will continue, and health and care organisations will utilise their established governance and response structures.
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Scottish Government Riaghaltas na h-Alba © Crown copyright 2024 OGL This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew's House Edinburgh EH1 3DG ISBN: 978-1-83601-763-9 (web only) Published by The Scottish Government, September 2024 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 SNA PPDAS1502050 (09/24) WWW. g O V. SC O t ►◄
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Please select Health Board from drop down above Return Due: 16 October 2024 Appendix 2 Chief Officers Claire Rae, Soumen Sengupta Number of integration partnerships 2 Submitted by Craig Cunningham Approved by Jann Gardner Date of approval 14-Oct-24 WHOLE SYSTEM CHECKLIST RETURN - AREA DETAILS SUMMARY DASHBOARD # Area Progress Status Partial No Yes n/a 1 Complete Complete 0 0 10 0 2 Complete Partial and/or No 7 0 12 2 3 Complete Yes 0 0 17 0 4 Complete Partial and/or No 1 0 10 0 Partnerships North Lanarkshire, South Lanarkshire
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Section 1 Overall Status Complete Automatic status Subsection # Statement Response Rationale for response rating Words Overarching principles 1.1 There are sufficient mechanisms in place to support the collaboration and co- operation with other Boards and Partnerships in the delivery of health and care. Yes There is a mutual Aid agreement in place. Other stakeholder groups will be in place across various disciplines. Information may be sought from the various divisions. Effective resilience partnership arrangements are in place as demonstrated during Operation Flow and respective 'firebreaks'.. 40 Overarching principles 1.2 Plans have been developed through joint working between the Board, associated HSCPs, and other key partners (i.e. Primary Care practitioners, SAS, Scottish Prison Service, care at home and care home providers etc.). a) It is clear to all parties how plans will be delivered through joint mechanisms. Yes The Lanarkshire-wide winter planning group is multi-agency and covers all aspects of service provision. It encompasses both H&SCPs as well as having representation from the two Councils. The Lanarkshire wide LRP is also closely associated with the winter planning group and will have a dedicated winter planning BCP session (Winter Breach) on 14 November 2024. 64 Overarching principles 1.3 Winter Planning includes demand, capacity, and activity plans across all health and care delivery (including urgent, unscheduled, social care and planned care provision). a) Projected staffing levels in your acute wards and community hospital wards are sufficient for the winter period; if no, please provide further detail. Yes The planning process is closely aligned to the work currently ongoing in relation to Operation Flow. This is builds upon effective understanding of demand and an associated series of developments intended to meet same. Both H&SCPs are also part of the Operation Flow process and this includes demand management. 49 Resilience preparedness 1.4 Planning for winter reflects identification of surge capacity to ensure capacity is made across the health and care system to allow new emergency admissions to be accommodated. Yes The basis of the plans this year will be to create 'suge' by utilising additional staffing to increase flow through the system as opposed to the creation and subsequent staffing of surge beds. This is the case both in relation to inpatient NHS beds as well as additional interim beds in care homes. This process evaluated well as part of the winter debrief. 63 Resilience preparedness 1.5 Business Continuity Management arrangements are in place and regularly reviewed, exercised, and updated. These are in accordance with Civil Contingencies Act 2004 for Category 1 and 2 organisations and other guidance including: a) NHS Scotland Standards for Organisational Resilience 2018. b) Preparing For Emergencies: Guidance for Health Boards in Scotland. Yes BCP arrangements are reviewed across all service areas, ranging from BCPs in the H&SCPs through to major incident plans in each of the three general hospitals. This includes the respective responses associated with Cat1 and 2 arrangements. As above, a dedicated session to test current BCPs is scheduled for 14 November 2024. 52 Resilience preparedness 1.6 Plans have identified potential disruptive risks to service delivery and associated mitigation responses. These incorporate lessons identified from Winter 2022/23 in addition to concurrent risks. Resilience Teams are involved in winter preparedness to ensure that business continuity management principles are embedded as part of year-round capacity and service continuity planning. Yes Resilience Teams from NHSL, NLC and SLC are standing members of the Winter Planning Group. NHSL Resilience Group check disruptive weather planning arrangements as per the Disruptive Weather SOP. Arrangements are also in place across SAS and the Roads Departments of the respective Councils to ensure arrrangements are in place to ensure patients are able to access essential hospital services during any period of severe weather disruption. Winter planning arrangements also take account of the debrief from WInter 2023/ 24. A winter planning event, Winter Breach 24, is being organised to take place on 14 November with the aim of raising awareness of preparations and dependencies for severe weather across Lanarkshire and testing the Lanarkshire LRP severe weather protocol. 118 Resilience preparedness 1.7 Business Continuity plans take into account critical activities across the NHS Board / HSCPs spectrum of activity and include analysis of the risks of disruption and their actual effects and demonstrate that planning has been based upon the likelihood and impact of worst-case scenarios. Yes As above, BCPs are updated and there is a Winter Breach event every year such that various scenarios are tested in terms of system resilience. These include loss of power, inclement weather, terrorist attacks and so on. 37 Resilience preparedness 1.8 Business continuity plans include response(s) if a clinical system outage occurs and the steps required to ensure continuity of services. Yes There is a series of BCP arrangements bespoke to specific systems such that alternative arrangements can be set in place pending resolution. 22 Communications 1.9 Local communication plans: A review has been undertaken of communication channels to ensure that key messages about winter planning are clearly and consistently delivered to all parties, involved. This includes : a) Key partner communication protocols b) OOH information including four day festive period c) Surgery hours & access arrangements General practices contingency plans for respiratory disease outbreaks d) Signposting to Scottish Government assistance for households struggling to meet their energy bills. e) Service-linked communications issued, whether online or printed format, include content or text highlighting where public can access information on which service is right for which medical need, such as nhsinform.scot/right-care Yes A local comprehensive communication plan will be in place to ensure the local population remains informed and supported over the winter period, using multiple communication mechanisms. Messages will focus on staying well over the winter period and where Lanarkshire residents can seek appropriate care and highlighting the care that is on offer within the community, including during public holidays. Areas of focus will include, but not be limited to: winter preparedness (including Ready Scotland website), vaccination reminders, GP and pharmacy opening hours, services provided by pharmacies and other community based care, promotion of self-care and NHS Inform website, communications of the public and staff vaccination programme. 117 Step up / Step down care 1.10 Boards and HSCPs can evidence plans to increase the provision of intermediate care to impact positively on patients and services over the winter; and work towards building sustainability for the future. Yes A number of services can be 're-prioritised' to support additional intermediate/rehabilitation care beds if required. This will be directly linked to the daily flow and demand figures. 27 Progress Status Complete Manual dropdown - use this box to track your progress
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Section 2 Subsection # Statement Response Rationale for response rating Words Urgent & Unscheduled Care 2.1 To ensure Right Care is provided in the Right Place, a 24/7 Health Board Flow Navigation Centre is in place to offer rapid access to a senior clinical decision maker as well as the option of appointments via Near Me. Yes Through Operation Flow a new FNC Target Operating Model has been agreed that allows NHS Lanarkshire's FNC to operate 24/7 with a Senior Clinical Decision Maker rostered 8 am to 8 pm each day. Due to current staffing constraints, there can be periods where there is not full coverage. In addition to this the FNC has a SAS ANP rostered 8 am to 8 pm to support CBYC. This also supports a hybrid SCDM model with SAS Practioners and Consultants (ED and Acute Medicine) to support direction of patients to the right care and in the right place. This resource will take time to recruit to the organisation and will not be fully available for Winter 2024/25. A Frailty Consultant is also rostered each afternoon Mon- Friday to facilitate direct access to frailty units. Near Me is available within our FNC and is utilised as required. We have a number of pathways developed that are now being implemented to support scheduling of attendance at ambulatory care units. Training of the nursing workforce in the FNC is also underway to further enhance their decision making skills. 186 Urgent & Unscheduled Care 2.2 Effective communication protocols are in place to support whole-system situational awareness of emerging pressures. Monitoring of key indicators across the system forms the basis of huddle discussions. This ‘early warning system’ should highlight areas of concern and drive action to maintain or regain a balanced system. Yes In place through our x 3 daily huddles. An action and responsibility framework has been developed, along with action cards underpinned by a summarised ladder of escalation which clearly defines the level of escalation and the actions required by the relevant key disciplines and staff groups. 46 Urgent & Unscheduled Care 2.3 Robust communication processes are in place across each hospital site, following Discharge Without Delay (DWD principles) including morning hospital- safety huddles, focusing on the day's activity and current status, and afternoon huddles, setting Planned Date of Discharge and using this to predict capacity and demand for the next day. a) There is a Home First / Transition Team in place to support hospital discharge and Discharge to Assess; please provide further detail. Yes Whole system communication is in place through the whole system calls and site huddles. We have developed an Optimal Discharge planning Target Operating Model (TOM) to support good discharge planning across our bed holding areas. The TOM is underpinned by the FLOW foundation bundles and a Home First Assessment Approach. A training and education plan supported by P&D, OD, Practice Development and Quality Improvement is being developed to support sustainable implementation of the TOM. We have developed a flow foundation bundle which comprises of a set of simple rules to enhance flow across our assessment areas and wards, including acute and off site areas. This consists of: Planned Date of Discharge (PDD) setting; criteria led discharge; criteria to reside assessment for every patient; structured board rounds x 3 daily; and daily ward beat for each ward. We audit process implementation on a weekly basis and are transitioning to auditing outcome measures also. 153 Urgent & Unscheduled Care 2.4 Emergency Physician in Charge (EPIC), Flow Co-Ordinator roles are in place where possible to provide dedicated leadership in Emergency Departments. A Discharge Co-ordinator is in place in each ED to act as a single point of contact (SPOC) to arrange rapid discharge from ED and take responsibility for co- ordinating community support. Partial EPIC roles and Flow Co-ordinator roles are in place across all our 3 departments as staffing levels allow. Our SW team and discharge teams support early discharge from our EDs but there isn't a dedicated discharge facilitator in each ED. 40 Urgent & Unscheduled Care 2.5 Pathways are in place which provide care closer to home through pathways such as Hospital at Home for Older People; Respiratory Rapid Response and Out-patient Parental Antibiotic Therapy (OPAT); and supported by appropriate digital interventions such as Remote Consultation by phone and Near Me and Remote Monitoring, call before convey with SAS and flow navigation hub working to maximise virtual/remote Monitoring. Partial H@H frailty and OPAT pathways are operational to support admission avoidance and early discharge. Having concluded tendering process Doccla has been awarded the contract to support up to 400 virtual H@H beds. This system will provide electronic patient records, remote monitoring via a range of intermittent and continous monitoring devices, patient reported outcomes and two way communication with patients including remote video consultations. Initial specialties being explored are Diagnostic virtual step down, cardiology, respiratory and gastroenterology. We anticipate expanded capacity from mid November. We developed our workforce and clinical models to increase hospital @ home capacity. OPAT capacity was increase through funding secured via OP flow and recruitment continues to maximise this resource. We continue to test our Community Respiratory Service (1.0 wte Nurse and 1.0 wte physio specialist). Our pathways and models of care are being developed and expanded through the creation of our interface division and expansion of our FNC to FN + Plus. 157 Urgent & Unscheduled Care 2.6 Boards and Partnerships have effective organisation of care across between primary and secondary care so that patients receive high-quality care and the best use is made of clinical time and resources in both settings. This could be through a mechanism such as an Interface Group. Yes Our Operation Flow structures are whole system and therefore facilitate good interface working. A primary/ secondary care interface group has been established within the interface devision that is working on redesigned patient pathways - initial pathways developed are anaemia, headaches and hypertension. 42 Urgent & Unscheduled Care 2.7 Escalation procedures are directly linked to a plan which encompasses the full use of step-down community facilities. Yes Yes escalation plans are linked to use of step down. 10 Urgent & Unscheduled Care 2.8 Boards and HSCPs have additional festive arrangements, over the four-day public holiday, planned in collaboration with partner organisations such as Local authorities, Police Scotland, SAS and the local Voluntary Sector and in line with recommendations from the Four Day Public Holiday Review. Yes Our Winter Planning structures are whole system. We also have >60% of GPs opening at some point on the two public holidays of 26 December and 2 January as well as Saturday 28 December and all Saturdays in January. 39 Urgent & Unscheduled Care 2.9 Patients identified as being at high risk of admission from both the SPARRA register and local intelligence, and who have a care manager allocated to them, will be identifiable on contact with OOH and acute services to help prevent admissions and facilitate appropriate early discharge. Partial Community nursing gets an email each week of all care managed patients that have been admitted. The Integrated Discharge Facilitators on each site also get this list each day. 29 Urgent & Unscheduled Care 2.10 Processes are in place to enable patients with respiratory conditions and those who are frail are given the opportunity to have an anticipatory or future care plan. There should be a system in place for identifying these individuals and it should be clear which professional clinical groups will take a lead on having these care planning conversations depending on the persons circumstances. Partial Some respiratory patients are provided with advice re ACPs and use of medication to proactively avoid exacerbation of their illness linked to adverse weather. The establishment of the 3 frailty units with direct admissions where possible will also assist in managing respiratory illness as well as being able to respond pro- actively to patients with ACPs as part of this process. It is recognised that further work is required in developing robust anticipatory care planning across NHS L 87 Urgent & Unscheduled Care 2.11 Pathways are in place for patients who are identified as ‘frail’ and those with respiratory or cardiac exacerbations, and these are embedded within primary care services, in and out of hours, as alternatives to admissions. Partial Consultant Connect is available for GPs 'in' and 'out of hours' for profession to professional advice to avoid admission where appropriate and we are committed to enhancing use of technology to suupport admisison avoidance. Consultant Geriatricians have been embedded within FNC to support discussions and virtual consultation where appropriate with opportunities for direct admissions to frailty units on all three sites. We also have a dedicated frailty workstream as part of Operation Flow with a dashboard now operational showing frailty scores of inpatients available on Milan. There is subsequently a wide range of work underway including interface teams on each of the sites and connection with community based Locality 112 Urgent & Unscheduled Care 2.12 People living with a respiratory condition have access to a respiratory team 7 days a week, should they become unable to self-manage their condition from home. People with heart failure and those who are living with frailty should be given the opportunity to have an anticipatory or future care plan. Partial A respiratory pilot is underway in one locality and funding has been extended for a further year. This work will form the basis of our respiratory H@H virtual ward pathways which are currently being planned. A heart failure application to access H@H funding was declined. We are currently exploring local funding opportunities and we re currently planning our H@H heart failure virtual ward capacity.. 64 Urgent & Unscheduled Care 2.13 Care Homes will be supported with timely access to professional support and clinical advice to enable admission prevention and more planned interventions to keep residents safe in their own home. This includes proactive contact on at least a weekly basis to discuss any residents the care home staff are concerned about and agree a plan of care and interventions if these should be required. Remote consultations via phone or Near Me video consultation should be available. Yes Our Care Home Liaison Team provide professional support and advice to keep residents safe in their own home. Consultant Connect is available for GPs for profession to professional advice to avoid admission where appropriate and we are committed to enhancing use of technology to suupport admisison avoidance. The vast majority of care homes are also covered by the GP Care Homes LES which means there is a dedicated GP practice looking after all the residents in these homes. 78 Urgent & Unscheduled Care 2.14 For Health Boards with Major Trauma Centres (Grampian, GGC, Lothian, Tayside), to incorporate into their winter surge plans, assurance of sufficient safe staffing on MTCs (both adult and paediatric) to ensure Scottish Trauma Network MTCs will continue to deliver high quality, integrated, multi-speciality care to severely injured patients. Further consideration is also required for those Boards with Major Trauma Units to similarly support safe staffing. n/a N/A 1 Urgent & Unscheduled Care 2.15 Where admission is necessary, ensure there is a mechanism and/or agreements in place with primary care and secondary care clinicians to minimise delays in pathway, and avoid multiple discussions that can lead to delays; recognising that in periods of increased demand, general practice may not have the functional capacity to follow the usual processes such as pathways for admission. Yes Consultant Connect in place and use being promoted via Operation Flow and our Winter planning processes. We are scoping if we can patch calls from our FNC direct to consultant connect. We are keen to undertake a test of change for direct access to determine if we can reduce delays for patients. All requests for direct admissions are managed via our FNC who will add to expect lists, order transport and discuss directly with SCDM if required 77 Planned Care 2.16 Plans are in place to maintain activity over winter for planned care, including outpatients and inpatient / daycase, diagnostics, imaging and cancer, with plans considering the impact of increased unscheduled admissions on planned care activity. Planned care activity will not be paused or cancelled routinely – if Health Boards need to consider this as part of their business continuity / escalation plans it needs to be discussed and agreed in advance with Scottish Government. Yes Ortho protected beds at UHH aligned to an SOP detailing the identification/ criteria for patients suitable to board to ward 7. Establishing a 23-hour care unit at UHM. Work underway to fully embed Active Clinical Referral Triage (ACRT) & Patient Initiate Returns (PIR) within clinical pathways. 45 Planned Care 2.17 Health Boards are considering opportunities to maximise capacity through Pooled Lists - locally for high volume specialties and pooled lists regionally / nationally for those patients waiting the longest. Yes Working across sites to ensure the utilisation of capacity within the services as a whole to sustain NOP & TTG standards. Continue to ensure full utilisation of Outsourcing capacity GJNH and Independent providers. 33 Planned Care 2.18 Health Boards are making use of the National Elective Coordination Unit (NECU) to support admin and clinical validation. Yes Working in partnership with NECU to progress validation campaigns for all services to support the management of waiting lists including diagnostic services (MRI & Ultrasound). 25 Planned Care 2.19 For those Health Boards with National Treatment Centres (NTCs), plans are in place to enhance and maximise use of the NTCs through winter and beyond. n/a N/A 1 Planned Care 2.20 Discharge: close partnership working is in place, including the third and independent sector, to ensure that adequate care packages are in place in the community to meet all discharge levels. Yes Partnership discharge planning progressed through ward based flow bundles including MDT discussions supporting PDD and associated actions. There is also significant social work presence in each of the hospitals to ensure rapid access to necessary assessment, advice and focus on all action areas. The development of the Optimal Discharge TOM has further facilitated strong partnership working in relation to discharge planning. Partnership discharge planning progressed through ward based flow bundles including MDT discussions supporting PDD and associated actions. There is also significant social work presence in each of the hospitals to ensure rapid access to necessary assessment, advice and focus on all action areas. 105 Digital assets 2.21 Plans are in place to support the availability of Near Me video consultations to optimise estate and workforce capacity. Partial Enhacing the use of 'near me' is included in new Front Door Target Operating Model and we plan to increase use during Winter 24/ 25. 25 Progress Status Complete Manual dropdown - use this box to track your progress Overall Status Partial and/or No Automatic status
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Section 3 Overall Status Yes Automatic status Subsection # Statement Response Rationale for response rating Words Primary Care 3.1 Plans are in place to support General Practice (and where necessary other independent contractors) to manage provision of core General Medical Services (and sustainability more widely) over the winter period. Specific reference should be made to contingency arrangements where practices are unable to open (or provide General Medical Services) due to staffing or other reasons. Health Boards and HSCPs should ensure that where services are reduced or unavailable they support the practice with communications to patients including alternative arrangements. Yes There is a dedicated GMS sustainability group which meets weekly to consider any GP practices which are in difficulty such that associated resources can be brought to bear where at all possible to provide support to the respective practice. This includes providing staff from other areas of NHSL to give tailored support depending on the nature of the sustainability issues/staffing difficulties. Throughout such processes, comms plans are provided to support the practice and the associated patient group. Advice has also been obtained from the respective medical defence organisations to re-assure GPs tha they can work to 105 Primary Care 3.2 Maximising Multi-Disciplinary Teams (MDTs) Plans explicitly reference the use of MDTs within OOH services; indicate where increased use of MDTs are in place. This includes increasing capacity of senior clinical and non- clinical leadership, use of multidisciplinary teams and availability of professional-to-professional advice across acute and community. Yes The service has increased MDT staffing, with recruitment of senior ANP, trainee Paediatric NP's and SAS Advanced Practitioners on a seconded basis. The service will recruit qualified ANPs when academic year complete end September 2024. Sessional Pharmacists who posses the necessary non-medical prescribing qualifications to process medication requests undertake sessions within the PCOOH service at peak times (weekend dayshifts and public holidays) to alleviate pressures on GP colleagues; this initiative is entirely separate of community pharmacy. Whilst plans include the utilisation of MDTs, this may be tempered by the availability of the relevant qualified staff for the PCOOH service. 99 Primary Care 3.3 Executive level overview and oversight for Out of Hours (OOH) A Primary Care OOH winter plan has been signed off at Executive level, with clear escalation processes in place. There is Board Executive level oversight of OOH to support resilience, explore other operational solutions and agree appropriate escalation plans during the winter period given its essential role as a “front door” service Yes A specific plan for additional cover for OOH over the winter period is being prepared and forms part of the wider winter plan. There is an executive lead as well as escalation processes being in place. Specific work continues with NHS24 with a view to increasing dispositions to community pharmacy and not OOH services. This also involves ongoing discussion with community pharmacies in the context of the increasing pressures on community pharmacy. NHSL comms team will continue to issue specific comms signposting service users to other self care options to reduce footfall to EDs and PCOOH service. 97 Primary Care 3.4 Link with wider winter plans and engagement with SAS and NHS 24 to improve system resilience. The plan puts Primary Care OOH within the context of winter readiness preparedness, as part of the urgent/unscheduled care landscape and whole system local planning, including community and social care responses through urgent care resource hubs/flow navigation centres (FNCs), or equivalent. Yes SAS are also key partners in our winter planning group and have effective liaison with our OOH service. P2P referrals are also a key feature of the service. Both SAS and NHS24 have representation on the OOH National Operations Group meeting and there is a dedicated NHS24/OOH partnership group convening on a regular basis. In addition to this, up to 74% of GPs across Lanarkshire are opening at various stages such as 26/12, 28/12, 2/2 and the subsequent Saturdays throughout January 2025 to assist in managing demand that may otherwise have fallen to OOH or A&E to manage. 98 Primary Care 3.5 NHS Board Directors of Dentistry engage with NHS 24 to ensure they have sufficient capacity in place to meet any potential increased demand for out of hours care during the winter period Yes Public Dental Service representatives meet regularly with NHS 24 on Regional and one-to-one basis to review past demand vs capacity and discuss any measures/ mitigations and current pressure 'pinch points'. This information is used to inform decisions on clinic opening times and additional stand-by useage. Director of Dentistry meets weekly with PDS representatives to receive updates on issues of concern with OOH/ NHS24. 63 Primary Care 3.6 Provision of OOH dental services Plans reference provision of dental services; services are in place either via general dental practices or out of hours centres. This should include an agreed escalation process for emergency dental cases, i.e. trauma, uncontrolled bleeding and increasing swelling. Yes Plans include the current template for Next Day Care via GDS practices Mon-Fri as well as OOH clinics via GDS/ PDS staff mix on health board premises at weekends. In addition, PDS unregistered weekday clinics are run to remove burden of pressures resting solely with NHS24/ OOH. There are outcomes agreed with NHS24 for cases triaged as emergency at NHS24 eg. 1 hour outcomes or ED referral for those requiring specialist OMFS surgical/ medical assessment and management. 77 Primary Care 3.7 Working with mental health services HSCPs should have clear arrangements in place to enable access to mental health crisis teams/services 24/7, including availability of professional to professional advice for out of hours services, particularly during the festive period Yes Psychaitric Liaison Nursing Service provides access to MH assessment via the three Acute Sites ED services 24/7. 17 Primary Care 3.8 Increased level of professional-to-professional advice Boards and HSCPs have increased, where possible, the availability of professional to professional advice across acute and the community to ensure the patient receives right care in the right place at the right time. Yes Maximising P2P advice through a range of measures is a key feature of Operation Flow. This includes maximising the coverage and use of a fully functioning FNC as well as extending the reach of Consultant Connect. There is also 24/7 access from NHS 24 to Psychatric Liasion Nurse as well as Police Scotland Triage via the service based at Douglas Street clinic. The stress/distress pathway with SAS and Police is also well established allowing for providing community based responses without the need for conveaynce to hospital/A&E attendances. 86 Primary Care 3.9 Working with social care OOH Plans demonstrate consideration to social care services and where possible close links are in place for emergency respite, community alarm services and home care provision. OOH Plans will identify how Care Homes will be supported with timely access to professional support and clinical advice (particularly in the OOH period) to enable admission prevention and more planned interventions to keep residents safe in their own home. Yes Emergency Social work services are available across both North and South Lanarkshire HSCPs and the respective communication measures in place. Home visiting continues by the OOH clinicians. Care homes are directed to contact the OOH service via the FNC obviating the need to go through NHS24 thereby removing associated delays. Public Health/ Health Protection is also available to provide advice for control of outbreaks in Care Homes. Additionally, our PH and Care Home team provide pro-active advice to Care Homes in relation to a range of factors, eg infection control to try to minimise any infections and mitigate their subsequent impact. 100 Primary Care 3.10 Winter readiness plans consider the needs of those living with a mental health, learning disability, neurodiverse or dementia diagnosis, including the needs of carers. Yes Community Learning Disability Teams ensure there are indivudal plans of care are in place that support patients, carers and other providers of services. Similarly. CMHTs ensure effective comms such that all patients are aware of who to contact in the event of crisis - including over the winter period. 49 Primary Care 3.11 Plans to ensure appropriate staffing levels include consideration of mental health services and the need to maintain support for service provision and patient rehabilitation (such as suspension of detention), including for forensic mental health patients. Yes Winter plan will be in place for all mental health services, including inpatient and community forensic services, which will ensure sufficient numbers of staff are available to be able to maintain all core services and have the ability to meet respective need. Again this will include all mental health services, including forensic services. 53 Primary Care 3.12 The discharge partnership working plans include consideration of those requiring mental health supports and/or being discharged from a mental health setting, including the unique support package needs of those leaving forensic inpatient settings or with complex care needs. Yes The winter plan for mental health services referred to above includes the availability of staff who will be linked to discharge planning from all ward settings, including adult mental health, mental health of old age, forensics and learning disabilities. 40 Primary Care 3.13 Plans ensure continued access to dementia diagnosis services for both inpatients and those in the community, ensuring people have care and treatment appropriate to their needs and any potential dementia-related issues are recognised and addressed. Yes Consultant run clinics as part of the Older Adult Community Mental Health Teams will continue across winter. Patients within specialist MH wards will also have access to MDT with a specialist input around dementia diagnosis. 35 Primary Care 3.14 Plans are in place to ensure data is available to monitor the performance and capacity of primary care and mental health services throughout the winter. Yes There is a suite of data that is used to measure overall performance across both primary care and mental health services and these will continue across the winter period. In relation to primary care, as well as the weekly sustainability meetings referenced above, there is also a weekly proforma issued toask that any specific isses are ntoified proactively. In relation to mental heath services, measures 84 Prisons 3.15 Plans are in place to ensure that the delivery of prison healthcare, including mental healthcare, is maintained and that there are appropriate levels of healthcare staff in prisons to deliver efficient and effective patient care. Yes The Prisoner Healthcare service within HMP Shotts will has a sustainable, experienced, and consistent workforce provision which has been covering any gaps in recruitment. This contingency will remain in situ over the winter period. 35 Social Care 3.16 Care at home assurance boards and care home assurance arrangements are in place to ensure all risks in care provision are recorded and appropriate mitigating actions are put in place. Yes We have established boards that meet regularly - we track all risks and take active action to mitigate risks where possiblework. 21 Social Care 3.17 Capacity to deliver key public protection functions is in place e.g. child and adult protection, MAPPA (Multi Agency Public Protections Arrangements) Yes Established processes and services in place to deliver key public protection functions. 31 Progress Status Complete Manual dropdown - use this box to track your progress
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Section 4 Overall Status Partial and/or No Automatic status Subsection # Statement Response Rationale for response rating Words Workforce 4.1 Appropriate steps are being taken to support recruitment of staff on an ongoing basis within recognised financial parameters, utilising the full range of potential contractual arrangements including (but not limited to) Permanent, Sessional Worker, Bank or Fixed Term contracts (or a combination of these). Work undertaken with local college and HEI student workforce to offer holiday shifts and regular part time contracts can be evidenced. Yes Open external bank registered nurse recruitment is ongoing. Streamlined internal staff bank recruitment process continues. Recruitment of students to bank is ongoing and use of fixed-term contracts as a recruitment option for winter pressures is well enshrined within NHSL. 39 Workforce 4.2 Boards and HSCPs are continuously deploying the range of tools available to them to support efforts aimed at staff retention. For Boards, this is including but not limited to those set out through DL (2022) 30: DL(2022)30.pdf (scot.nhs.uk) to enable those staff who have retired to return to work on a part time basis should they wish to do so. Yes Retire and return policy is well embedded within NHSL. The Board had a pre- existing retire and return policy to encourage those colleagues retiring to return to a similar or their current post.We also actively email colleagues leaving the organisation 2 weeks before their last working day to invite them to complete an exit survey to capture more insight into why people leave NHSL. As referenced elsewhere, the whole-system staff health and wellbeing programme is well established and is also supportive to staff recruitment and retention. 85 Workforce 4.3 Plans are in place for appropriate levels of staffing across the whole system to facilitate efficient and effective patient care, ensuring consistent effective discharge planning takes place over 7 days and the holiday periods. This requires sufficient senior medical and other senior clinical decision makers to facilitate decision- making, and pharmacists to prepare timely discharge medications. For HSCPs, this includes sufficient social work staff and others associated with discharge planning. Partial All managers have been asked to ensure there is effective staff planning to ensure there is sufficient numbers of staff at weekend and public holidays to support flow. Work is currently ongoing to populate rotas seeking to ensure an appropriate level of coverage. As mentioned in Section 3, specifically in Primary Care, over 70% of GPs across Lanarkshire are opening at various stages across the 26th Decmeber and 2nd January public holidays as well as on Saturday 28 December and the subsequent Satyurdays throughout January 2025. 86 Workforce 4.4 A strategy is in place for the deployment of volunteers over winter, making appropriate use of established local and national partnerships. Investment in and funding of local voluntary and third sector organisations to support care@home teams and provide practical support to people who are ready for discharge, and across the wider community can be evidenced. Yes Both North and South H&SCPs have invested significantly in voluntary organisations to be able to support the wider statutory sector to ensure that a range of support is available that helps initially to avoid admission to hospital as well as being able to support some patients earlier discharge home. 49 Workforce 4.5 Staff are appropriately supported to access the range of available local and national staff wellbeing resources. This includes Primary Care independent contractor staff. Yes Over and above our existing communication with teams, during October we will be raising awareness of local and national staff wellbeing resources. This will be via weekly staff bulletins, social media and cascade information for managers and team leaders. We will be promoting the Your health matters website where details of the three main staff support services (Occ Health, Psychology and Staff Care) are available. 65 Workforce 4.6 In relation to potential adverse weather, Boards and Partnerships have contingency plans in place covering staff disruption to manage the impacts – for NHS this is specifically according to DL(2022)35.pdf (scot.nhs.uk). Staff are fully aware of the contingency plan. Yes There is a recognised adverse weather policy in the NHSL suite of HR policies. This is communicated to all staff as part of the comms plan and additionally, there is early warning of any weather warnings via LRP colleagues. In such circumstances, there is an alert email as part of the comms plan which also refers staff to the respective policy. Colleagues in North and South Lanarkshire Council's also have robust adverse weather contingency plans in place and will undertake complementary comms and resilience arrangements to maximise the 'public sector' response to any adverse 98 Seasonal outbreak 4.7 COVID-19, RSV, Norovirus, Seasonal Flu, Staff Protection & Outbreak Resourcing All patient-facing (i.e. “frontline”) Health and Social Care Staff (including Primary Care independent contractor staff) and ALL NHS workers have easy and convenient access to the seasonal flu vaccine and that: a) staff are able to drop in to any community clinic without needing to make an appointment b) peer to peer vaccination for flu is facilitated, where practicable, to bring the vaccine as close to the place of work for staff as possible. c) information and guidance is provided to staff on how to book appointments via the online portal or the National Vaccination Helpline and that they can drop in to any clinic without needing to book. d) Information and guidance / promotional materials are provided to staff on the benefits of vaccination for both themselves, their colleagues and their patients. (Full details on the programme can be found in the annual flu CMO letter.) Yes The Covid and Flu Winter programme for 2024 commenced with Flu only vaccinations WC 16th September for under 5’s and adults later in the programme. Covid will be offered to those eligible alongside their Flu vaccine from WC 7th October, including H&SW staff. Plans in place for Health and Social Work staff to be vaccinated on acute and community sites through SALUS clinics, with ongoing development of peer vaccinations. Where capacity allows, H&SW staff will be offered drop ins alongside the clinics running across acute and community sites. - Information and guidance has been issued nationally and locally through all Lanarkshire email with booking instructions and available on the website. NHSL computer log in screens also changed to inform staff. - Work is continuing with a number of staff to support peer vaccination where possible. Regular review will be undertaken to assess rate of uptake across all sites such that any areas requiring targeted work can be identified and the associated uptake rate improved where possible. 163 Seasonal outbreak 4.8 Plans take into account the predicted surge of Covid-19 as well as other viruses including seasonal flu, RSV and Norovirus activity that can happen between October and March and have adequate resources in place to deal with potential outbreaks and the impact these have on services (health and social care inclusive of primary care) across this period. Yes Winter preparedness planning is in place to re-circulate information and education on respiratory illnesses such as Influenza, COVID-19 and RSV. Infection Prevention and Control Education sessions will be delivered on loose stools management including norovirus. This will be done within acute hospitals & H&SCPs. Whilst the plan takes account of the potential for additional demand due to seasonal flu, it is not possible to say that there will be adequate resources to deal with it internally without impact on other services, e.g. planned care, without knowing the extent of any flu/other illness surge. Plans are also in place across our paediatric services such that they are more able to manage any surges in RSV activity. 114 Seasonal outbreak 4.9 Adequate resources are in place to manage all potential increases in Covid-19 including possible new variants with increased severity, RSV and seasonal flu that might coincide with norovirus, severe weather and festive holiday periods. Debriefs should be undertaken following significant outbreaks or end of season outbreaks to identify lessons and ensure system modifications to reduce the risk of future outbreaks Yes Plans are in place for discussions to take place for any COVID 19 and other winter illness outbreaks that might occur during festive holiday periods. Clinical staff, IPCT, Domestic Staff. Occupational Health and Safety and Microbiology are included in these discussions. Depending on severity and possible concurrence, it may be necessary to stand down non-urgent service delivery. There are well established ‘escalation plans’ and associated services which will be prioritised and continued across health and social care. Debriefs will be arranged should any significant events occur to identify learning to reduce future risks. 93 Seasonal outbreak 4.10 To help detect early warnings of imminent surges in activity, Boards routinely monitor PHS weekly publications, showing the current epidemiological picture on COVID-19, RSV, Norovirus and influenza infections across Scotland, and PHS Whole System Model Winter outputs. Yes The Health Protection Team have processes in place to monitor PHS outputs and those produced by UKHSA for the wider picture across the UK. Members of the Health Protection Team attend regular national meetings with PHS on influenza and COVID activity. The Health Protection Team also use local data to monitor local trends. During the winter season weekly outputs are produced and shared internally. Health Protection Scotland weekly publications are disseminated to IPCT and Microbiology IPC and fed back to sites at local level to monitor for possible early warnings of a surge in activity. The information is also accessible to Public Health colleagues. 104 Seasonal outbreak 4.11 Boards must ensure that staff have access to and are adhering to the national guidelines on Preparing for and Managing Norovirus in Care Settings Yes IPCT will provide information to all staff to raise awareness of how to access relevant guidance. As part of winter preparedness planning promotion of the National Infection Prevention and Control Manual will be done during drop in visits and by utilising other communication methods such as the NHSL Screen Saver and hospital newsletters. 53 Progress Status Complete Manual dropdown - use this box to track your progress
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REPORT Item No: 10 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) for: For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the period 1 April 2024 to 30 September 2024. 2. ROUTE TO THE 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) Acknowledge the contents of the report; and (2) Acknowledge the projected outturn for 2024/25 is an underspend of £1.446m. 4. VARIATIONS TO DIRECTIONS SUBJECT: Financial Monitoring Report 2024/25 TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Nicola Scott, Chief Finance Officer DATE: 4 December 2024
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5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Chief Officer (Finance). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in the following table, the IJB projected outturn position, is an underspend of £1.446m, assuming the current trajectory of spend continues until the end of this financial year. Currently there is no ring-fenced funding included in this reported position. 6.2 Appendices 1 to 3 show a detailed budget position for each care group including South led hosted services. 6.3 In line with Scottish Government guidance, unspent ring-fenced funding must be transferred to relevant reserves at the end of each financial year for use in later years. Subject to IJB approval, in-year underspends will be allocated to manage, on a non-recurring basis, ring-fenced commitments, Strategic Commissioning Plan commitments and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2023/24 FINANCIAL PERFORMANCE 7.1 The current financial forecast for 2024/25 projects a yearly underspend of £1.446m relating to various under and overspends across the whole integrated budget. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – projected underspend of £15.119m As reported throughout 2023/24, there are continuing challenges in terms of recruitment and retention across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. £m £m £m £m £m Health Care Services 533.623 9.996 543.619 543.443 0.175 Social Care Services 263.871 0.000 263.871 262.601 1.270 TOTAL 797.494 9.996 807.490 806.044 1.446 Annual Budget 2024/25Care Group Projected Year End Variance 2024/25 Projected Year End Spend 2024/25 In Year Drawdown From Reserves Revised Budget 2024/25 Yes No N/A
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As highlighted in the financial plan, included in this underspend is £6.961m relating to a non-recurring reduction in pension contributions. This will be used to offset overspends in other areas of Adult Social Care during 2024/25 to allow time for savings plans to be realised. 7.1.2 Payments to Other Bodies (PTOB) – projected overspend of £4.003m There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. • Independent care homes have a yearly budget to fund 1,361 care plans but at present the number of care plans is 1,463 resulting in a overspend of £1.316m. • SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,692 care plans for 2024/25. This is an area which is currently under review and is included in the 2 year savings delivery plan. Further details are at Appendix 6. 7.1.3 Prescribing – projected overspend of £6.348m The current overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on actual prescribing data available to July 2024 and estimated data for August and September 2024. The forecast will be updated as further data becomes available. 7.1.4 North Lanarkshire Hosted Services – projected overspend of £2.486m The main variances within North Lanarkshire hosted services relate to: • Continence Services – overspend of £0.738m which is related to increases in product and delivery costs. • Children Services – overspend of £1.788m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. • Prisoner Healthcare – overspend of £0.402m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. 7.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and the table below shows the current funding allocation received from Scottish Government:
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*Further discussion is underway with Scottish Government regarding this funding stream as the allocation received in September does not cover all the partnerships current Mental Health commitments. 8. SAVINGS 8.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. 8.2 CORE management team and various sustainability and value groups have been meeting on a regular basis to discuss and monitor the management actions reported in the financial plans to progress savings and redesign of services to help support future years budget planning. This includes the following areas of work: • Review of financial planning assumptions for 2024/25. • Review of all current vacancies including length of time left vacant. • Review of discretionary spend and supplementary staffing. • Updates on saving planning in significant areas of budget pressures. • Various service reviews across the partnership. • Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 8.3 The current IJB savings position at the end of September 2024, show total savings achieved of £8.342m and is summarised in the table below: Scottish Government Allocations as at 30 September 2024 £m Alcohol and Drug Partnership Funding 1.684 Band 7 OPAT Post 0.069 Digital Mental Health Licences 0.120 Distress Brief Intervention 2.780 Family Nurse Partnership 1.074 Hospital at Home 0.276 Long Covid Support Fund 0.224 Meningitis C 0.106 Mental Health Outcomes 0.166 Specialty and Specialist Doctors Contract 0.194 Enhanced Mental Health Outcomes Framework * 11.800 TOTAL 18.493
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8.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving plans. 9. GENERAL RESERVES 9.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statue and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 9.2 The current IJB reserves position for 2024/25 after adjustments for the drawdown of in-year reserves, is a revised balance of £64.682m and is summarised in the table below: 9.3 Appendix 5 shows a detailed list of all reserve movement during this financial year. 9.4 Regular updates will be provided to the IJB throughout the year as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 10. VACANCY POSITION 2024/25 Opening Balance As At 1 April 2024 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 September 2024 £m £m £m £m NHSL Ring-Fenced Reserves 19.281 0.000 (4.470) 14.812 NLC/NHSL Earmarked Reserves 20.955 0.000 (1.270) 19.684 NLC/NHSL Risk-Based Reserves 17.045 0.000 0.000 17.045 NHSL Contingency Reserves 13.390 0.000 (0.250) 13.140 NLC/NHSL Closed Reserves 4.853 0.000 (4.852) 0.001 75.524 0.000 (10.842) 64.682Total LEAD SUMMARY
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10.1 The table below shows the full time equivalent (FTE) vacancy numbers at 30 September 2024 within each service compared against their budgeted establishment: * Over establishment is in relation to Mental Health commitments highlighted in para 7.2 above. 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours is used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7. 11. DIGITAL FINANCE POSITION 2024/25 11.1 Below is a summary of the current North Lanarkshire IJB digital programmes of work and the agreed funding associated with each: Establishment Actual Vacancies FTE FTE FTE North West Locality 394.98 367.43 27.55 North East Locality 330.93 313.24 17.69 Adult Services 294.61 286.37 8.24 Children Services* 492.37 543.60 -51.23 Mental Health* 1,167.25 1,180.78 -13.53 Social Care Services 986.90 823.68 163.22 Home Support 1,000.17 956.83 43.34 Other 218.78 233.48 -14.70 TOTAL 4,885.99 4,705.41 180.58 Position as at 30 September 2024 Service Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.047 0.015 0.312 0.011 0.385 North East Locality 0.030 0.011 0.196 -0.002 0.235 Adult Services 0.031 0.034 0.137 0.021 0.223 Children Services 0.083 0.020 0.300 0.000 0.402 Mental Health 0.162 0.042 1.986 2.170 4.360 Social Care Services 0.358 - - 0.002 0.360 Home Support 2.196 - - - 2.196 Other 0.007 0.006 0.027 - 0.040 TOTAL 2.913 0.129 2.957 2.203 8.202 SERVICE Costs As At 30 September 2024
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11.2 Currently two of the three programmes are progressing within their allocated funding however, Community Alarms envisage a gap in recurring funding from 2026/27 onwards. To ensure future financial transparency, the Medium Term Financial Plan will be updated to reflect this additional pressure. Social Work Case Management System (MOSAIC) COST £m FUNDING £m Year 1 (23/24) 0.213 Year 2 (24/25) 0.174 Year 3 (25/26) 0.114 Year 4 (26/27) 0.114 Year 5 (27/28) 0.114 Year 6 (28/29) 0.114 Year 7 (29/30) 0.114 TOTAL COST OF PROGRAMME 0.957 Capital Budget (0.157) Non-Recurring Funding (0.100) Earmarked Reserve (0.700) TOTAL FUNDING AVAILABLE (0.957) Home Support Scheduling System (ACCESS) COST £m FUNDING £m Year 1 (23/24) 0.521 Year 2 (24/25) 0.610 Year 3 (25/26) 0.547 Year 4 (26/27) 0.312 Year 5 (27/28) 0.326 Year 6 (28/29) 0.340 TOTAL COST OF PROGRAMME 2.656 Recurring Revenue Budget (0.224) Earmarked Reserve (2.432) TOTAL FUNDING AVAILABLE (2.656) Community Alarms Analogue to Digital COST £m FUNDING £m Year 1 (24/25) 0.399 Year 2 (25/26) 0.229 Year 3 (26/27) 0.279 TOTAL COST OF PROGRAMME 0.907 Capital Budget (0.087) Recurring Revenue Budget (0.135) Earmarked Reserve (0.465) TOTAL FUNDING AVAILABLE (0.687) Recurring Funding Gap From Year 3 (26/27) 0.220
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12. IMPLICATIONS 12.1 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 ☐ 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 ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae
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12.5 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 Chief Officer (Finance) within 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 ☒ 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. 12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None.
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14. APPENDICES Appendix 1 - North Lanarkshire IJB Budget Position Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 5 – North Lanarkshire IJB Movement on Reserves Appendix 6 – North Lanarkshire IJB 2 Year Savings Delivery Plan Appendix 7 – Analysis of Additional Employee Costs 2024/25 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on scottn@northlan.gov.uk.
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North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 September 2024 Appendix 1 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2024/25 September 2024 September 2024 September 2024 2024/25 £m £m £m £m £m Health Care Services Locality and Other Services 63.652 31.421 29.947 1.474 2.948 Addiction Services 4.765 2.404 2.404 (0.000) (0.000) Medical and Nursing Directorate 4.442 2.339 2.119 0.221 0.441 Prescribing 73.439 36.920 40.094 (3.174) (6.348) Out of Area Services 4.318 2.159 1.928 0.231 0.461 Area Wide Services 7.951 3.459 3.245 0.214 0.427 Hosted Services 179.383 96.439 95.315 1.123 2.247 Family Health Services 131.133 64.597 64.597 0.000 0.000 Set-Aside Budget 74.537 37.269 37.269 0.000 0.000 Total Expenditure - NHSL 543.619 277.006 276.918 0.088 0.175 Social Care Services Social Care Services Gross Expenditure 267.780 144.189 143.549 0.640 1.189 Social Care Services Gross Income (6.138) (3.305) (3.349) 0.044 0.081 Social Care Services Net Expenditure 261.642 140.884 140.200 0.684 1.270 Housing Revenue Account 2.229 (1.200) (1.200) 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 263.871 139.684 139.000 0.684 1.270 Total Expenditure - NHSL and NLC 807.490 416.690 415.918 0.772 1.446 Annual Budget 2024/25 £m NHS Lanarkshire Funding (533.623) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.962) Transfer from Reserves (Approved) (9.996) Total Funding - NHSL (597.973) NLC Funding - Social Care Services (207.288) NLC Funding - Housing Services (2.229) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (209.517) Total Funding - NHSL and NLC (807.490) Care Group Year To Date Funded By:
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Hosted Services Appendix 2 September 2024 September 2024 September 2024 September 2024 September 2024 September 2024 September 2024 September 2024 September 2024 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 3.461 1.837 1.831 0.006 1.800 0.955 0.949 0.006 1.661 0.882 0.882 0.000 Continence Services 2.483 1.249 1.618 (0.369) 1.291 0.650 1.019 (0.369) 1.192 0.600 0.600 0.000 Immunisation Services 2.072 1.981 2.094 (0.113) 1.078 1.030 1.144 (0.113) 0.995 0.951 0.951 0.000 Speech and Language Therapy Services 7.094 3.561 3.133 0.428 3.689 1.852 1.423 0.428 3.405 1.709 1.709 0.000 Children and Adolescents Mental Health Services 9.490 6.737 6.154 0.583 4.935 3.503 2.920 0.583 4.555 3.234 3.234 0.000 Childrens Services 12.592 6.624 7.518 (0.894) 6.548 3.444 4.338 (0.894) 6.044 3.179 3.179 0.000 Integrated Equipment and Adaptations Store 0.817 0.534 0.527 0.007 0.425 0.278 0.271 0.007 0.392 0.256 0.256 0.000 Dietetics Services 4.312 2.227 2.108 0.119 2.242 1.158 1.039 0.119 2.070 1.069 1.069 0.000 Podiatry Services 4.901 2.461 2.236 0.225 2.549 1.280 1.054 0.225 2.353 1.181 1.181 0.000 Prisoner Healthcare Services 2.022 1.028 1.007 0.020 1.051 0.534 0.514 0.020 0.971 0.493 0.493 0.000 Blood Borne Viruses Services 1.885 0.958 0.819 0.140 0.980 0.498 0.358 0.140 0.905 0.460 0.460 0.000 Hospital at Home 3.024 1.495 1.500 (0.005) 1.573 0.778 0.782 (0.005) 1.452 0.718 0.718 0.000 Mental Health and Learning Disability Services 85.505 45.857 44.881 0.976 44.462 23.845 22.870 0.976 41.042 22.011 22.011 0.000 TOTAL 139.659 76.549 75.425 1.123 72.623 39.805 38.682 1.123 67.036 36.743 36.743 0.000 Year to Date North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the North Partnership Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Hosted Services Appendix 3 September 24 September 24 September 24 September 24 September 24 September 24 September 24 September 24 September 24 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 8.111 4.099 3.640 0.459 4.218 2.131 2.131 0.000 3.893 1.968 1.509 0.459 Brain Injury Unit 2.489 1.162 1.119 0.043 1.294 0.604 0.604 0.000 1.195 0.558 0.515 0.043 Out of Hours Services 10.069 5.035 4.536 0.499 5.236 2.618 2.618 0.000 4.833 2.417 1.918 0.499 Palliative Care Services 7.214 3.639 3.605 0.034 3.751 1.892 1.892 0.000 3.463 1.747 1.713 0.034 Physiotherapy Services 11.528 5.764 5.234 0.530 5.995 2.997 2.997 0.000 5.533 2.767 2.237 0.530 Primary Care Services 0.857 0.429 0.361 0.068 0.446 0.223 0.223 0.000 0.411 0.206 0.138 0.068 South Improving Cancer Journey 0.180 0.180 0.180 Occupational Therapy Services 8.545 4.294 4.099 0.195 4.443 2.233 2.233 0.000 4.102 2.061 1.866 0.195 Diabetic Services 4.321 2.199 2.682 (0.483) 2.247 1.143 1.143 0.000 2.074 1.056 1.539 (0.483) Primary Care Improvement Fund 23.258 11.629 11.611 0.018 12.094 6.047 6.047 0.000 11.164 5.582 5.564 0.018 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 TOTAL 76.572 38.430 37.067 1.363 39.724 19.890 19.890 0.000 36.668 18.360 16.997 1.363 North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Year to Date
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North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 4 2024/25 NHSL Financial Allocation to North Lanarkshire HSCP £m 2024/25 NLC Financial Allocation to North Lanarkshire HSCP £m 2024/25 North Lanarkshire HSCP Financial Allocation 338.816 2024/25 North Lanarkshire HSCP Financial Allocation 206.811 Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229 South Hosted @ 52% 39.188 NLC Financial Allocation at 11 October 2024 209.040 Family Health Service South @ 52% 124.475 Budget Adjustments Posted in Month 5 NHSL Financial Allocation at 31 May 2024 577.016 Transfer Scottish Living Wage budget to Housing -0.023 NHSL Financial Allocation at 23 August 2024 209.017 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 6 Draw Down From Reserves 1.747 Scottish Living Wage for Childrens Services 0.500 Increase in ERS Usage 1.943 NHSL Financial Allocation at 11 October 2024 209.517 Long Covid, ADP, Men C Funding 0.387 Budget Realignment 0.981 Increase in Hosted Services Led by South 1.358 Increase in Area Wide Services 0.072 Other Budget Adjustments 0.273 NHSL Financial Allocation at 30 June 2024 583.777 Budget Adjustments Posted in Month 4 Draw Down From Reserves 1.626 Non Recurring Funding Hospital at Home 0.442 Other Budget Adjustments 0.084 NHSL Financial Allocation at 31 July 2024 585.929 Budget Adjustments Posted in Month 5 Draw Down From Reserves 2.935 Increase in Hosted Services Led by South 0.087 Veterans 1st Point Funding 0.126 Other Budget Adjustments 0.886 NHSL Financial Allocation at 31 August 2024 589.963 Budget Adjustments Posted in Month 6 Draw Down From Reserves 0.846 Increased income 0.099 Increase in Hosted Services Led by South 5.734 Prescribing adjustments 1.144 Other budget adjustments 0.187 NHSL Financial Allocation at 31 September 2024 597.973
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North Lanarkshire IJB Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 September 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug 3.597 (1.021) 2.576 (1.021) 1, 2, 4, 5 NHSL Area Wide Services - Ref 0.106 (0.017) 0.088 (0.017) 1, 2, 4, 5 NHSL Blood-Borne Viruses Serv 0.194 (0.031) 0.162 (0.031) 1, 2, 4, 5 NHSL Children and Adolescent 2.849 2.849 0.000 1, 2, 4, 5 NHSL Community Living 1.164 1.164 0.000 1, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.000 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 (0.400) 0.001 (0.400) 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.962 (0.204) 0.757 (0.204) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 (0.208) 0.026 (0.208) 2, 3, 4, 5 NHSL Mental Health Covid 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service 0.972 (0.189) 0.783 (0.189) 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.111 0.000 1, 2, 3, 4, 5 NHSL Mental Health Eating 0.036 0.036 0.000 1, 2, 4, 5 NHSL Mental Health Recovery Renewal Facilities 1.029 1.029 0.000 1, 2, 4, 5 NHSL Mental Health Wellbeing 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 P 2.719 (2.048) 0.671 (2.048) 1, 2, 3, 4, 5 NHSL PCR Prison Care Network 0.013 (0.012) 0.001 (0.012) 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.155) 0.466 (0.155) 1, 2, 3, 4, 5 NHSL Specialist Doctor Contrac 0.194 0.194 0.000 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 3 NHSL Third Sector Initiatives 0.247 (0.172) 0.075 (0.172) 1, 2, 3, 4, 5 NHSL Unscheduled Care 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 0.027 (0.011) 0.016 (0.011) 3 19.281 0.000 (4.470) 14.812 (4.470) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 September 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter P 1.000 1.000 0.000 1, 2, 3, 4, 5 NLC Adaptations Fund 0.308 0.308 0.000 2, 4 NLC Adult Protection (share 0.050 0.050 0.000 1, 2, 4, 5 NLC Advocacy Services 0.065 0.065 0.000 1, 2, 4, 5 NHSL Breast Feeding Team (2 0.705 (0.115) 0.590 (0.115) 1, 2, 5 NLC Business Case - Non- 1.319 1.319 0.000 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.596 2.596 0.000 1, 2, 4, 5 NHSL Children and Adolescent 0.268 0.268 0.000 4 NHSL Childrens Services - 0.107 (0.123) (0.016) (0.123) 3 NHSL Development of 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy 0.465 0.465 0.000 2, 3 NLC Digital and IT Strategy 3.699 3.699 0.000 2, 3 NLC Digital and IT Strategy 0.389 0.389 0.000 NLC Digital and IT Strategy 0.700 0.700 0.000 2, 3 NLC Financial Strategy - 0.027 0.027 0.000 NHSL Health Inequalities - 0.044 (0.013) 0.031 (0.013) 2 NHSL Health Visiting 0.311 (0.162) 0.149 (0.162) 3 NLC Home Support 0.656 0.656 0.000 3, 4 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 3 NLC IJB Helpline (2 years 0.360 0.360 0.000 1, 4, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NLC Mental Health Social 0.162 0.162 0.000 3, 4 NHSL Mental Health Wards 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics 0.450 (0.089) 0.361 (0.089) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes 0.569 (0.031) 0.538 (0.031) 1, 2, 3 NLC Planned Date of 0.109 0.109 0.000 1, 5 NHSL Podiatry Services - Foot 0.350 (0.002) 0.348 (0.002) 1, 2 NHSL Regrading of Posts 0.250 0.250 0.000 3 NHSL Scottish Clinical 0.060 (0.023) 0.037 (0.023) 3 NHSL Sexual Health Services - 0.152 (0.096) 0.056 (0.096) 1, 2 NHSL Sexual Health Services - 0.404 (0.067) 0.337 (0.067) 1, 2 NLC Social Care Contracting 0.087 0.087 0.000 3 NLC/NHSL Staff Training Academy 2.042 (0.366) 1.676 (0.366) 3 NHSL Vulnerable and Complex 0.816 (0.176) 0.640 (0.176) 5 20.955 0.000 (1.270) 19.684 (1.270) Ambition Statement & Performance APPENDIX 5 Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ongoing TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 LEAD RING-FENCED RESERVES
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Opening Balance As At 1 April 2024 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 30 September 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Prescribing Fund 4.361 4.361 0.000 2, 4 NLC Social Care Demand 12.684 12.684 0.000 2, 4 17.045 0.000 0.000 17.045 0.000 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 September 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance 13.390 (0.250) 13.140 (0.250) 13.390 0.000 (0.250) 13.140 (0.250) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 September 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL District Nursing 0.292 (0.292) 0.000 (0.292) 1, 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 (0.730) (0.000) (0.730) 1, 2, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 (3.396) 0.000 (3.396) 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.074) 0.000 (0.074) 1, 2, 4, 5 NHSL Pharmacy Mental Health R 0.341 (0.341) (0.000) (0.341) 1, 2, 3, 4, 5 NHSL Prisioner Healthcare - 0.020 (0.019) 0.001 (0.019) 3 4.853 0.000 (4.852) 0.001 (4.852) 75.524 0.000 (10.842) 64.682 (10.842) KEY (10.842) 1 2 3 4 5 Supporting people through a whole family approach. Do the right thing first time. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Ambition Statement & Performance Develop and support a workforce for the future. Improve mental health and wellbeing. Ambition Statement & Performance Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing TOTAL CONTINGENCY FUND LEAD To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance CLOSED RESERVES TOTAL CLOSED RESERVES TOTAL RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing APPENDIX 5 (CONTINUED) LEAD CONTINGENCY FUND RESERVES
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APPENDIX 6 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 1 Ongoing Prescribing Savings 2.280 0.988 0.988 1.292 2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000 3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds 2.600 0.088 0.088 2.512 4 Review of Discretionary Spend 2.188 0 0.000 2.188 5 Review of Supplementary Staffing 0.982 0.902 0.902 0.080 6 Workforce Management and Service Redesign 4.699 0.678 0.678 4.021 7 Financial Management - Support Costs and Vacancy Review 1.486 0.543 0.543 0.943 17.681 6.645 0.000 6.645 11.036 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 8 Financial Management - Overspends 4.827 0 0.000 4.827 9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.287 0.287 0.313 10 Review of Supplementary Staffing 0.750 0.75 0.750 0.000 11 Service Redesign and Contract Review 0.400 0.485 0.485 (0.085) 12 Review of Operating Model Supporting Back to Basics 3.825 0.118 0.118 3.707 13 Financial Management - Vacancy Review 1.000 0.057 0.057 0.943 11.402 1.697 0.000 1.697 9.705 29.083 8.342 0.000 8.342 20.741 Reference 1 2 3 4 5 6 7 8 Reference 9 10 11 12 13 14 Health Care Services Savings Delivery Plan Review all areas of discretionary spend including postage, stationery and printing, staff travel and subsistence, domestic supplies, subscriptions and licenses and hospitality. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. The prescribing efficiency programme will continue. This will include additional efficiencies around medicines of low clinical value, drug patent expiry list, product switches, complex rebates and prescribing waste. Reducing current overspends to align with allocated budgets. For 2024/25, this is being off set by non-recurring consequential funding from Scottish Government. Additional non-recurring funding received in year from Scottish Government. This will be used in 2024/25. Outstanding Target to Date 2 Year Savings Delivery Plan (Target = £17.681m) Plan Total Achieved 2 Year Savings Delivery Plan (Target = £11.402m) Plan The current model of HBCCC is being reviewed with a view of moving patients into a more suitable and homely environment, such as a mainstream care home which would be a less intensive setting whilst also improving the quality of life of the individual. Total Adult Social Care Services TOTAL Total Achieved Review of all unfunded posts (£4.324m). Redesign of Continence Service delivery schedule and products (£0.375m). Review of all vacant posts and realignment of support costs to all funding streams to show true cost of each service. Health Care Services RAG Rating Adult Social Care Services RAG Rating North Lanarkshire IJB 2024/25 & 2025/26 - 2 Year Savings Delivery Plan Total Health Care Services Reference Reference Outstanding Target to Date Adult Social Care Services Savings Delivery Plan Review of non traditional respite, advocacy and community services. Review of whole system approach to ensure that when people contact our services the response is quick and effective, with a focus on helping people to help themselves first. Review of all vacant posts. Reducing current overspends to align with allocated budgets. (IEAS, Independent Care Homes, SDS, Private Sector Housing Grants) Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities by opting to reconfigure some existing sheltered/very sheltered housing to retirement models. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review.
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Analysis of Additional Employee Costs 2024/25 Appendix 7 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 50,169 38,615 22,052 56,191 305,642 4,702 477,371 2 41,325 32,875 23,320 46,102 264,497 7,042 415,161 3 51,328 40,468 21,249 52,407 367,143 3,350 535,945 4 58,802 28,506 17,872 45,313 315,928 4,243 470,664 5 61,261 31,359 29,225 52,339 399,493 4,356 578,033 6 49,005 24,134 22,906 47,399 332,879 3,695 480,018 7 0 8 0 9 0 10 0 11 0 12 0 TOTAL 311,890 195,957 136,624 299,751 1,985,582 27,388 2,957,192 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 6,112 -1,743 - - 286,364 - 290,733 2 - - 589 -80 569,840 - 570,349 3 1,526 - 1,229 - 337,115 - 339,870 4 1,280 - 18,440 - 335,537 - 355,257 5 528 - - - 351,443 2,311 354,282 6 1,352 0 606 0 290,147 0 292,105 7 0 0 8 0 9 0 10 0 11 0 12 0 13 0 TOTAL 10,798 -1,743 20,864 -80 2,170,446 2,311 2,202,596 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 7,896 6,109 4,121 14,860 30,578 -5,031 -36,239 737 23,031 2 11,173 8,470 4,855 17,042 30,317 84,416 341,911 2,508 500,692 3 7,738 7,429 5,896 10,311 21,831 65,331 331,451 1,247 451,234 4 7,253 5,666 3,373 17,206 29,554 48,786 385,446 1,407 498,691 5 6,018 1,257 7,614 10,756 19,232 40,111 412,126 253 497,367 6 7,059 714 5,354 12,415 30,811 60,954 400,282 490 518,079 7 63,268 360,760 424,028 8 0 9 0 10 0 11 0 12 0 13 0 TOTAL 47,137 29,645 31,213 82,590 162,323 357,835 2,195,737 6,642 2,913,122 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 4,408 2,005 7,033 9,061 9,873 1,559 33,939 2 2,745 3,160 4,339 3,462 5,718 1,250 20,674 3 1,508 1,689 4,890 850 6,956 776 16,669 4 2,606 991 5,042 3,474 5,352 1,315 18,780 5 1,732 2,785 5,716 1,863 6,623 966 19,685 6 2,353 632 7,455 1,266 7,388 554 19,648 7 0 8 0 9 0 10 0 11 0 12 0 TOTAL 15,352 11,262 34,475 19,976 41,910 6,420 129,395 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period AGENCY COSTS YEAR TO DATE
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1 REPORT Item No: 11 SUBJECT: North Support Care & Clinical Governance (NSCCG) 6monthly healthcare Quality Assurance & Improvement Committee (HQAIC) Report TO: Integration Joint Board Lead Officer for Report: Dr Lucy Munro Medical Director NHSCP Author(s) of Report Dr Lucy Munro Medical Director NHSCP Diane Fraser, Chief Officer (Adult Social Work Services) Joanne Jenkins, Interim Nurse Director NHSCP Contact details for Author(s) of Report Lucy.munro@lanarkshire.scot.nhs.uk DATE: 04 December 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:
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2 Prepared By: Dr Lucy Munro Ms Diane Fraser Ms Joanne Jenkins ☒ Reviewed By: ☐ Endorsed By: ☐ 3. EXECUTIVE SUMMARY 3.1 This report provides an overview on the work undertaken by the North Support Care and Clinical Governance (NSCCG) committee from April to September 2024. 3.2 The NSCCG met on 17/04/2024, 06/06/2024, 08/08/2024. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note the update from the Support Care and Clinical Governance committee. 5. 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 6. BACKGROUND 6.1 The arrangements for Support, Care and Clinical Governance within Health and Social Care North Lanarkshire (HSCNL) build on well-established prior arrangements within NHS and NLC but bring processes together to receive assurance from both Health and Social work clinical services. 6.2 The group meets bimonthly and works to a work plan to allow service areas to report in routinely and to offer assurance. Part of the governance framework for the group is to provide a 6 monthly and yearly report to the Healthcare Governance Assurance Group and the Healthcare Governance Committee and Adult Care and Social Work Committee. Yes ☐ No ☒ N/A ☐
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3 7. SUMMARY OF KEY ISSUES 7.1 Public Protection assurance via NSCCG. The Head of Adult Social Work, Medical Director and Interim Nurse Director met with the Chief Social Worker, the Executive Nurse Director and the Independent Chair for the Public Protection committees to review our reporting arrangements for public protection to this group in order that those arrangements truly reflect the activity on the ground. A way forward was agreed, tabled at the next meeting and agreed. The Head of Adult Social Work is now invited to the Adverse Events Review Commissioning Group. 7.2 Workshop with the Senior Leadership Team. A workshop has taken place with the senior leadership team on date 27/08/2024 The feedback was; to update the reporting templates for the sectors, consider a newsletter and that overall SMT felt that systems and processes in train were working well albeit this is an area which needs constant attention. 7.3 Social Work and Social Care Framework for Governance. The Chief Social Work Officer is Responsible for Care Governance and has delegated this function to the Chief Officer, Adult Social Work Services. The Adult Social Work Governance Group is led by the Chief Officer, Adult Social Work and Senior Manager, Quality Assurance. The group oversees all quality assurance activity and act as the central resource for quality standards and quality monitoring information across the service. 7.3.1 The ASW&SC Group will ensure the delivery of a planned programme of audit, self-evaluation and customer feedback through quality assurance activity and will have the authority to commission themed audits when areas for potential improvement are identified. To support this a newly established sub-group for registered services is being established. This will provide a forum for registered managers from a range of social care services and support in-house monitoring activity. 7.4 Specialist Mental Health Reporting and Assurance. There have been two changes to specialist mental health services; firstly, the associate nurse director and associate medical director have refreshed the reporting to ensure the breadth of activity is being picked up, for example, making care assurance and fall improvement work more visible alongside tracking of continuous roll out of Triangle of Care training and Lanarkshire Safety Assessment Framework. Secondly, the Mental Welfare Commission & Legislation Review Group now reports directly into the NSCCG rather than solely through Specialist Mental Health services. 7.5 The North Lanarkshire Health and Social Care Partnership Governance Team have been working with service areas and the Adverse Events Group to identify key themes / trends from Adverse Events, ensure learning from Adverse Reviews are collated and reported periodically and used to drive improvement across the partnership and maintain a register of actions arising from Significant Adverse Events Review’s with assurance that these are being completed timeously by operational units/sectors.
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4 8. CONCLUSIONS 8.1 The IJB is asked to note the 6 monthly progress report from the North Support Care & Clinical Governance group and to be assured that processes are being established to manage the key issues outlined. 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) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT
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5 Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 ☐ 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 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report:
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6 Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. . CHIEF ACCOUNTABLE OFFICER (or Depute)
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7 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
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8 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 12 SUBJECT: Climate Change Reporting 2023-2024 TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer North HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager Contact details for Author(s) of Report NLHSCPGovernance@lanarkshire.scot.nhs.uk DATE: 04 December 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, Service Support ☒ Reviewed By: Claire Rae, Chief Officer. ☐ Endorsed By: ☐
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2 Project Manager 3. EXECUTIVE SUMMARY 3.1 Each year the IJB is required to complete the Public Bodies Climate Change Duties Compliance Reporting template in accordance with the Climate Change (Duties of Public Bodies Reporting Requirements) (Scotland) Order 2015, as amended by the Climate Change (Duties of Public Bodies: Reporting Requirements) (Scotland) Amendment Order 2020 which took effect for reporting periods commencing on or after 1 April 2021. 3.2 Reports must be submitted to ccreporting@ed.ac.uk by 30th November 2024. 3.3 Late submissions will not be accepted for analysis and may be deemed non- compliant with Public Bodies Duties reporting requirements. 3.4 To enable timely submission the Climate Change Template for 2023-24 was discussed by North Lanarkshire IJB at a Liaison session on the 21st November 2024. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the content of the Climate Change Duties Compliance Reporting template for 2023-2024 and are assured the template was submitted within the required timelines. 5. 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 6. BACKGROUND 6.1 Mandatory reporting legislation in relation to Climate Change came into force in 2015 with the IJB, as a public body, required to report annually on compliance with climate change duties. The relevant legislation is the Climate Change (Duties of Public Bodies; Reporting Requirements) (Scotland) 2015 and the associated amendment order of 2020. Yes ☐ No ☒ N/A ☐
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3 7. SUMMARY OF KEY ISSUES 7.1 North Lanarkshire IJB has complied in full with reporting requirements since the enactment of the legislation. 7.2 Further guidance specific to IJBs was issued by the Scottish Government for the 2023-2024 reporting period. This guidance relates to areas that NL IJB report on, including the structure of the IJB, links to Climate Change Duty Reports for each of the council and Health board areas, and any joint work undertaken throughout the year between the IJB and partners on climate change policies . 7.3 A copy of the North Lanarkshire IJB Climate Change Duties Compliance Reporting template for 2023-2024 is attached in Appendix 1 and was consideration and review by the IJB on the 21st of November 2024 via a Liaison Session. 8. CONCLUSIONS 8.1 The responsibility to enact measures to directly address climate change rests with NLC and NHSL. 8.2 The IJB’s Compliance with the 2023/2024 Climate Change reporting requirements resulted in the submission of the attached report after discussion at the IJB Liaison session on the 21st November 2024. 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 ☐
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4 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 ☐ 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
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5 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 9.6 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 No N/A 10. BACKGROUND PAPERS 10.1 PBDR Guidance 2024 August v1.2.pdf (sustainablescotlandnetwork.org) 10.2 NHS Lanarkshire Sustainability and Climate Change Policy Sustainability-and- Climate-Change-Policy | NHS Lanarkshire (scot.nhs.uk) 10.3 North Lanarkshire Council Plan ACT2030 https://www.northlanarkshire.gov.uk/your-council/council-strategies-and- plans/council- strategies/climate-plan-act2030 11. APPENDICES Appendix 1 - Public Bodies Climate Change Duties Compliance Reporting .
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6 CHIEF ACCOUNTABLE OFFICER (or Depute)
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7 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
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8 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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9
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Terms of Ref IJB Version 4. Nov 2023 REPORT Item No: 13 SUBJECT: Terms of Reference Integration Joint Board (IJB) and Performance, Finance & Audit Committee (PF&A) TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer NL HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager Contact details for Author(s) of Report NLHSCPGovernance@lanarkshire.scot.nhs.uk DATE: 04 December 2024 1. PURPOSE OF REPORT To review the Terms of Reference for the IJB and PF&A and approve any proposed amendments, note the schedule of dates for both committees during 2025. 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: ☐
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Terms of Ref IJB Version 4. Nov 2023 Stacey Anderson, Support Services Project Manager 3. EXECUTIVE SUMMARY This paper set out the annual review of the Terms of Reference of the IJB and IJB PFA. 4. RECOMMENDATIONS 4.1 The IJB is asked to approve the revised Terms of Reference for the IJB and IJB PFA. 4.2 The IJB is asked to note the reporting schedule and meeting dates proposed for the IJB and IJB PF&A future meetings. 4.3 It is recommended that stakeholder membership of the IJB committee is reviewed in line with the IJB membership guidance that all IJB members (apart from Chief Accountable Officer, Financial Officer and Chief Social Work Officer) 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. VARIATIONS TO DIRECTIONS? 6. BACKGROUND 6.1 The Terms of Reference for the Integration Joint Board are formally set out in the Public Bodies (Joint Working) Integration Joint Monitoring Committees (Scotland Act) Orders 2014 with particular reference to the Scottish Statutory Instruments 2014 No.285. http://www.legislation.gov.uk/ssi/2014/285/pdfs/ssi_20140285_en.pdf Yes ☐ No ☒ N/A ☐
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Terms of Ref IJB Version 4. Nov 2023 6.2 The Terms of Reference for both committees were formally approved at the IJB meeting on 23rd November 2017 and membership of both committees was formally reviewed in March 2018, June 2019 and November 2020. 6.3 The Terms of Reference for the IJB PFA was amended and formally approved in March 2023. 6.4 The Terms of Reference for the IJB was amended and formally approved in November 2023. 7. SUMMARY OF KEY ISSUES 7.1 Minor amendments to the current Terms of Reference for the IJB are proposed to reflect the changes in membership of the IJB. 7.2 The review period of the IJB PFA Terms of Reference has been changes to annually in order to align with the review of the IJB Terms of Reference. 7.3 The proposed IJB and IJB PFA reporting schedule and meeting dates are detailed in Appendix 3. 8. CONCLUSIONS 8.1 The Terms of Reference for the IJB has been reviewed and amended to reflect the current membership of the IJB. 8.2 The Terms of Reference for the IJB PFA has been reviewed and review schedule for this Terms of Reference has been changes to annually. 8.3 The reporting schedule and dates for the future meetings of the IJB and IJB PF&A are attached for noting. 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 ☐
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Terms of Ref IJB Version 4. Nov 2023 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) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 ☐ Provide stakeholders with information on how to get involved
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Terms of Ref IJB Version 4. Nov 2023 ☐ 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 9.6 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 No N/A 10. BACKGROUND PAPERS
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Terms of Ref IJB Version 4. Nov 2023 11. APPENDICES Appendix 1 – Terms of Reference IJB (November 2024) Appendix 2 – Terms of Reference IB PFA (November 2024) Appendix 3- IJB and IJB PFA Reporting Schedule for 2025. CHIEF ACCOUNTABLE OFFICER (or Depute)
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Terms of Ref IJB Version 4. Nov 2023 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
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Terms of Ref IJB Version 4. Nov 2023 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Terms of Ref IJB Version 4. Nov 2023
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Terms of Ref IJB Version 4. Nov 2023 DATE: November 2024 Appendix 1 TERMS OF REFERENCE INTEGRATION JOINT BOARD (IJB) 1. Purpose The primary function of the IJB is to; • Develop an annual commissioning plan • Direct NLC and NHSL to carry out of the functions delegated to it through the North Lanarkshire Integration Scheme. • Produce an annual report on progress • Oversee operational delivery of integrated services • Approve the annual accounts • Adhere to the content of any future regulations or guidance issued by Scottish Ministers • Ensure stakeholder engagement • Take into consideration national developments in policy and practice 2. Membership and Quoracy The IJB will meet four times per annum. Additional or extended meetings may be held as necessary. The procedure for appointment of members and transaction of business is set out in the Scottish Statutory Instruments (2014) No.285. No business is to be transacted at a meeting of the IJB unless at least one half of the voting members are present as follows; • Two members from NLC • Two members from NHSL The role of Chair and Vice Chair will alternate between the constituent authorities on a 3-year cycle. All IJB 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. This rule 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. Current IJB membership is set out in section 5 below. Terms of Ref IJB Version 5. Nov 2024
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3. Reporting Arrangements Minutes of each meeting will be ratified at the next IJB meeting and thereafter made publicly available via the North Lanarkshire Health and Social Care Partnership Website https://hscnl.org.uk 4. Key Responsibilities The IJB will; • Approve the directions to NHSL and NLC • Approve the Strategic Commissioning Plan • Approve the annual Performance Report • Approve the Financial Offer • Approve the appointment of the Chief Accountable Officer • Approve the appointment of the Chief Financial Officer (Section 95) • Approve the annual accounts • Approve, review and maintain effective governance arrangements for the discharge of IJB functions • Ensure that a Participation and Engagement strategy is developed and is effectively put in place • Ensure that a records management plan is developed and implemented in line with the duties as set out in the Public Records Act • Issue directions to Health Boards and Local Authorities as to how to integration functions are to be carried out. • Ensure effective communication and engagement with key partner organisations, in particular NHSL, NLC and North Lanarkshire Partnership Board • Monitor Risk • Review its Terms of Reference on an annual basis • Review its committee structure on annual basis Reviewed by Committee: November 2017 December 2020 November 2023 November 2024 Ratified by Integration Joint Board : November 2018 Review Date: November 2025 Terms of Ref IJB Version 5. Nov 2024
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12 Section 5. Integration Joint Board Membership Voting Members Name Title Cllr Claire Barclay NLC Nominated Councillor Cllr Bob Burgess NLC Nominated Councillor Mr Philip Couser NHS Lanarkshire Nominated Non- Executive Nauman Dar NHS Lanarkshire Nominated Non- Executive Cllr Paul Kelly NLC Nominated Councillor Cllr Anne McCrory (Chair) NLC Nominated Councillor Mr Brian Moore (Vice Chair) NHS Lanarkshire Nominated Non- Executive Ms Siobhan White NHS Lanarkshire Nominated Non- Executive Non-Voting Members Professional Advisors Dr Kenneth Dagg Consultant in Geriatric Medicine, Acute Division /Secondary Medical Care Practitioner Alison Gordon Head of Children’s, Families & Justice Services Chief Social Work Officer of NLC Nicola Scott Chief Finance Officer (Section 95) Joanne Jenkins Nurse Director NL HSCP Nurse Representative Claire Rae Chief Office NL HSCP Dr Josephine Pravinkumar Director of Public Health Dr Tyra Smyth General Practitioner (GP)
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13 Stakeholder Members David Wood Chief Executive VANL Third Sector Representative Cathy McGinty Unison and Staff Side Representative (NHSL Partnership for Change) Elizabeth Seaton User Representative Harry Robertson North Lanarkshire Carers Together Carer Representative John Watson Unison Employee Representative NLC Officers in Attendance Stacey Anderson Support Services Manager, Project Manager Rose Walker Governance Support Manager Minute Secretary
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14 Others Invited Paul Carey Audit Scotland Rep Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Care Martin Hill Chair NHS Lanarkshire Jann Gardner Chief Executive NHS Lanarkshire Dr Lucy Munro Medical Director North HSCP Des Murray Chief Executive NLC Thomas Moan Senior Manager – Community Solutions VANL Maggs Thomson Head of Health North HSCP
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APPENDIX 2 TERMS OF REFERENCE COMMITTEE: IJB PERFORMANCE, FINANCE AND AUDIT COMMITTEE DATE: November 2024 Version 5 1. Purpose The Performance, Finance and Audit Committee has been established by the Integration Joint Board (IJB) to: • Oversee a range of matters relating to finance, internal audit, and external audit. • Ensure financial and other controls are in place to operate effectively, including processes for audit and risk management. • Oversee the development of the annual integrated budget and financial statement. • Oversee a range of matters relating to service provision and performance reporting. • Ensure the delivery of the highest possible quality of service to users by monitoring performance and considering audit inspection reports. • Oversee the development of the annual performance report. 2. Membership and Quoracy Meetings will be held four times a year. Additional meetings may be held as necessary. The IJB shall appoint members to the Committee and nominate a Chair and Vice Chair. The Committee will comprise of 13 members as follows: • 4 voting members appointed by the NHS Lanarkshire Health Board (NHSL). • 4 voting members appointed by North Lanarkshire Council (NLC). • 5 non-voting members representing stakeholders. The quorum for meetings of the Committee is four voting members, comprising two NLC members and two NHSL members. The Chief Accountable Officer and the Chief Finance Officer will attend all meetings. Attendance by other staff and officers will be agreed by the Chair in advance. Any updates or proposed variation to membership will be approved by the IJB in line with the IJB Terms of Reference and Statutory Instruments. 3. Reporting Arrangements
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The Committee will report to the IJB. The minutes of Committee meetings will be submitted to the next appropriate meeting of the Committee for approval as a correct record and will then be submitted to the next IJB meeting for noting. 4. Key Responsibilities In relation to finance matters, the PF&A Committee is authorised to: • Provide financial governance and scrutiny of the in-scope budget for the IJB. • Review the annual budgets with recommendations to the IJB. • Review the overall internal control arrangements of the IJB and ensure that appropriate levels of accountability, scrutiny and discussion are undertaken in the key areas of business. • Ensure that the senior management team maintain effective controls within their services which comply with financial procedures and regulations. • Ensure effective arrangements are in place to register all finance and audit risks as soon as possible and that the appropriate lead officer is notified to ensure compliance and mitigating actions are detailed. • Review risk management arrangements and receive regular risk management updates and reports, as appropriate. • Report and review the IJB’s financial strategy in support of the strategic commissioning plan and recommend approval to the IJB. • Receive reports on any new and emerging national policy developments related to health and social care and consider any impact on the financial position. • Consider the unaudited Annual Accounts and oversee the preparation of the Governance Statement before submission to and approval by the IJB. • Approve the Annual Accounts. In relation to audit matters, the Committee is authorised to: • On an annual basis, approve the risk-based Internal Audit plan, including Internal Audit’s resource requirements. • Consider reports from Internal Audit on their activity and performance during the year including the Internal Audit annual opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control. • Consider the external auditor’s annual plan and all relevant external audit reports issued to those charged with governance. • Consider, where appropriate, responses to internal and external audit and scrutiny reports and to monitor any subsequent recommendations and requirements emanating from these. • Consider and review strategic financial risks pertaining to the IJB’s responsibilities. In relation to performance matters, the Committee will: • Review service performance reporting processes. • Review quarterly performance and recommend remedial action to address concerns.
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• Consider response/actions in relation to any external scrutiny reports that relate to service provision. • Oversee the implementation of any recommendations made within external scrutiny reports. • Ensure a rigorous and systematic approach to the monitoring of delivery of national and local priorities. • Ensure effective arrangements are in place to identify and register all performance and finance risks as soon as possible and review high rated risks at each meeting to ensure effective mitigating actions are being followed and risks regularly updated. • Oversee the development of the annual performance report. Ratified by Integration Joint Board: Version 1 – December 2017 Version 2 – March 2018 Version 3 – December 2020 Version 4 – March 2023 Version 5- November 2024 Review Date: The Terms of Reference for the Performance, Finance & Audit Committee will be reviewed every year and approved at the Integration Joint Board. Planned Review Date – November 2025
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Appendix 3 – IJB and IJB PFA Reporting Schedule 2025. IJB 2025 Report Schedule 19/03/2025 Mental Health Strategy SCP Update 19/03/2025 Prisoner Healthcare SCP Update 19/03/2025 Alcohol & Drugs SCP Update 19/03/2025 MAT Standards SCP Update 19/03/2025 Risk Update Routine report 19/03/2025 HBCCC Update Routine Report 19/03/2025 Annual Chief Social Work Officer Report Annual Update 19/03/2025 IJB Directions Letters Annual Update 19/03/2025 Financial Plan Annual Update 19/03/2025 Frailty Strategy Update SCP/ Annual Report 19/03/2025 Delegated Health & Social Care Budget Annual Update 19/03/2025 HBCCC Update Routine Report 18/06/2025 Membership Update Annual Update 18/06/2025 PCIP Update 18/06/2025 Unaudited North Lanarkshire IJB Annual Accounts 2023/24 Annual Update 18/06/2025 Declaration of Interest Forms Annual Update 18/06/2025 Code of Conduct Annual Update 18/06/2025 IJB Directions Annual Update 18/06/2025 Community Nursing Review Update Update report 18/06/2025 IJB Governance Overview Report Annual Update 18/06/2025 Records management plan Annual Update 18/06/2025 Public Sector Equality Duty
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18/06/2025 Public Health Annual Report 18/06/2025 Risk Update Routine report 17/09/2025 CAMHS Recovery & Renewal SCP Update 17/09/2025 Paediatric Modernisation SCP Update 17/09/2025 SLT Improvement SCP Update 17/09/2025 Financial Monitoring Routine Report 17/09/2025 Audited Accounts Routine Report 17/09/2025 External Audited Accounts Routine Report 17/09/2025 Annual Records 17/09/2025 Annual Performance Report Annual Update 17/09/2025 Quality Assurance Annual Report Annual Update 17/09/2025 Whistleblowing Annual Update Annual Update 17/09/2025 Community Solutions Annual Report SCP Update 17/09/2025 Strategic Commissioning Plan Progress SCP Update 17/09/2025 Risk Update 10/12/2025 Financial Monitoring Routine Report 10/12/2025 Terms of Reference Annual Review 10/12/2025 Support Care & Clinical Governance Update Routine Report 10/12/2025 Risk Update Routine Report 10/12/2025 Winter Planning Routine Report
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IJB PFA 2025 Report Schedule Date of Committee Title of Report Nature of Report 26/02/2025 Lanarkshire Winter Plan Debrief Annual Report 26/02/2025 Resettlement Update Annual Report 26/02/2025 Q2 Performance Report Routine Report 26/02/2025 Risk Report Routine Report 26/02/2025 Internal Audit progress Report 26/02/2025 Financial Monitoring Routine Report 21/05/2025 Staff Health & Wellbeing Annual Report 21/05/2025 Partnership with Universities Annual Report 21/05/2025 Prescribing: Sustainability and Value Programme Progress Update SCP Update 21/05/2025 Supporting Unpaid Carers & North Lanarkshire Carers Strategy Update SCP Update 21/05/2025 Financial Monitoring Routine Report 21/05/2025 Q3 Performance Report Routine Report 21/05/2025 Risk Report Routine Report 21/05/2025 Cat One Responders Update Annual Report 21/05/2025 Internal audit progress report 2025/26 workplan Routine Report 21/05/2025 Tackling Poverty Team Report Update requested by IJB at Oct meeting
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21/05/2025 Chryston Update Routine Report 27/08/2025 Q4 Performance Report Routine Report 27/08/2025 Our Health Together SCP 27/08/2025 Risk Update Routine Report 27/08/2025 Strategic Commissioning Overview Plan Update SCP 27/08/2025 Community Solutions Strategy & Investment Plan SCP 27/08/2025 Engagement Participation Strategy SCP 27/08/2025 HAT SCP 27/08/2025 Hospital @ Home SCP 27/08/2025 Home Support Redesign SCP 27/08/2025 Internal audit progress report 2025/26 workplan Routine Report 22/10/2025 Annual Climate Report SCP 22/10/2025 Q1 Performance Report Routine Report 22/10/2025 Risk Update Routine Report 22/10/2025 Trauma Informed Practice SCP 22/10/2025 Chryston Update Routine Report 22/10/2025 Internal audit progress report 2025/26 workplan Routine Report 22/10/2025 Care Academy SCP
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1 REPORT Item No: 14 SUBJECT: Risk Management Report TO: Integration Joint Board Committee Lead Officer for Report: Claire Rae, NL HSCP Chief Officer Author(s) of Report Stacey Anderson, Service Support Project Manager Contact details for Author(s) of Report NLHSCPGovernance@lanarkshire.scot.nhs.uk DATE: 04 December 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: ☐ 3. EXECUTIVE SUMMARY
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2 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. 4. RECOMMENDATIONS 4.1 The IJB is asked to note 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. 4.2 The IJB may wish to consider the inclusion of climate change risk to the IJB risk register to align risk sharing across parent organisations. 5. 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 6. BACKGROUND 6.1 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. 6.2 The IJB PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 7. SUMMARY OF KEY ISSUES 7.1 The following risk are currently rated as Very High on the IJB risk register. • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges • IJB 21/24- Pharmacy Pressures within Prison Services 7.2 The following risks are rated high on the IJB risk register. Yes ☐ No ☒ N/A ☐
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3 • 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 • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy 7.3 The 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 are highlighted within the Risk Overview Dashboard (Appendix 1) and Risk Register (Appendix 2). 7.4 At the IJB PFA on the 23rd October 2024, the board discussed the potential inclusion of risks relating to climate change and public protection to the IJB Risk Register to align risk sharing across parent organisations. 7.5 Further information relating to climate change was presented to the IJB via the IJB Liason session on the 21st November 2024, with a following report being tabled at the IJB meeting on the 4th December 2024. 8. CONCLUSIONS 8.1 The IJB currently has 19 risks identified on its IJB risk register with 11 risks rated as high or very high. 8.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 8.3 Following additional information being presentation to the IJB around Climate Change, the IJB may wish to consider further the inclusion of a climate change risk to the IJB risk register to align risk sharing across parent organisations. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES
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4 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) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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
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5 ☐ 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 9.6 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 No N/A
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6 10. BACKGROUND PAPERS 11. APPENDICES Appendix 1 – Risk Overview Dashboard Appendix 2 – Risk Register . CHIEF ACCOUNTABLE OFFICER (or Depute)
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7 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
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8 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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14 IJB ID Categor y 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.0 1/ 21 Financia l Strategi c 01/04/2021 Financial Challenges CONTROLS VERY HIGH Medium Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.06.2024 Previousl y IJB2, IJB7, IJB10 and IJB12. 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: HIGH 1. IJB PFA Committee. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 1. The absence of a unique IJB financial settlement from the Scottish Government. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. Reviewed and updated Jan 2024. 2. The IJB is dependent on funding from both partners. 4. Regular budget meetings with Chief Executives and Directors of Finance. 3. Late Scottish Government financial settlement. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. Reviewed and updated
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15 March 2024. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 7. IJB medium term financial plan 2023‐26 and reserves strategy 2023‐24 approved at March 23 IJB Review and risk increased June 2024. 6. Demographic growth. 8. Capacity plans in place to maximise efficiency. 7. Competing service priorities. 9. IJB Integration Scheme setting out the budget recovery processes. Reviewed and no changes Sept 2024 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 10. IJB Financial Regulations and financial procedures. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks 11. Consultation and involvement with key stakeholders including service users and carers.
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16 which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels.
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17 14. The continuing recovery from the pandemic on the financial sustainability of external providers 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. ACTIONS 1. Annual budget setting processes within each of the partners. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget IJB02 . 21 Financia l Reputati onal 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption CONTROLS LOW LOW Claire Rae Amanda Kilburn SLT, IJB PFA, IJB 31.08.24 Previousl y IJB6. Reviewed and updated on March 2023. There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of LOW 1. Fraud awareness e‐learning.
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18 inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. 2. National Fraud initiative. Reviewed and Updated Oct 2023, 3. Locality/SW Enablement Groups. (previousl y title ineffectiv e governan ce arrangem ents). 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. Reviewed May 2024 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. Reviewed and No changes Sept 2024 8. Effective governance arrangements are in place and subject to internal and external audit review.
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19 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. 01/0 4/20 Notional Set‐Aside Budget CONTROLS HIGH MED IUM Clair e Ama nda SLT, IJB 28.0 820
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20 IJB04 . 21 Financia l Strategi c 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 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. Reviewed and Updated May 2023. 3. Bed modelling and capacity planning arrangements are in place. Reviewed Oct 2023. 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 Reviewed Jan 2024 ACTIONS Reviewed May 2024 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. Reviewed July 2024. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 Reviewed Sept 2024 01/0 4/20 Hosted Services CONTROLS MED IUM MED IUM Claire Ama nda SLT, IJB 28.0 820
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21 IJB05 . 21 Financia l Strategi c 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 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. Reviewed Jan 2024 2. Financial and budgetary controls. Reviewed May 2024 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. Reviewed July 2024. Reviewed Sept 2024 IJB06 . 21 Financia l Operati onal 01/04/2021 Prescribing Activity and Costs CONTROLS VERY HIGH LOW Claire Rae Amanda Kilburn SLT, IJB PFA, IJB 28.08.24 Previousl y IJB11. Reviewed and updated June 2023. 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 Medium 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. Reviewed and
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22 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. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. Updated (risk increased ) October 2023. 4. Locality Pharmacist input. Reviewed Jan 2024 5. Earmarked reserve established to address prescribing costs. 6. 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. Reviewed June 2024. 7. 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. Reviewed July 2024. 8. 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. Reviewed Sept 2024 9. 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
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23 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 IJB07 . 21 Financia l Strategi c 01/04/2021 Third and Voluntary Sector CONTROLS LOW LOW Claire Rae Amanda Kilburn SLT, IJB PFA, IJB 30.06.24 Previousl y IJB16. 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 HIGH 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. Reviewed April 2024. 3. Community capacity building is regularly reviewed.
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24 instability, recruitment and retention challenges and an increasing reliance on statutory services. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. Reviewed July 2024 Reviewed and no changes Sept 2024 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 IJB.1 0. 21 Financia l Strategi c 01/04/2021 Ineffective Governance Arrangements CONTROLS LOW LOW Claire Rae Amanda Kilburn SLT, IJB PFA, IJB 30.10.24 Reviewed and updated June 2023. 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. MEDIUM 1. National Networks are established which are providing the framework to support a national approach where appropriate.
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25 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 2. Public Health advice and support is in place. Reviewed and updated Oct 2023. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. Reviewed and updated Jan 2024. 5. Communications with employees, patients and service users may be ineffective. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐ 19 Risk Register in place. 6. There will require to be changes to the working environment including remote working and working from home. 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, 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's Working Time Regulations which implement the EU Reviewed and Risk level lowered June 2024.
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26 Working Time Directive will continue to apply unless and until amended by UK law. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. 8. 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. Reviewed and no changes Sept 2024 9. IJB Governance reporting reviewed and associated documents updated. IJB.1 1 21 Perform ance 30/07/2021 Oversight of Performance Activity CONTROLS LOW LOW Claire Rae Morag Dendy SLT, IJB PFA, IJB 31..10.24 Reviewed May 2024. There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and LOW 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. Reviewed June 2024.
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27 oversight role; make informed decisions and recommend remedial actions to address any performance concerns. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. Reviewed and no changes Sept 2024 IJB.1 2. 21 Perform ance 30/08/2021 Staff Health & Wellbeing MEDIUM CONTROLS HIGH low Claire Rae Claire Rae SLT, IJB PFA, IJB, SC&CG, AH&SC 28.08.24 Reviewed and Updated May 2023. 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. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. Reviewed and updated Dec 2023. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). Reviewed May 2024. Rest & Recuperation areas identified. Peer Support Networks established Reviewed Sept 2024 Well established Occupational Health supports available to support staff sickness.
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28 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 IJB.1 3. 2021 Perform ance 30.08.21 Care Homes HIGH CONTROLS medium medium Claire Rae Sharon Murphy IJB, PF&A, SLT, SC&SC, A H &SC 28.08.24 Reviewed and updated Oct 2023 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. Establishment of Care Home Assurance Team. Escalation Process in place. Reviewed May 2024. . National protocol to support discharge of Covid 19 patients in place. Reviewed Sept 2024 ACTIONS
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29 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 IJB.1 4. 2022 Strategi c & Perform ance 30.04.22 CAMHS VERY HIGH CONTROLS Medium Medium Claire Rae Morag Dendy IJB, PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. 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 Prioritisation of referrals; all referrals vetted 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 Reviewed and updated Dec 2023. 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 Reviewed and risk level lowered Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023
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30 outcomes; delays in redesign and reputation of the IJB. May 2024. Continuous review and validation of the waiting list Reviewed and no changes Sept 2024 Waiting list validation exercise completed in April 2022 with reduction in list by 16% CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion Monthly monitoring at board Incremental implementation of the new service model Performance monitoring through the programme board CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals Waiting list initiative commenced Udston opened for patients September 2022 Upgrade to North physical infrastructure agreed. Close working with health improvement and GP reps
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31 IJB.1 5. 2022 Strategi c & Perform ance 05.09.22 Cost of Living HIGH CONTROLS High Medium Claire Rae Claire Rae SLT, IJB 30.08.2024 Reviewed and Updated May 2023. 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. NLC Silver command group stood up focused on cost of living NHSL commenced review through CMT Reviewed Oct 2023. Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 Reviewed May 2024. ACTIONS Reviewed Sept 2024 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
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32 Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost. IJB.1 6. 2022 Strategi c 05.09.22 National Care Service HIGH CONTROLS High Low Diane Fraser Claire Rae SLT, IJB PFA, IJB, ASWC&WB 31.08.24 Reviewed and Updated May 2023. 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. NLC establishing NCS working groups Reviewed and Updated Oct 2023. Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA Reviewed and Updated May 2024 ACTIONS Reviewed Sept 2024 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
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33 IJB.1 7. 2022 Strategi c & Perform ance 05.09.22 Unscheduled Care Very High CONTROLS High Medium Claire Rae Claire Rae SLT, IJB PFA, IJB 28.08.24 Reviewed and Updated in June 2023. 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. 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 Reviewed Oct 2023 NHS CMT and Covid response group oversight of performance Daily PDD meetings to review every planned supported discharge and delayed discharge Reviewed Jan 2024. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges Reviewed and risk level reduced May 2024. Expansion of Home Support service Reviewed Sept 2024 Roll out of Home Assessment Teams across all 6 Localities
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34 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 Regular Firebreaks across the system Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) IJB.1 8. 2022 Strategi c and Perform ance 05.09.22 Community Alarms HIGH CONTROLS Medium Low Diane Fraser Claire Rae SLT, IJB PFA, IJB, ASWC&WB 28.07.2024 Reviewed and updated June 2023. 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 Working group established to coordinate all activity Oversight through Home Support Programme Board Reviewed Oct 2023. Reporting to Adult Social Work, Care and Wellbeing Committee
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35 not getting a response when required. Reporting to IJB Reviewed Jan 2024. Reviewed April 2024. ACTIONS Reviewed Sept 2024 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 centre 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 IJB.1 9. 2023 Perform ance 27/02/2023 Service Sustainability High CONTROLS Claire Rae Claire Rae SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023 Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to IJB PFA Committee. High Low IJB Chief Officer is a member of each partner's key decision‐making forums. Reviewed and
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36 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 Updated Oct 2023. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Reviewed and updated Jan 2024. Regular budget meetings with Chief Executives and Directors of Finance. Reviewed April 2024. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Reviewed Sept 2024 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.
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37 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 analysing service challenges and implementing phased changes to support winter pressures and beyond. IJB.2 0. 2023 Workforce Sustainability HIGH CONTROLS Claire Rae Claire Rae SLT, IJB PFA, IJB 28.07.24 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 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 High Medium Updated May 2023
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38 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 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. Reviewed and updated Oct 2023. Development of the Care Academy Reviewed and updated Jan 24 Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Reviewed April 2024. Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support
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39 and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment Reviewed Sept 2024 Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. IJB21 .24 Financia l Jun ‐24 Pharmacy Pressures within Prison Service High CONTROLS Very High Low Claire Rae Claire Rae IJB PFA, IJB 30.07.24 Added to register June 2024. 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. 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 IJB23 .24 Perform ance Jul‐ 24 Speech and Language Therapy (SLT) Service High CONTROLS High Low Claire Rae Claire Rae IJB PFA, IJB 30.07.25 There is a risk that the SLT service cannot meet the increasing clinical demands 1. Good communication processes, and the sharing of information and practical learning online have been established and will be further Added to the register
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40 with variance in waiting list length by area, continued challenges around the recruitment and retention of new colleagues, funding streams from Local Authority being reduce therefore reducing staff WTE. developed as service improvement work progresses. August 2024. 2. Service model review to ensure that future TrakCare builds on local learning and builds on organisational learning from other builds. Forward planning for inclusion in the AHP Hub model will proceed in parallel to these TrakCare developments. 3. Revised workforce planning, incorporating the best‐practice and learning from other areas who have specialist children’s health services units. 4. The professional relationships between service and university have already been improved and we have academic representation that actively contributes to both our Workforce Planning and Service Improvement Steering Group. ACTIONS 1. Working with university colleagues to identify new practitioners who have expressed their desire to work in Lanarkshire on registration. This allows us to maximise and enhance opportunities for placement, improvement projects and induction planning, ensuring that we present ourselves as an area that is not only welcoming but committed to the ongoing development of individuals and the service
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41 2. Work with professional colleagues to ensure that all activity is aligned to direct and/or indirect pursuit of meeting the SLT waiting time target. 3. Transition from restrictive locality models for managing the waiting list.
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