2025 03 19 - Agenda Pack
North Lanarkshire Council · 19 March 2025
Back to Health and Social Care Integration Joint Board — 19 March 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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A meeting of the IJB will be held on Wednesday 19th March 2025 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 (04.12.2025) For Approval Attachment Chair 4. Matters Arising/ Rolling Action Log For Noting Attachment Chair 5. Chief Officer Update For Noting Verbal Claire Rae Strategic Planning & Development 6. Mental Health Strategy For Noting Attachment Maggs Thomson 7. Prisoner Healthcare For Noting Attachment Maggs Thomson 8. Annual Chief Social Work Officer Report For Noting Attachment Alison Gordon 9. Frailty Strategy Update For Noting Attachment Hazel Gilmour Performance & Finance 10. Financial Plan For Approval Attachment Nicola Scott 10.1 Appendix 1 MTFP 2025- 2028 Attachment Nicola Scott 11. Delegated Health & Social Care Budget For Approval Attachment Nicola Scott 12. IJB Reserves Strategy 2025-26 For Approval Attachment Nicola Scott Governance & Policy 13. Risk Update For Noting Attachment Morag Dendy/Claire Rae 13.1 Appendix 1 Risk Report Overview Dash Board For Noting Attachment Morag Dendy 13.2 Appendix 2 Risk Register For Noting Attachment Morag Dendy
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14 IJB Directions Letters to NLC and NHS L For Approval Attachment Morag Dendy/Claire Rae 14.1 IJB Directions Policy Attachment Morag Dendy/Claire Rae 15. NL IJB Integration Scheme 2025 For Noting Attachment Morag Dendy 16. IJB Chair Arrangements 2025-2028 For Approval Attachment Morag Dendy/Claire Rae For Noting 17. 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 18. Date of Next Meeting IJB – 18th June 2025 For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from the meeting held on Microsoft Teams, Wednesday 4th December 2024 at 9:30am – 12:00pm PRESENT Voting Members: Cllr Claire Barclay North Lanarkshire Council Nominated Councillor Cllr Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Exec Director Cllr Anne McCrory (Chair) North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non-Exec Director Siobhan White NHS Lanarkshire Nominated Non-Exec Director Non-Voting Members: Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Claire Rae Chief Officer, North Lanarkshire HSCP Dr Tyra Smyth General Practitioner Officer In Attendance: Stacey Anderson Support Services Project Manager Michael Breen Director of Finance Morag Dendy Chief Officer Planning, Performance & Quality Mark Dell Communications Manager Iris Henzel Community Solutions VANL Jacqui Jones Deputy Chief Executive and Director of Human Resources Peter McCrossan Director of AHPs Cathy McGinty NHSL Partnership/Staff Side Rep Thomas Moan Senior Manager – Community Solutions VANL Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Harry Robertson Carer Representative Marie Rooney Associate Director of Nursing – MHLDA Liz Seaton Carers Together Maggs Thomson Head of Health North HSCP John Watson Employee Representative NLC Unison Apologies: Paul Carey Audit Scotland Cllr Paul Kelly North Lanarkshire Council Nominated Councillor Nauman Dar NHS Lanarkshire Nominated Non-Exec Director Jann Gardner Chief Executive NHS Lanarkshire Dr Kenneth Dagg Consultant in Geriatric Medicine, Acute Division / Secondary Medical Care Practitioner Nicola Smith Chief Finance Officer Dr Josephine Pravinkumar Director of Public Health Joanne Jenkins Interim Nurse Director NLHSCP Maria Williamson Senior Manager, Quality Assurance Diane Fraser Head of Adult Social Care Martin Hill Chair NHS Lanarkshire
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2 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 (25th September 2024) The previous minutes were agreed as an accurate reflection of the discussion. 4. 5. Minutes of IJB PFA (23rd October 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 Claire Rae advised Items 18 & 25 are complete. Items 26 to 30 are all ongoing. 6. Chief Officer Update Claire Rae provided an update to the IJB. There has been considerable work done on the Hospital Based Complex Clinical Care (HBCCC) model within Lanarkshire. Claire is meeting with HC1 today, and this evening will meet with families and carers, in regards to the final decision on HBCCC within Lanarkshire. Hatton Lea's resident count has decreased from 41 to 11, with 4 confirmed for transition to mainstream care homes, marking a significant reduction in numbers previously anticipated as requiring ongoing HBCCC. A decision has been made to repatriate the remaining residents of Hatton Lea to Cleland Hospital, which will be discussed with families and carers this evening. In terms of Mental Health funding, there has been a reduced allocation from Scottish Government regarding of the Enhanced Mental Health Outcome Framework bundle funding. Projected current annual costs for the services included within this bundle sits at £17m. The recent allocation from SG was £11.8m. Claire and Michael Breen (Finance Director NHSL) have engaged with the Scottish Government, resulting in an additional £3.8m being provided for this financial year to break even and an extra £3m
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3 on top of the initial allocation, meeting our NRAC (National Resource Allocation Formula) allocation for Lanarkshire. Although it is a significant reduction in the annual cost of £17m, it is going to come out around £14.6m. There is work underway to identify the clinical priorities within the bundle to stay within budget for 2025-2026 and beyond. There was also notification from SG regarding a reduction in the multi-disciplinary team funding, primarily for home assessment teams (HAT), but the decrease wasn't as significant as expected. We will maintain our home assessment team workforce through 2025/2026, after which, the additional 20 WTE posts agreed upon in 2022 will need to be reviewed ongoing. There has been a series of roadshows set up throughout Nov and Dec ‘24, where the Core Team have gone out to staff, which have been positive to date. The roadshow features the back to basics programme linked with the transformation and reform agenda. CAMHS performance reached the target of 90% in September. Currently sitting at 91% against the performance trajectory. There is a caveat in regards to the Mental Health funding and what it is going to equate to in terms of the detriment on performance. Claire advised IJB that she will keep them update on this as it moves forward. Councillor Claire Barclay raised a question in regards to the CAMHS and if there is a time, medium to long term, to bringing the 18 weeks down to a shorter period, or would it be a case of letting it bed in before trying to bring down? Claire Rae answered by advising that it is the set trajectory target provided by SG but brought in Lucy Munro to advise further. Lucy Munro advised that it is contingent on funding. The aim is to have a minimum wait to get the choice appointment. There is a balance between that and supporting the neurodevelopmental pathway also. Brian Moore asked about the additional £3.8m & £3m for Mental Health and whether it is recurring. Claire Rae confirmed that the £3m is recurring but the £0.8m provided in addition this financial year is non-recurring. 7. Strategic Commissioning Plan Progress Morag Dendy provided IJB 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. Brian Moore expressed the opinion that it is something IJB should see on a periodic period. This would then allow an overview in terms of where we’re going in the commissioning intentions Phillip Couser shared that his understanding is that the RAG rating focuses on delivery, and raised the question on how IJB can assess if the service meets its objectives.
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4 Morag Dendy advised that through the engagement and participation work, there have been discussions on how capture more routinely and specifically. A good example of work is the Alcohol and Drug Partnership (ADP), which has undergone several independent studies featuring structured interviews with service recipients. We are restructuring our meetings to focus on themes across work streams and enhance our whole system approach, which has refreshed engagement among carer representatives and community workers. We anticipate visible impacts as we enter the new calendar year. The hope is the element will become stronger as it is important. Councillor Anne McCrory expressed that she appreciated the visibility of the thread throughout the documents and found it to be quite beneficial. IJB Committee note and agreed the following recommendations: I. The IJB noted the contents of the report. II. The IJB approved the current status of the Programme of Work, as contained within Appendix 1 of this report. 8. Chryston Update Maggs Thomson provided the IJB with an update on the development and delivery of Chryston Community Health Clinic. Chryston Community Health Clinic was delivered for service provision from 18th December 2023. All services have transferred from Muirhead Clinic and are being delivered in Chryston Community Health Clinic with the addition of Midwifery and CAMHS. Muirhead Clinic will not be decommissioned and site responsibility was handed over to the SLUH&SCP on 31st January 2024. The IJB has 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. Councillor Anne McCrory inquired about the Mental Health issue by January, to which Maggs replied that it's currently difficult to assess due to general challenges. While there is a repatriation element, a similar clinical model is already being delivered in Cambuslang and Rutherglen Locality and is functioning well. However, medical staffing will not transfer; we manage psychology and nursing that will be repatriated. IJB Committee note and agreed the following recommendations: I. IJB noted the papers. 9. Whole System Winter Planning Morag Dendy provided the IJB with an update on the whole systems winter planning. 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
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5 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. Councillor Anne McCrory referred to the 70% uptake of GPs, and asked if last year’s figure was known. Tyra Smyth advised that the figures are similar. Lucy Munro gave some background advising that Lanarkshire is one of few boards that have done this over the years and that it makes a big difference to the primary care out of hours and Emergency Departments. It is not expected for GP practices to work all the bank holidays. Most practices do some of the bank holidays. Brian Moore noted that while it is encouraging to see mention of discharge lounges in the report, the actual performance in this area requires improvement. It will be valuable to explore this matter further when the IJB convenes again in January. Brian also referred to section 1:10 and the intermediate/rehabilitation care beds, and suggested that it would be useful to know the details. It is also encouraging to see the mention of the four frailty units; however, Brian felt it would be beneficial to gain an understanding of their current level of establishment. Phillip Couser expressed the support for the whole system approach and working together with colleagues in South. One of the observations made during the Operation Flow & Firebreak review, is that there is still a difference in the operating models between the North and South. Phillip inquired about how the Integrated Joint Board perceives the opportunity to establish a unified target operating model across the system. Claire Rae noted that there are distinctions between the North and South regions. The goal is to establish a unified 'Once for Lanarkshire' assessment request process, particularly for the Wishaw acute site, which serves both areas. Efforts are currently underway to create a single point of access for telephone inquiries related to the Wishaw site. The newly developed and implemented Optimal Discharge Planning target operating model is the use of common language across the whole system.
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6 Claire is conscious that in the new year IJB will need to be updated on how Operation Flow is progressing i.e. bed occupancy, weekend discharge numbers and the use of the discharge lounge. Siobhan White inquired with Morag about the availability of data regarding vaccination uptake and whether additional campaigning efforts are necessary. Morag Dendy advised Siobhan that this is something she can look into and get back to her with an answer. Maggs Thomson contributed by highlighting that the staffing uptake is currently low, and efforts are underway to enhance communication regarding vaccinations. In terms of what North is responsible for in vaccine delivery, they do Primary 2s and Primary 5s routing vaccines, but equally for Nursery, Primary and Secondary School flu service. Haven’t seen any significant shift in people declining. Maggs advised she can pull details and a report if requested. David Wood noted that in section 6.2.4 of the document, there is a reference to additional details in item 7; however, item 7 does not appear to be present. He inquired whether this information might be located elsewhere. Morag Dendy apologies and advised she will look into as numbering could be incorrect. Catherine McGinty addressed Siobhan's inquiry about vaccines, noting her role within the vaccine group as a Partnership Representative. Catherine shared that significant efforts are underway for outreach campaigns, specifically targeting nurseries and schools, in response to the observed low vaccination rates. Anne McCrory inquired whether the recent changes in centres have had an impact, noting that individuals in the Bellshill area are now required to travel to Eddlewood in Hamilton for vaccinations. Catherine McGinty informed the IJB that the current situation is having an impact, and staff will be organising additional pop-up events to address this need. There is a lot of planning work going on to get vaccine centres in place. The project is currently in the planning with the objective to move it forward in Spring 2025. Claire Rae echoed Catherine's recommendations regarding the efforts to improve localized access for individuals and service users. The national comms have been slow. slower than anticipated. It is important to consider winter 2025 and collaborate also with our education colleagues to strengthen our messaging. Brian Moore addressed the concern raised at the previous IJB meeting regarding 7-day working. He expressed the importance of assessing whether this initiative will result in substantial additional capacity. It was suggested that during the IJB meeting in January, it would be beneficial to evaluate whether there has been any impact from this change. IJB Committee note and agreed the following recommendations: I. IJB Noted the plans in place to mitigate the impact of winter. 10. Financial Monitoring Claire Rae gave an overview of the financial position up to the 30 September 2024, second quarter. The financial report details an underspend of £1.446 million pounds split
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7 £175,000 pounds for health care and £1.2 million pound on social care services. There are no new developments to report during this period regarding the variances; employee costs, payments to other bodies and prescribing is what has been seen up until now. The report will further detail what makes up those variances. Reserve position; start of year at £75 million and already drawn down just under £11 million pounds. 53% of reserves are either earmarked or ring fenced reserves there for a specific purpose. Have a number of risk based reserves and hold money in contingency. Currently projecting £64 million pounds sitting in reserves. Nicola to share the most up to date savings tracker for distribution to the IJB members. Of the total £29 million pounds’ savings target; have achieved over a third of, £9.4 million pounds. There is £7.5 million pounds been achieved towards the £17 million in Health and almost £2 million pounds achieved towards the £11.4 million pounds. There will be a shortfall on the Mental Health funding; looking at projected costs of £17million pounds and confirmed will only receive £11.8 million, will need to utilise some of reserves. The Scottish Government has confirmed that it will allocate an additional £3.8 million to address the funding gap for the 2024/25. The baseline figure for 2025/26 is projected to have a short fall, and this will be integrated into the financial plans for next year. The funding for the multidisciplinary team for the Home Assessment Team (HAT) service has exceeded expectations. Based on the contributions from the Scottish Government and own reserves, we are in a good position for 2024/25 and 2025/26. However, will need to assess the staffing compliment in that area for 2026/27 and beyond to ensure that there is adequate funding to support. Brian Moore has raised a question regarding the use of agency within Mental Health by asking if we are taking a proactive approach to this matter, considering our ongoing efforts to reduce agency costs. Claire Rae confirmed that is something that needs to be looked at in regards to agency usage and bank spend to get better control of it. There is a review of the models as there are no psychiatrists coming through. Lucy Munro advised that on an assurance side, it is split into 3 main areas. • Chris Deighan, the Executive Medical Director, leads a team that reviews all locum medical expenditures across Lanarkshire, with a specific focus on agency locums, which represent a significant area of spending. • Looking at the model of acute Mental Health teams which could be Psychiatric lighter. Only use Psychiatrists for those things we need Psychiatrists to do. In- patient and Mental Health work. • How do we retain and recruit Psychiatrists? Currently working with CfSD (Centre for Sustainable Delivery) to look at international recruitment. Lots of activity going on at all levels, such as in schools, FY1s, Specialist Trainee Doctors, New Physiatrists coming into post. Marie Rooney advised that from a Nursing perspective, agency use has been a challenge, due to not having the same numbers joining the profession as there have been in the past. There is a reduced numbers of graduates coming into service at the end of their training. Looking at developing other pathways into nursing, both within Mental Health and Learning Disabilities. The challenges significantly impact the nursing staff within CHMTs and In-Patient wards. We are involved in the work in terms of
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8 advance practice roles, specialist practitioner roles which is all taken into consideration within the work streams Lucy summarised. For assurance of the IJB, all avenues are being looked at to try and both retain staff, and build a range of alternative pathways into the different professions. Maggs Thomson reported that there are 15 inpatient wards for Mental Health in which we understand our staffing levels and recruitment shortfalls, and we offer overtime and utilise internal bank staff when necessary. Our environment is reactive, particularly during out-of-hours and weekends, as patient observation statuses can change hourly. A full staff at shift start may quickly become insufficient if a patient requires one-on-one supervision, necessitating rapid staff deployment. Brian Moore proposed that a report on the expenditure and utilisation of agency staff would be beneficial in the future. Councillor Bob Burgess directed a question to Marie asking about the recruitment and retention, and if we are losing staff during training or are they leaving to go to a better paid job elsewhere. Marie Rooney noted that we are beginning from a lower baseline, as there are currently fewer individuals entering training programs. This trend can be attributed to various factors, one of which is the competitive job opportunities in the private sector. The mental health and learning disabilities sector presents unique challenges, and are collaborating closely with the NHSL workforce to implement targeted recruitment strategies aimed at reducing reliance on bank and agency staffing, particularly in these specialised care areas. The goal is to establish a more stable workforce. Marie suggested that she could contact the Universities to gather data on the number of students enrolling in training programs and those who exit during their studies, which can be shared with the IJB in the next meeting in the new year. Marie Rooney also shared with the IJB that within NHSL, mental health and learning disabilities have their own Induction and Support Programme which supports Newly Qualified Nurses (NQNs) through their first year and works with them whilst in clinical areas. This doesn’t happen in any other board areas. This program has been running for 3 years, and through word of mouth, student have become aware of the extended support they would get. There is data available regarding the impact on our ability to attract and retain NQNs, which can be shared with the IJB if requested. Claire Rae shared that she is happy to take a report into 2025 in regards to workforce as proposed by Brian Moore. IJB Committee note and agreed the following recommendations: I. IJB acknowledge the contents of the report II. IJB acknowledge the projected outturn of the underspend 11. Support, Care and Clinical Governance Update Lucy Munro provided IJB with an overview on the work undertaken by the North Support Care and Clinical Governance (NSCCG) committee from April to September 2024. Key issues were discussed and progress made to date.
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9 Brian Moore noted that Lucy had asked if we're ready to proceed, and I believe we are, having previously discussed this area. We welcome the report's structure. However, we need to consider how it relates to the PFA's terms of reference, particularly regarding performance oversight. It's important to address potential issues or lessons from adverse events and ensure that the learning is applied effectively. Perhaps we can discuss this further with Claire separately. Alison Gordon noted that a national thematic review of social work governance by the care inspectorate is underway and won't report until Spring 2025. Consequently, it may be premature to consider implications in the next 6-month report. The review may suggest new arrangements. IJB Committee note and agreed the following recommendations: I. IJB Noted the update from the Support Care and Clinical Governance committee. 12. Climate Change Reporting Stacey Anderson provided IJB with the background on climate change and informed 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 1st April 2021. Reports were to be submitted to ccreporting@ed.ac.uk by 30th November 2024. Late submissions would not be accepted for analysis and may be deemed non- compliant with Public Bodies Duties reporting requirements. To enable a timely submission, the Climate Change Template for 2023-24 was discussed by North Lanarkshire IJB at the Liaison session on the 21st November 2024. Bob Burgess inquired about the count of electronic vehicles in transport divisions, to which Stacey replied that the data can be obtained from the submissions of both partnership reports. IJB Committee note and agreed the following recommendations: I. The IJB noted the content of the Climate Change Duties Compliance Reporting template for 2023-2024 and are assured the template was submitted within the required timelines. 13. Terms of Reference Stacey Anderson discussed with the IJB the annual review of the Terms of Reference of the IJB and IJB PFA. David Wood noted that in Appendix 3, there could be a half dozen additional reports which can be added in which would be of interest to the CBS sector. Stacey Anderson advised that Claire Rae would be able to pick this up as she has now moved post. IJB Committee note and agreed the following recommendations: I. The IJB approved the revised Terms of Reference for the IJB and IJB PFA.
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10 II. The IJB noted the reporting schedule and meeting dates proposed for the IJB and IJB PF&A future meetings III. The 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. 14. Risk Register Stacey Anderson provided a summary to the IJB on risk management activity, noting any amendments or additions to the current risk register. Brian Moore & Phillip Couser shared that in terms of the ask, they are both happy to support the recommendation around climate change. Phillip Couser expressed a need for clearer articulation of financial risk, which remains high but is expected to achieve balance this year. Historically, we've always delivered balance despite this risk. We should consider a long-term perspective on risk, especially in light of the latest report from Scotland, prioritising long-term implications over short- term concerns. Stacey Anderson emphasised the importance of achieving consensus on risk tolerance within the financial framework. The new Chief Financial Officer, Nicola Scott, will conduct a thorough risk review. Siobhan White inquired about the topic of vaccinations and the potential risks associated with them. She suggested that if vaccination uptake declines, this issue should be considered for inclusion on the risk register. It may be beneficial to review the current data regarding this matter. Claire Rae recommended assessing the vaccination uptake, as it may be pertinent to include this information on the risk register. In response to Phillips' previous point concerning financial risk, it is essential to conduct a thorough assessment of our risk appetite. Additionally, we need to collaborate with Nicola, who is newly appointed, to undertake a targeted analysis of financial risk in conjunction with the IJB. Harry Robertson inquired if National Care Service be downgraded as a risk? Stacey Anderson advised that it can’t be officially be downgraded as a risk until the full official update has been received from the National Care Service. Claire Rae shared with IJB that the Integration scheme was approved at Scottish Government and has been added to the website. IJB Committee note and agreed the following recommendations: I. The IJB 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. The IJB agreed to consider the inclusion of climate change risk to the IJB risk register to align risk sharing across parent organisations.
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11 15. Risk There was no new risks identified. 16. Date of Next Meeting IJB – 22nd January 2025
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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: 6 SUBJECT: Mental Health and Wellbeing Delivery Plan To: Integration Joint Board Committee Lead Officer for Report: Maggs Thomson, Head of Health North Lanarkshire Author(s) of Report Iain Sharkey Service Manager MH, Addictions and Learning Disabilities, Dr Adam Brodie - Associate Medical Director, MHLD&A DATE: 19 March 2025 1 PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2 ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ This paper has been prepared by Iain Sharkey Service Manager MH, LD and Addictions and Dr Adam Brodie - Associate Medical Director, MHLD&A 3 RECOMMENDATIONS It is recommended that the IJB: (1) Acknowledges the process and timeline to develop a Lanarkshire Mental Health and Wellbeing Delivery Plan aligned to the National, Scottish Government/COSLA Mental Health and Wellbeing Strategy and separate Delivery Plan, both published in 2023; (2) Through the Strategic Commissioning Plan, we are reviewing structures and will provide an update at future meetings. 3.1 The delivery programme comprised of 4 main work streams: • Good Mental Health for All.
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2 • Improving Access to Mental Health Support and Services. • Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans. • Specialist Mental Health Services. The Strategy also had in place a number of cross cutting interdependent work streams. These included Communication and Engagement, Workforce and Finance. 3.2 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 3.3 Over the course of 2024, we endeavoured to take advantage of the opportunities and experiences of working in different ways. All work streams reviewed their delivery plans. Over the course of 2024 further progress has been made to compliment the work of the last few years, whilst retaining a focus on the vision and objectives set out in the original Lanarkshire Mental Health and Wellbeing Strategy. 3.4 This report outlines the progress made across all Strategy work streams and sets out our progress in developing a Mental Health and Wellbeing Delivery Plan for Lanarkshire aligned to Scotland’s Mental Health and Wellbeing, the new national Mental Health and Wellbeing Strategy launched in 2023 by COSLA and the Scottish Government. 4 ACHIEVEMENTS Good Mental Health for All 4.1 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. This remains a key drive with an even greater focus on Trauma Informed service delivery. 4.2 Now 2 years post the COVID-19 Pandemic the learning has been invaluable. The impact was not experienced equitably. It exacerbated long- standing inequalities in being able to thrive in the face of adversity. The Workforce have met the challenges directly exhibited by the innovative approach by continuing to embed the Triangulation of care. 4.3 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 4.4 The Good Mental Health for All Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Healthy Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and
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3 Common Mental Health Problems. 4.5 There is also recognition that PLNS have received 3 awards, 2 for partnership working for the community police triage model and 1 for NHS staff awards. Recognition both locally and nationally of the good work and improved outcomes across partner agencies. 4.6 The below remains the same as the last report but there is evidence of outcomes being met and key indicators below being achieved. • Promoting a confident, diverse and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention • Promoting a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports • Delivering a programme of work to tackle mental health stigma and discrimination and ensure people can talk about their mental health and wellbeing. • Driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together • Improving access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund • Delivering a Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them • Exploring robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. Improving Access to Mental Health Supports and Services (IAMHSS) 4.7 IAMHSS has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and with some focus on the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy, 2017.
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4 4.8 Primary Care Mental Health & Wellbeing Teams: • PCMHW model developed with Mental Health Liaison Nurses now covering 91 GP practices supported by LAMH Mental Health and Wellbeing Workers providing a non-clinical role. This service is currently under review which may impact on the delivery model. It is anticipated that this review will be completed by summer of 2025 and any transition plans completed by March 2025. • A Task and Finish Group is focussing on - The review of the Primary Care Mental Health (PCMH) service model is ongoing. The aim remains the same to learn from our experience to date and ensure we make the most effective and efficient use of resources. We aim to provide a central point of referral for self & practitioner referrals of people experiencing mild to moderate mental health problems and divert patients from GP practice; - The review remains focused on enhancing and developing standard internal referral processes between the PCMH service, Primary Care Occupational Therapy (PCOT) and Community Link Worker (CLW) programmes, CMHTs, Mental Health Flow Navigation Centre & Community Addiction Services. • Assessment Plus CBT model is no longer part of the service. This was a test of change and assessment concluded that this can be incorporated into Psychological Treatment Teams. 4.9 Transforming Mental Health in Emergency Departments (ED) • Flow Navigation Centre (FNC) fully established 24/7 providing an alternative to ED triage for a mental health assessment. • Direct links with Psychiatric Liaison Nurse Service for Community Police Triage and Scottish Ambulance Service triage fully established in hours via FNC and Out-of-Hours at Douglas Street. • Out-of-Hours service expanded and fully embedded. Patients triaged and assessed via telephone, virtual platform, or face-to-face. • Mental Health Advanced Nurse Practitioners now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. • Overall reduction has risen to 82% in police attendance at ED. 4.10 Custody Suites: • We have 4 Lanarkshire Custody Suites. As a service we developed a new Mental Health and Wellbeing Team staffing model. This was aligned to the Unscheduled Care Team, the Primary Care Team, and the Community Mental Health Teams. This complements current models established to support people affected by poor mental health.
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5 4.11 Two Advanced Nurse Practitioners are in post through Action 15 funding and are providing a valuable mental health assessment resource to support people who present with mental health needs when detained. This is out of hours and the SOP remains in place at all other times. The ongoing review of the service will maintain positive outcomes. 4.12 Prisoner Mental Health: • Mental health Multi-Disciplinary Team staffing model for Shotts Prison developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. There is ongoing input across the prison estate to embed best practice. • Prisoner population of HMP Shotts now has improved access to a wider range of mental health services – in particular psychological therapies and health improvement – through a match-stepped model of care. This is now embedded in Shotts and outcomes are being monitored. 4.13 Digital Solutions: • Digital solutions explored to help provide services in new ways that make them more accessible and enhance patients’ experience. Services actively promoting opportunities for patients to give feedback. • Near Me well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. • MORSE transition completed for all previous Midis users. Work remains underway for migration of remaining services. • Successful collaboration with Connecting Scotland to provide devices and support to service users. • Digital champions remain in place supporting the teams. Child and Adolescent Mental Health Services 4.14 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services (CAMHS) and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). 4.15 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
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6 services ensuring a whole systems approach based on children and young people’s rights and relationships. 4.16 The board remains committed to delivery of safe, effective and child centred mental health care for children and young people across Lanarkshire who require support and intervention to manage their complex mental health challenge. 4.17 The strategic commissioning of CAMHS and NDS for the NHS Lanarkshire area is hosted by the North Lanarkshire IJB and managed by the North Lanarkshire Health and Social Care Partnership (HSCP). In April 2021, North Lanarkshire HSCP received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 4.18 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by complex mental health problems, moving early intervention support to the Schools Counselling Model, School Nursing and the Community Wellbeing Framework. It also separated the request for assistance pathway for children and young people who primarily required assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Foetal Alcohol Spectrum Disorder (FASD), Developmental Coordination Disorder (DCD) and Tourette’s and Tic disorders. 4.19 In order to co-ordinate and monitor the delivery of the programme plan, North Lanarkshire HSCP established the CAMHS & NDS Recovery and Renewal Programme Board, which his is chaired by the North Lanarkshire HSCP Medical Director and has support from a Professional Adviser from the Scottish Government. 4.20 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. 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) 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.
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7 • 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. 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- 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. • CAMHS RTT reported as being met in October 2024 and performance has been stable since. Analysis is ongoing to map variation in demand profiles to assist with service model development. Specialist Mental Health Services 5.0 Key achievements include: • Dedicated specialised Community Perinatal Mental Health Team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. • Multi-agency, multi-disciplinary Infant Mental Health team established and now imbedded in service delivery. • Maternity and Neonatal Psychological Interventions Service embedded in service delivery. • New referral form in place with a single point of referral; pathway to community rehab now live; planned date of discharge in place; new Community Rehabilitation Team nursing model embedded in practice; new Rehabilitation & Recovery Service Operational Policy in place. • South Lanarkshire Community Mental Health Team (CMHT) funding and staff transferred from the previous hosted arrangements with North Lanarkshire to enable integration of Community Mental Health services within South Lanarkshire HSCP. • Scottish Government funding for Dementia Post Diagnostic Support (PDS) Services utilised to create a single dedicated PDS service that focuses on those individuals not requiring secondary care input of an Older Adult CMHT. • Adult Autism Assessment Service established as Phase 1 of a wider Adult Neurodevelopmental Pathway.
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8 5 MENTAL HEALTH AND WELLBEING DELIVERY PLAN (The below points 5 – 5.10 were included in the previous report but are relevant to the current information) Scotland’s Mental Health and Wellbeing 5.1 The new national Mental Health and Wellbeing Strategy recognises mental health as a cross-government priority, building on the partnership between the Scottish and Local Governments. 5.2 It recognises that underlying factors, inequalities and types of disadvantage affect certain groups of people who may suffer disproportionate impacts on their mental health. 5.3 We know that mental health does not just mean mental illness; it is a continuum that may include a range of needs, from having the right words to describe how we feel, through to everyday worries and feelings of distress or hopelessness. We must ensure that the right help is always available to those who experience severe and enduring mental health conditions and provide the wider support people may need to maintain good mental health. 5.4 In publishing the Strategy in 2023, the Scottish Government and COSLA acknowledge that all areas of Government will need to work together to achieve our shared vision and to make progress towards our outcomes, which are outlined below. The Strategy sets out a vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. 5.5 The Strategy describes a whole system model which very much aligns with the Lanarkshire Mental Health and Wellbeing Strategy 5.6 The Strategy sets out the following outcomes: • Improved overall mental wellbeing and reduced inequalities. • Improved quality of life for people with mental health conditions, free from
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9 stigma and discrimination • Improved knowledge and understanding of mental health and wellbeing and how to access appropriate support • Better equipped communities to support people’s mental health and wellbeing and provide opportunities to connect with others • More effective cross-policy action to address the wide-ranging factors that impact people’s mental health and wellbeing. • Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. • Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. • Better access to and use of evidence and data in policy and practice. • A diverse, skilled, supported and sustainable workforce across all sectors 5.7 It also identifies ten priorities which provide the structure for the first national Delivery Plan for 2023-25: • Increased availability of timely, effective support, care and treatment that promote and support people’s mental health and wellbeing, meeting individual needs. • Better informed policy, support, care and treatment, shaped by people with lived experience and the workforce, with a focus on quality and recovery. • Better access to and use of evidence and data in policy and practice. • A diverse, skilled, supported and sustainable workforce across all sectors • Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk • Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies • Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery • Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk
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10 • Improve mental health and wellbeing support in a wide range of settings with reduced waiting times and improved outcomes for people accessing all services, including Child and Adolescent Mental Health Services (CAMHS) and psychological therapies • Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery Lanarkshire Mental Health and Wellbeing Delivery Plan 5.8 Given the close alignment between the 2019-2024 Lanarkshire and 2023 national strategies, the Integration Joint Board agreed at its Liaison Session on 8th November 2023, that, rather than produce a new Lanarkshire Strategy, partners should work together to develop a Lanarkshire Delivery Plan, aligned to the strategic actions set out in the national Delivery Plan, and clearly linking to local strategies and plans including both Health and Social Care Partnership Strategic Commissioning Plans, Our Health Together, Children’s Services Plans, the Plan for North Lanarkshire Community Plans and Local Outcome Improvement Plans. 5.9 Since then, work is continuing to: • Establish a programme sustainability plan- to identify any outstanding priorities and actions from 2019-2024 strategy to be carried forward into the new Lanarkshire Delivery Plan • The 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 is ongoing. • The contributions from stakeholders regarding existing and new priorities and actions (period of engagement and development) is being progressed through work streams already established. • Engage with stakeholders both at Lanarkshire-wide and locality level, via the Community Boards in North Lanarkshire and with an equivalent engagement process in South Lanarkshire, to identify any further priorities and actions for the Lanarkshire Delivery Plan • Review and ensure governance and leadership arrangements • Establish governance structures and implementation process (embed in operational governance and supported by in-house enablers)
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11 5.10 The timeline has not changed and remains the agreed process set out in Appendix 1. 6 CONCLUSIONS 6.1 Work is ongoing across all partners to continue to develop and deliver against the key workstreams of the plan. 6.2 Note progress over last 12 months 7 IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) An outcomes-focused Achievement Framework is now in place (Appendix 2) for the Mental Health and Wellbeing Strategy. The below has not changed but remains ongoing. We noted in our strategy that as GIRFEP was implemented, people in Lanarkshire would see campaigns to promote ways of improving our mental wellbeing, changes and improvements to the way they access mental health support and services, new ways of working, observe new staff roles, a programme of work to tackle mental health stigma and discrimination, increased interventions to support prevention and early intervention as well as every effort to improve services for people with severe and enduring mental health conditions.
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12 The ambition continues to reflect on culture in Lanarkshire and improve people’s physical wellbeing and mental health. This will be further discussed via work streams. A monitoring and evaluation framework is now in place to accompany the new National Strategy. This will be continually reviewed to measure outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The landscape in relation to additional funding streams, including Mental Health, released throughout the year by Scottish Government, is complex with continued uncertainty around the scale and timing of future funding. The costs and funding available for 2024/25 and future years will be closely monitored and reported. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. This is currently no direct risk for the delivery plan. 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Discussion at Lanarkshire Links quarterly meetings Engagement events involving Mental Health and Wellbeing Strategy Board and Comms & Engagement Group Presentation/discussion at Community Boards Staff involvement Lived and living experience contribution involved via VANL and VASLAN
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13 ☒ Provide stakeholders with information on how to get involved As above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs As above ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery As above ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Presentation/discussion at Community Boards 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIAs were completed for the development of the 2019-24 Strategy and for most of the workstreams. These will be reviewed and will inform the completion of an EQIA for the Delivery Plan. EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire, 2019-23 Scotland’s Mental Health and Wellbeing Mental Health and Wellbeing Delivery Plan, 2023-25
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14 9. APPENDICES Appendix 1 – Lanarkshire Mental Health and Wellbeing Delivery Plan - Timeline for Development Appendix 2 – Achievement Framework Maggs Thomson – Head of Health Members seeking further information about any aspect of this report, please contact Maggs Thomson, HSCP North, Head of Health at Maggs.Thomson@lanarkshire.scot.nhs.uk CHIEF ACCOUNTABLE OFFICER (or Depute)
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15 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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17 MENTAL HEALTH AND WELLBEING DELIVERY PLAN APPENDIX 1
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18 LANARKSHIRE MENTAL HEALTH AND WELLBEING STRATEGY ACHIEVEMENT FRAMEWORK APPENDIX 2
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1 IJB Reporting Template REPORT Item No: 7 SUBJECT: Prisoner Healthcare TO: IJB Performance Finance Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NL HSCP Author(s) of Report Tracey Hughes, Senior Nurse Jamie Quin, General Manager Contact details for Author(s) of Report Tracey.hughes@lanarkshire.scot.nhs.uk Jamie.Quin@lanarkshire.scot.nhs.uk DATE: 19 March 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for noting. This paper is to inform the Board of the continuing health service improvements undertaken within HMP Shotts. It will explore the compliance with the local Service Model Review, and in parallel with the HIS recommendations. Also to note on-going work around the National Target Operating Model and next steps. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒
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2 2. ROUTE TO THE BOARD This paper has been: prepared by Tracey Hughes, Senior Nurse and reviewed by Jamie Quin, General Manager, AHSU and Maggs Thomson, Head of Health, NHSCP Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB note the contents of the report. (1) It is recommended that the IJB recognise the service changes and continuous improvements made within prisoner healthcare at HMP Shotts in accordance with the recommendations made by HIS. (2)) It is recommended that the IJB recognise the service changes and continual improvements made within prisoner healthcare at HMP Shotts in accordance with the local recommendations and actions identified in the Local Service Model review, including the efforts made by the AHSU to address the recruitment & retention issue within Prisoner Healthcare. (3) It is recommended that the IJB endorse the future work streams of the Prisoner healthcare team and to achieve all recommendations within the National Target Operating Model 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND The Prison Health centre based within HMP Shotts serves a population of 540 male patients. The service is to provide these patients, many with advanced Mental Health and Addictions issues, with a primary care level service, equivalent to that of patients Yes ☐ No ☒ N/A ☐
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3 in the community. In terms of health equalities, it is estimated that the prison population has an average health age of 10 years higher than their actual age. The service has continued to be managed within the Adult Health Services Unit (AHSU) and has delivered on all Service Model Review recommendations. The 2022 HIS review led to 64 recommendations of which there are only 2 outstanding in relation to pharmacy and are part of the ongoing pharmacy review 5.1 Target Operating Model In 2024 the National Prison Care Network at NHS National Services Scotland (NSS) developed the Target Operating Model for prisons to support a “Once for Scotland” approach to the planning, design and delivery of an integrated, holistic, person- centred care pathway across the healthcare system for people living in prison. HMP Shotts are making great progress with this utilising various workstreams across NHS Lanarkshire Key recommendations have been made around; • Governance and Leadership • Workforce and Education/Training • Health Improvement • Emergency Response • Admissions • Mental Health • Addictions • Primary Care • Sexual Health • Learning Disability • Pharmacy • AHPs • Technology A National overview of current services that have been fully implemented is outlined below.
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4 The summary above indicates NHS Lanarkshire current status towards achieving the Target Operating Model. The areas that require improvement have been highlighted around AHPs, Health Improvement, Pharmacy and Sexual Health. There are various improvement workstreams feeding into this. 5.2 Workforce The workforce has continued to stabilise and there has been no use of agency within this service over the last 6 months. 5.3 Finance The financial position as at Month 9 2024/2025 financial year is as follows: t The Pays budget is reviewed/scrutinised/managed accordingly in-line with allocated funds. The £217k overspend within non-pays is within the Medicines Management/Pharmacy remit of the prison health centre, to be discussed below. All other areas of the prisoner healthcare budget are reviewed and managed accordingly within the SFIs and allocated budget.
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5 5.4 Pharmacy 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. The non-pay spend relating to Pharmacy/Drugs is as below: The actual spend for medicines was only £15,773, with the £250k miscellaneous (other supplies) overspend being the management fees for the pharmacy contract with M+D Green. Prior to 2023 the National contract for pharmaceutical supplies was held by Lloyds group. Upon expiry of this contract Lloyds did not want to renew this, Boots uninterested in tendering also. Upon first tender request no supplier submitted any interest. With time against the national team, and a high risk raised on the SPS register regarding potential prisoner riots, a second attempt at sourcing a contracted supplier was met with a bid from M&D Green. This new bid came in 2 parts, the processing and management of drugs by M&D Green, and the delivery from Phoenix Healthcare. This new contract came with an almost 22% increase in costs, as well as a £35k per month management fee. This contract came into effect from June 2023 and none of these factors were uplifted in the Annual budget, creating a potential £600k annual cost pressure. A Pharmacy Medicines Action Group has been created. Chaired by Senior Nurse and consisting of Senior Clinical Pharmacists, Lead GP, Prison sessional GPs, Team Leaders, ANP and the Consultant Psychiatrist. The main focus is to perform polypharmacy reviews within the principles of Realistic Medicine. There is a clinical focus to reduce prescribing volumes and costs and improve safety within the prison for diverted drugs. 5.5 Chronic Disease Management/National Screening The nursing team continue to deliver all key aspects of the CDM and National Screening requirements. The following services are delivered within the prison Health Centre • Diabetes (clinics & awareness)
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6 • Sexual Health (clinics & awareness) • Keep Well clinics • Asthma – initial stages of implementation • Hypertension • National Bowel Screening • Prostate Screening • Routine eye tests • Treatment Room service 5.6 Deteriorating Patient and Emergency Response Senior Nurse has implemented NEWS2 and a prison specific structured response document within the prison To ensure compliance to the escalation policy and for consistency in care this is audited on a monthly basis which has in turn improved patient outcomes and compliance with National Excellence in Care standards. Noted below, the service achieved 95-100% compliance consistently across the year. 5.7 Staff Training As part of the programme to fully utilise new increased staffing has been devised in collaboration with the Practice Development & Organisational Development teams. This includes Mandatory and other relevant desired training, including both practical on-line sessions. Outlined below there is noted 85-100% compliance with all training
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7 5.8 Call before you Convey This is now business as usual and all non life threatenting patients are now being safely navigated through FNC There was a total of 185 Ed attendances from HMP Shotts over 2024. The most common presenting complaint is suspected illicit drug overdose. This is also impacting nursing resources with increased illicit drugs within the prison at the moment. Harm reduction interventions are in place in collaboration with SPS 5.9 Associated Risk As the improvements undertaken above were all necessary for patient care, staff governance, and as per HIS recommendations, any reduction to staffing levels in relation to proposed 10% financial savings within the prison would create a clinical 0%10%20%30%40%50%60%70%80%90%100% HMP Shotts Learnpro Compliance % Oct Nov Dec 0 5 10 15 20 25 30 35 HMP Shotts ED Presentations 23-24
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8 risk to the successful delivery of the service. This will be discussed as per the finance cluster review meetings. 6. SUMMARY OF KEY ISSUES Next Steps • Continue to provide service delivery as per new model • Continue to work collaboratively with SPS • Continue progressing to achieve the National Target Operating Model • Represent the Prison Healthcare service at finance cluster review meeting • Complete MAT standards benchmarking and evidence gathering • Continue to develop the workforce and role diversification 7. CONCLUSIONS The AHSU, in collaboration with SPS and on-site staff, have successfully implemented a new service model to deliver excellence in health care to the people who live within HMP Shotts. 8. IMPLICATIONS As previous mentioned in section 6.9, any reduction in budget to the Prisoner Healthcare service, could result in a significant adversity in the ability to fulfil the service provision as per national guidelines. The fragility of the staffing budget would not allow for any reduction in FE otherwise the implication of reverting to an unsatisfactory outcome for patients. 8.1 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 ☒
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9 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) • HIS Recommendations • NSS published guidance for prisoner health • MHWC Recommendations • Safe Staffing Legislation • NSS Target Operating Model 8.3 FINANCIAL Any reduction in staffing budget would adversely affect service provision and performance. £600k annual cost pressure in drug/medicines management provision. The prescribing review group has a target saving of £43k (realised by Jan 26). This will include reviewing items prescribed, formulary switches, developing pain pathways, reviewing Gabapentanoids, reviewing the PRN medications, and also promoting use of “in-possession” 28 day prescriptions where safely possible as opposed to supervised and daily bags. This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken.
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10 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 Staff, patients & SPS involved in service review process ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services IPMs, SPS and patients involved ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Monthly meetings with SPS and review meetings with HIS and NSS ☐ 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 8.6 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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11 9. BACKGROUND PAPERS HIS inspection report available on request 10. APPENDICES Nil Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Tracey.Hughes@Lanrakshire.scot.NHS.UK Lorraine.Smith@lanarkshire.scot.mnhs.uk Jamie.Quin@lanarkshire.scot.nhs.uk
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12 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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13 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 IJB Reporting Template REPORT Item No: 8 SUBJECT: Annual Report of the Chief Social Work Officer 2023/24 TO: Integration Joint Board Lead Officer for Report: Alison Gordon, Chief Social Work Officer (Education, Families, Justice, and Integrated Practice) Author(s) of Report Alison Gordon, gordonal@northlan.gov.uk Maria Barry, barrym@northlan.gov.uk Contact details for Author(s) of Report DATE: 19 March 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD
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2 This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☒ In line with requirements the Annual CSWO Report has been approved by the Council’s Adult Care and Social Work Committee and Education, Children and Families Committee on 12/11/24 and 19/11/24 respectively. I was also considered by North Lanarkshire Partnership’s Strategic Board on 6/12/24. It is remitted to the IJB for information. 3. EXECUTIVE SUMMARY 3.1 In line with Scottish Government guidance the Chief Social Work Officer (CSWO) is required to provide an annual report. This report provides an overview of social work service delivery in North Lanarkshire for the period April 2023 to March 2024 and covers the following areas: • Governance and accountability arrangements, including partnership working. • Service Quality and Performance, including service developments. • Resources • Workforce • Future Priorities The report also reflects social work’s contribution to the Programme of Work underpinning the Plan for North Lanarkshire. As the report is retrospective and covers a broad range of key development and delivery activity, the IJB will previously have received more detailed reports on a number of key strands covered. The report however provides further context in setting these within the framework of the wider social work service. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB consider and note the contents of the report. 4.2 Note that the report has been approved by Adult Care and Social Work Committee.
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3 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 Yes ☐ No ☐ N/A ☒ 6. BACKGROUND 6.1 The requirement that each local authority appoint a professionally qualified Chief Social Work Officer is contained in Section 45 of the Local government (Scotland) Act 1994. Statutory Guidance on the role of the Chief Social Work Officer was updated in 2016, to reflect the impact of Health and Social Care integration, extending the responsibilities of the role to provide advice to the Integration Joint Board (IJB). In addition to providing advice both to the Local Authority and IJB in relation to the discharge of statutory social work functions the role continues to carry key responsibilities for professional leadership, values, and standards both for directly provided and commissioned services. 6.2 Social Work Services in North Lanarkshire continue to play a lead role in supporting and safeguarding our communities. Adult Social Work and Social Care Services are delivered through Health and Social Care North Lanarkshire (HSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service. 6.3 The CSWO role requires to be undertaken by one designated individual, delegation of responsibilities is permitted where required by the scale of business. In North Lanarkshire this means that the Chief Officer Adult Social Work Services, routinely exercises delegated responsibilities for decision- making and professional standards within adult services as well as providing support and cover with respect to the wider functions of the CSWO role. 6.4 The Annual Chief Social Work Report is intended to provide a key overview of social work service delivery and performance. The Office of the Chief Social Work Advisor (OCSWA) also produces a national report each year which draws on key themes and messages from CSWO reports across Scotland. 7. SUMMARY OF KEY ISSUES 7.1 Social Work in North Lanarkshire employs around 2,800 staff and in collaboration with commissioned services and third sector partners provides to
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4 around 30,000 individuals and families at any one time. Social work also makes a key contribution to wider partnership and community activity. 7.2 As illustrated within the report partnership working is fundamental to social work at every level and a key aspect of the CSWO role involves developing and sustaining partnership working and relationships across a range of organisations and structures. In addition to the specific responsibilities of the CSWO to the Council and HSCNL, the CSWO holds a key leadership role within several local partnerships as well as contributing to the wider national social work community. Social Work also plays a key role within the Council’s Programme of Work in particular, but not limited to, work being progressed under the Resilient People programme. Equally many of the aspirations of the wider programme including the core commitment to inclusive growth are critical to those in our communities most likely to require social work support. 7.3 Whilst the delivery of core statutory responsibilities including for public protection remain a significant part of social work service delivery, social work also plays a key role in early support and both primary and secondary prevention as highlighted within the report. Income maximisation and tackling poverty also continue to be key strands in the delivery of social work and social care in North Lanarkshire. These have become increasingly integrated into day- to-day practice and service delivery and have a strong fit with the core values of social work. Equally important and threaded through the activity reflected within this year’s report is a commitment to relationship based and trauma- informed practice. 7.4 Demand for social work services has continued to increase across all social work care groups continuing a trend which has seen this increase beyond pre- pandemic levels however as reflected within the report the service has continued to maintain a strong ‘balance of care’ meaning that a high proportion of those receiving support receive this within the context of their own homes and communities. There has also over recent years been an increased focus on the area of ‘transitions’ to ensure those receiving support do not face a ‘cliff edge’ as they move between child and adult life or between services or statutory and voluntary supports. Whilst further work is still required in these areas progress in this is evidenced in the steadily growing number of young people supported in continuing care and in those in receipt of voluntary throughcare from justice services. 7.5 External scrutiny of social work services is undertaken primarily through the Care Inspectorate and its partner agencies. In addition to ongoing inspections of regulated services a Joint Inspection of Services for Children and Young People at Risk of harm in North Lanarkshire took place between April and October 2023 evaluating the impact of services on children and young people
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5 ☒ People are able to look after and improve their own health and wellbeing and live in good health for longer as Very Good and identifying a number of key strengths including in respective of collaborative leadership and the strong relational and trauma informed approaches which supported staff form trusting relationships with children, young people and their families. 7.6 Staff commitment and resilience has continued to be strong although as reflected in Section 5 of the report there remain staffing pressures in key areas including with respect to home support services, the mental health officer workforce, administrative support and other social care roles. A range of initiatives to support staff recruitment and retention against a challenging backdrop is outlined within the report and a number of these including the updating and re-evaluation of main grade social worker and occupational therapy roles have contributed to a reduction in vacancies in this critical area of the workforce. 7.7 Both despite and in response to pressures the service has continued to innovate including in the use of digital technology and has also continued to strengthen the involvement of those with lived experience in planning. 7.8 Looking forward the report reflects on future challenges including the likely increase in financial pressures, in part arising from the ending of temporary funding streams. but also identifies opportunities to build on successful areas of practice, and strong partnerships to continue to work holistically and in particular to improve early support to strengthen and empower individuals, families and communities. 8. CONCLUSIONS 8.1 The report provides an overview of social work activity and performance over the period 2024/25. 9. IMPLICATIONS None specific to the report, issues relevant to forward planning and service delivery will be incorporated into ongoing reporting to the iJB. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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6 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) 9.2.1 N/A – Annual Report to meet reporting requirement. A range of outcome measures, KPIs and specific service standards are applied across social work services. 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 Key risks highlighted within the report are incorporated in relevant risk registers. The report itself is part of a wider framework of reporting which supports the scrutiny of social work Choose an item.
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7 services and therefore aids the Council in its duties with respect to the delivery of key statutory functions. 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 Whilst there is no engagement or participation specific to this report it provides a range of examples of engagement and participation in 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
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8 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 11. APPENDICES 11.1 Appendix 1 CSWO Annual Report 2023-24 Please include a glossary of terms if not already included. Alison Gordon Chief Social Work Officer (Education, Families, Justice, and Integrated Practice) Members seeking further information about any aspect of this report, please contact the following; Alison Gordon GordonAl@northlan.govuk Maria Barry BarryM@northlan.gov.uk CHIEF ACCOUNTABLE OFFICER (or Depute)
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9 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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1 Appendix 1 Chief Social Work Officer Annual Report 2023 - 2024
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2 ANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2023-2024 ............................................ 4 THE CHIEF SOCIAL WORK OFFICER FUNCTION ............................................................................ 4 ANNUAL REPORT ...................................................................................................................... 4 1. GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS ..................................................................................... 6 1.1 NORTH LANARKSHIRE COUNCIL AND NORTH LANARKSHIRE PARTNERSHIP ............................. 6 1.2 HEALTH AND SOCIAL CARE NORTH LANARKSHIRE .................................................................... 8 1.3 SUPPORT, CARE, PRACTICE AND STAFF GOVERNANCE ARRANGEMENTS ................................ 8 1.4 CARE HOME ASSURANCE .................................................................................................... 9 1.5 ENGAGEMENT WITH THE PEOPLE WHO USE SUPPORT SERVICES AND THE COMMUNITY AND VOLUNTARY SECTOR ........................................................................................................................................ 10 2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE ................................................................................... 11 2.1 PERFORMANCE AND IMPACT MEASUREMENT ................................................................... 11 2.2 SUPPORT TO UNPAID CARERS ............................................................................................ 12 2.3 JUSTICE SOCIAL WORK SERVICES ....................................................................................... 12 2.3.1 COMMUNITY PAYBACK ORDER - INCLUDING UNPAID WORK ................................................................ 13 2.3.2 OTHER ACTIVITY ................................................................................................................................. 13 2.3.3 DIVERSION FROM PROSECUTION ........................................................................................................ 14 2.3.4 OFFENCE FOCUSED WORK .................................................................................................................. 14 2.3.5 MOVING FORWARD TO CHANGE (MF2C) ............................................................................................. 15 2.3.6 WOMEN’S COMMUNITY JUSTICE SERVICE (WCJS) AND BAIL SUPERVISION ........................................... 15 2.3.7 NEW DEVELOPMENTS: ENHANCEMENT OF VOLUNTARY THROUGHCARE AND DRUG AND ALCOHOL SOLUTIONS COURT ..................................................................................................................................... 15 2.3.8 THROUGHCARE: ARREST REFERRAL ..................................................................................................... 16 2.4 CHILDREN AND FAMILIES SOCIAL WORK SERVICES ............................................................. 16 2.4.1 THE BALANCE OF CARE ....................................................................................................................... 17 2.4.2 MOVING ON: SUPPORTING CARE EXPERIENCED YOUNG PEOPLE .......................................................... 18 2.4.3 A LOVING HOME: ADOPTION, FOSTERING & KINSHIP CARE .................................................................. 19 2.4.4 INTENSIVE FAMILY SUPPORT ............................................................................................................... 21 2.4.5 YOUNG PEOPLE IN CONFLICT WITH THE LAW ........................................................................................... 23 2.4.6 CHILDREN WITH ADDITIONAL SUPPORT NEEDS ................................................................................... 24 2.5 ADULT SOCIAL WORK SERVICES ......................................................................................... 24 2.6 EARLY AND PREVENTATIVE INTERVENTIONS – RIGHT SUPPORT, RIGHT TIME .......................... 25 2.6.1 GETTING IT RIGHT FOR EVERYONE (GIRFE) ........................................................................................... 25 2.6.2 MAKING LIFE EASIER .......................................................................................................................... 25 2.6.3 ASSISTIVE TECHNOLOGY TEAM ........................................................................................................... 26 2.6.4 COMMUNITY ALARMS ........................................................................................................................ 26 2.6.5 EQUIPMENT & ADAPTATION SERVICE (EAS) ......................................................................................... 27
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3 2.6.6 INTEGRATED DAY SERVICES (IDS) ......................................................................................................... 27 2.6.7 HOME ASSESSMENT TEAM (HAT).................................................................................................................. 27 2.6.8 HOME SUPPORT SERVICE .................................................................................................................... 28 2.6.9 TRANSFORMATIONAL SELF-DIRECTED SUPPORT (SDS) AGENDA & INDIVIDUAL BUDGETS ...................... 29 2.6.10 COMMUNITY LIVING CHANGE FUND/COMING HOME.................................................... 29 2.7 DIGITAL SYSTEMS TRANSFORMATION ......................................................................................................... 30 3. STATUTORY INTERVENTIONS ........................................................................................................................... 31 3.1 MENTAL HEALTH OFFICERS SERVICE AND ADULTS WITH INCAPACITY ACT (SCOTLAND) 2000. 31 3.2 MENTAL HEALTH (CARE AND TREATMENT) ACT 2003 AND MENTAL HEALTH (SCOTLAND ACT 2015) 32 3.3 DEVELOPMENT OF MHO SERVICE TO MEET NEEDS ............................................................. 33 3.4 APPROPRIATE ADULT SERVICES .......................................................................................... 33 3.5 PUBLIC PROTECTION ......................................................................................................... 34 3.5.1 ADULT SUPPORT AND PROTECTION VESTIGATIONS/CASE CONFERENCES AND STATUTORY ORDERS/ FUNCTIONS ....................................................................................................................................................... 34 3.5.2 MAPPA (MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS) ............................................................. 35 3.5.3 CHILD PROTECTION INCLUDING CONTEXTUAL SAFEGUARDING ............................................................ 36 3.5.4 GENDER BASED VIOLENCE .................................................................................................................. 39 4. RESOURCES .................................................................................................................................................... 40 4.1 FINANCIAL MODELLING FOR SERVICE DELIVERY ................................................................. 41 5. WORKFORCE .................................................................................................................................................. 41 5.1 WORKFORCE PLANNING ................................................................................................... 41 5.2 SOCIAL WORK RECRUITMENT AND RETENTION .................................................................. 41 5.3 SOCIAL CARE ..................................................................................................................... 43 5.4 OTHER RECRUITMENT AND RETENTION CHALLENGES ........................................................ 43 5.5 CARE ACADEMY ................................................................................................................ 44 5.6 WORKFORCE DEVELOPMENT AND STAFF SUPPORT ............................................................ 44 5.7 ASSESSMENT CENTRE AND REGISTRATION ................................................................................ 44 5.8 POST GRADUATE OPPORTUNITIES ..................................................................................... 45 5.9 SOCIAL WORK DEGREE PATHWAY WITH THE OPEN UNIVERSITY .......................................... 45 5.10 STUDENT SOCIAL WORK HUB .......................................................................................... 45 5.11 NEWLY QUALIFIED SOCIAL WORK PROGRAMME .............................................................. 46 5.12 OTHER KEY TRAINING AND DEVELOPMENT ACTIVITIES ..................................................... 46 5.13 TRAUMA INFORMED PRACTICE ....................................................................................... 47 5.14 REVISION OF SUPERVISION POLICY .................................................................................. 47 5.15 SUPPORT FOR STAFF WELLBEING ......................................................................................... 47 6. LOOKING FORWARD – PRIORITIES FOR 2024-2025 AND BEYOND ......................................................................... 48
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4 ANNUAL REPORT THE CHIEF SOCIAL WORK OFFICER FUNCTION Every local authority must appoint a professionally qualified Chief Social Work Officer (CSWO) as reflected in Section 46 of the Local Government (Scotland) Act 1994. The CSWO provides professional leadership, accountability, and governance, for the delivery of social work and social care services, including commissioned services. The CWSO also provides advice on social work service delivery and on related issues to the local authority Chief Executive, Elected Members, and the Integrated Joint Board (IJB) promoting understanding of the range of social work and social care services, and the complexities involved in delivering statutory responsibilities which require both consideration of need and the management of risk and liberties. The then Scottish Office specifically recognized that the need for the CSWO role was driven by “the particular responsibilities which fall on social services in that they affect personal lives, individual rights and liberties to an extent that other local authority services do not.” (Circular: SWSG2/1995 May 1995). Operationally the CSWO also has a direct remit for decisions on specific statutory matters including in relation to secure accommodation, adoption and welfare guardianship as illustrated below. A further aspect of the CSWO role is to inform the delivery of wider services which support or impact on social welfare. The CSWO role within North Lanarkshire is held by the Chief Officer, Children, Families, Justice, and Integrated Services however the CSWO is supported by the Chief Officer, Adult Social Work Services who holds delegated responsibilities with respect to adult social work and social care, deputises in other areas as required and works alongside the CSWO in relation to the other functions of the role. In line with Scottish Government guidance, the CSWO is required to provide an annual report. This report provides an overview of social work service delivery in North Lanarkshire for the period April 2023 to March 2024 and covers the following areas: • Governance and accountability arrangements, including partnership working and statutory functions • Service Quality and Performance, including key service improvement activity and challenges impacting on service delivery • Resources • Workforce Issues, including workforce planning, training, and development • Future Priorities – Social work landscape and priorities looking forward to 2024/25 Social Work Services continue to play a critical role in supporting communities in North Lanarkshire and in meeting both national and local priorities to improve outcomes and empower those individuals and families who may face exclusion or a range of adversities. Demand challenges driven by societal factors including the legacy of the pandemic and the cost-of-living crisis, demographic change and health inequalities have continued to impact on social work services over the past year alongside the challenging financial context for the public sector and whilst recruitment challenges have eased in some areas of the service they continue to present substantial challenges in others. This is reflected within the report along with our achievements as staff across the service continue to work with resilience and commitment to achieve the best possible outcomes for those we support. ANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2023-2024
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5 I would like to record my thanks and pay tribute to all staff involved in the delivery of social work services in North Lanarkshire for their work over the past year I would also like to thank all internal and external partners, carers, families, and communities who have supported us in our work. Alison Gordon Chief Social Work Officer
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6 Adult Social Work and Social Care Services are delivered through University Health and Social Care North Lanarkshire (UHSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service. Primary reporting and governance arrangements for Adult Social Work are through the Integrated Joint Board (IJB) and its Performance, Finance and Audit Sub-Committee but with local authority oversight and scrutiny also maintained through them Council’s Adult Care and Social Work Committee. Reporting and governance of Children and Justice Social Work Services is in turn primarily exercised through the Council’s Education, Children and Families Committee with reporting also to other council committee’s including Audit and Scrutiny Panel where relevant on specific issues. Social Work Chief Officers are part of the Council’s Corporate Management Team whilst a number a number of joint arrangements support governance, service delivery and practice alignment across all social work care groups, including regular Social Work Solutions (Business) Meetings, the Social Work Leadership Team, and a Social Work Workforce Group. Social Work in North Lanarkshire directly employs around 2,800 staff and in collaboration with commissioned services and third Sector partners, we are involved in providing support to around 30,000 individuals and families at any one time, in addition playing a key role in wider partnership and community planning activity. Partnership working at local level remains fundamental to social work and a key aspect of the CSWO role involves developing and sustaining partnership working and relationships across a range of organisations and structures. In addition to the responsibilities of the CSWO to the Council and UHSCNL, the CSWO holds a key leadership role within several local partnerships, as well as contributing to the wider national social work community, as illustrated below: 1.1 NORTH LANARKSHIRE COUNCIL AND NORTH LANARKSHIRE PARTNERSHIP The Plan for North Lanarkshire | North Lanarkshire Council sets out the shared priorities of NLC and partners and has a focus on inclusive growth and tackling inequalities. The plan focuses on: • improving economic opportunities and outcomes • supporting all children and young people to realise their full potential • improving the health and wellbeing of communities • enhancing participation, capacity and empowerment across our communities and improving North Lanarkshire’s resource base Social Work continues to play a fundamental role in working towards these aims, notably around supporting children and young people to achieve their potential, improving community health and well-being and in supporting and facilitating engagement and participation. The plan is supported by a five-year Programme of Work, approved in March 2023. The Programme of Work has seven priorities for delivery: • Transforming Places – to deliver transformational change across town centres and local communities. • Invest in North Lanarkshire – Faster delivery of outcomes and investment. • Sustainable Futures - Focus commitments towards Net Zero Carbon and climate resilience and the associated energy solutions and investments required to make it a reality. • Resilient People - Deliver whole family support locally, when families need it, in a way that addresses the impacts of poverty and reduces inequality. • Brighter Futures - Support and improve educational attainment, employment opportunities, entrepreneurship, and volunteering. 1. GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS
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7 • Digital North Lanarkshire - Develop a skilled digital workforce, promote an innovative, sustainable culture and be the Digital Leader for a transformed North Lanarkshire. • One Service - Ensure services are delivered, in a streamlined, efficient, and supportive model, with the overall vision of inclusive growth and prosperity for all. Whilst all services contribute and are supported by change activity across these seven priorities, social work’s role is particularly significant within the Resilient People and Brighter Future strands of the programme which have key interdependencies in terms of delivery models with elements of the Digital and One Service programmes. This is reflected in the participation of senior social work managers in the programme boards and the CSWO’s role as SRO for Resilient People. Connections made across the wider range of corporate work programmes, continue to make a meaningful difference to people who use social work services. Examples include employability services, homelessness prevention and community wealth and capacity building with key examples of progress detailed within the relevant sections of this report. Across the service a key focus remains to promote resilience, encourage and support preventative planning and anticipatory approaches and minimise the risk of crisis and the involvement of the Community and Voluntary Sector continues to be an essential strand of our wider approach, in promoting self-help, independence and resilience. The North Lanarkshire Council Equality Strategy 2019 – 2024, sets out key objectives for success with all council services committed to knowing, understanding, and involving our communities and demonstrating leadership in equalities and human rights. There is recognition that the poverty, disadvantage, and inequalities that exist for some people in North Lanarkshire can be further exacerbated due to specific characteristics. Clearly this is a key area for social work and during this period this has also aligned closely with our work to embed trauma informed practice and systems and the strengthening focus around the United Nations Convention on the Rights of the Child (UNCRC) Adult Services have developed a Service Equality Action Plan which details how the service will meet the objectives identified in the Equality Strategy within Adult Health and Social Care. The plan includes equality actions in relation to the implementation of a new social work information system and the refresh of the Engagement and Participation Strategy. A programme of training in relation to good practice in Equality Impact Assessments has been initiated with around 40 senior staff having participated to date whilst the CSWO has taken on the role of Executive Race Champion for the Council. North Lanarkshire Children’s Services Partnership (CSP) is the structure through which partners provide governance, strategic planning, direction, and delivery of shared priorities for children’s services in North Lanarkshire. The Children’s Service Partnership Board membership includes Elected Members, UHSCNL/NHS Board representation and representation from young people through links with North Lanarkshire Youth Council, and Champion’s Board links. There are developed links and cross over with other strategic partnerships such as NL Child Protection Committee and the Tackling Poverty Strategy. The North Lanarkshire Children’s Services Plan is refreshed every three years and supported through annual reporting: Annual Report 2023-24 Social Work has a key role in all the CSP priorities. The CSWO is lead officer for the CSP and chairs the Improving Children’s Services Group which has oversight of the work of task groups delivering on the priorities in the Children’s Services Plan that are organised under the foundation of The Promise, Voice, Family, Care Scaffolding and People. The Community Justice Partnership, currently also chaired by the CSWO has responsibility for the multi-agency oversight of Community Justice in North Lanarkshire.
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8 The partnership has continued to benefit from strong collaboration with a wide range of partners including employability services and the NL Alcohol and Drug Partnership. This has supported continued developments in a range of areas including diversion, throughcare, bail supervision and our local Arrest Referral Pilot initiated in April 2023. Commitment from partners has also ensured a holistic response to the needs, examples being ‘keep well’ clinics for justice service users and a dedicated employability worker Routes to Work. A partnership steering group has also been stood up to support Early Release. NL Community Justice Annual Report 2022-23 and our new CJOIP: Community Justice Outcome Improvement Plan 2023 to 2028 was informed by significant engagement including with those with lived experience and a Strategic Needs Assessment and sets the framework for our ongoing activity in this area. North Lanarkshire Partnership (NLP) brings together the major public sector agencies in the area along with Voluntary Action North Lanarkshire (VANL) the third sector interface in the area. NLP operates as the overarching framework for partnership working and the priorities for delivery across the partnership are included in The Plan for North Lanarkshire. The nine Community Boards continue to support community leadership, involvement, and capacity building, with local outcome and improvement plans (LOIP) guiding this work. Social work services support these local partnership structures. The CSWO continues to have the role of Community Co-ordinator for one of the local boards and the Chief Officer Adult Social Work and Senior Managers for Quality Assurance and Strategy & Performance provide links to the UHSCPNL and its strategic commissioning activity across all Community Boards. Senior Social Work Managers also participate in area-based teams and the sub-groups which support the delivery of the LOIPs (Local Outcome Improvement Plans). 1.2 HEALTH AND SOCIAL CARE NORTH LANARKSHIRE UHSCNL adopted its new Strategic Commissioning Plan 2023-26 from April 2023, setting out key priorities for the next three years with the aim of ensuring that people are robustly supported to live in their own homes and lead independent lives in their communities. The plan was developed through a collaborative process with people who use Health and Social Care services, partners, the public, and partnership staff. Key priorities include: • Do the right thing first time • Increased focus on prevention, early intervention and tackling inequalities by working with communities and people • Develop and support a workforce for the future • Improve mental health and wellbeing • Support people through a whole family approach Under each priority area, an agreed set of short- and medium-term goals has been developed underpinned by the Programme of Work which sets out in detail the programmes to be progressed. These are updated on an annual basis to ensure we are able to respond to any new or emerging issues. The plan will be implemented over the next three years, with ongoing monitoring to ensure that services continue to meet the needs and goals of local people. The Annual Performance Report for 2023-24 which will be published later in the year, and this will give further details and achievements of the partnership. 1.3 SUPPORT, CARE, PRACTICE AND STAFF GOVERNANCE ARRANGEMENTS
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9 Coherence in practice and staff governance within social work are maintained through a variety of processes and key forums. In addition, the HSCP’s Support Care and Clinical Governance Committee (SCCGC) has met quarterly over the reporting period, currently chaired by the HSCP Medical Director but with the rotational chairing arrangement also involving the CSWO/Chief Officer Adult Social Work. Adult Social Work Governance meetings included a robust programme of assurance and improvement for Adult Social Work Services and feed into the SCCGC framework. Over the 24/25 a review of the current framework will be undertaken by the professional and operational managers supported by our Quality Assurance team. A programme of work to support assurance, performance and improvement in the service delivery is planned. There is a commitment to ensure that practitioners and managers are supported with linked assurance activity which will include. • Introduction of self-evaluation for each of the teams • Audit of key processes including supervision • Feedback from individuals and carers experience • Feedback from staff • Monitoring of regulated services and regulated workforce • Staff/ individuals and carers safety • Review of complaints and compliments • 6 monthly reports on learning and development • Planned programme of review current policies and procedures Our In-House Monitoring Framework was approved, and a test of change has been in progress over the reporting period. A full evaluation is pending and, following refinements, will be rolled out across our adults and children’s services. The Quality Assurance team have also prioritised the review of our contract monitoring processes to take account of multiple reporting requirements for commissioned services whilst information governance, complaints and Duty of Candour activity also continues to be overseen by our Quality Assurance team with key learning and reflections taken forward. This work is reflected in the Quality Assurance Annual Report ADD LINK whilst work over the coming months will further expand on the streamlining and connection of activity to date. 1.4 CARE HOME ASSURANCE A review of the enhanced clinical and care oversight arrangements for care homes took place during this reporting period. The purpose of this was to ensure continued support for care homes supporting adults and older people and improvements in care and outcomes by building upon the learning from the arrangements implemented during the COVID pandemic. It has been widely recognised that although we are post pandemic, significant achievements have been made in maximising opportunities for partnership working and the outcome of the review captures the ethos of collaboration, sector expertise, access to healthcare and support for workforce development. The functions of the refreshed Care Home Assurance and Support Board are to: - • Ensure assurance and support to care home sector continues in the context of Excellence in Care, including Infection Prevention and Control (IPC), direct support and the embedding of the national IPC manual. • Oversee whole system support to care homes to improve the health and wellbeing of adults living in these environments, through implementation of My Health, My Care, My Home – the healthcare framework for adults living in care homes, and Health and Social Care Standards in Scotland
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10 1.5 ENGAGEMENT WITH THE PEOPLE WHO USE SUPPORT SERVICES AND THE COMMUNITY AND VOLUNTARY SECTOR • Ensure that a collaborative improvement model is utilised in all developments with care homes • Ensure systems and processes are in place to share intelligence between agencies to identify and allow support to be provided to care homes at risk. • Ensure systems and processes are in place to provide immediate response to serious concerns to mitigate risks • Monitor overall capacity of the sector – identify risks and mitigate where possible • Ensure contingency plans are in place for the sector and regularly updated. Two subgroups, the Care Home Governance Group and Care Home Healthcare Framework Implementation Group have also been established. It is envisaged that following an initial gap analysis of the Healthcare Framework these two subgroups will merge with implementation of the Healthcare Framework continuing to be monitored and evaluated. Engagement and Participation There has been considerable progress in enhancing participation, capacity, and empowerment across our communities, in line with Ambition Statement 19, in the Plan for North Lanarkshire - Improve engagement with communities and develop their capacity to help themselves. This also a priority the UHSCNL Strategic Commissioning Plan and is critical to ensuring: • We involve people in the decisions that affect their wellbeing. • Improvement comes from feedback on the experiences of services and supports. • Our services and supports continue to be based on what matters to people. • We have a continued focus on person centred approaches to embed the wider approach to Getting it Right for Everyone (GIRFE). During 2023-24 there was an increased focus on these areas has sought to ensure that the voices of supported people, carers and communities were strengthened. The diagram above depicts the three principal areas of investment that sought to: • Improve communication and increase connections. • Increase awareness of what matters to people • Increase capacity for early intervention and prevention.
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11 2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE UHSCNL Engagement and Participation Strategy Refresh 2024-2027 The Engagement and Participation Strategy has been refreshed to cover 2024-27. The approach to the refresh has engaged stakeholders, representatives of community-based organisations, supported people, carers and communities and representatives from UHSCNL staff. Strengthening the voice of supported people and unpaid carers. There have been significant developments to strengthen the voice of supported people through the awarding of a contract, following a tender process, to a consortium bid, headed by North Lanarkshire Disability Forum, alongside Voice of Experience and Lanarkshire Links increasing capacity to include those we need to work harder to reach, for example, people from minority ethnic communities, people from the LGBTQI+ communities and those in more rural communities, including through the recruitment of an Equalities Information Worker in North Lanarkshire Carers Together. This Equalities post augments a similar post that was already in place with Lanarkshire Carers. Extensive engagement and participation activity was also undertaken to inform the North Lanarkshire Carers’ Strategy 2024-2027 with carer feedback has influenced and shaped developments described elsewhere in this work. Within Children’s Services the Voice Task Group supporting the work of the partnership has been strengthened with young people also increasingly involved in planning and commissioning, including having a direct role in the tender for a specific counselling service for care experienced young people and more broadly in decision-making around allocation of funds for community mental health and wellbeing supports. Over two thousand families also participated in a survey which has informed the shaping of whole family supports. In Justice Services two development workers with lived experience have been employed and have supported consultation activity with those involved with the service including the development of a digital questionnaire which has supported more routine gathering of feedback. 2.1 PERFORMANCE AND IMPACT MEASUREMENT Our formal reporting is presented for a variety of audiences, reflecting the scheme of integration and delegation of services to the North Lanarkshire Integrated Joint Board (IJB) and the governance of services within several partnership arrangements. As reflected above there are mature governance frameworks for the Local Authority, the Health & Social Care Partnership, and the other established partnerships, including the North Lanarkshire Alcohol and Drug Partnership and the North Lanarkshire Community Justice Partnership (NLCJP). Performance reporting is presented to the various boards, committees, and groups of these organisations on a cyclical basis, covering the key performance indicators for the relevant services and areas of work. Indicators are in place for core aspects of service, such as access, operational performance, workforce, quality, and outcomes, ensuring that we both monitor and demonstrate how we have met the needs of the community, produced positive outcomes for the supported people and that the work represents best value for the Local Authority. Critically in addition to quantitative data a variety of methods are used to measure impact, outcomes and how people experience our service as reflected throughout this report. In addition to these internal arrangements, performance and quality is both monitored and regulated by several external bodies, including the Scottish Government, the Scottish Social Services Council, and the Care Inspectorate. All Social Work services provide validated performance and demographic data to the Scottish Government and the various agencies who support Social Work development in Scotland. This data supports the creation of national
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12 indicator sets, such as the Local Government Benchmarking Framework and the Integration Indicators. North Lanarkshire provides annual returns for several national datasets, which can then be used for benchmarking purposes. 2.2 SUPPORT TO UNPAID CARERS Unpaid carers continue to provide the vast majority of support to people who need it, across North Lanarkshire. Estimates vary as to the number of unpaid carers in our area, but we believe there could be as many as 50,000 or so unpaid carers, with about 13,000 of these being known to services and the Community and Voluntary Sector (CVS). We have a robust carer support infrastructure in place, with three commissioned carer focused organisations: • North Lanarkshire Carers Together (NLCT) • Lanarkshire Carers • Action for Children Young Carers Project All of whom provide a wide range of carer focused support or information. There is also a broader range of other CVS organisations with a direct, or indirect, role in supporting carers. These, and many other carer focused organisations are part of a wider Carer Support Network (CSN), where caring related topics and issues of common interest can be raised, discussed and actions taken to improve carer experiences. Alongside ongoing carer support, our focus during 2023-24 was engagement with carers (to augment ongoing day to day carer engagement) to help inform and develop the North Lanarkshire Carer Strategy for 2024-27. Engagement activity, facilitated by the commissioned carer organisations and the wider CSN, meant that a wide range of carers helped to inform and shape the new strategy; offering feedback relating to a range of topics of interest to carers around what was working well, not so well, and suggestions for improvement. There was recognition through this work, that many carers experienced disappointment or frustration – citing not being listened to, or having to tell their story multiple times, experiencing an inconsistent approach, or poor outcomes. Our intention is to use such instances to inform and drive improvement, through what is, a carer led and carer informed Carer Strategy, to be launched in May 2024. Conversely, there was also a wide range of examples that demonstrated that when carer support is done well, outcomes can be very positive. Such was the wealth of information provided, that alongside the strategy itself, consideration has been given to publication of some of the positive stories that we heard- to help promote awareness of preventative and anticipatory approaches leading to good outcomes, imaginative and creative use of carer budgets, or the enabling role that assistive technology can play. 2.3 JUSTICE SOCIAL WORK SERVICES Justice Social Work Services have seen demand relating to core statutory responsibilities increase as the justice system continues to address the backlog of COVID impacts with, for example, a 69% increase in hours of unpaid work requirements imposed over the past two years. Alongside this service delivery has been shaped by key priorities set out in both our new Community Justice Outcome and Improvement Plan (2023-2028) and the Scottish Government’s Vision for Justice published in February 2022, and its supporting strategy published in June 2022, with an increased focus on areas such as diversion from prosecution and bail supervision. The service continues to promote a holistic approach to working with people with convictions to ensure that in addition to robust risk management, support is offered to address the range of issues, such as health and employment barriers, which can inhibit rehabilitation and inclusion and in turn better lives and safer communities.
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13 2.3.1 COMMUNITY PAYBACK ORDER- INCLUDING UNPAID WORK The communities of North Lanarkshire have benefited from 92,624 hours of unpaid work delivered by the Restorative Justice Team. This constitutes an increase in activity of just over 20% since the last reporting year. Of note, service activity in this area has risen by 54% over the last 2 years. Demand continues to grow and during the period of this report 133,941 hours were imposed by Courts in relation to Unpaid Work and Other Activity, a 69% increase in the hours imposed in this regard over the last 2 years. The following paragraphs provide an overview of some unpaid work activities. More detail on specific activity is referenced in the Community Payback Annual Report. The bike recycling workshop refurbished bikes which are donated by individuals or have been discarded in local recycling centres. The bikes are repaired to a gold standard and are distributed to local community groups, schools and individuals. This helps to maximise opportunities for better health and wellbeing and provides greater transportation access. Service users within the workshop also undertake bike repair for individuals who are unable to afford the cost of this. Due to the success of this workshop, a mobile bike recycling trailer has been purchased and this enables the provision of bike maintenance and repair within the local communities. In total 8,746 hours of unpaid work were completed through this initiative in 2023/24. This represents a significant increase in activity over the last 2 years when 1,075 hours were completed in 2021/2022, and 6,213 hours were completed in 2022/2023. The woodwork workshop teaches joinery skills which enables bespoke items to be made from reclaimed wood pallets which were destined for landfill. Partnership working with family learning centres, nurseries, schools and communities have allowed for unpaid work service users to be involved in the construction of outdoor classrooms, and play equipment in the form of trucks, trains, cares. This approach has helped to promote outdoor play for children throughout our community. Squad placements have benefitted the local communities through activities such as landscaping. In total 54 squad have been completed within North Lanarkshire. These range from one to two-day pieces of work to larger projects with a duration of four to six months. The home improvement workshop provides opportunities for services users to gain experience in decorating, painting, and plastering. Once the individuals are proficient in these disciplines, they utilise the skills on projects within the local community. In partnership with local housing colleagues and school staff the Restorative Justice unpaid work team has also facilitated learning events at our community allotments in Townhead, Clydeside, and in Wishaw. These events enable children and people in the local community to sow seeds and learn about different growing techniques. Participants can take away some of the produce and can be invited back later in the year to experience the harvest taking place. This project has allowed for a creative teaching space which helps individuals to develop new skills which they can contribute to the benefit of the local community. 2.3.2 OTHER ACTIVITY The availability of Scottish Government Covid-19 recovery funding has enabled the continued commissioning of Third Sector colleagues to assist in the delivery of ‘other activity’ programmes. Co-production of this aspect of Community Payback Orders includes collaboration between Justice Services and a variety of organisations including the Wise Group, Creative Change Collective, SACRO, Reeltime Music and Ten for Zen.
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14 In addition to the above commissioned third sector organisations, Justice Services provides a range of opportunities for service users to engage in Other Activity. The e-learning workbook resource pack provides blended digital learning which can be completed in partnership with staff. The Centre for Clinical Interventions as well as NHS Mental Health Foundation Trust resources are also utilised to complete workbooks in the following: • Anxiety, Self-Care, Social Anxiety, Bereavement, PTSD, Self-harm, Sleeping Problems, Depression and Low Mood, Obsessions/ Compulsions and Panic. • Alcohol and You, Cannabis and You, Cocaine, Gambling, Anger Management and Procrastination. • Goal Setting, Self-Development, Writing applications and Interview techniques. 2.3.3 DIVERSION FROM PROSECUTION In partnership with Police Scotland, a bespoke Diversion from Prosecution awareness training session was delivered by Justice Services in December 2023. This session was delivered at Jackton Police College to Inspectors in Lanarkshire. Following this event, it was identified that Police Sergeants would also benefit from this training. Consequently, a further five training sessions were delivered in March 2024. It is envisaged that this awareness raising will result in a further increase in people being diverted from the justice system through Diversion from Prosecution. Within the reporting period of 2023–2024, 242 individuals were diverted from formal justice systems by being involved in the Diversion from Prosecution Scheme. This is a 38.29% increase from the previous year’s figures of 175. 2.3.4 OFFENCE FOCUSED WORK Offence focused intervention continues to be central to the delivery of Justice Social Work services, regardless of whether that engagement is mandated through Community Payback Order, Statutory Licence, Structured Deferment or Diversion from Prosecution. This is delivered through a trauma informed approach, considering wellbeing and individual responsivity and supporting others to recognise the links between wellbeing and risk whilst person-centred case management plans are informed by LSCMI, other relevant accredited risk assessment tools, the service user’s views, and professional judgement. Offence focussed interventions remain a priority area of work and a crucial element of supervision, particularly for those convicted of sexual offending, physical violence, and intimate partner violence. Such interventions are delivered by social work case managers as well as pathways into a dedicated programmes which offer trauma informed therapeutic interventions to individuals convicted of domestic abuse and sexual harm. Increasing accessibility to offence focussed interventions is also a priority area in our Prison Based Social Work (PBSW) team based in HMP Shotts. During this period PBSW staff successfully cleared the Programme Case Management Board waiting list of 102 individuals in the establishment who did not have a risk assessment and were awaiting access to an intervention programme. This also enabled the Risk Management Team to make informed decisions about individuals who could be considered for progression. Through collaboration with Scottish Prison Service (SPS) staff, a streamlined system has been implemented to ensure that all individuals are risk assessed within the first five months of entry into HMP Shotts and ahead of their first Integrated Case Management Meeting (ICM). In addition to offence related work Justice Social Work support individuals in areas such as education, employment, health, leisure, housing and financial needs. The Justice Outcome Star is employed to identify the service user's priority areas of need, and to support measure progress and outcomes.
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15 2.3.7 NEW DEVELOPMENTS: ENHANCEMENT OF VOLUNTARY THROUGHCARE AND DRUG AND ALCOHOL SOLUTIONS COURT 2.3.5 MOVING FORWARD TO CHANGE (MF2C) NLC Justice Services have been one of the pilot areas for the new Scottish Government MF2C programme which has been designed to supersede the MFMC (Moving Forward Making Changes) programme. This programme is an intensive cognitive behavioural therapy intervention for men over the age of 18 who have committed sexual offences. The programme seeks to assist participants in addressing their offending and reduce their risk of reoffending as part of a Court Order or release Licence. The new programme has been adapted to incorporate up to date literature, can be delivered in Prison based establishments as well as the community. The Justice Programme Service is currently maintaining delivery of the MF:MC programme to relevant service users, whilst also delivering the pilot MF2C programme. In time the service will transition to increasing MF2C delivery while reducing and phasing out MF:MC delivery. The pilot has been delivered on a 2:1 basis with a small group of service users and with relative success in relation to low reoffending rates. The pilot has been considered as part of the wider evaluation by Scottish Government and a decision reached that full implementation of the new programme will begin throughout 2024-25. 2.3.6 WOMEN’S COMMUNITY JUSTICE SERVICE (WCJS) AND BAIL SUPERVISION The Women’s Community Justice Service (WCJS) was established in 2014 in response to the Commission on Women Offenders by Dame Elish Angiolini. The service works with women who are involved in the justice system. The majority of the service users are subject to Community Payback Orders with requirements of supervision and/or unpaid work. Additionally, the service work with women subject to parole board licences, those subject to bail supervision and also alternatives to prosecution. A key development in the WCJS, has been the recruitment of a Justice Support Worker to support women who are made subject to Bail Supervision. Proactive engagement has taken place with the Pan-Lanarkshire Court Social Work Team to agree a pathway for early identification of these cases and to ensure timeous communication with the WCJS. This supports the national vision for Justice to reduce the number of women who experience custody. A partnership approach is adopted to plan, intervene/support and review service users' needs and risks. This assists to build on strengths and work towards achieving their goals and aspirations. With regards to unpaid work the female specific service allows for female only unpaid work activities. Most of the women using the service have experienced trauma and much of the work involves supporting them with their emotional and mental health needs. Multi agency partnership working with Children and Families, Shine Women’s Mentoring Service, Domestic Abuse and Addiction Services is crucial to support this service user group. Additionally, the Women’s Community Justice Service have commissioned a new intervention resource entitled ‘Managing Emotions and Relationships’. This approach enables staff to utilise Cognitive Behaviour Therapy to facilitate structured conversations that help Women to develop better coping strategies. Voluntary Throughcare Through the local Community Justice Partnership employability subgroup, additional funding was secured to extend the offer of our current voluntary throughcare service beyond HMP Addiewell. As a result, a Justice Support Worker was recruited and the Bridges and Beyond initiative now offers person centred outreach support to individuals serving a short-term sentence in various prisons across central Scotland.
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16 The Bridges and Beyond service has supported 53 service users in 2023-24. The service aims to remove barriers to employment and resettlement for those serving short term prison sentences is crucial in helping to reintegrate individuals into the community and reduce the prison population. Drug and Alcohol Solutions Court In September 2023, NLC Justice Services recruited two Justice Support Workers funded by the North Lanarkshire Drug & Alcohol Partnership (NLADP) to support the introduction of a Lanarkshire wide Drug & Alcohol Solutions Court. This has been instigated as a 12-month test for change. The initiative is based at Hamilton Sherrif Court and adopts a public health approach to working with people who are impacted by drug and, or alcohol, and who are in conflict with the law. The age range for eligibility is 35-55, and consideration is being given to extending this to people aged between 21-55. Despite the early stages of the test for change, outcome star data indicates that all service users currently engaged in Structured Deferred Sentence through the new test for change have reported progress across multiple life domains. Service user feedback indicates that those individuals who have previously breached more stringent orders such as Drug Treatment and Testing Order, find the flexibility and assertive outreach dimension to the support as well as the trauma informed approach within court more effective. 2.3.8 THROUGHCARE: ARREST REFERRAL An Arrest Referral test for change has continued to operate in North Lanarkshire’s Police Custody Suites. Importantly this service is delivered by people with lived experience of the justice system offering an opportunity for partnership working with individual being held in custody with a focus on early intervention, direct and practical support, and a pathway for referral to appropriate agencies. This test for change is being funded by the NLADP and will be independently reviewed. 2.4 CHILDREN AND FAMILIES SOCIAL WORK SERVICES Children and families social work, working closely with our partners, has continued over this period to focus on embedding a culture that enables practice that is rights-based, trauma informed and built on relationships. To promote this, we developed further training in Safe and Together where domestic abuse is a concern and continued to implement the Contextual Safeguarding approach where young people are at risk in the community. Agreement was also secured to begin the implementation of Signs of Safety. Taken together, these complimentary approaches support staff practise in ways that build relationships with children, young people, and their families in need of support and protection by building on strengths. Crucially these approaches also form a key part of our commitment to keep The Promise by finding creative ways of supporting children remain cared for and loved in their families, reducing the need for crisis support or alternative care. We were therefore pleased that the Joint Inspection of Services for Children at risk of harm found our impact on children was Very Good as a result of children’s experience of nurturing relationships to keep them safe (see section 2.4.3 for more detail).
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17 2.4.1 THE BALANCE OF CARE Our balance of care data outlined in the table shows that overall, the number of children in care has remained stable from 2020-2024. However, this needs to be seen in the context of a 20% increase in children referred to the service over the same period and within this a significant 44% increase in child protection referrals and the higher number of Unaccompanied Asylum Seeking Children now supported (55 and increasing) having arrived through the now mandatory National Transfer Scheme (NTS) or presenting directly from the community. In this context the maintenance of a stable position reflects the use of strengths-based approaches outlined above, finding solutions for children through family group decision making and a strategic approach to investment in family support through funds such as the Community Mental Health and Wellbeing Framework and Whole Family Wellbeing Fund. Positively, we have also continued to reduce our use of out of authority foster placements which means more children have remained in North Lanarkshire close to their families and communities. Placement type Number as of 31 March 2020 Number as of 31 March 2021 Number as of 31 March 2022 Number as of 31 March 2023 Number as of 31 March 2024 Foster NLC 100 112 94 112 109 Foster Care (Independent) 67 61 53 51 47 Home Supervision 298 227 188 205 196 Formal Kinship Care 355 321 307 325 358 Informal Kinship Care 153 170 183 191 180 Residential (NLC) 28 27 27 31 32 Residential (Independent) 13 11 11 9 7 Secure* 0 2 6 7 5 Continuing Care 45 53 73 74 77 *number of young people spending time in any secure accommodation during full year. Nothwithstanding this, there are some significant pressures. The numbers of young people in need of our residential care or secure care has increased. In large part this is due to an increase in young people being at risk of violence in the community and/or criminal and sexual expliotation. These risks to young people compounded pressures and difficutlies facing families. Similar trends are seen elswhere in the UK (Jay, 2024). Our children’s houses therefore continued to look after young people with a high level of complex needs. Following a 59% reduction in missing episodes
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18 over the previous 3 years, the number increased in 2023-24 with young people often facing strong ‘pull factors’ linked to criminal exploitation and peer relationships. We continued to promote and invest in approaches such as Contextual Safeguarding (see section 3.6.3), and intensive family support (see section 2.4.4) to address these concerns. 2.4.2 MOVING ON: SUPPORTING CARE EXPERIENCED YOUNG PEOPLE As part of our relationship-based approach, we have focused on supporting young people make a positive transition from care into independence. The table above illustrates a 71% increase in the number of young people in continuing care (remaining in the care placement after reaching the age of 18) so they can leave care when ready and further to our investment in after care services we have seen a 107% increase in the number of young people receiving support – 252 18–26-year-olds as of 31 March 2024. Much of this support is coordinated by the Care Experienced Young Persons Operations Group comprising several partners and care experienced young people as illustrated below: A Housing Operations subgroup looks at the housing needs, resources to support preparation and sustainability and matching of young people to available properties. Through coordinated support there was a noted improvement in care experienced young people sustaining tenancies, with over 100 young people sustaining their tenancy long term. This was supported by partnership working with housing colleagues and the Tackling Poverty Team to quickly identify any debt and budget management issues that may have impacted on young people sustaining a tenancy and ensure their rights to financial support were in place. A dedicated and coproduced counselling service, the Exchange Counselling Project, was established and now operates from our Aftercare Hub 5 days a week as well as reaching out to young people as required. In 2023-24, the service worked intensively with 42 young people, with 78% of young people reporting improved wellbeing on finishing counselling. Referrals indicated anxiety, family relationships/ home issues, violence and abuse, and bereavement were the main reasons for presentation. Following a review of the unmet health needs of care leavers, NHS Lanarkshire agreed funding for two Throughcare and Aftercare Nursing posts to deliver front line health support to care leavers and undertake an analysis of the challenges and barriers faced by care experienced young people accessing adult services. One of the nurses started in November 2023 and was working with 28 care leavers by March 2024. From the outset, it was apparent that this support has made a significant difference in enabling care experienced young people to exercise their rights to appropriate health care. Care leavers told us that they would like information about their rights and entitlement to support and this should be accessible in the one place. Given the preference of young people to communicate and access information digitally, an
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19 Adoption 2020-2024 20 18 19 17 15 15 15 14 11 11 10 5 1 1 1 1 0 2020-2021 2021-2022 2022•2023 2023-24 Direct Adoption Agreed Permanence Order With Authority to Adopt Agreed Children Linked aftercare website was developed in partnership with a group of care experienced young people and care leavers. Aftercare North Lanarkshire went live in March 2024 and can be accessed via the QR code below. 2.4.3 A LOVING HOME: ADOPTION, FOSTERING & KINSHIP CARE The Children’s Carers Service provides support to kinship carers, supported carers of young adults, as well as to adopters and foster carers to achieve loving homes for children and young people into adulthood. Despite a reduction of the overall number of carers, we have been able to place more children in North Lanarkshire thanks to the commitment and flexibility of our carers supported by our carers team. Recruitment therefore continues to be a high priority. As can be seen from the table below, interest in fostering or adoption has remained static post-Covid and the numbers of potential carers deciding to progress to an assessment has not increased. Positively, however, 2023-24 saw an increase in fostering approvals on the previous year. This was an indicator of the increased focus on recruitment through community-based initiatives. Adoption approvals have also increased, representing the continued interest and enquiries for adoption which has now been consistent for several years. As illustrated in the table below, this means that we are able to match children in need of adoption to adoptive parents, mostly within North Lanarkshire. The recruitment strategy group developed an action plan to widen recruitment opportunities focussing on digital promotion and increased presence within local communities. This included recruitment stands within hospitals and local community events, on-line drop-in sessions for targeted staff groups within North Lanarkshire, and mail drops in local communities. These were in addition to the bi-annual radio and media campaigns.
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20 As well as recruitment, retention of existing carers has been a priority for the service. The training and support programme for carers has therefore been enhanced to include adopters and kinship carers. Early indications are this has been successful in increasing numbers of participants and feedback has been positive about the added value to carers understanding of each other's roles and the needs of the children within their care. To support carer wellbeing, sessions in mindfulness and mindful yoga were provided along with a second therapeutic support group for adopters and permanent carers. An increase and backdating of fostering allowances (in line with the Scottish recommended allowance) and fees (10% uplift) recognised the value North Lanarkshire places on its foster care resources. Similarly, an increase and backdating of kinship allowances in line with the Scottish recommended allowance recognised the valuable and important role kinship carers have. There continues to be an increase in children being placed with kinship carers. Therefore, there is a higher demand for support for kinship carers from the kinship team. Over the last year support for kinship carers has developed and over and above the allowances paid, the service provided direct support to 190 kinship carers. Kinship support groups also took place on a fortnightly basis across Noth Lanarkshire and individual therapeutic and groupwork sessions were also introduced involving mindfulness and yoga which were well attended by kinship carers at the children’s carers centre. The number of children formally looked after in kinship care has increased over the past three years and in response, we have recruited additional support workers to help carers manage the complexity and emotional demands of their caring role. This will increase our capacity for practical and emotional support going forward. Our Virtual School has also prioritised support to kinship families including in school holiday periods. 150 100 50 0 Initial Enquiries and All Outcomes 2020-2024 120 128 131 68 63 68 57 3016 21 28 28 7 8 10 9 2020-2021 2021-2022 2022-2023 2023-2024 Initial Enquires Initial Interviews Attended Prep Group Progressed to Full Assessment Approved Assessments by Type of Resource 2019-2024 18 17 16 16 14 14 12 11 10 10 10 10 8 8 7 7 7 7 6 6 4 3 3 2 0 2019-2020 2020-2021 2021-2022 2022-2023 2023-2024 Approved Assessments Adoption Foster Care
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21 When children need care, the priority continues to be to secure a foster family where brothers and sisters remain together. In the last year, five of the eight groups of brother and sisters that required a fostering home, were placed together. The reasons for not keeping brothers and sisters together were due to individual children’s needs and, for one family, difficulty finding carers to keep four brothers/sisters together. However, in this situation, North Lanarkshire carers have actively promoted their relationships. Updated permanence planning training for staff and guidance for independent chairs emphasised the priority in considering brother and sister relationships. In response to feedback from our inspection from January 2023 specific life story training by was also commissioned and delivered. Another area identified for improvement including through inspections of registered services was linked to risk assessments. As a result, the risk assessments for placement requests and specific incidents were reviewed and updated and is now established in practice. 2.4.4 INTENSIVE FAMILY SUPPORT Community Alternatives & Families First Our Intensive Social Work Services Team continue to successfully deliver whole family support 7 days a week where families need a high level of support to prevent a child or young person entering care or to sustain a care placement. The service uses a range of materials to support interventions, such as structured parenting programmes and thematic interventions. Over 2023-24, a review was undertaken of the core programmes and interventions used to support children, young people, and their parents to ensure continuity and alignment with the supports available across the partnership. To support the workforce, staff training and development sessions were undertaken in partnership with health, early years and children’s house staff focusing on the Solihull approach to parenting, Assessment of Care Toolkit, Infant Mental Health Indicator set in additional to training in Contextual Safeguarding and Safe and Together. This enhanced the individual and groupwork support provided through the service and with partner agencies. The service also delivered eleven thematic workshops to social work staff. Intensive Services work with around 450 children, young people, and their families at any given time. Over 2023-24 52% of the children and young people supported were living at home with their family; 20% were supported in a residential, foster or a kinship care placement; 17% of the young people supported were care leavers needing a high level of emotional and practical support and 11% were young people in the community subject to Structured Deferred Sentence or Diversion from Prosecution or were supported through Youth Bridges whilst detained in Polmont YOI for a period and through their transition back to the community. 120 100 80 60 40 20 0 Number of Kinship Assessments Approved 2020-2024 111 102 105 93 98 94 82 64 2020-2021 2021-2022 2022-2023 2023-2024 No of Kinship Assessments Total Approved
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22 Weekend support is a crucial feature of our approach to prevent crises or a child coming into care. On average the service supported 28 individuals and families each weekend on a planned basis. The service also worked closely with the Social Work Emergency Service (SWES) to respond to emerging care, protection, and support needs out of office hours. In recognition of the additional challenges experienced by families over the school holiday periods and to offer positive opportunities during the Easter and summer holidays, the service delivered individual support to families and daily structured activities in the local community for younger children, attracting up to 40 participants and family-based day trips with around 45 participants. There were a range of activities arranged for teenagers with between 6-10 participants in attendance at each and one weekend activity camp. All activities and trips received positive feedback from the participants. Family Group Decision Making (FGDM) and Lifelong Links The FGDM and Lifelong Links Service are an integral part of Intensive Services as part of our commitment to build on family assets, promote and maintain important relationships. The team practice from a rights respecting and strengths-based approach to support children remain in their family through listening and supporting families to develop a family plan to sustain family care. The Lifelong links service has now been operational for nearly two years, supporting young people make sense of their care journey and support reconnection for those who have lost connection to important people in their life. The QR code below links to an animation that explains more about Lifelong Links and a young person’s experience of the service. Referrals to FGDM and Lifelong Links have remained consistent over the past two years. Year Number of FGDM Referrals Number of Lifelong Links Referrals 2021-22 115 N/A 2022-23 171 14 (partial year) 2023-24 172 16
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23 Care Experienced Exclusions Summary: 2019-24 400 339.5 300 233 200 158 138.5 92 105 100 72 82 56 19 40 15 11 22 11 0 2019-20 2020-21 2021-22 2022-23 2023-24 CE Exclusions Days Days Lost Young People Of the referrals received for FGDM during 2023-24, 70 were successfully progressed to family meetings where a family plan was devised, and 28 referrals progressed to a significant piece of work being concluded with the family without a family meeting. Lifelong Links is long term work that takes a trauma informed approach going at the pace of the young person as they come to understand their life story and consider who they want to reconnect with and how. Up until end of March 2024, 4 connections and 14 lifelong connections have been established with young people. A Right to an Education Our Virtual School, which is an integrated service comprising social work and education staff, has a focus on inclusion, providing bespoke packages of support based on a child’s needs, strengths, interests, and future career aspirations. For young people who are at significant risk of leaving school without formal qualifications, individual teaching input is provided. Supported by curricular leads, this session Virtual School teachers were able to extend the range of subject areas they could support young people to achieve in beyond English and Mathematics. National qualifications have been achieved in History, Modern Studies, Media, People in Society, Hospitality and PE. In session 2023-24 a total of 87 National 3 and 4 level qualifications were achieved by 27 young people working individually with Virtual School teachers: 93% achieved a qualification in English and 93% achieved a qualification in Maths. 63% achieved three or more national qualifications, 37% achieved four or more and 19% achieved five or more. In addition, ongoing partnership work across our schools and wider services to support care experienced learners and reduce school exclusions continues to move forward positively with significant improvements recorded. For example, over the past five school sessions, exclusions of care experienced learners have reduced overall by 93% (158 to 11), learning days lost reduced by 93.5% (339.5 to 22) and the number of care experienced learners receiving an exclusion reduced by 88% (92 to 11). This is an area of work we continue to prioritize in line with our commitment to fulfilling the ambitions of The Promise. 2.4.5 YOUNG PEOPLE IN CONFLICT WITH THE LAW At 13.0 per 1000, the proportion of children referred to the Children’s Reporter (SCRA) locally on offence grounds has increased and remained higher than the national average. In parallel the number of referrals for Early and Effective Intervention have decreased by 17%. In response to this and feedback from young people during a service review, plans are already in in place to promote EEI as an effective alternative to referrals to SCRA. During the year we launched our new EEI youth work service, The Compass Project, with the aim of promoting rights and relationships over behavioural responses. The service delivers group work and bespoke individual support and a route into preventative
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24 universal offers (such as DofE) as part of a prevention model. This project launched in January 2024 and already 5 young people have gained outdoor learning awards and were linked into universal support and youth work programmes. Between January 2023 and January 2024, North Lanarkshire also participated in a pilot with SCRA and South Lanarkshire Council to improve the experiences and outcomes for children referred to hearings on offence grounds by increasing their understanding of their rights, improving relationships, and ensuring supervision orders are tailored to the plan of support. A dedicated speech and language service was offered to provide advice to social workers and families and, where appropriate, direct support to young people to address unmet need and help them express their views in hearings: ‘I like working with you. After I work with you my brain feels less fuzzy’ The pilot was evaluated by the University of West of Scotland, and initial findings have highlighted the impact of the focus on relationships. The researchers found that support workers roles went beyond offence-focused interventions to encompass a comprehensive family support approach. This included accompanying young people to the hearings, providing practical advice, facilitating access to education or employment opportunities, and most importantly building trusting relationships that help understand the young person's perspective better. This perspective was supported by young people on the project who discussed the importance of the relationship-based practice that they engaged in which helped build relationships with their own families, communities, and education. Youth Bridges has continued to provide support to young people subject to diversion from prosecutions and structured deferred sentences and to young people under 21 subject to remand/ custody in Polmont YOI and through their transition back to the community. The number of under 18s from North Lanarkshire continued to decline with only 2 young people under 18 being remanded to Polmont YOI over the year. One young person was remanded to secure care. This is in line with the Scottish Government’s to end remand to Polmont for those under 18 in 2024. 01/04/23- 30/06/23 01/07/23- 30/09/23 01/10/23- 31/12/23 01/01/24- 31/03/24 Young People Supported 37 43 43 42 New admissions Polmont YOI 8 7 11 7 Diversion/ Structured Deferred Sentence 9 7 9 13 Ongoing Support 20 27 23 2 2.4.6 CHILDREN WITH ADDITIONAL SUPPORT NEEDS There was an increase in requests for assistance to the service for children and young people with complex needs, particularly around young people experiencing neurodiversity. Across the year, 211 had access to an individual budget. As a part of a wider service evaluation, we found that budgets alleviated stress for families and improved outcomes, but that staff wanted to feel more confident in this area of work. The service has therefore strengthened its central support to staff working with this group of children and young people to improve assessment and planning. Alongside this we also used grant funding to invest in family support for children with additional support needs, working in an integrated way across Social Work, Health, and Education. Improving the experiences and outcomes for this group of children remains a key priority and further work in this area is planned over the coming year. 2.5 ADULT SOCIAL WORK SERVICES In January 2024, a whole system project of work (Back-to-Basics), which aims to support individuals differently, commenced. Back to Basics is an overarching approach, which comprises a range of discrete and inter-related
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25 programmes, projects and activities that support our wider approach across the whole system to ensure that when people contact services, the response is quick and effective, with a focus on helping people to help themselves first. The overall ambition of the project is to have a system that is streamlined, minimises the risk of repeat actions for people and makes best use of resources. This will ensure that we are offering people the right support, at the right time and so increasing their quality of life, as well as increasing the quality of experience for staff in terms of work satisfaction. Access Social Work continues to be the initial point where many people first come into contact with our service. Pressures around Access, like other teams, continues to be grow. There is a high volume of requests for support which could better be met by resources out with statutory services. As part of the Back to Basics approach this work will be a focus of our development and improvements in the coming months. 2.6 EARLY AND PREVENTATIVE INTERVENTIONS – RIGHT SUPPORT, RIGHT TIME Self-directed support, Getting It Right for Every Child (GIRFEC) and Getting It Right for Everyone (GIRFE) as well as the Carers (Scotland) Act 2016 all emphasise the importance of choice and control early interventions and preventative approaches. Our approach across 2023-24 sought to embrace these principles to ensure that people who required our support experienced responses in line with these aspirations. 2.6.1 GETTING IT RIGHT FOR EVERYONE (GIRFE) Getting it right for everyone (GIRFE) is a Scottish Government led multi-agency approach to Health and Social Care support and services. Building on existing best practice and aligning with the GIRFEC approach within children’s services it aims to provide a national framework to deliver Health and Social Care services that support person centred outcomes for everyone throughout their adult lives. GIRFE is focused on providing a more personalised way to access help and support at the time when people need it. It is aimed at placing the person at the centre of all decision making that affects them, with a joined-up consistent and multi-disciplinary approach. UHSCNL is one of 10 place-based pathfinders with the progression of this work supported by the Scottish Government’s GIRFE Design School. Our focus is on Frailty and Older People with the pathfinder linking to a range of local as well as national aspirations, policies and strategies including The Plan for North Lanarkshire, the Health & Social Care North Lanarkshire Strategic Commissioning Plan and the Strategy for Preventing and Managing Frailty. Learning from GIRFE work locally and nationally will inform future policy and practice across the authority. Nationally, GIRFE work has reached the point where 16 prototypes are currently being tested, with North Lanarkshire focusing on the following areas: ageing well, personal networks, accessible and usable information, peer support and Community Hubs. A process of co-production with both people who live and use services in North Lanarkshire and Health and Social Care staff is underway, with the consultation and co-design process having involved over 600 people to date. Active testing of the GIRFE prototypes is now underway to enable the approach to be more widely interpreted and implemented both locally and nationally. 2.6.2 MAKING LIFE EASIER Disability Information Officers have been active in the community over the past year, promoting our Making Life Easier, web-based service and supporting individuals to use the site and undertake self-assessments. The service also developed telephone assessments to help assessing staff during clinics/assessments. In addition, the service invested time in work with ADL Smart care working on a new and improved website and life curve and reviewing the content of the service system.
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26 2.6.3 ASSISTIVE TECHNOLOGY TEAM The assistive technology team have continued to work across social work and the partnership to improve quality, delivery, and safety in assessment and care planning aiming to identify and achieve outcomes with people supported by the service in the least invasive of ways. The team’s main ambition is that all individuals working for UHSCNL consider assistive technology as a necessary tool to enhance and safeguard wellbeing and making sure the most vulnerable people have the skills, connectivity, and devices to participate in a digital nation. There is also focus on reducing carer stress and empowering individuals, supporting independence and on reducing isolation whilst the team can also offer solutions which complement other services whilst mitigating some of the demand on them. Across 2023-24 1,081 people were referred to the team. 36% of people accessing the service were over 80 years of age, 38% between 61-80. There were 1,005 assessments of need and 267 assistive technology flat visits. There continues to be upward trend for all referrals, assessments undertaken, and equipment provided. The assistive technology flat has been further developed and showcases an extensive range of council provided assistive technology as well as technology which can be purchased privately. Funding for the flat derived from housing budgets 2023-24. This will not continue for 2024-25 and an alternative source of funding will be sought. 2.6.4 COMMUNITY ALARMS As of 31 March 2024, Community Alarm Service supported approximately 7,700 people with 6,150 individuals supported in individual homes and a further 1,550 people in housing with support accommodation. The community alarm service also supports around 1,000 pieces of assistive technology programmed through the alarm receiving centre, with equipment ranging from door contacts to hard-wired smoke detectors for individuals with a cognitive impairment. Response Advisors also provide support to out-of-hours Home Support and takes social work emergency service calls from 01.30am. The average call volume each month received within Community Alarm is around 48,000 with around 2,180 of these leading to a visit from a Community Alarm Home Support worker (HSW) for face-to-face support to be provided. The service’s current alarm receiving centre ‘Tunstall’ servers had been identified as becoming obsolete/end of life by colleagues from Infrastructure resulting in the procurement of a ‘Software as a Service’ (SAAS) solution as we transitioned to the new ‘Alarm Receiving Centre’ (ARC). As all UK telephone lines are being migrated to digital it is also essential that we move to a fully digital community alarm system for both the devices and the ARC and to support this Analogue to Digital Board meets every 8 weeks to have oversight of the ongoing works being undertaken to transition the Community Alarm Service to a fully Digital solution. Replacement of these analogue alarms commenced in January 2023 and to date 3,000 units have been purchased and replaced. A further 1,000 units are currently being procured for a planned installation by the end of September 2024.
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27 Staffing levels within the Community Alarm service have remained largely unchanged since the service was established and a priority over the next period is to review this in the light of both digital system developments, high call levels and the diversity of needs supported by the service. 2.6.5 EQUIPMENT & ADAPTATION SERVICE (EAS) The service has been internally reviewed and evaluated over the last year with changes informed both by scrutiny of key processes and feedback from both Health and Social Care staff and service users. Importantly the service has cleared all outstanding waiting lists and is progressing a proactive service delivery approach to facilitate delivery by priority, helping avoid hospital admission and facilitating timely discharges. The service has also procured a new equipment ordering system which has assisted staff to deal with the demand on service in a more streamlined way aiding improved communication and response times. The service can now record and report more accurate performance information whilst qualitative data on how equipment delivered by the service has impacted on people has been collated through a survey. Core staffing has been enhanced through recruitment to additional posts and training. Looking ahead, the service is seeking to procure recycling equipment to ensure appropriate standard are met, increase recycling time and rates within the service, and to reduce waste whilst there is ongoing work with Enterprise and Communities colleagues to improve adaptation processes. 2.6.6 INTEGRATED DAY SERVICES (IDS) Integrated Day Services (IDS) for older adults have continued to support people with complex support needs to safely live in their own homes, often preventing admissions to hospital. Support that the service provides covers the six North Lanarkshire localities. During Covid there were changes with IDS Nursing staff being redeployed to older adult community mental health teams and these changes have remained apart from one locality. This will be addressed through the current service review to agree a service model fit for purpose post covid, ensuring improved supports for older adults in North Lanarkshire aligned to the Dementia Strategy. The IDS outreach via community groups continues in each locality, and these are well attended however transport and community venues can be a constraint and locality link workers continue to work with local agencies to address this and overcome any barriers to accessing this support. This is an alternative low-level support for older adults whereby the fuller service is for people more advanced in their dementia journey. It is noted across North Lanarkshire that dependency levels and complexity of need of people living in the community and needing support from IDS has increased. IDS staff continue to provide high levels of support to people known to the service as well as to unpaid carers and continue to stay committed, focused, and passionate about the positive contribution IDS has to older adults living in North Lanarkshire. 2.6.7 HOME ASSESSMENT TEAM (HAT) North Lanarkshire’s Home Assessment Team (HAT) is a multi-disciplinary Social Work, Health and Social Care resource which applies a whole system approach to planning and preparation for hospital discharge and admission avoidance by facilitating both assessment and intervention within each person’s own home. During the reporting period 1,224 patients have been referred to HAT and supported to return home from hospital.
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28 As illustrated by the chart below, there has been a gradual build-up in the volume of referrals as staff have been recruited and trained. Whilst all localities are not yet fully operational, an average of 102 people are currently supported by the service every month. Those people who are referred to HAT are also being discharged quicker from hospital to be fully assessed in their home environment, with 94% of individuals referred to HAT and discharged from hospital on the same day. As the HAT developed, the team were able to accept more complex cases and fully implement the multi-disciplinary teamwork that is required to support a ‘Home First’ approach. As more complex cases have been accepted, the proportion of people recorded as completing the service with no further service required has decreased; however, we know from our monitoring of delayed discharges that the HAT approach is improving flow. The contribution of the Home Assessment Team also appears to be having an indirect impact on the Partnership’s overall performance in relation to patients’ discharge being delayed in hospital. 2.6.8 HOME SUPPORT SERVICE As of the end of February 2024, there were 2,305 people being supported by 955 Full Time Equivalent (FTE) care at home staff across North Lanarkshire. The in-house service has a workforce of Home Support Workers (HSW) in Reablement, HAT, Intensive, Longer-term Home Support provision and the Community Alarm Service. Across these services, a total of 1,403 staff are employed, with a worker profile of 6% male staff (figure inclusive of 101 sessional staff). In addition, there are 235 back-office staff in various support roles. Over the past year, increasing demand, service complexity and the recruitment and retention of a skilled and flexible workforce has remained a challenge. To mitigate this, we have implemented a range of actions to support improvement in the quality and consistency of care and support across our Home Support Service. The service model is being reviewed to ensure it is fit for purpose, in the current environment, and into future, including consideration of new roles introduced since 2019. Planned changes will ensure that the service is sustainable and can support both demand pressures and our strategic ambitions, in line with ‘enabling hubs and the Back-to-Basics approach. To support this, stakeholder consultation events were held in local communities to capture feedback on the current and future service model with surveys to seek views on the service being issued prior to events, with paper copies and QR codes also made available at these events. Initial analysis of feedback from people using the service and carers who responded reported positive experiences of care and support delivered by HSWs (Home Support Worker). A common theme from consultation however was the service not always getting the right balance of care and support for individuals receiving a service. Data from consultation events was captured and any operational issues were addressed
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29 by Service Delivery Managers with a more general improvement action being the was provision of a link to all HSWs to assist the service to prioritise reviews where the support required to be adjusted to meet individual outcomes Consultation events were also held for office-based staff during July 2023, and again held in each locality area. The events supported the workforce to understand and commit to the vision behind service transformation. The service continues to work closely with the Care Inspectorate to meet requirements and improvements that have been identified through the inspection process. All teams have now received a full inspection, with some teams receiving follow up visits to address outstanding requirements. The new inspection year will commence in April 2024, and the service has been informed each team will receive a full inspection during follow up visits. Over the last few months, the service has taken delivery of a brand-new fleet of hybrid 4x4 vehicles to replace its ageing fleet. This investment supports North Lanarkshire Council’s drive towards ensuring that a more environmentally friendly fleet of vehicles are in place supporting the citizens of North Lanarkshire. 2.6.9 TRANSFORMATIONAL SELF-DIRECTED SUPPORT (SDS) AGENDA & INDIVIDUAL BUDGETS The overarching aim of the SDS (SELF DIRECTED SUPPORT) transformation agenda in North Lanarkshire is aligned with the intention and values underpinning the SDS Act 2013 - to support and empower people to achieve the outcomes that are important to them, to lead full and meaningful lives, and to participate in, and contribute to, their communities. Our approach has a focus on ensuring that we deliver fully on the SDS principles of participation and dignity, involvement, informed choice, and collaboration. In 2023/2024 we supported 2,480 people with an individual budget, delivered across the four options as shown involving 99.7 million in resourcing and reflecting the centrality of self-directed support to social work practice: Option 1 – Direct payment - 360 Option 2 – Budget managed by support provider – 1,957 Option 3 – Budget managed by local authority - 152 Option 4 – Budget managed by a mixture of first three options - 11 Over this period North Lanarkshire have been represented on national groups reviewing the SDS Standards and facilitated by Social Work Scotland. We continue to be part of the national group who are developing an approach to the realisation of the standards reflecting our desire to support decision making as close to people as possible, decisions being made quicker, empowering frontline workers and leaders, and increase local creativity. 2.6.10 COMMUNITY LIVING CHANGE FUND/COMING HOME The Coming Home team has been in place since 2023, funded from the community change funding from Scottish Government to identify and support planning for people in hospital or out of area for prolonged and unnecessary reasons. The team have, through collaboration, identified the people who fall into this category and in line with Scottish Government guidance, have populated a Dynamic Support Register (DSR) for North Lanarkshire. Coming Home Review and implementation groups have been created to implement all the required measures to minimise people having to leave our area for support or treatment and the team continue to link with each allocated social worker for those on the DSR to track progress towards ensuring a suitable and preferred living arrangement is identified and actively pursued.
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30 Understanding who is at risk of support breakdown is a priority and prevention of hospital admission is key. Work has therefore also commenced to understand the at-risk population in more detail, with the aim being to explore what is required to keep people as well supported and safe as possible. North Lanarkshire’s allocation of the change fund was committed for a two-year period and is set to cease in March 2025. We understand no further change fund resourcing will be available after this date. We recognise the areas of focus and are using existing resources to develop our understanding further, with the aim being to minimise any impact. 2.7 DIGITAL SYSTEMS TRANSFORMATION During 2023-24, there has been significant progress and investment in digital solutions to support the management of social work and social care services. In addition to developments in Assistive Technology and those linked to the Community Alarm Service reference above these have included: Mosaic Case Management System As part of the North Lanarkshire Council’s Digital NL programme of work and Digital and IT Strategy 2019-24, the council carried out a cloud readiness assessment to determine which line of business system would be suitable for transitioning to a range of cloud-based solutions. This reinforced existing service concerns around the functionality of our SWIS case management system and led to a tender for a new system. Mosaic, the new Social Care Case management system, will be used across all social work services and the tackling poverty team presenting significant opportunities to improve worker access to relevant information, provide a single source for data on the people we support, improve data analytics and reporting to inform service improvement, and better opportunities for data sharing across the partnership. Reflecting the scale of work required to safely and effectively support this transition the development and implementation of Mosaic is supported by a project team, which has spent several months working with teams from across all care groups and the wider system to configure the system to reflect our streamlined processes and workflows with testing to take place in late summer, supported by a training programme for staff commencing in Autumn 2024. Importantly the functionality of the new system is designed to better support practice. Dynamic Scheduling System for Care at Home Services (CM 2000) As reflected above the Home Support Service is currently engaged in a service redesign exercise and within the context of the wider redesign activity, has procured a digital solution to ensure staff capacity is optimally utilised supporting the provision of over 6,000 visits per day by the approximately 750 home support workers on shift daily and importantly also supporting improvement in continuity of service and the matching of the right staff with the right skills to people at the right time, essential to the provision of quality care and services. Procurement in February 2024 of the CM2000 product is anticipated to support service delivery by aiding back-office staff to schedule support and adapt quickly to changing needs efficiently and effectively with the opportunity to explore additional benefits which would allow both supported people and family members to access care notes via an application allowing real time updates. ELMS 2 – Equipment Management System (Integrated Equipment & Adaptation Service) The Integrated Equipment & Adaptation Service has for many years used a software platform which is no longer supported. The system manages the day-to-day demands of delivering independent living equipment services across both North and South Lanarkshire. This includes stock control and asset management. The legacy system has suffered from a lack of integration across other systems and applications resulting in a reliance on paper-based systems and processes requiring significant double keying, A newly procured software solution, ELMS 2, will now be implemented to better support service requirements including: • Direct ordering and tracking of orders technology providing delivery routes and times • Linking directly to the stock control process, reducing administrative functions
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31 3. STATUTORY INTERVENTIONS AIRDRIE BELLSHILL COATBRIDGE CUMBERNAULD MOTHERWELL WISHAW GUARDIANSHIP ORDERS (LOCAL AUTHORITY) GUARDIANSHIP ORDERS (PRIVATE) INTERVENTION ORDER FINANCIAL/PROPERTY 3 3 3 0 4 9 6 9 19 15 24 24 30 34 42 38 38 50 40 30 20 10 0 Number of New Legal Orders 90 80 80 70 60 • Use on handheld devices reducing the reliance on printed paperwork and providing real-time delivery information to the prescribers and route management • Improved monitoring of equipment due for review and maintenance • Giving staff direct access to equipment catalogues stock levels and service users equipment history ELMS 2 also offers interoperability and integration with Mosaic, 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 across a range of settings. 3.1 MENTAL HEALTH OFFICERS SERVICE AND ADULTS WITH INCAPACITY ACT (SCOTLAND) 2000 There has continued to be considerable demand placed upon the Mental Health Officer (MHO) Service in recent years in terms of orders being sought under incapacity law in part because of large scale investigations which meant that a considerable resource had to be channelled towards meeting the demands of making new applications for orders. There has also been a significant increase in private guardianship applications. As illustrated in the above graphic there is a marked increase in new orders. During the period 2022-23, there were 150 new ‘private’ Guardianship Orders, with a rise to 248 in 2023-24, an increase of 49.2% on the previous year. Guardianship Orders granted to the local authority also rose from 73 in 2022-23 to 114 in 2023-24, representing an increase of 43.9%. A similar trend is seen with Intervention Orders which rose from 5 in 2022-23 to 19 in 2023-24. This representing an increase of 116.7%. The overall number Guardianship Orders in place for individual's resident in North Lanarkshire has fallen very slightly by 23 to 1,031, involving 237 (23%) orders where the CSWO is appointed as Welfare Guardian, with the remaining 794 (77%) being ‘private’ Guardianship Orders. Reviews of all orders take place on a regular basis, with the intention of ensuring that powers are being used in accordance with the principles of the Adults with Incapacity (Scotland) Act 2000. Despite the slight fall referenced above the significant increase in new orders is matched by an ongoing increase in
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32 applications as illustrated below: Between April 2023 to March 2024, 272 new Guardianship Orders were requested an increase of 2% on the previous year– this total is inclusive of renewal requests for ‘private’ Guardianship Order. Local Authority applications and renewals totalled at 153 for the period. This continues a trend which has seen an increase of 67.3% in applications since April 2021. It is possible that the impact of Covid and extensions to the expiry date of orders during the pandemic may have had a bearing on these figures. However, what is evidenced is an upward trend in demand placed upon the service to allocate MHOs, to complete reports to support AWI applications, to the Courts, under incapacity law. This alongside recruitment challenges described below has led to delays in the ability to allocate MHOs to support applications which are less urgent, a situation which the service recognises runs counter to our desire to support anticipatory planning for individuals. 3.2 MENTAL HEALTH (CARE AND TREATMENT) ACT 2003 AND MENTAL HEALTH (SCOTLAND ACT 2015) National trends for civil detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 have continued to rise both nationally and locally. Locally there has been a significant increase in the number of recorded Emergency Detention Certificates, up by 102% on the previous year and Short-Term Detention Certificates have increased by 4.4% on the previous year, 2022-23 however, the number of Compulsory Treatment Orders has decreased slightly at 2.7% less than the previous year. There has been a modest increase of 6.7% seen in the number of new requests for Mental Health Officer (MHO) input to ‘forensic’ mental health orders under the Criminal Procedure (Scotland) Act 1995. The requirement for MHOs to be appointed to Compulsion Order with Restriction Orders (COROs) and Compulsion Orders rose significantly with an increase of 52.2% on the previous year, 2022-23. All these figures are illustrated in the table below: Total Emergency Detention consents (101) 203 [102% increase] Total Emergency Detentions where no consent was sought (76) 47 [47.2% decrease] Consent refused by MHO – Emergency Detentions (0) 0 [No change] Total Short Term Detention consents (247) 258 [4.4% increase] Consent refused by MHO – Short Term Detentions (11) 6 [58.8% decrease]
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33 Total Compulsory Treatment Orders (191) 186 [2.7% decrease] Total Forensic Report Requests (28) 30 [6.7% increase] Total Forensic orders supervised (CORO/CO) (17) 29 [52.2% increase] 2022-23 data for comparison is highlighted in red. 3.3 DEVELOPMENT OF MHO SERVICE TO MEET NEEDS Previous reports outlined a rapid development within the service during the Covid pandemic. This saw the implementation of remote working and a centralisation of the MHO Service. Over the past two years, there has been a return to face-to-face working with clients alongside a hybrid approach to meetings. The centralisation of the MHO service at that time was seen to provide a degree of flexibility in the allocation of MHOs across the council area, to help relieve resourcing pressures in specific localities, as far as was possible. On review in 2023 it was however agreed that a return to locally based teams provided better connections and working arrangements for staff and better supported effective planning for individuals. This has now been actioned following appropriate consultation processes. Internal development opportunities continue with Mental Health Officer forums held quarterly. These events allow discussion on upcoming legislation and legislative changes and provide an opportunity for guest speakers to attend. Remote external training and development opportunities also continue through organizations' such as the Scottish Forensic Network and Scottish Association of Social Workers. 3.4 APPROPRIATE ADULT SERVICES It is a statutory duty for local authorities to deliver an Appropriate Adult (AA) Service under the Criminal Justice (Scotland) Act 2016 (s99), in line with functions conferred by the 2019 regulations. This legislation also places a statutory duty on Police Scotland (and other policing authorities as listed within the National Guidance) to facilitate an Appropriate Adult (AA) whereby they believe that an adult (above the age of 16) requires support with communication and understanding, owing to a mental disorder (s42). Over the last financial year, 12 new appropriate adults have been recruited, making the total number of Appropriate Adults within North Lanarkshire Council 39. 29 of these carry out the AA role on a duty rota basis during office hours whilst the remaining 10 undertake their role as an AA out-of-hours through the Social Work Emergency Service (SWES). In comparison to the last financial year, requests to the AA Service have increased by 30.5% from 59 to 77. This continues to be monitored through quarterly reports alongside regular meetings with the AA’s and with Police Scotland. The primary reason for people who requiring an AA was Learning Disability which accounted for 37 of the 77 referrals. 32 of the referrals were for Victims whilst 22 were for those ‘Officially Accused’, 16 ‘Not Officially Accused’ and 5 Witnesses. Of these 31 requests were to support adults involved with a Police Statement with the remaining referrals varied for support in procedures such as Caution and Charge, DNA, Medical Examinations, Police Interview Rights of Suspects (PIRoS) and Interviews. Currently, a process to gather feedback from the people using the service is being developed, to support feedback, assurance, and improvement. Links have also been made with other AA services and with the Care Inspectorate to share knowledge, skills, and experience to further develop the AA service within NLC. In the next financial year, the aim is to have developed a wider self-evaluation framework. As part of this development, a staff survey has been undertaken which has provided a further insight into the AA service as well as offering invaluable feedback on how to support and further develop the AA team.
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34 3.5.1 ADULT SUPPORT AND PROTECTION VESTIGATIONS/CASE CONFERENCES AND STATUTORY ORDERS/ FUNCTIONS 2022-23 2023-24 Total ASP referrals NHS Fire & Rescue Police Scotland Scotland Social Work 583 645 330 410 110 116 408 399 3,314 3034 3500 3000 2500 2000 1500 1000 500 0 ASP referral sources 3.5 PUBLIC PROTECTION Over the period, North Lanarkshire received 3,314 ASP referrals, an increase of 9%, compared to 2022-23 (3034 to 3314). This is the fifth consecutive year that an annual increase has been measured. Referrals from NHS Lanarkshire colleagues continue to rise, showing a 11% increase compared to last year from 583 to 645 whilst ASP referrals from Police Scotland have increased 24% from 330 to 410. Social Work referrals fell slightly by 2% from 408 to 399, whilst Scottish Fire and Rescue increased 5% from 110 to 116. Care homes were the highest ASP referrer group in 2023-24 accounting for 34% (1,124) of all ASP referrals received a 21% increase on the previous year from 933 to 1,124, in part reflecting the challenges in managing increasing complexity of care needs within group living settings. Monitoring and support in this area is provided by colleagues in Quality Assurance. In addition, a pan Lanarkshire task group has been set up through North and South Lanarkshire’s Adult Support and Protection Committees with all care home stakeholders involved. This aims to provide support to care homes to achieve a balanced and consistent approach in relation to ASP referrals and decision making. Whilst Police ASP referrals have increased, Police ‘Adult Concern reports’ continue to increase also with a total of 4,280 Police ‘Adult Concern’ Reports received during the period an increase of 7% and reflecting the significant activity undertaken to keep adults in our communities safe. Physical harm remains the most common harm type for referral with 1,594 referrals received, up 11% from last year This high number of referrals with physical harm as the primary harm type is closely linked to the high number of ASP referrals received from the care home sector which often relate to witnessed/unwitnessed falls and low-level altercations between residents. As noted, work with care homes and stakeholders remains a priority in ASP. Cases featuring self-neglect can be some of the most difficult and complex for practitioners to manage as they often span ethical, legal, and practical considerations. For the period there were 309 ASP referrals relating to self-neglect, an 11% increase in comparison to the previous year. Supporting good practice in these circumstances is a priority and this area has been targeted through ASP multi agency training with a specific focus on defensible decision making and professional curiosity. ASP Inquiry with investigatory activity
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35 It is important to note that NLC Social Work Adult Support and Protection procedures have now been updated. Key changes within the procedures centre on language and how we now view ASP ‘Inquiries and investigations.’ We now refer to initial inquires as ‘inquiries without investigatory activity’ and ASP investigations and ASP ‘Inquiry with investigatory activity.’ Importantly investigatory activity involves any direct contact with the adult or their legal proxy, as such, it is anticipated there will be a rise in investigatory activity, and this should be reflected in future reports. There was a total of 477 inquiries with investigatory activity in the reporting period reflecting the number of ASP referrals which converted to inquiry with investigatory activity is 14%. This is a slight increase from last year’s conversion rate of 13%. ASP Case Conferences A total of 66 initial case conferences held and 56 review cases conferences were held meaning 14% of all investigatory activity led to an initial case conference. This conversion rate has declined from the last reporting period (17% to 14%) and reflects a continued decline in this rate over the last three years. Statutory Orders issued over the period: Type of Protection Orders Number of Protection Orders granted Assessment Order 0 Removal Order 1 Temporary Banning Order 0 Banning Order 0 Temporary Banning Order with Power of Arrest 4 Banning Order with Power of Arrest 2 Total 7 The use of protection orders fell 50% compared to last year (15 to seven). It is recognised that where ‘adults at risk ‘are subject to protection planning measures, and as such, a range of actions have been implemented to mitigate risk of harm, this can reduce the requirement for an ASP Protection Order. 3.5.2 MAPPA (MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS) Justice Social Work continues to work effectively within MAPPA arrangements to manage and support people convicted of sexual offences or otherwise identified as presenting a risk of serious harm (ROSH) to maximise public protection, whilst maintaining a proportionate and individualised approach to risk and need. The number of individuals managed under MAPPA has continued to grow year on year in part due to the rise in online offences contributing to increased demand pressures on the service. The increase in the number of individuals being managed under the MAPPA process with no corresponding increase in resource in funding and staff continues to put pressure on the service. This is a situation which shows no signs of diminishing in the coming years. This reporting year has witnessed an 8.4% increase in MAPPA activity from the previous year. Overall, the number of individuals managed under MAPPA have grown significantly since arrangements were established 17 years ago. More specific detail of MAPPA related activity is published annually within the pan-Lanarkshire MAPPA report.
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36 MAPPA arrangements interface often with other public protection processes including child and adult protection and with adult social work more broadly due to the increasing number of individuals managed through MAPPA who have care needs relating to frailty or disability. MAPPA awareness sessions for wider staff groups are therefore held regularly. In March 2024, a local multi-agency event was held, focused-on people being managed and supported under the Justice system with a diagnosed learning disability, or with neurodiversity challenges. This event was provided delivered by NHS colleagues. In addition, in partnership with South Lanarkshire Council and MAPPA partners two multi-agency events were hosted in September 2023. Staff from Social Work, Police Scotland, Housing, and NHS Lanarkshire attended a full day input in relation to Risk Practice which was delivered by Professor Hazel Kempshall. This offered a valuable opportunity for colleagues to reflect on shared responsibilities, joint practice and strengthened collaborative approaches to managing risk and enhancing public protection. 3.5.3 CHILD PROTECTION INCLUDING CONTEXTUAL SAFEGUARDING Following a trend identified in previous annual reports, child protection notifications have continued to increase as illustrated below representing a 125% increase from 2017/18. Year Number of Referrals Investigations Percentage Of Referrals Proceeding to Investigation Number of Investigations That Proceeded to Case Conference Number Of Registrations from Case Conferences 2023-24 2,326 768 33% 254 179 2022-23 1,895 775 41% 264 198 2021-22 1,714 754 44% 229 177 2020-21 1,482 831 56% 261 199 2019-20 1,617 800 49% 339 254 2018-19 1,150 642 56% 329 251 2017-18 1,030 692 67% 340 252 The overall increase in the number of referrals received is related to the extension of our child protection framework in line with child protection national guidance which now includes areas including care and risk management arrangements for those young people whose behaviour may present a risk of harm to others and extra familial harm within the contextual safeguarding approach. These extensions to our framework alongside Equal Protection legislation and additional pressures on families have increased demand but also consistency in practice and recognition, and response to harm, strengthened by early response to risk and harm by embedding our revised IRD (Initial Referral Discussion) guidance. Contextually it is notable that one in four children still live in poverty and progress in addressing the developmental concerns for children at 27-30 months slowed in 2023-24. Given the established links between poverty, harm, and statutory interventions we believe this is also a factor in the continued demand for support to children in potential need of protection. As noted elsewhere tackling poverty is fundamental to protecting children and supporting families in North Lanarkshire and both child protection and family support responses are integrated with our approach to tackling poverty, under the leadership of the Chief Social Work Officer. Our increased referral numbers have not resulted in an increase in children whose names are placed on the child protection register and this is due to the routes into our IRD process and the routes out of IRD. This means that alongside or as alternative to Child Protection Registration children can, where appropriate be supported by care and risk management processes, a referral to the Young People’s Safeguarding Panel and through family support provided to the family through the Getting it Right for Every Child (GIRFEC) pathway.
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37 There has been an increase in older children’s (12+) names being registered on the child protection register. This change indicates that practitioners and managers are increasingly focussing on and recognising the protection of older children and their rights in line with our commitments to Keeping the Promise, the United Nations Convention on the Rights of Children (UNCRC (United Nations Convention on the Rights of the Child)) and our investment in contextual safeguarding, The service has continued to work with the partners in the Child Protection Committee, the Chief Officers, and Lead Officers groups to monitor and understand the relationship between child protection referrals and rates of registration to ensure the right children get the right support when they need it. Our data suggests that children and families are receiving early help and support through our cluster wellbeing approach. This is telling us that our strategic focus and commitment to early help and support, through staged intervention and planning for wellbeing, through the clusters is the right direction of travel to improve outcomes for children and families. No. on Register as at 31 80 60 40 20 0 Age Range On The Child Protection Register As At 31 March 63 56 54 58 44 38 33 32 3334 27 22 24 25 12 16 19 10 6 2 5 5 5 5 2 2 0 0 0 1 2018 2019 2020 2021 2022 2023 0 to 4 years 5 to 10 years 11 to 15 years 16 years and over Unborn 31 29 29 5 2 2024 March 2024 140 131 125 120 116 111 96 96 100 80 60 54 40 20 0 2018 2019 2020 2021 2022 2023 2024 Joint Inspection Between April 2023 and October 2023, the partnership was also subject to external scrutiny through Joint Inspection of services for children and young people at risk of harm. The main findings from the inspection were: • The partnership has a strong multi-agency approach to early intervention, collaborative working, and information sharing. • Staff are confident in their knowledge, skills, and ability to recognise, report and respond to signs of child abuse, neglect, and exploitation. We work together to ensure timely identification and responses to safety concerns for children and young people at risk of harm • Staff demonstrate trauma informed and relational practices, which help children and young people experience supportive and trusting relationships with them. • Children and young people have early access to services to support their mental health and emotional wellbeing, before concerns escalated. Partnership approaches were helping to identify need and secure support earlier. • The majority of children and young people are meaningfully and appropriately involved in decisions about their lives. Staff listen to children and young people and understand them. • Senior leaders have a clear vision, which was understood by staff. It was threaded through strategic documents, plans, and outcomes. The partnership was highly aspirational and has a strategic focus to improve outcomes for children and young people.
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38 • Collaborative leadership is strong across the partnership. Leaders are aware of strategic risk and jointly deployed resources to the areas of greatest need. Areas identified for Improvement: • Chronologies, assessments, and plans are in place and staff are confident in assessing risks and preparing plans, the quality of these chronologies, assessment and plans is inconsistent. This will be the focus of our improvement work moving forward. Improvement activity cannot be achieved by the Social Work service alone and we are progressing the areas of improvement highlighted by our own self-evaluation activity and the findings from inspection as part of the wider partnership. Partnership actions are driven through our child protection business plan with the three main areas of focus being: • Voice: Strengthen Voice of children, young people, and families within the delivery of CPC functions • Operational practice: Strengthen joint operational practice with a focus on the quality of assessment and planning for individual children and young people. • Data: Strengthen the use of data to drive improvements in practice and process and strategic planning These areas for improvement are being addressed by the Continuous Improvement Group which reports to both the CPC and Children’s Services Planning Partnership. Contextual Safeguarding As reflected above we have continued our commitment to embedding contextual safeguarding as a key vehicle to address the increase in extra-familial harms impacting on our young people. Over the course of 2023 and into 2024, we targeted Domains 2-3 above - improving staff awareness and understanding across the workforce while embedding the recognition of, and response to, extra familial harm within child protection processes. This was reflected in the finding of the Joint Inspection of a culture of rights-based, relational practice and collaboration between young people and staff. Going forward we will have a focus on the conditions of abuse, improving safety, and providing support in a trauma informed way (Domain 1) in addition to taking a more strategic approach to the collation of impact data and monitoring of outcomes (Domain 4). Key areas of development to promote social work practice in this area included the creation of an online training module, the development of a Directory of resources and the availability of consultations for practitioners dealing with complexities in this area.
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39 A key area of our systems supporting young people who may be experiencing extra-familial harm is our Young Peoples Safeguarding Panel. Over this period panel actions were strengthened to focus on welfare and safety not surveillance with a fourteen individual young people and two groups of young people referred. Key themes identified included that many young people discussed experienced some neurodevelopmental difficulty, requiring specific support and follow up. The panel continues to play a key role locally in ensuring that the exploitation that underpins the offences that some young people commit is addressed through disruption and the reframing of information provided to SCRA (Scottish Children’s Reporter Administration) and COPFS (Crown Office and Procurator Fiscal Service) to highlight the exploitation and support to young people and peer groups in addition to the increased use of the National Referral Mechanism where appropriate. Our senior officer for contextual safeguarding, played a leading role in a UK-wide research study of the experiences of social workers using the contextual safeguarding approach. The findings of this continue to inform our approach to staff support and training. - Sustaining Social Work: Practitioner experiences of Contextual Safeguarding | Contextual Safeguarding 3.5.4 GENDER BASED VIOLENCE Social Work staff across care groups continue to have a key role with respect to both the prevention and response to Gender Based Violence (GBV). The last year has seen work progress through the VAWG to carry out Customer Journey Mapping, a process of gathering information from women on their experience of services. Women interviewed were survivors of domestic abuse. Key improvement actions have been developed from the information given including domestic abuse inputs to trainee GPs (scheduled for the new year) an audit of out of hours homeless services to determine domestic abuse practice and a domestic abuse development session for frontline police officers in Lanarkshire Division. A multi-year funding solution is now in place for North Lanarkshire MARAC. MARAC in North Lanarkshire in 2023/24 discussed 424 cases, 96% of victims discussed were female and referrals included 852 children. A quality assurance sub-group is now in place and is chaired by Education and Families Manager (Social Work Justice). A process of auditing MARAC meetings and MARAC cases has been approved. The implementation of the Safe and Together Model continues with over 150 children, families and justice social workers trained in the model. Over 500 staff from multi-agency partner services have completed the Overview course. Work is progressing to support workers to take learning into practice. Monthly Safe and Together workshops where staff are supported to apply Safe and Together tools to a specific case are established. Workshops are open to workers who have and haven’t completed Safe and Together training. Strategic linkages are in place with North Lanarkshire Council Equally Safe at Work planning group. The group have representation from the VAWSG and has been working towards Bronze Award renewal. With a key milestone being the launch of North Lanarkshire Council Sexual Harassment Policy. UP2U Family Practice Model The UP2U intimate partner violence approach continues to be invested in by Justice Social Work (JSW) with new staff continuing to be trained in this programme and existing staff being given access to refresher training inputs. UP2U – Creating healthy relationships 2 is the updated version of the domestic abuse intervention programme. Staff have begun to use the updated programme with individuals convicted of intimate partner violence and who are subject to a requirement to undertake UP2U. Integral to this intervention is the offer and provision of partner support for those who have been or are still the victims of intimate partner violence. UP2U family practice is a version of the UP2U programme that can be delivered in a Children and Families context, and this adopts a more flexible approach to early intervention where domestic abuse has been identified within a family. This aims to work with perpetrators of domestic abuse to consider the impact on their children and the wider family.
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40 4. RESOURCES All children and families social work teams have identified Family Practice trainers, and this is an intervention that can be utilized as part of child’s plans. For financial year 2023/24 North Lanarkshire Council had gross annual social work budget of almost £310m. This was allocated as £255m for Adult Social Care and £55m for Children, Families & Justice. The equivalent funding for the previous financial year was £292m. In totality Social Work activity during 2023-24 was undertaken within the overall budget resource and resulted in an underspend position. Within Adult Social Care the underspend was almost entirely because of ongoing recruitment issues being seen across the sector, both internally and within the care at home sector reducing the payments to these bodies. The overall underspends across the service were a continuation of the 2022-23 position. These underspends however are non-recurring and the longer-term outlook for the service projects financial pressures across the following areas: • Home Support • Independent Care Homes • Self-Directed Services Social Work FY23-24 - Gross Expenditure Budget £309.547m ACCESS SOCIAL WORK (£1.097m) All Support Functions (£24.790m) ASC Locality Support (Inc A&P) (£23.367m) Assistive Technology (£0.130m) CARE HOMES (£44.157m) CARERS SUPPORT (£3.805m) CHILDREN AND FAMILIES (£28.834m) COMMUNITY ALARMS (£2.561m) HOME SUPPORT (£55.331m) IEAS (£6.290m) JUSTICE SERVICES (£8.495m) MENTAL HEALTH&ADULT PROTECTION (£3.307m) REGISTERD SOCIAL LANDLORDS (£0.716m) SELF DIRECTED SUPPORT (£97.047m) Children & Families A&P (£9.620m)
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41 5. WORKFORCE • Integrated Equipment and Adaptation Service • Children’s Houses • External Placements 4.1 FINANCIAL MODELLING FOR SERVICE DELIVERY Financial Planning and monitoring continue to be a key responsibility for the management team. The Council’s financial strategy includes Service input to four key processes. These are: • Preparation of detailed single year budget • In–year budget monitoring and projections • Preparation of rolling 3-year budgets • Preparation of a Medium-Term Financial Plan Alongside these the Council Finance Team work closely with the IJB Chief Finance Officer to prepare a medium-term financial plan for the Health and Social Care Partnership. In terms of financial modelling the Management Team increasingly take a whole systems approach to delivering new and more efficient operating models which often requires joint working with other Council services and key external partners. With respect to Children’s Services the council and local partnership is one of three areas who have committed to working with the Promise team nationally on ‘Human and Economic Cost Modelling’, work which is intended to support longer term change both nationally and locally by identifying how money is currently spent and the system changes required to move the balance of spend toward early intervention and family support in line with the aspirations of Christie. Workforce planning within social work is overseen by the Social Work Workforce Group, which both informs and is informed by the Council’s corporate ‘Workforce for the Future Strategy’ and the wider UHSCPNL workplan. 5.1 WORKFORCE PLANNING Challenges in the labour market have impacted on recruitment to certain posts and the pressures on local authorities and HSCPs to provide services in the face of savings agendas has also impacted on workforce plans. Demand pressures have also continued to impact on the ask of the social work workforce over this period. To support overcome these challenges, a close partnership approach between the service and HR colleagues has been built. Working together on recruitment, training and development and the management of employee absence, as well as developing and implementing initiatives has supported the service to manage demands whilst supporting workforce resilience. 5.2 SOCIAL WORK RECRUITMENT AND RETENTION Enhanced whole career support and development, allied to the wider ambitions of Workforce for the Future and the Scottish Government ambition to create a strategic framework from qualification though to enhanced practice, remains at the forefront of NLCs commitment to Social Workers. This work commences prior to recruitment, building strong
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42 relationships with further education establishments and supporting student placements in the development of future qualified Social Workers. Our commitment to the provision of Practice Learning has remained strong and a model which continues to include student hubs has supported ensure quality learning experiences are available to all students as referenced in section 5.10 below. To support both enhanced career pathways and recruitment our Social Work Trainee Scheme was recently re- established and funding for eight Social Work employees agreed via an earmarked reserve. In order to support access to a broader range of staff courses varying in length from 18 months to three years, dependent on the individual’s current qualification level, have been sourced and funded, with the employees fully supported in becoming qualified Social Workers. Due to popular demand 14 candidates who were not successful this time have had learning pathways identified to support them to continue their journey to become a Social Worker. A further 25 employees are also working through development plans with a view to progressing to the social work degree pathway. NLC has also sponsored five self-funded employees, as they studied for their Social Work qualification. Recruitment opportunities were made available to these students as they neared completion of their course. All five were successful and subsequently offered Social Work positions within NLC. In addition to internal pathways, we continue to recruit externally, and advertising frequency and dates have been reviewed to streamline processes and quicken the employee onboarding experience with improvements seen in recent campaigns. We continue to offer immediate access to our Senior Practitioner scheme for eligible Social Workers. These processes will continue to be reviewed, and improvements made wherever possible to support our ability to attract and retain social workers in what remains a challenging context. During 23/24 we also commissioned research into the recruitment of social workers from global ethnic minority communities, as we endeavour both to recruit a more diverse and representative workforce and improve the support and the experience of our BAME staff. It is hoped that any changes implemented for Social Work recruitment will also be of benefit to authority wide recruitment processes. Whilst too early to assess the full impact of the regrading of main grade, senior practitioner and first line management social work roles reported last year and actioned on 1 May 2023 the council is now more competitive in terms of salary, when compared to the other authorities and there are early indications of reducing vacancies and there is hope that this plus the support and development that is offered will encourage applicants and assist in the retention of current Social Workers. In line with the re-evaluation of roles the job description and employee specification for social workers has now been reviewed, and issued to all Social Workers, bringing this in line with the expectations of the role within an increasingly complex context whilst remaining grounded in relationship-based practice. Recruitment to temporary posts however remains challenging. These requirements exist for a number of reasons, including temporary promotions, maternity leave and long-term absence cover and the increasing number of roles related directly or as backfill for posts supported through temporary funding streams principally linked to Scottish Government recovery funding in justice services and change initiatives in other areas. Temporary vacancies are being closely monitored in terms of numbers, locations and the impact on teams. Whilst for a period, and in line with predicted turnover, the service was able to offer permanent contracts against temporary vacancies for social workers the capacity to do this has reduced as vacancies have decreased and many temporary funding streams remain committed only to the end of the parliamentary term. Whilst social Workers are being appointed through NLC recruitment processes and entering the workforce with new skills, creativity, and commitment there are now issues relating to the balance of experience within the service with a high number of relatively newly qualified staff. To mitigate this for both new and experienced Social Workers, managers
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43 are monitoring caseloads, assisting in the prioritisation of statutory responsibilities, and ensuring additional supports, such as Health and Wellbeing, are available when required. Support is also being provided through the hubs and the TOD Team are working closely with the service. The commitment to the requirements of the Support Year in Practice in both time and resource is substantial. A review of the Supported Year in Practice has recently been undertaken to ensure compliance with new requirements issued by SSSC, ‘Definitions of employer support 2023’. Prior commitment to NQSW support and development assisted NLC, however lack of funding from the SSSC or Scottish Government to support these requirements beyond the pilot period is disappointing and reconfiguration within the TOD team and additional input from managers will be required to retain commitment to this key area of support for staff. Targeted advertising has proven invaluable in securing the skill and experience required for specific posts in hospital and home assessment teams however recruitment, in particular external recruitment in the key area of Mental Health Officer roles has remained challenging and has not kept pace with need impacting on service provision in key areas. We continue to be committed to promoting the MHO programme to existing Social Workers within the service. The route is through the MHO Traineeship Scheme, which supports Social Workers in gaining an MHO award – a postgraduate award through the University of Strathclyde, Glasgow. It is expected that three MHO trainees will successfully complete the MHO Award in June 2024, to then take up full-time MHO vacancies within the service. To further support the MHO Service and to help expedite the discharge of hospital patients awaiting powers under AWI legislation (typically in the form of Guardianship Orders), the MHO Service now has eight sessional MHOs who can be allocated work thus easing a significant pressure on Locality-based MHOs. Funding for temporary positions within the Community Mental Health Teams continues, allowing Social Workers from across Education and Families, Adults and Justice Services who are considering applying for the MHO award, to be a part of a Mental Health Team. The establishment of the Practice Assessor role and the ongoing work of the postholder, not only for MHO students but also for those who have expressed an interest in the course, is invaluable. Opportunities for experienced Social Workers including MHOs include the Senior Practitioner Scheme. This scheme maintains our commitment to Social Workers, and Community Occupational Therapists, beyond qualification and appointment. With over 50 practitioners holding the status the scheme enables those who meet the criteria to progress to an enhanced salary scale. The service also benefits with Senior Practitioners committing to undertake additional responsibilities within the authority. 5.3 SOCIAL CARE Linked with both the national and local focus on supporting hospital discharge and providing quality support and reablement within the community a significant focus remains on the recruitment of home support workers and other social care roles. Recruitment to these positions is in line with the strategic direction of the service and whilst there has been success, staff turnover has resulted in little net increase in staffing numbers overall. Monitoring of recruitment and the placement of newly appointed HSW across the six localities therefore continues with the wider Home Support Service review referenced earlier having a key focus on a sustainable staffing model. In recognition of the key role that Home Support Schedulers play within the Home Support Service, six new Home Support Scheduler Supervisors have been introduced. To date, five positions have been filled, and the remaining one will be advertised. These roles will direct, guide, and instruct scheduling through a person-centered approach, ensuring excellent customer service. 5.4 OTHER RECRUITMENT AND RETENTION CHALLENGES
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44 Other areas in which recruitment challenges are evident include roles within Locality Support Services and Clerical and Administration posts. The recruitment and retention difficulties within Social Work administration have resulted in a planned review and redesign which will progress over the coming year. In the interim action is being taken to promote recruitment to these difficult to fill roles, for example, linking directly with local colleges as adverts are released and work continues to develop apprenticeship schemes as a route into these areas. The service has also benefited from the corporate Summer Placement Programme developed to provide paid work to NLC pupils for seven weeks of the school summer holidays. Over the summer, fifty placements were made within Social Work services in roles such as HSW, Locality Support Worker and Clerical Assistant. Placements within other services have also been facilitated, for example in Early Years, Customer Service, Health and Safety and Sports Development. 5.5 CARE ACADEMY During this year and drawing on funding from the UK Shared Prosperity Fund and earmarked HSCP reserves projects taken forward under this umbrella have included: Project one – Trainee Social Worker Scheme As noted in section 5.2 above there are eight internal Social Work trainees who have been successful in becoming part of this programme with a further 46 now on the pathway to gaining the necessary qualification which will allow them to be considered for future programmes. Project two – Upskilling for Home Care Workers In line with the qualification agenda, we continue to utilise the monies available from the UK Prosperity Fund to develop a training pathway for our Home Support staff. Our partnership with New College Lanarkshire has enabled us to procure access to ongoing spaces for the programme over the next year with another 60 workers currently undertaking qualification from our August 2023, November 2023, and March 2024 cohorts. The success of this programme has also allowed us the opportunity to extend this relationship with New College Lanarkshire with us recognising the ongoing staffing difficulties within the service and the level of new recruits also requiring access to qualifications within a shorter time frame. Project three – Home Care Support Officers We are continuing to liaise with services across the Home Support workforce to identify opportunities to support this group of staff to access suitable qualifications and opportunities for future employment pathways. However, this work will now be aligned with the redesign of the home support service and the new structure of the staffing complement. We envisage using available monies from the UK Prosperity Fund to ensure that we invest in this group of staff to both attract and retain the quality and skills of our support staff who are a vital resource for home support services. The group which will be targeted initially are the Schedulers and Senior Schedulers. A relevant career pathway has been built for this group of staff with access to a recognised qualification. 5.6 WORKFORCE DEVELOPMENT AND STAFF SUPPORT Our online platform for learning, LearnNL is a key component in providing improved access to learning and provides each employee with an individual learning record linked to the Performance Review and Development (PRD process). The reporting function within LearnNL allows us to filter and sort information in a variety of ways and ensures that training-related information can be shared quickly and easily with colleagues and with the Care Inspectorate when required. A specific social work space developed within the platform allows staff to see what training opportunities they should be accessing as part of their mandatory training requirement and optional opportunities for development and future progression. 5.7 ASSESSMENT CENTRE AND REGISTRATION
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45 Continued provision of qualifications through the Assessment Centre The Assessment Centre continues to support Scottish Vocational Qualification (SVQ), and Professional Development Award (PDA) qualifications required to meet registration, role and CPD requirements. This is achieved through both in house assessment and access to SVQs through external providers. Active Candidates – External Programmes (2023 – present) Scottish Credit and Qualifications Framework (SCQF) Level 6 (SVQ2) – 48 including Home Support and Locality Support Staff SCQF Level 7 (SVQ3) – 23 including Residential Workers, Locality Workers, and Justice Staff SCQF Level 9 (SVQ4) – six including Senior Residential Worker, & Locality Support Manager Higher National Certificate (HNC) – two Residential Worker and Children & Families Support Worker Active Candidates – Internal Programmes (2023 – present) SCQF Level 7 (SVQ3) – two: one HSW and one Technology Support Assistant 5.8 POST GRADUATE OPPORTUNITIES The team also continue to provide access to Post Graduate Certificate opportunities through the Learning and Development budget. The numbers undertaking some form of qualification are detailed below: • Advanced Practice skills – one commenced September 2023 • Postgraduate in Child Welfare and Protection at Stirling University – four candidates commenced September 2023 due finish June 2024 • Postgraduate Certificate in Children and Young People in Conflict with the Law – two candidates started in September 2023 completed June 2023 • Postgraduate in Adult Support and Protection – three • Postgraduate Certificate Securing Children’s Futures – one • Postgraduate in Mental Health – three • MSc In Leading People Centred Care – one • Part funding of final year of PHD qualification – one 5.9 SOCIAL WORK DEGREE PATHWAY WITH THE OPEN UNIVERSITY As reflected in section 5.2 there continues to be a strong appetite across all our Social Work and Social Care workforce in becoming a Social Worker. We have had interest expressed from admin staff, HSWs, education and family support workers, locality day services staff and other staff. We are currently working with 46 members of staff on individual learning plans; all of whom are undertaking Open University modules and working towards a degree in Social Work. The monies received from the UK prosperity fund enabled us to fund modules for staff from October 2023 to May 2024. We anticipate further use of the UK prosperity fund later this year to again support staff on the pathway and further modules commencing in October 2024 and February 2025. 5.10 STUDENT SOCIAL WORK HUB From August 2023 to date, 60 Social Work students were placed within North Lanarkshire; 52 being external students from four different Universities, with 14 of these students securing Social Work posts within North Lanarkshire and now progressing onto our NQSW supported year. From August 2023 onwards we have been developing two student Hubs: one Community Care Hub and one Justice Hub. Both Hubs have evaluated well, with very positive feedback received.
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46 We have seconded two full-time Practice Learning Officers and a permanent Practice Learning Officer who also oversees the NQSW supported year. Our Hub activity continues to grow and expand, and we foresee this continuing to develop in line with Service needs and demands. The Hubs are a reflective and educational forum for the students to experience peer to peer support, 1:1 teaching and support from their Practice Learning Officer. They also take part in extensive training sessions and presentations by external speakers whilst direct teaching from their Practice Learning Officer has included risk assessment theory, outcome focused practice, anti-oppressive practice, reflective practice, unconscious bias training, exploration of use of self, development of professional accountability, authority, and assertiveness. All of which are crucial in solidifying the fundamentals required of a qualified Social Worker. The students have also benefited from the relationship and links created within the Hub to gain shadowing opportunities and learning experiences with various other service areas/ 5.11 NEWLY QUALIFIED SOCIAL WORK PROGRAMME The Newly Qualified Social Worker (NQSW) Supported Year referenced in section 5.2 above will become mandatory across Scotland from October 2024. This is to ensure that support is given to NQSW in their transition to front line practice enabling us to develop an increasingly confident and competent workforce for the people who use our services and their families. 5.12 OTHER KEY TRAINING AND DEVELOPMENT ACTIVITIES Provision of a practice learning pathway for link workers We have 120 link workers, and twenty-five practice educators based onsite with students on traditional placements. We currently have five link workers applying to undertake the PDAPL, which starts in September 2024. We also have a waiting list of link workers all interested and working towards making applications for the next PDAPL intake in January 2025. To fully support the Service and ensure the learning and development needs of all staff are met, a Social Work Learning and Development sub team was established in March 2023 consisting of two Senior Learning and Development Advisors, two Learning and Development Advisors and two Clerical Assistants. This team have been responsible for the implementation of a range of initiatives including: An updated programme of Adult Support and Protection Training including the delivery of ASP Level 1 refresher training to 1,000 staff and bespoke ASP level 2 training for home support team leaders. Provision of Getting it Right in Child Protection training including a broad range of e learning modules in child protection awareness, contextual safeguarding, understanding child neglect, assessment and planning for children and young people, child sexual exploitation and Age of Criminal Responsibility with over 2, 800 course completions. Safe and Together - We are working alongside our Child Protection Committee and our partners at the Safe and Together Institute to look at the further possibilities of commissioning specialist eLearning modules and materials in relation to the Safe and Together Model. Continued provision of Moving and Handling and Medication training - 352 Home Support staff and nine Home Support team leaders have attended role specific moving and handling training during reporting period. Implementation of a robust induction programme for HSW’s 152 HSWs have attended induction training since April 2023. The online HSW induction course is currently being reviewed. Carrying out a full Training Needs Analysis (TNA) across the Service to identify key learning and development needs as part of the development of the Learn NL Social Work dashboard.
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47 Refresh and reintroduction of Assessment, Planning and Recording Practice learning, this will also align with the most recent Back to Basics approach in Adult Services and Signs of Safety and Healing in Children’s Services ensuring person centred practice is at the forefront. This work was supported by a Steering Group of managers, practitioners and TOD staff who refined the training materials to ensure alignment with North Lanarkshire’s value base and best practice in addition to making the training more accessible, sustainable, engaging, and interactive to enable staff to re-access the training materials and learning whenever they require in the future. Introduction of Autism Awareness and Neurodiversity training delivered by facilitators with lived experience has also been a huge success. As of March 2024, we have commissioned Part 1 “Making Connection” and Part 2 “Building Bridges” as well as bespoke models which has resulted in 61 members of Social Work staff completing this targeted training. Refresh of the Senior Practitioner programme - It is envisaged that the new model will enable Senior Practitioners to be involved in development opportunities across the services and to utilise their enhanced skills and qualifications for the benefit of the wider community. We also envisage the involvement of our senior practitioners in the roll out of future assessment and planning developments and offering support to their Senior Social Workers by fulfilling supervising and mentoring roles to our NQSW in their supported year as per the revised standards and framework. Justice training and staff development has included Naloxone Training delivered In partnership with NHS Lanarkshire’s Harm Reduction Team, to help staff to respond confidently and appropriately to situations of overdose and assist combating the number of drug deaths among people engaging with Justice Services in North Lanarkshire. A continued training schedule is in place to ensure that all relevant staff receive training on this intervention. 5.13 TRAUMA INFORMED PRACTICE Implementation of Trauma Informed training Towards the end of March 2024, we successfully adopted and integrated Trauma Informed Practice eLearning modules from the NHS digital platform TURAS to our own LearnNL. Since the launch of the modules in March 2024 staff have been able to access all the materials digitally. We envisage that work in this area will continue to grow with the roll out of the face-to-face ‘skilled’ and ‘enhanced‘ level training, as well developing our training for trainers programme which will enable us to develop our own team of in-house facilitators ready and able to respond to any training requirements in relation to trauma informed practice. 5.14 REVISION OF SUPERVISION POLICY Over the past year and following consultation our supervision policy has been updated and linked to a new toolkit of resources to support reflective and outcome focused practice aligned to developments in practice and also recognising that whilst one-to one supervision remains fundamental to social work practice that other supports such as group supervision and case consultations can play a key role in supporting practice. 5.15 SUPPORT FOR STAFF WELLBEING Within each locality a variety of teams have held development days focussing on Health and Wellbeing (HWB), staff resilience and supports, team building, and this continues. Recruitment for an North Lanarkshire HWB officer took place, an appointment made in early 2024 to support this activity and to work with the NHSL HWB officer for a joined- up partnership approach. HWB is at the forefront of staff development. Various Social Work management teams were subsequently engaged by Organisational Development (and the health-based Staff Health and Wellbeing Officer), with particular focus on the ‘Stay Conversation’ project. These initial briefings and workshops have led to engagement across a range of teams for ongoing collaboration looking at enhancing Social Work Wellbeing.
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48 Continuing the pattern of the last two years demand for social work and social care services, often accompanied by increased complexity of presenting need, has continued to grow and surpass pre-pandemic levels across all areas of social work driven by a range of demographic and societal trends including continuing cost-of-living pressures impacting on the resilience of our communities. This is a pattern that is likely to continue into the immediate future. Whilst the service has been successful in maintaining a strong balance of care existing pressure points such as those on care at home services and MHO services have also been supplemented by new ones, for example growing demand for children’s house places. Neither the council or IJB have to date responded to financial pressures by reducing core social work staffing, however nor has there been capacity simply to expand resources to meet demand and pressures on wider budgets are also likely to continue to impact on social work service delivery. Moreover, innovation and investment in service improvement and redesign for longer term sustainability is increasingly reliant on temporary funding streams many of which are uncertain beyond the current Scottish parliamentary term creating additional challenges in planning, Alongside additional uncertainty associated with future proposals for a National Care Service, the proposed National Social Work Agency, review of elements of social work education and discussions on a national improvement programme, albeit focussed primarily on social care, have brought welcome attention at national level to the key role of social work. It is however disappointing in this context that commitments for investment have not matched those made to some other areas of the public sector with even relatively modest developments like the embedding of the ‘Supported Year In Practice’ from 2024 implemented with no funding support. Locally there is some indication that investment in the social work workforce may be reducing vacancy levels and the number of our own staff seeking a pathway into social work is positive and encouraging however although the potential introduction of a graduate apprenticeship in social work nationally is a welcome development it is unlikely on its own to meet need. Key areas of workforce focus for us going forward will include continuing efforts to grow our MHO workforce and to address the workforce vetting requirements associated with the introduction of MAPPS (a highly secure home office system) within justice services. Further work is also planned to consider the implications of local research relating to diversity in recruitment alongside national findings on racism experienced by BAME staff. In addition, continued attention to staff well-being and trauma informed systems will remain key both to supporting retention and best practice. In this context both to support improved outcomes and experiences for those who need our support and for demand and cost avoidance, the continuation of our focus on prevention will be critical over the coming year. Vital to delivering this will be our programmes to improve core practice such as the ‘Back to Basics’ work in Adult Services and ‘Signs of Safety and Healing’ in Children’s Services alongside continuing investment in early family support and carer support. We will also continue to maximise the opportunities created by the integrated working embedded in the Programmes of Work for the Council and that supporting the HSCP’s Strategic Commissioning Plan with a key focus also on improving outcomes and continuity of support at key transition points. The redesign of social work administration to a business support model alongside work to introduce the new social work management system Mosaic and the ELMs2 and Dynamic Scheduling Systems for the Integrated Equipment Service and Home Support respectively, will all involve significant preparation and time and people resource over the coming year but are again vitally important to future operational efficiency. Finally, the requirement to respond to and embrace a plethora of national policy and legislative drivers, external scrutiny findings and continued reporting requirements to the SCAI (Scottish Child Abuse Inquiry) will also continue to place significant demands on the service over the coming year. A continued focus on strong partnership working across and beyond social work including with those who use our services will be central to ensuring that our workforce is not overwhelmed and can instead continue its central role in delivering positive outcomes for our communities. 6. LOOKING FORWARD – PRIORITIES FOR 2024-2025 AND BEYOND
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1 IJB Reporting Template REPORT Item No: 9 SUBJECT: Frailty Strategy Update TO: Integration Joint Board Lead Officer for Report: Hazel Gilmour Frailty NMAHP Consultant Author(s) of Report Dr Helen McKee Associate Medical Director for Frailty Contact details for Author(s) of Report Helen.McKee@lanarkshire.scot.nhs.uk Hazel.Gilmour@lanarkshire.scot.nhs.uk DATE: 19 March 2025 1. PURPOSE OF REPORT This paper is coming to the IJB to provide an update on the Frailty Strategy to note. 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 Hazel Gilmour, Frailty NMAHP Consultant, and Dr Helen McKee, Frailty AMD. This has been reviewed by some key members of the Frailty Strategy Implementation Group.
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2 Prepared By: Dr Helen McKee and Hazel Gilmour ☒ Reviewed By: Frailty Strategy Implementati on Group ☒ Endorsed By: ☐ 3. EXECUTIVE SUMMARY The NHS Lanarkshire Strategy for Preventing and Managing Frailty has been in circulation for a year, with significant progress made in implementing and embedding its initiatives across Lanarkshire. This report outlines the work completed to date and sets out the key next steps for advancing the strategy in 2025. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB: (1) Acknowledge the content of this report (2) Acknowledge the Frailty workplan for 2025 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 In 2023, NHS Lanarkshire developed the Strategy for Preventing and Managing Frailty 2023–2028, which received approval and endorsement from NHS Lanarkshire and North and South Lanarkshire Integration Joint Boards (IJBs) by the end of 2023. Implementation of this strategy and creating a work plan began January of 2024. 6.2 The strategy’s primary aim is to ensure that: Yes ☐ No ☒ N/A ☐
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3 “Every older person in Lanarkshire with, or at risk of, frailty is supported to achieve better health, maintain independence for longer, and live their best possible lives. Partners work collaboratively with older people, unpaid carers, families, and communities to prevent, identify, and manage frailty proactively through personalised, coordinated support delivered at home or close to home, alongside integrated, age- appropriate acute and community services”. 6.3 Following the launch of the strategy in 2024, various work streams have been created to support its implementation across Lanarkshire. Key activities included extensive stakeholder engagement with internal and external partners and the establishment of the Frailty Network and Frailty Strategy Implementation Group. These groups have driven the development of workstreams aligned with the strategy’s three objectives: Promoting Health and Wellbeing, Tackling Inequalities, and Delivering Sustainable Healthcare. 7. SUMMARY OF KEY ISSUES 7.1 In November 2024, the Frailty Strategy Implementation Group held the One Year On event to review progress on the NHS Lanarkshire Strategy for Preventing and Managing Frailty. 7.1.1 The event’s objectives were to: • Showcase the progress made in implementing the strategy throughout 2024. o Frailty and FNC+ o Frailty in Acute – Establishment of the Frailty Units in all acute sites o Carers Academy in Lanarkshire (carer support for people living with dementia, in collaboration with Alzheimer’s Scotland) o Blantyre Life – Reablement and promoting independent living o Active Wards – Reducing deconditioning through mental and physical activity • Encourage partners to pledge their commitment to incorporating the strategy’s principles into their areas of work. • Collaboratively develop the 2025 work plan with partners and stakeholders. 7.1.2 The in person event was attended by 41 participants, fostering engaging discussions and inspiring numerous pledges from attendees. These commitments have played a key role in shaping our approach to implementing the strategy in 2025, highlighting shared priorities that are essential for the strategy's success
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4 7.2 The 2025 work plan will prioritise three focus areas each linked to one of the strategy’s objectives: • Promoting Health and Wellbeing: Enhancing public access to frailty information to support self-directed care. Alongside early identification of frailty. • Tackling Inequalities: Engaging with local communities with the highest levels of frailty to understand their priorities and improve early frailty identification within these areas. • Delivering Sustainable Healthcare: Collaborating with technology teams and universities to explore and share innovations that aid in identifying frailty and supporting individuals to live independently at home for longer. Improving frailty pathways within acute hospitals to support sustainable healthcare in secondary care. These three areas will be focused across Acute, Community and Locality settings. 7.2.1 All members of the frailty strategy implementation group have been asked to identify the focus area they are most passionate about or where their work aligns. This will help determine the composition and participation of each group. 7.3 The recent publication of the Ageing and Frailty Standards (2024) (Appendix 1) by Healthcare Improvement highlights several key areas integral to the frailty strategy. These 11 evidence-based standards highlight the critical importance of supporting and resourcing adequately the implementation of the strategy and emphasises the value of preventative measures in managing frailty effectively. 7.4 The Frailty Network will continue to take the lead in delivering the Frailty Strategy, under the oversight of the newly established Ageing and Frailty Programme Board. The new governance structure (Appendix 2) will not only oversee ongoing work but also integrate other key work groups, such as the Dementia Framework. This enhanced governance framework highlights the health boards commitment to prioritising frailty across Lanarkshire, and ensuring the strategy’s implementation is successful in enhancing the quality of life for the people living in this area. The Ageing and Frailty Programme Board will be chaired by the Chief Officer of the North Health and Social Care Partnership and will provide direction, leadership and guidance. The Ageing and Frailty Programme Board will follow a 7 step model, that will be created in collaboration with the expertise of the
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5 multidisciplinary teams and align with the Ageing and Frailty Standards (HIS, 2024). 7.5 The significance of delivering the Frailty Strategy was reaffirmed by the national letter by the Chief Officer for NHS Scotland, John Burns, which outlines key priorities for the next few years. The Scottish Government has emphasised key focus areas, including Frailty at the Front Door, including Accident and Emergency, Frailty Prevention and the enhancement of integrated community frailty pathways, all of which are central to the Frailty Strategy. Over the past 12 months, significant progress has already been made in improving frailty pathways within acute settings, including the establishment of Frailty Units across all acute sites. 8. CONCLUSIONS To fully implement the strategy and achieve its outlined aims, extensive stakeholder engagement was essential. Over the past year, priority was given to understanding Lanarkshire’s existing services that currently, or have the potential to, positively impact its residents. This foundational insight set the stage for informed progress. The One Year On event showcased the significant strides made in embedding the NHS Lanarkshire Strategy for preventing and managing frailty. It also reinforced the strong commitment of partners to its continued implementation. The pledges made by stakeholders demonstrate a united effort to align actions with the strategy’s goals: promoting health and well-being, addressing inequalities, and delivering sustainable healthcare. These pledges have enabled key stakeholders to focus on specific objectives, advancing the strategy to the next level. Looking ahead to 2025, efforts will focus on early identification of frailty in our communities to allow for early access to preventative frailty teams or services. This work will engage with community partners to address inequalities and how technology can be used to promote independent living. Work will also continue to refine frailty pathways within acute settings, while collaborating with community and interface teams to establish robust support systems that enable people living with frailty to remain in their homes. Strong partnerships across all sectors will be essential to the strategy’s success, driving meaningful outcomes for frail people in Lanarkshire. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES
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6 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 None 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 Frailty Strategy Implementation Group Medium Hazel Gilmour Dr Helen McKee 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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7 ☒ 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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8 10. BACKGROUND PAPERS Strategy for Preventing and Managing Frailty: 2023 – 2028 11. APPENDICES Appendix 1 Healthcare Improvement Scotland (2024) Ageing and Frailty Standards. Available at: Ageing and frailty standards – Healthcare Improvement Scotland Appendix 2 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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9 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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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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REPORT Item No: 10 SUBJECT: Medium Term Financial Plan 2024-2028 including the Long Term Outlook 2025-2035. TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 19 March 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report advises the IJB of the medium term financial forecast position for 2025- 2028 as set out in the attached Medium Term Financial Plan and Long Term Financial Outlook. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge the assumptions and context of the Medium Term Financial Plan (2) Approve the Medium Term Financial Plan 2025-2028 (3) Approve the savings proposals to meet the savings gap in 2025/26 (4) Acknowledge the Long Term Financial Outlook for 2025-2035. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Medium Term Financial Plan (MTFP) outlines the financial challenges the University Health & Social Care Partnership (the Partnership) faces over the next three years and provides a framework which will support the Partnership to remain financially sustainable. Included within this plan is a Long Term Financial Outlook (LTFO) which provides board directors with a longer term view on the financial and demand pressures from 2025 to 2035. 5.2 The long term financial plan for 2024-2035 was approved by the board in March 2024 which highlighted total pressures ranging from £40.597m to £45.487m. Included in this was the recurring cost pressure identified for 2024/25 which resulted in a savings Yes No N/A
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target of £22.856m. Board Directors will recall that this target was to be split equally between 2024/25 and 2025/26, as at December 2024, 49% of the total target had been achieved. 5.3 Taking the approved 2024/25 approved budget as the new baseline, this MTFP updates the financial planning assumptions and projected funding gap for the three year planning period 2025-26 to 2027/28. 6. FINANCIAL OUTLOOK 6.1 Looking into 2025/26 and beyond, it is anticipated that the public sector in Scotland will continue to face a number of challenges in the years ahead. There is significant uncertainty over what the scale of this is likely to be and it is therefore important that the Partnership plans for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner over the coming years. 6.2 In addition, it is clear from North Lanarkshire Council and NHS Lanarkshire financial outlook, that both partners anticipate they will be subject to significant pressure over the coming years with a further period of constraint and reduction in core funding. In this context, there is a greater risk that future uplifts in funding to the Partnership similar to that provided in previous years may not be deliverable. 7. MEDIUM TERM FINANCIAL PLAN 2025/26 – 2027/28 7.1 Using the financial planning assumptions detailed in Appendix 1 of the MTFP, a range of risk-based scenarios have been considered, resulting in envisaged, pessimistic and optimistic positions. Based on the projections it is recommended that the IJB progresses with a financial strategy based on the envisaged scenario. 7.2 The envisaged scenario projects an estimated budget gap of £51.854m over the 3 year planning period 2025/26 to 2027/28 of which £14.729m relates to 2025/26. 7.3 Section 8 of the MTFP details ‘Our Response’ and demonstrates the service redesign proposals to be implemented over the coming 12 months to address the £14.729m funding gap in 2025/26. 7.4 It is recognised that service redesign and savings plans take time to implement, therefore, to mitigate any delays from timing of implementation, contingency reserves may be needed to fund the gap until the full savings can be realised. Updates on the service redesign will be presented to the board throughout the year. 7.5 The MTFP assumptions have been extended for a further seven years up to 2034/35 to provide a long term outlook. This identifies cost pressures in 2028/29 of £40.020m rising to £58.075m in 2034/35. 7.6 The MTFP and LTFO are based on a range of demand and cost pressures which could be faced by the IJB over the long term. These assumptions are informed by both the local and national context for which there remains significant and real uncertainty. 7.7 Detailed below are the main areas of cost pressures which will be subject to ongoing review: • Future funding allocations • Future pay settlements • Cost of living and inflation • Contractual pressures and the living wage commitments • Demand led services including deprivation and health issues • Prescribing costs and availability
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7.8 It is therefore essential that the IJB continues to focus on the longer term financial challenge and where appropriate generate reserves to help: • Address future pressures on the assumption that the financial position is more than likely to remain challenging • To provide temporary funding to drive transformation • To build contingency reserves which will be crucial in ensuring the financial sustainability of the partnership in the medium term 7.9 Looking beyond the financial year and into the term of the financial plan, it is inevitably more difficult to forecast. It is important the IJB adopts a plan, not just in the delivery of strategic outcomes and services, but also from a financial perspective to ensure risks to the financial sustainability of the IJB are identified early, even though there may be uncertainty over the specific timing, scale, and ultimate effect. 7.10 On this basis, the IJB should continue to plan for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner. Looking beyond 2025/26, a significant level of savings and redesign will be necessary to continue to deliver sustainable and modern services which meet the needs of service users and their families. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
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8.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated where necessary. 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 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ 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.
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8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 9. BACKGROUND PAPERS None. 10. APPENDIX IJB Medium Term Financial Plan Appendix 1 Nicola Scott Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581 007187. CHIEF ACCOUNTABLE OFFICER (or Depute)
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ITEM 10.1 Strategic Commissioning Plan FINANCIAL PLAN Engage with Partner Bodies Support Transformation Budget Setting & Monitoring 2025/26 to 2027/28 APPENDIX 1 Medium Term Financial Plan INCORPORATING THE LONG TERM FINANCIAL OUTLOOK
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1 | P a g e CONTENTS 1. INTRODUCTION 2 2. EXECUTIVE SUMMARY 2 3. PURPOSE 3 4. NATIONAL & LOCAL CONTEXT 4 5. FINANCIAL CONTEXT 6 6. FINANCIAL PLANNING ASSUMPTIONS 7 7. MEDIUM TERM FINANCIAL PLAN 2025/26 -2027/28 8 8. THE RESPONSE 10 9. LONG TERM FINANCIAL OUTLOOK 2025/26 – 2034/35 11 10. RESERVES STRATEGY 12 11. RISKS & UNCERTAINTIES 13 APPENDIX 1 – FINANCIAL PLANNING ASSUMPTIONS 14
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2 | P a g e 1. INTRODUCTION The North Lanarkshire Integra�on Joint Board (IJB) was established as a corporate body by Sco�sh Government and became opera�onal in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. It is a joint venture between NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC). The IJB has responsibility for the strategic planning and commissioning of a wide range of services within North Lanarkshire. The North Lanarkshire University Health and Social Care Partnership (the Partnership) is responsible for the opera�onal delivery of the IJB strategic direc�ons. This includes the services we are required to provide, the funding allocated and the monitoring of performance. The services include: • Accident and emergency services provided in a hospital • Inpa�ent services related to general, respiratory and rehabilita�on medicine • Pallia�ve care services • Community health services including Lanarkshire wide hosted services • Social care services. 2. EXECUTIVE SUMMARY The Medium Term Financial Plan (MTFP) 2025/26 – 2027/28 provides a medium term view of the challenges and opportuni�es facing the IJB and considers what the implica�ons of this are for the finances of the organisa�on. A robust MTFP will support the priori�es and ambi�ons as outlined in the Strategic Commissioning Plan whilst ensuring the organisa�on remains financially sustainable. The Partnership is opera�ng in an increasingly challenging environment with funding not keeping pace with increasing costs and demand, therefore the Long Term Financial Outlook (LTFO) 2025/26 – 2034/35 provides an es�mate of the longer term posi�on against this backdrop. In May 2023 the Sco�sh Government published an updated Medium Term Financial Strategy for the period 2023/24 to 2027/28, providing insight into future funding and spending priori�es at a na�onal level. The move to mul�-year setlements however remains an aspira�on which means the uncertainty which is currently impac�ng on strategic commissioning ac�vity across Partnership will con�nue. Both the MTFP and LTFO provide an overview of the financial planning assump�ons in rela�on to projected cost pressures arising from demographic growth, legisla�ve and policy developments, employee costs and infla�on alongside poten�al partner funding contribu�ons in future years. The MTFP es�mates a budget gap of £51.854m over the 3-year planning period 2025/26 to 2027/28, of which £14.729m relates to 2025/26. Therefore, to meet the requirement on the Partnership to set a balanced budget, a package of savings has been iden�fied to meet the 2025/26 gap. Any in year shor�alls will be met by reserves, as permited in the IJB Reserves Strategy. The LTFO iden�fies cost pressures in 2028/29 of £40.020m rising to £58.075m in 2034/35, however due to the uncertainty in funding beyond the 3 year medium term planning period no assump�ons have been made on the likely income receipts to meet these pressures. The long term financial constraints will require the Partnership and both partners to make difficult decisions in the years to come. Therefore, the whole system approach and working collabora�vely with carers, third par�es and independent providers is essen�al. An effec�ve communica�on strategy is also essen�al to ensure public confidence is maintained.
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3 | P a g e 3. PURPOSE The long-term vision for the Partnership was set out in the original Strategic Plan 2016- 2026 and con�nues as the over-arching vision of the Strategic Commissioning Plan 2023-26. This states that the people of North Lanarkshire will achieve their full poten�al through: In order to implement this vision, the Partnership has 6 key ambi�ons which were revised in 2023, following engagement with stakeholders, taking experience gained since 2016 and looking at the current and future challenges facing the Partnership. Longer term planning is integral to the Partnership’s Financial Strategy and strategic approach to budge�ng. Effec�ve decision making relies on robust financial planning and the MTFP and LTFO assist in ensuring resources are aligned to the key priori�es and ambi�ons highlighted above. With limited resources and increasing pressures on the Partnership’s services it is there is a need to adapt and change to be more efficient, responsive, and sustainable. A co-produc�ve approach therefore needs to be adopted that fully involves communi�es in decisions ensuring an approach that supports and empowers them when a different model of service delivery is proposed. It is therefore essen�al that service re-design and transforma�on is delivered in a planned and holis�c manner, rather than reac�ve cuts to services. The adop�on of a medium to long term approach for financial planning enables this approach. • Living safe, healthy and independent lives in their communi�es. • Receiving the informa�on, support and care they need, efficiently and effec�vely, at the right �me, in the right place and in the right way. • Ensuring North Lanarkshire is the best place in Scotland to grow up. KEY AMBITIONS Do the right thing first �me Increased focus on preven�on, early interven�on and tackling inequali�es by working with communi�es and people Develop and support a workforce for the future Improve mental health and wellbeing Support people through a whole family approach
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4 | P a g e 4. NATIONAL & LOCAL CONTEXT Health & Social Care Partnerships operate in a complex, challenging and changing environment where na�onal issues can have an impact on what and how services are delivered along with the financial resources they have available to meet this. The MTFP has considered a number of key issues, some of which are outwith the Partnership’ control, and those internal issues which the Partnership has the ability to influence. Both internal and external influences need to be considered with key variables modelled to guide the IJB decisions about the future. External Influences (outwith the Partnership’s control) • Increase in demand • Interest rate fluctua�ons • Level of funding from partners and Sco�sh Government • Na�onal pay agreements • Supply chain issues associated with the wider economy • Further financial and economic impacts and poten�al future pandemics • Na�onal Care Service. Internal Influences (within the Partnership’s control) • Community engagement, partnership working and co-produc�on of service delivery models • Working to clear priori�es as set out in the Strategic Commissioning Plan • Transforma�onal change programmes to improve outcomes • Effec�ve people planning and wellbeing • Use of robust performance data to drive improvement • Use of digital technologies to improve services and reduce cost • Effec�ve risk management to keep risk levels within tolerance • Effec�ve financial planning to ensure best value for the resources available There are mul�-faceted factors that impact on this budget and the demand for health and social care services across North Lanarkshire which include: • North Lanarkshire is the 4th largest area in Scotland. It is also the 5th most populated with a popula�on of 341,890. • Between 2011 and 2022, the 25 to 44 age group saw a percentage decrease (-7.3%), in contrast the 75 and over age group saw a percentage increase (+21%). • Although the popula�on is projected to decrease from 2028 to 2043 by 1.2% there is a forecast increase of 71.4% in the age group 75 years and over across the same �mescale. • 20% of North Lanarkshire’s data zones are within the 20% most deprived in Scotland. • The number of people income deprived in North Lanarkshire is 50,897, a reduc�on of 3% from SIMD 2016 data. • The unemployment rate is currently 3.3% which is the lowest in period between 2005 and 2024. However, the 2022 census reports that the amount of people who are long term sick or disabled has grown by 6%.
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5 | P a g e • The 2022 census also provides the following comparisons to the 2011 census: o Individuals who reported themselves as “not in good health” has grown by 24.6% (+6039) o Individuals who reported themselves as ‘in fairly good health’ as opposed to ‘good health’ has grown by 15% (+7036) o Individuals who reported themselves as having ‘long term health condi�ons’ has grown by 30.6% (+43,943) o Individuals self-repor�ng mental health issues has grown by 158.6% (+24,903) o Individuals self-repor�ng as providing informal / unpaid care has grown by 31.6% (+10,877) • There remains significant ongoing pressure in all health and social care systems across Scotland. High demand and pa�ent acuity, coupled with increased flu numbers in recent months has placed even greater demand on the system. In Lanarkshire, there is a genuine whole-system focus to the resilience response and there has been a tremendous effort across the whole system, including third and independent sectors, communi�es, carers, and public partners in the con�nued response to increased pressures and demand. • Whilst many older people are expected to enjoy beter health than their predecessors did at an equivalent age, they will s�ll have significant health needs, living with poten�ally mul�ple and complex condi�ons. The impact of this will be a steadily increasing demand on health and social care services, including care at home, care homes, increases in demand for community-based healthcare, equipment and adapta�ons and an increased demand for GP services and medica�on.
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6 | P a g e 5. FINANCIAL CONTEXT The Partnership delivers and commissions a range of health and social care services to the local popula�on. This is funded through budgets delegated from both NHSL and NLC. The baseline for the MTFP and LTFO is the 2024/25 budgets; the total resources available during this year has been £810m. This includes funding from NHSL of £483.74m and £209.52m from NLC. Also included is a ‘Large Hospital Service’ (No�onal Set Aside) budget totalling £74.54m. This budget is in respect of those func�ons delegated by the Health Board which are carried out in a hospital within the Health Board area. The Set Aside resource for delegated services provided in acute hospitals is determined by appor�oning the hospital expenditure to individual pa�ent episodes, separa�ng out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJB based on postcode. The IJB is responsible for the strategic planning of these services but not their opera�onal delivery. Finally, £42.05m represents a number of delegated services where South Lanarkshire IJB acts as the lead host on behalf of North Lanarkshire Partnership. The value consumed by North Lanarkshire equates to 52% of South Lanarkshire IJB hosted budget. North Lanarkshire IJB 2024/25 Resources NHSL NLC Set Aside South Hosed
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7 | P a g e 6. FINANCIAL PLANNING ASSUMPTIONS Financial planning requires assump�ons to be made about future demand and cost pressures which could be faced by the Partnership and our partners. This MTFP focuses on the likely cost pressures that the Partnership can reasonably expect over the next three years which has then been extended to look at the following seven years for the LTFO up to 2034/35. These assump�ons have been informed by the local and na�onal context within which the Partnership operates. It is widely expected that the public sector in Scotland will con�nue to face a very challenging financial outlook for the foreseeable future. The cabinet Secretary for Finance and Local Government announced the Sco�sh Government’s budget for 2025-26 in Parliament on 4th December 2024. The Director of Health & Social Finance said this budget provides: “a platform for the health and social care system to focus on reform and innovation. We must work as a whole system and across organisational boundaries to improve outcomes and deliver the best possible care within our available resources” The Dra� Local Government Financial Setlement confirmed the posi�on at individual Council level, for North Lanarkshire this presented a more favourable posi�on than previously assumed in their MTFP in June 2024. However, the Accounts Commission, in its Local Government in Scotland Financial Bulle�n 2023/24 published in January 2025, highlighted that ‘despite the Scottish Government’s budget proposals in December 2024 indicating a further real terms uplift in funding for 2025/26 the financial outlook for Scotland’s councils remains challenging’. The same can be said for NHSL, the headline increase to baseline funding is 3% however there remains significant pressures across the system which require to be addressed. Therefore, whilst the provision of recurring investment and non-recurring reserves will help, there remains significant uncertainty over increasing cost pressures and what the scale of the likely reduc�on in available funding will be over the term of this plan. It therefore remains important that the Partnership ensures sufficient flexibility to manage, in a sustainable manner, the posi�on which emerges over the coming years, with the likely scenario that a significant level of further recurring savings will be required. Consequently, the Partnership’s financial planning arrangements remains subject to ac�ve review using a scenario-based approach in recogni�on of the significant uncertainty over rising costs and the scale of variability in the poten�al funding available to the Partnership in future years. The key variables which have been considered in preparing the MTFP & LTFO are detailed in Appendix 1. This is not an exhaus�ve list of variables, however, the assump�ons iden�fied are considered to be the core issues which require to be included in this plan. Adjus�ng for these key variables will give the Partnership a robust approach to ensuring the board remains financially and opera�onally sustainable, and in doing so ensures that it meets its statutory obliga�ons, its policy aspira�ons, and the needs of local communi�es.
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8 | P a g e 7. MEDIUM TERM FINANCIAL PLAN 2025/26 -2027/28 As outlined in sec�on 5, the 2024/25 budget is the baseline for the MTFP updated with the financial planning assump�ons outlined in Appendix 1. A range of risk-based scenarios have been considered, resul�ng in envisaged, pessimis�c and op�mis�c posi�ons with regards to total pressures as shown in Table 1. Table 1: Es�mated Cost Pressures Financial Year Total Pressures Envisaged (£000) Total Pressures Pessimistic (£000) Total Pressures Optimistic (£000) 2025/26 60.803 65.712 57.219 2026/27 36.905 44.096 33.016 2027/28 37.737 46.607 33.063 Total 135.445 156.415 123.297 Based on these projec�ons the Chief Financial Officer (CFO) recommends that the Partnership progress with a financial planning strategy based on the envisaged scenario, this is shown in Table 2 with the es�mated funding envelope available for 2025/26 to 2027/25 and results in a budget gap of £14.729m for the forthcoming financial year. Table 2: Es�mated Cost Pressures and Funding (Envisaged Scenario) 2025/26 (£000) 2026/27 (£000) 2027/28 (£000) Pressures: Contractual Pressures 10.922 11.328 12.081 Demand Pressures 11.922 7.182 7.434 Pay Pressures 14.611 8.577 8.834 Local Cost Pressures 10.998 1.283 0.000 Prescribing 12.350 8.535 9.388 Total Pressures 60.803 36.905 37.737 Recurring Funding: Social Care Spend Reductions 4.804 0.000 0.000 NLC & NHSL Contributions 20.375 18.583 18.933 Non Recurring Funding Reduction in Employers Superannuation 6.961 0.000 0.000 Budget Management - Pays & Non Pays 4.982 0.000 0.000 Prescribing Reserve 4.361 0.000 0.000 Additional sustainability funding 4.591 0.000 0.000 Total Funding 46.074 18.583 18.933 FUNDING GAP 14.729 18.322 18.804
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9 | P a g e Opportuni�es to redesign services, remove duplica�on and achieve efficiency savings have been implemented over the last number of years and in order to achieve a balanced budget and meet the budget gap in 2025/26 this service transforma�on will need to con�nue over the coming 12 months. There is no doubt it is becoming increasingly challenging to deliver further savings on a recurring basis however, the focus should be on the budget available to the Partnership of over £800m and how services can best be delivered and priori�es achieved within that financial envelope rather than focussing on the savings that have to be implemented. Table 3 highlights the financial Strategy for 2025/26. Table 3: 2025/26 Financial Strategy North Lanarkshire IJB Financial Plan 2025/26 £000 Total Pressures - Envisaged Outlook 60.803 Financial Strategy to address Funding Pressures: £000 Social Care Budget Management -4.804 NLC & NHSL Funding Contributions -20.375 Reduction in Employers Superannuation Contribution -6.961 Budget Management - Pays & Non Pays -4.982 Prescribing Reserve -4.361 Additional sustainability funding -4.591 Service Redesign and Transformation -14.729 Total Financial Strategy -60.803 More detail is provided on the proposed service transforma�on and redesign opportuni�es in sec�on 8 ‘The Response’.
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10 | P a g e 8. THE RESPONSE The Partnership is opera�ng in an increasingly challenging environment with funding not keeping pace with increasing costs and demand for services. This is reflected in the MTFP which has iden�fied a £51.854m funding gap over the next 3 years. In order to remain sustainable in future years, the Partnership will need to make significant changes to its opera�ng model, by con�nuing to explore new ways to deliver services that beter meet the needs of the people in the community. The focus of a whole system approach is to reduce inequali�es, build community capacity and resilience and thereby decrease demand for services in other parts of the system. The response to this challenge is to propose service review and redesign which will result in efficiencies that meet the £14.729m funding gap in 2025/26. SERVICE REDESIGN & TRANSFORMATION £14.729m Health £4.343m Budget Management Non-Pays £0.247m A review of budget lines including (but not limited to) travel, training and printing costs. Prescribing £4.096m A review of prescribing will be undertaken with a 5% savings target being applied. Social Care £10.386m Home Support £2.838m Home Support re-design which will include the introduction of the dynamic scheduling tool to support the process of streamlining shift patterns alongside service provision. The re-design will further develop the enabling approach as the operating model. Independent Care Homes £4.710m Focus the strategic direction to reduce both the length of stay in care homes and the number of people being placed. Care at Home £2.838m A review of the guided self-assessment process to align with a more strategic assessment and planning practice.
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11 | P a g e 9. LONG TERM FINANCIAL OUTLOOK 2025/26 – 2034/35 The table below gives an es�mated impact of cost and demand pressures arising from employee costs, infla�onary cost pressures, demographic growth and demand, local cost pressures and legisla�ve and policy developments for the next ten years. Unlike the MTFP, it does not include a financial strategy to address these cost and demand pressures or any mi�ga�on to reduce the gross cost through budget upli�s; recurring savings plans or funding from other sources. Table 4 details the es�mated long term pressures. Table 4: Es�mated Long Term Cost Pressures As previously stated, due to the con�nuing changing financial environment the Partnership is facing, the reliance which can be placed on the financial es�mates decreases the further into the future the projec�ons relate to. The CFO will con�nue to update and refresh the assump�ons as new financial informa�on, including future funding and savings plans becomes available. Pressure on Base Budget (Envisaged Outlook) 2025/26 (£000) 2026/27 (£000) 2027/28 (£000) 2028/29 (£000) 2029/30 (£000) 2030/31 (£000) 2031/32 (£000) 2032/33 (£000) 2033/34 (£000) 2034/35 (£000) Contractual Pressures 10.922 11.328 12.081 12.900 13.786 14.746 15.785 16.911 18.133 19.458 Demand Pressures 11.922 7.182 7.434 7.694 7.963 8.242 8.530 8.829 9.138 9.458 Pay Pressures 14.611 8.577 8.834 9.099 9.372 9.654 9.943 10.242 10.549 10.865 Local Cost Pressures 10.998 1.283 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Prescribing 12.350 8.535 9.388 10.327 11.360 12.495 13.745 15.120 16.631 18.295 Total Pressures 60.803 36.905 37.737 40.020 42.481 45.137 48.004 51.101 54.451 58.075 Pressures:
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12 | P a g e 10. RESERVES STRATEGY The Partnership has the same legal status as a local authority and is therefore able to hold reserves under sec�on 106 of the Local Government (Scotland) Act 1973. A reserves strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The use of reserves must be prudent and controlled and are generally held for the following purposes: • To create a working balance to help cushion the impact of uneven income flows • To create a con�ngency to cushion the impact of unexpected events or emergencies • To create a means of building up funds, to meet known or predicted liabili�es • To fund non-recurring costs and to help with payment profiles straddling more than one year • To enable the implementa�on of longer-term savings proposals. The reserves strategy for 2025/26 is being presented to the IJB in March 2025 and summarises the reserves posi�on as at 31 January 2025 as detailed in Table 5. Table 5: Reserves as at 31 January 2025 SUMMARY Balance at 31 January 2025 £m Ring-Fenced Reserves 24.529 Earmarked Reserves 19.006 Risk-Based Reserves 17.045 Con�ngency Reserves 13.140 TOTAL 73.720 It is recognised that service redesign and savings plans take �me to implement therefore, to mi�gate this risk to the Partnership, con�ngency reserves may be needed to fund the gap un�l the full savings can be realised. Updates, tracking savings achieved against target, will be presented to the board throughout the year as iden�fied savings op�ons are implemented.
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13 | P a g e 11. RISKS & UNCERTAINTIES Given the current poli�cal climate and the associated economic uncertainty, it is important to note that projec�ons made within this MTFP and LTFO may poten�ally be subject to significant varia�on. The assump�ons applied to income and expenditure models are based on the best informa�on available at the �me of wri�ng. There are also a number of risks inherent in this MTFP which will require to be monitored over the coming months. Financial Risks & Uncertain�es • Future funding levels from partner organisa�ons and Sco�sh Government. • Con�nued increasing costs and raising infla�on including future pay awards. • Increasing costs of equipment and adapta�ons • The outcome of the nego�a�ons for the na�onal care home rate • The impact of the increase to na�onal insurance contribu�ons for both direct staff and commissioned services and the poten�al lack of addi�onal funding to support these • Impact of rising costs of commissioned services with providers outwith the na�onal frameworks asking for significantly above infla�on increases. • The level of non-recurring solu�ons included to meet the 2025/26 cost pressures. Opera�onal Risks & Uncertain�es • Impact of proposed savings op�ons which could include an increase to delayed discharge figures and bed delays. • The ability to recruit and retain quality staff to con�nue to deliver services and manage increasing demand. • Unexpected shortage of supplies and materials. • Increasing level of complex care packages materialising that are currently unknown. • Vola�lity of the external care market and the support required in order to provide stability. • Increased numbers of providers seeking to set up separate companies and exit the Na�onal Care Home Contract which would lead to individual placement and price nego�a�ons. • Opera�onal impact of the increased contract prices from providers leading to issues with placement of clients. • Changing poli�cal factors which influence the UK and Sco�sh Government priori�es and policy ini�a�ves. The Partnership maintains a strategic risk register and both partners maintain opera�onal risk registers. Strategic and opera�onal risks are regularly monitored and updated by the board and senior management to mi�gate against key risks and uncertain�es.
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14 | P a g e APPENDIX 1 – Financial Planning Assump�ons An�cipated Sco�sh Government Funding Levels The Sco�sh Government finance setlement for both partners will significantly influence the funding contribu�on each partner can make to the IJB. The Sco�sh Government has historically provided one year funding setlements which has impacted on the ability to plan over the longer term with certainty. Single year setlements have required assump�ons in the MTFP & LTFO from year 2 to 10. For financial year 2025/26 another one-year setlement was provided in December 2024, however there is s�ll a commitment from Sco�sh Government to move to mul�-year setlements in the future. Assump�ons on Infla�on Consumer price index (CPI) and retail price index (RPI) infla�onary increases are assumed for a range of contractual commitments and purchasing of supplies and materials. The Office for Budget Responsibility (OBR) published its latest Economic and Fiscal Outlook alongside the UK Government’s budget, which indicated that CPI/ RPI infla�on is an�cipated to remain higher for longer than previously expected. The OBR published figures have been used throughout the plan. Na�onal Care Home Contract A significant cost pressure relates to the Na�onal Care Home Rate Contract (NCHR) which is nego�ated annually. The level for this year is currently unknown, work remains ongoing within the sector to agree this rate. The primary factor influencing this has been the decision in October of the Chancellor to change the Employers Na�onal Insurance Contribu�on (eNICs) which will have an impact on the agreed NCHR. It is prudent to assume, based on past year trends and the on-going cost of living crisis that this is likely to increase significantly over the life of this plan therefore a 10% increase has been included. Pay Increases Employee costs represent a large por�on of IJB net budgets with any increase in pay awards impac�ng directly on current and future cost pressures. The Sco�sh Government has set the Public Sector Pay Policy (PSPP) at a maximum of 9% over the next 3 years therefore an es�mated 3% has been assumed for staff employed in NLC in both the MTFP and LTFO. This increase has also been assumed for NHSL staff over the life�me of the plan, in line with previous years, full funding is expected for pay upli�s to NHSL staff. In the event of an upli� greater than that es�mate and no addi�onal government support, the forecasted gap could poten�ally change materially. Considera�on is also given to the challenges of recrui�ng and whether pay setlements are keeping pace with industry standards. As future pay agreements are confirmed, these assump�ons will be updated in the model.
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15 | P a g e Increase to Na�onal Insurance Contribu�ons As part of the UK Government’s Budget on 30 October 2024 it was announced that there would be changes to employer Na�onal Insurance Contribu�ons (eNICs). The increase to the pay bill is es�mated at 2.2% for direct staff and early indica�ons on the increases likely to be seen on commissioned services could range from 2.2-2.5%. While it is understood that Public Bodies will receive funding to support this addi�onal cost pressure, such funding will be insufficient to meet the overall cost. For Social Care Services it is currently es�mated that funding to Local Authori�es will be c.60% for direct staff therefore the unfunded element of 40% is included in the 2025/26 plan. However, uncertainty over funding for commissioned services means that this cost has not been included and will be funded from reserves un�l more is known. NHSL have been advised by Sco�sh Government that funding may be available to them therefore the assump�on in the plan is that this will be fully funded. The full recurring impact will be included in future MTFP updates. Assump�ons on Increased Demand for Services Including Prescribing Health and social care services are experiencing increasing demand due to demographic growth, an ageing popula�on, complexity of care needs, depriva�on, and health issues. This increase has been factored into the financial plan over the full 10 year period to ensure that costs are adjusted in line with forecast demand, however, close monitoring is required to ensure that demographic growth is in line with assump�ons made. If investment in this area is insufficient over a number of years, this could destabilise services whilst an over-provision of growth would mean the resources available would not be effec�vely allocated in line with need and priority. The amount and cost of drugs prescribed usually increases year on year. The price of drugs is set na�onally and influenced by factors such as supply and demand, currency movements and patents. Prescribing ac�vity is a clinical decision made by a qualified health professional. At the �me of wri�ng, the current prescribing budget is projected to overspend by year end 2024/25. Based on this trend, a volume and price upli� has been included in future projec�ons to mi�gate against deteriora�ng health within the popula�on and the con�nuing uncertain�es experienced in supply and demand due to fluctua�ng market condi�ons. Investment in Local Priori�es Including IT Improves and Upgrades A range of local priori�es are included in the LTFO including digital and IT technology improvements, inves�ng in home support and tests of change pilots. Depending on when the cost commitment is expected to be incurred and expected dura�on, the cost pressures will be recognised in the year it is forecast to materialise. Legisla�ve and Na�onal Policy Decisions There are a range of legisla�ve and policy developments which have and are con�nuing to be implemented across the partnership. To date, addi�onal funding has been made available by the Sco�sh Government to take these policies forward and it is assumed that the expenditure will be contained within the funding available. Recognising this, no varia�on in the cost projec�on is therefore considered, however, if future funding from Sco�sh Government is withheld or withdrawn, the financial forecast could change.
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REPORT Item No: 11 SUBJECT: 2025-26 Delegated Health and Social Care Budget TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 19 March 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report describes the financial allocation and budgets made available to the Integration Joint Board (IJB) for 2025/26 by North Lanarkshire Council and NHS Lanarkshire. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Agree to accept the delegated social care budget for 2025/26 in section 8.4 subject to any final adjustments in relation to recurring budget adjustments in March 2025 (2) Agree to accept the delegated health budget for 2025/26 in section 9.4 subject to any final adjustments in relation to recurring budget adjustments in March 2025 and any further funding allocated by the Scottish Government (3) Approve a drawdown of reserves, if required, in order to fund any shortfall in funding for 2025/26 (4) Acknowledge that both NHSL and NLC have passed through full budget uplifts as received from Scottish Government. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire IJB is a legal entity in its own right and is accountable for the stewardship of public funds and ensuring that its business is conducted under public sector best practice governance arrangements, including ensuring that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. 5.2 The budget delegated by our two partner bodies, is used by the IJB to commission services, which are delivered by North Lanarkshire University Health and Social Care Partnership (the Partnership). The principles of the funding allocated by the two partner organisations is set out in the Integration Scheme, however, utilisation of this funding is delegated to the IJB. 5.3 Under the terms of the Integration Scheme, partner organisations should make appropriate arrangements to fund pay awards, contractual uplifts, the impact of demographic changes and determine efficiency targets as part of their respective budget setting processes. 5.4 The role of the Chief Finance Officer (CFO) for the IJB includes both the adherence to professional standards as well as compliance with the Local Government (Scotland) Act 1973. For the IJB this includes the requirement to ensure a balanced budget is set. 6. CONCLUSIONS 6.1 This report sets out the implications of the Scottish Government budget for 2025/26 and provides an overview of the IJB’s budget allocation for 2025/26. 6.2 Over the medium term, significant uncertainty remains, and the Partnership will require to continue to plan for a wide range of potential scenarios. During the past number of years, the Partnership has taken a medium-term view of its financial position, agreeing transformation and redesign which have ensured a balanced budget year on year. However, the continuing rise in costs and demand, continues to provide uncertainty resulting in challenging times for services and the need for ongoing review and realignment of future transformation and savings plans. 6.3 In this context, it is more than likely that the Partnership will need to draw on the financial flexibilities available to the IJB to provide non-recurring support to balance the annual revenue budget position each year over the medium-term. 7. SCOTTISH GOVERNMENT BUDGET 2025/2026 7.1 The cabinet Secretary for Finance and Local Government announced the Scottish Government’s budget for 2025-26 in Parliament on 4th December 2024. The Director of Health & Social Finance said this budget provides: “a platform for the health and social care system to focus on reform and innovation. We must work as a whole system and across organisational boundaries to improve outcomes and deliver the best possible care within our available resources” 7.2 However it is widely expected that the public sector in Scotland will continue to face a very challenging financial outlook for the foreseeable future. 7.3 It therefore remains important that the Partnership ensures sufficient flexibility to manage, in a sustainable manner, the position which emerges over the coming years, with the likely scenario that a significant level of further recurring savings will be required.
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8. DELEGATED SOCIAL CARE BUDGET 2025/26 8.1 Similar to 2024/25 and as previously highlighted, demographic, and socio-economic factors continue to drive significant demand and cost pressures for 2025/26 relating to: • Funding for pay awards. • Cost pressures arising from contractual arrangements which are subject to renewal. • Financial impact of the negotiated application of the increased living wage across the sector. • Estimated increases associated with the National Care Home Rate (NCHR) contract. • Ongoing pressures on home support service in relation to costs associated with shifting the balance of care, supporting people to live safely at home for as long as possible and facilitating prompt discharge from hospital. • Increasing investment in self-directed support packages required to support adults and carers to achieve improved outcomes and live independently. 8.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for social care services in 2025/26 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £31m, including the increase to the living wage. 8.3 At its meeting on 20 February 2025, North Lanarkshire Council approved a recurring net uplift to the social care budget for the Scottish Living Wage of £7.793m. A further £0.300m has been approved to for the Children’s Social Care Pay Uplift, giving a total uplift from NLC of £8.093m. 8.4 The following table provides a summary of the indicative social care budget 2025/26 from North Lanarkshire Council: Social Care Budget 2025/26 £m Opening Budget 209.517 Uplift Scottish Living Wage 7.793 Children's Social Care Pay Uplift 0.300 2025/26 Budget 217.610 8.5 The CFO recommendation to the IJB is, to note and accept the delegated social care budget offer from North Lanarkshire Council for 2025/26 subject to any final adjustments in relation to recurring budget adjustments in March 2025. 9. DELEGATED HEALTH BUDGET 2025/26 9.1 Similar to social care, demographic and socio-economic factors continue to drive significant demand and cost pressures for our delegated health services in 2025/26 including: • Pay inflation and the impact of agenda for change. • Inflationary cost pressures across service level agreements on non-pay budgets. • Prescribing cost, volume, and short supply impact. 9.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for health services (not including Set Aside) in 2025/26 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £28m.
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9.3 The NHSL Board has approved a general allocation of £10.154m as well as a further £2.500m from the NRAC allocation giving a total contribution of £12.654m. 9.4 The following table provides a summary of the indicative health budget 2025/26 from NHS Lanarkshire: Health Budget 2025/26 £m Opening Budget 323.164 Set Aside Budget 77.397 General Allocation 10.154 Children's Social Care Pay Uplift 2.500 2025/26 Budget 413.215 9.5 The CFO recommendation to the IJB is, to note and accept the delegated health budget offer from NHS Lanarkshire for 2025/26 subject to any final adjustments in relation to recurring budget adjustments in March 2025, and any further funding allocated by Scottish Government during 2025/26. 10. FINANCIAL PLAN 2024/25 10.1 A 3 year Medium Term Financial Plan (MTFP) has been prepared taking the 2024/25 budget as a base line and updates on the key financial planning assumptions that will have the greatest impact on the Partnerships forecast financial position in the medium term. A range of risk-based scenarios were considered resulting in envisaged, pessimistic and optimistic positions with the envisaged position being the most appropriate for planning purposes. This medium-term position has an estimated recurring funding pressure in 2025/26 of £14.729m; to address this a number of service redesign and transformation proposal have been submitted to the IJB for approval as part of the MTFP report. 10.2 Alongside the MTFP, a Long Term Financial Outlook (LTFO) has also been prepared for the period 2025-2035 and highlights cost pressures ranging from £40.020m to £58.075m. This outlook reflects the economic outlook, adopting a strategic and sustainable approach linked to the delivery of priorities in the Strategic Commissioning Plan. These strategic priorities will continue to provide a focus for future budget decisions, where the delivery of core services must be balanced with the resources available. The financial plans and reserves strategy focuses on financial sustainability, acknowledging the uncertainty around key elements and the need to redirect resources to support the delivery of key priorities. 10.3 It is recognised that service redesign and savings plans take time to implement therefore, to mitigate the risk to the IJB, contingency reserves may be needed to fund the gap until the full savings can be realised. 11. IMPLICATIONS 11.1 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 ☐
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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 ☒ 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 11.5 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) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is Financial information is shared with stakeholders on a regular basis and
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shaping and influencing service development and delivery 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. 11.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 12. BACKGROUND PAPERS None. Nicola Scott Chief Finance Officer Members seeking further information, please contact Nicola on 07581 007187. CHIEF ACCOUNTABLE OFFICER (or Depute)
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REPORT Item No: 12 SUBJECT: IJB Reserves Strategy 2025/26 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 19 March 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integrated Joint Board (IJB) for: For approval For endorsement For noting 1.2 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge the contents of the report. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Consistent with a number of other Health and Social Care Partnerships, an underspend of £18.710m was reported in the 2023/24 Annual Accounts which were presented to the IJB on 25 September 2024. This underspend included funding made available by the Scottish Government to progress policy commitments and national priorities and was transferred to reserves. 5.2 The 2024/25 reserves position has been reported to the IJB throughout this year. During January 2025 an exercise was undertaken within Health Services to reinstate a number of drawdowns that had been undertaken during the year. These were in relation to areas where 2024/25 funding was received and it was decided that this Yes No N/A
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funding would be used in year to allow the reserves balances to remain in place. This is a change in practice to previous years and amounts to £10.945m as shown in Table 2. 5.3 The annual review of the Partnership’s reserve strategy has been undertaken. As part of the financial planning process the reserves held have been assessed to ensure these remain consistent with current priorities. As a result of this exercise no realignments are proposed at this stage. This will be reviewed again following the closure of the 2024/25 accounts and a further report will be brought to the next IJB in June 2025. 6. CONCLUSIONS 6.1 It is essential for the long-term financial stability and the sustainability of the Partnership that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that section 106 public bodies do not over-commit themselves financially. 6.2 The IJB Reserves Strategy 2025/26 provides an opportunity to strengthen long-term financial sustainability by considering all current reserves to ensure those held are still required and sufficient to meet on-going pressures. The IJB Reserves Strategy 2025/26 will enable the IJB to balance current commitments whilst planning and addressing financial risks. 7. IJB RESERVES STRATEGY 2025/26 7.1 As detailed Table 1, the reserve balances at 31 March 2024 were £75.524M. This figure comprised of £20.975m earmarked reserves to support the delivery of projects which span financial years and £24.114m ring-fenced monies to enable the Partnership to deliver on specific Scottish Government funded programmes. The remaining balance of £30.435m, are risk-based and contingency reserves which are not held to meet any specific liability and offer the Partnership some flexibility to deal with unforeseen events or emergencies. Table 1 LEAD SUMMARY Balance as at 31 March 2024 £m NHSL Ring-Fenced Reserves 24.114 NHSL & NLC Earmarked Reserves 20.975 NHSL & NLC Risk Based reserves 17.045 NHSL Contingency Reserve 13.390 TOTAL 75.524 7.2 A further in-year analysis and review was carried out with both partners in respect of all reserves to ensure the reserves held in 2024/25 and going into 2025/26 were still required and sufficient to meet on-going pressures. 7.3 No changes have been identified as a result of this review however this will be monitored on an ongoing basis.
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7.4 Reserves are utilised as required throughout the year and table 2 shows the projected year end position at 31 March 2025. Table 2 7.5 A detailed analysis of the realignment and audit trail of the movement of reserves throughout this financial year is at Appendix 1. 8. RISK 8.1 As part of the development of the financial plan and in line with the Partnership’s Medium term Financial Plan, if possible, it is recommended that the risk-based and contingency reserves are established as a percentage of the mainstream financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 8.2 The Partnership’s contingency and risk reserves currently equate to 4.5% of the financial envelope, however, following completion of the 2024/25 financial year end, it is anticipated this percentage may increase. 9. IMPLICATIONS 9.1 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 ☒ LEAD SUMMARY Opening Balance as at 1 April 2024 Transfers To / From Reserves Use of Reserves Revised Balance as at 31 March 2025 £m £m £m £m NHSL Ring-Fenced Reserves 24.114 10.945 (10.531) 24.529 NHSL & NLC Earmarked Reserves 20.975 0.000 (1.969) 19.006 NHSL & NLC Risk Based reserves 17.045 0.000 0.000 17.045 NHSL Contingency Reserve 13.390 0.000 (0.250) 13.140 75.524 10.945 (12.749) 73.720TOTAL
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9.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 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 National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 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 The Director of Finance of NHSL and the Chief Officer (Finance) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ 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
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☒ 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. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10. BACKGROUND PAPERS None. 11. APPENDICES Movement of Reserves Year to Date Appendix 1 Nicola Scott Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola on telephone number 07581 007187. CHIEF ACCOUNTABLE OFFICER (or Depute)
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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 31 January 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.597 0.860 (1.021) 3.436 (0.161) 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Dis 0.106 (0.029) 0.077 (0.029) 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.194 (0.039) 0.155 (0.039) 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 2.849 2.849 0.000 1, 2, 4, 5 NHSL Community Living Change Fund 1.164 (0.116) 1.048 (0.116) 1, 4, 5 NHSL District Nursing 0.292 0.178 (0.292) 0.178 (0.114) 1, 2, 3, 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 0.276 (0.322) 0.915 (0.046) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 0.193 (0.233) 0.193 (0.040) 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 0.730 (0.730) 0.730 0.000 1, 2, 4, 5 NHSL Mental Health Covid Clinicians 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 0.337 (0.274) 1.035 0.063 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.110 0.221 0.110 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 3.375 (3.396) 3.375 (0.021) 1, 2, 4, 5 NHSL Mental Health Eating Disorders 0.036 0.036 0.000 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.074) 0.000 (0.074) 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 1, 2, 4, 5 NHSL Mental Health Wellbeing in Primary 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-D 2.719 2.719 (2.719) 2.719 0.000 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming 0.013 (0.012) 0.001 (0.012) 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NE 0.341 0.640 (0.341) 0.640 0.299 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.348) 0.274 (0.348) 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 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 To Improve 0.247 (0.172) 0.075 (0.172) 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.027 (0.013) 0.014 (0.013) 3 NHSL MH Outcomes 1.527 1.527 1.527 1, 2, 4, 5 24.114 10.945 (10.531) 24.529 0.414 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 January 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter Preparedness F 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 with C&F and NHSL) 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 year funding) 0.705 (0.285) 0.420 (0.285) 1, 2, 5 NLC Business Case - Non-Recurring NLC 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 Mental Health 0.268 0.268 0.000 4 NHSL Childrens Services - Paediatric Band 7, 0.107 (0.107) 0.000 (0.107) 3 NHSL Development of Chryston Community 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - Double Running 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy Technology 0.465 0.465 0.000 2, 3 NLC Digital and IT Strategy Technology 3.699 3.699 0.000 2, 3 NLC Digital and IT Strategy Technology 0.389 0.389 0.000 NLC Digital and IT Strategy Technology 0.700 0.700 0.000 2, 3 NLC Financial Strategy - Changes to LA 0.027 0.027 0.000 NHSL Health Inequalities - Screening 0.044 (0.023) 0.021 (0.023) 2 NHSL Health Visiting Students/Trainees 0.311 (0.279) 0.032 (0.279) 3 NLC Home Support Resilience (2 year 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 funding) 0.360 0.360 0.000 1, 4, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NLC Mental Health Social Workers 2 x NL10 0.162 0.162 0.000 3, 4 NHSL Mental Health Wards Window 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics Dieteics 0.450 (0.146) 0.304 (0.146) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and 0.569 (0.031) 0.538 (0.031) 1, 2, 3 NLC Planned Date of Discharge - Discharge 0.109 0.109 0.000 1, 5 NHSL Podiatry Services - Foot Screening 0.350 (0.007) 0.343 (0.007) 1, 2 NHSL Prisioner Healthcare - Transitional 0.020 (0.019) 0.001 (0.019) 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 3 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.031) 0.029 (0.031) 3 NHSL Sexual Health Services - Forensic 0.152 (0.152) 0.000 (0.152) 1, 2 NHSL Sexual Health Services - Long-Acting 0.404 (0.107) 0.297 (0.107) 1, 2 NLC Social Care Contracting Staff within 0.087 0.087 0.000 3 NLC/NHSL Staff Training Academy 2.042 (0.500) 1.542 (0.500) 3 NHSL Vulnerable and Complex Cases - Test 0.816 (0.273) 0.543 (0.273) 5 20.975 0.000 (1.969) 19.006 (1.969) Ambition Statement & Performance TOTAL EARMARKED RESERVES TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing APPENDIX 1 LEAD RING-FENCED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance
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Opening Balance As At 1 April 2024 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 31 January 2025 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 31 January 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 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 31 January 2025 Movement in Reserves 2024/25 £m £m £m £m £m 0.000 0.000 0.000 0.000 0.000 75.524 10.945 (12.749) 73.720 (1.804) KEY 1 2 3 4 5 Improve mental health and wellbeing. Supporting people through a whole family approach. TOTAL CLOSED RESERVES TOTAL RESERVES Ambition Statement & Performance Do the right thing first time. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Develop and support a workforce for the future. Ambition Statement & Performance TOTAL CONTINGENCY FUND RESERVES LEAD CLOSED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing LEAD RISK-BASED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance
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1 REPORT Item No: Item 13 SUBJECT: Risk Management Report TO: Integration Joint Board Committee Lead Officer for Report: Claire Rae, NL HSCP Chief Officer Author(s) of Report Morag Dendy, Chief Officer / Head of Service (Performance, Planning, and Quality Assurance) DATE: 19 March 2025 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: ☐ Morag Dendy, Chief Officer / Head of Service (Performance, Planning and Quality Assurance)
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2 3. RECOMMENDATIONS 3.1 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. 3.2 The IJB may wish to consider the inclusion of climate change risk to the IJB risk register to align risk sharing across parent organisations. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 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. 5.2 The IJB PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 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 5.4 The following risks are rated high on the IJB risk register. • 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 Yes ☐ No ☒ N/A ☐
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3 • IJB 23/24- Speech and Language Therapy 5.5 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). 6. CONCLUSIONS 6.1 The IJB currently has 19 risks identified on its IJB risk register with 11 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S)
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4 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Yes ☒ No ☐ N/A ☐
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5 ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Overview Dashboard Appendix 2 – Risk Register . Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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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 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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8
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Item 13.1 NL H&SCP Risk Overview Report Meeting Name – IJB Reporting Period: IJB Risk Register – March 2025
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NL HSCP IJB Risk – Dashboard March 2025 Executive Summary Risk Register Number of Risks IJB 19 NL Council 21 NHS Lanarkshire 21 Risk movement since last report No Change Increase Decrease New Closed Riskswith updated actions 0 0 19 Risk Score Trend IJB06/21 PrescribingActivityand Costs VH IJB.01/21 Financial Challenges VH IJB.21/24 Pharmacy Pressures within Prison Service VH IJB Highest Scoring Risks NL H&SCP Risks Reported to Assurance Committees Service risks- Service level Level 3- North Health Professional/ Operational Group and Support Care and Clinical Governance IJB Risk Register – IJB and IJB PFA Level 2- Core Risk Overview Process NL H&SCP
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Risk in Focus –Pharmacy Pressures within Prison Service Risk Description Risk Owner Risk Lead Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. MT CR Current Controls CONTROLS • Reviewofthedispenseprocesseswithintheprison • Implementationofguidelines • Improvedcommunicationwithpharmacyprovider Actions ACTIONS • PrescribingActionGroupre-establishedtotryandmanagethenumberofitemsprescribed • Developmentofpainandmedicinemanagementpathways • Reviewofprescribinghabits Risk Trend FollowingthePrisonerHealthcareReportpresentedto IJB PFAonthe 22nd May 2024. The IJB PFArecommendedthat a PharmacyPressurewithinPrisonServiceRisk wasadded to therisk register. Target- Low Current – Veru High
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Risk in Focus –Financial Challenges Risk Description Risk Owner Risk Lead Financial Challenges 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: NS NS Current Controls CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023-26 and reserves strategy 2023-24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget Risk Trend No Movement Increasing financial pressures have resulted in no movement of the risk rating for this risk. Further controls and actions are currently being reviewed Target- Medium Current – Very High
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Risk in Focus –Prescribing Activity and Costs Risk Description Risk Owner Risk Lead The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. CR NS Current Controls 1. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 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 productsRegulatory Agency (MHRA) became the UK’s sovereign regulator. 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. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new tradedeal, the Northern Ireland protocol and the UK Internal Market Act. 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 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 Risk Trend No movement Consider any still ongoing, however good progress has been made regarding achievement of the prescribing target for 2024-25 Target- Low Current – Very High
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Financial Challenges CONTROLS Previously 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 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 which may lead to an overspend. 11. Consultation and involvement with key stakeholders including service users and carers. Review and updated Oct 2024 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. Reviewed and no changes March 2025 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. 14. The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. 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 4. Review the Audit Scotland Bulletin released on the 6 March 2025 Prevention and Detection of Fraud, Bribery and/or Corruption CONTROLS There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW 1. Fraud awareness e-learning. 2. National Fraud initiative. Reviewed and Updated Oct 2023, 3. Locality/SW Enablement Groups. (previously title ineffective governance arrangements). IJB.01/ 21 Financial Strategic 01/04/2021 VERY HIGH Medium Nicola Scott Nicola Scott SLT, IJB PFA, IJB 31.01.2024 Risk level (Target) Risk Owner Risk Register Lead Assuran ce Source Next Review Date Closed DateIJB ID Category Opened Date Description of Risk Mitigating Controls Risk level (Current Risk level (Initial) Previously IJB6. Reviewed and updated on March 2023.
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4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 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. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. Reviewed and no changes Oct 2024 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 partnerbodies. 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 Reviewed and no changes March 2025 ACTIONS 1. Continue to raise fraud awareness through teambriefings. 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. Notional Set-Aside Budget CONTROLS 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. 3. Bed modelling and capacity planning arrangements are in place. 4. Effective working relationships between both partners and the IJB have been established. 5. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set-aside budget. This arrangement continues to be in place for 2022/23 ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. Reviewed July 2024. Reviewed Sept 2024 Reviewed Oct 2024 and no changes (awaiting SG info) 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 Reviewed March 2025 Hosted Services CONTROLSVERY HIGH 1. North and South IJBs aim to co-operate to ensure a pan-Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. Reviewed Sept 2024 Reviewed Oct 2024 and no updates Reviewed March 2025 Prescribing Activity and Costs CONTROLS IJB02. 21 Financial Reputational 01/04/2021 LOW LOW Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 Nicola Scott HIGH MEDIUM Claire Rae MEDIUM Claire Rae IJB04. 21 Financial Strategic 01/04/2021 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. Reviewed May 2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Jan 2024 Reviewed May 2024 l d d SLT, IJB PFA, IJB 31.01.2025 MEDIUM Reviewed May 2024 Reviewed July 2024 Nicola Scott SLT, IJB PFA, IJB 31.01.2025 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. 01/04/2021 Financial StrategicIJB05. 21
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Medium 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 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. 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 Reviewed October 2024 no changes Reviewed March 2025 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 Third and Voluntary Sector CONTROLSHIGH 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. Reviewed July 2024 Reviewed and no changes Sept 2024 ACTIONS Reviewed March 2025 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 Ineffective Governance Arrangements CONTROLS1. 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 MEDIUM 1.National Networks are established which are providing the framework to support a national approach where appropriate. 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. 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. 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. IJB06. 21 Financial Operational 01/04/2021 VERY HIGH LOW Claire Rae Nicola Scott IJB.10. 21 Financial Strategic 01/04/20 LOW LOW Claire R LOW LOW Claire Rae Nicola Scott The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. IJB07. 21 Financial Strategic 01/04/2021 There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long-term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. Nicola Sc SLT, IJB PFA 31.01.20 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated (risk increased) October 2023. Reviewed Jan 2024 SLT, IJB PFA, IJB 31.01.20259. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. SLT, IJB PFA, IJB Previously IJB16. Reviewed April 2024. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. Reviewed June 2024. Reviewed and updated June 2023. 31.01.2025
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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, in particular front-line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law7. 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. Review March 2025 10. Recent review of Internal Audit team programme of work and participation in the IJB. 11. Review of IJB / PFA self assessment session Oversight of Performance Activity CONTROLS Reviewed May 2024. 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. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. Reviewed and no changes Sept 2024 Review March 2025 Staff Health & Wellbeing CONTROLS Reviewed and Updated May 2023. 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). Rest & Recuperation areas identified. Peer Support Networks established Reviewed Sept 2024 Well established Occupational Health supports available to support staff sickness. Review March 2025 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 Care Homes CONTROLS Establishment of Care Home Assurance Team. Escalation Process in place. National protocol to support discharge of Covid 19 patients in place. Reviewed Sept 2024 ACTIONS Review March 2025 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 CAMHS CONTROLS 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 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 021 ae 30.08.21 IJB.13. 2021 Performance IJB.11 21 Performance 30/07/2021 LOW LOW 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. medium medium IJB.12. 21 Performance 30/08/2021 HIGH low cott A, IJB 025 31.01.2025 MEDIUM HIGH Claire Rae Claire Rae Claire Rae There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. 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. Reviewed and updated Oct 2023 Reviewed and Risk level lowered June 2024. Reviewed May 2024. Reviewed May 2024. . Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and risk level lowered May Morag Dendy SLT, IJB PFA, IJB 31.01.2025 Joanne Jenkins IJB, PF&A, SLT, SC&SC, A H &SC 31.01.2025 Claire Rae SLT, IJB PFA, IJB, SC&CG, AH&SC
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Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 Continuous review and validation of the waiting list Reviewed and no changes Sept 2024 Waiting list validation exercise completed in April 2022 with reduction in list by 16% Reviewed and no change March 2025 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 Cost of Living CONTROLS NLC Silver command group stood up focused on cost of living NHSL commenced review through CMT Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 ACTIONS Reviewed Sept 2024 Survey of NLC hybrid workers to see if home working remains financially viable Reviewed March 2025 Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost. National Care Service CONTROLS Reviewed and Updated May 2023. NLC establishing NCS working groups Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA 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 Reviewed Oct 2024 no changes SG/COSLA working groups being established - local reps nominated for each Reviewed March 2025 National Advisory Group being established. Unscheduled Care CONTROLS Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 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. 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 New CSW roles in District Nursing teams to proactively support Care Managed patients Reviewed Oct 2024, no changes Additional Nursing capacity in District Nursing Teams Reviewed March 2025 Expansion of Equipment and Adaptation Service to support rapid access in community IJB.17. 2022 Strategic & Performance 05.09.22 IJB.16. 2022 Strategic 05.09.22 Strategic & Performance 30.04.22 IJB.15. 2022 Strategic & Performance 05.09.22 High Medium Claire Rae Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges 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. 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. Medium Medium Claire Rae There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non-clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. High Medium 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. Claire Rae High Low Diane Fraser Reviewed and Updated May 2023. 2024. Reviewed and Updated Oct 2023. Reviewed and Updated May 2024 Reviewed Oct 2023. Reviewed May 2024. Claire Rae SLT, IJB 31.01.2025 Claire Rae SLT, IJB PFA, IJB 31.01.2025 Claire Rae SLT, IJB PFA, IJB, ASW C&W B 31.01.2025 Reviewed and Updated in June 2023. VERY HIGH HIGH HIGH Very High Morag Dendy IJB,PF&A, SLT 31.01.2025 IJB.14. 2022
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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) Community Alarms CONTROLS Working group established to coordinate all activity Oversight through Home Support Programme Board Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB 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 Reviewed Oct 2024 NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Reviewed March 2025 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 Service Sustainability CONTROLS IJB PFA Committee. High Low IJB Chief Officer is a member of each partner's key decision-making forums. Reviewed and 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. 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. Reviewed Oct 2024 Consultation and involvement with key stakeholders including service users and carers. Reviewed March 2025 Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS Sustainability plans to be reviewed regularly Re-introduction of scrutiny panels Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. Review of reporting process into IJB to ensure continuous review of services/ service developments. Development of the programme of work to ensure regular reporting structure in place for service review. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. Workforce Sustainability CONTROLS All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one-off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. High Medium Updated May 2023 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. 31.01.2025 31.01 SLT, IJB PFA, IJB Claire Claire SLT, IJB Reviewed and Updated May 2023 It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non-EEA countries are subject to the same immigration rules.The new points-based immigration system makes exceptions for the majority of health care professionals with an NHS job Claire Rae Claire Rae HIGIJB.20. IJB.19. 2023 27/02/2023 HIGH High There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Performance 31.01.2025 Claire Rae SLT, IJB PFA, IJB, ASW C&W B Reviewed April 2024. Reviewed Oct 2023. Reviewed Jan 2024. Reviewed and updated June 2023. IJB.18. 2022 Strategic and Performance 05.09.22 Medium Low Diane Fraser
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Development of the Care Academy Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment Reviewed Sept 2024 Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. Reviewed March 2025 Pharmacy Pressures within Prison Service CONTROLS Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS Prescribing Action Group re-established to try and manage the number of items prescribed Development of pain and medicine management pathways Review of prescribing habits Speech and Language Therapy (SLT) Service CONTROLS 1. Good communication processes, and the sharing of information and practical learning online have been established and will be further developed as service improvement work progresses. Added to the register 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. Reviewed Oct 2024 3. Revised workforce planning, incorporating the best-practice and learning from other areas who have specialist children’s health services units. Reviewed March 2025 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 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. IJB PFA, IJB 31.01.2025 Claire Rae IJB PFA, IJB 31.01.2025 .2025 e Rae e Rae PFA, IJB Financial Reviewed April 2024. Added to register June 2024 and reviewed Sept 2024 Reviewed March 2025 Reviewed and updated Jan 24 IJB23.24 Performance Jul-24 There is a risk that the SLT service cannot meet the increasing clinical demands with variance in waiting list length by area, continued challenges around the recrutiment and retention of new colleagues, funding streams from Local Authority being reduce therefore reducing staff WTE. IJB21.24 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. offer and for qualified social workers via a new fast-track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers.The Mutual Recognition of Professional Qualifications Directive is an EU-wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. High High Low Claire Rae Claire Rae Jun-24 High Very High Low Claire Rae GH2023
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1 REPORT Item No: 14 SUBJECT: IJB Directions Letters TO: Integration Joint Board Committee Lead Officer for Report: Claire Rae Chief Officer Author(s) of Report Morag Dendy Head of Planning, Performance and Quality Assurance DATE: 19 March 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 1.2 This report seeks the approval of the IJB in regard to the issue of the directions to each partner for 2025/2026 in line with the Strategic Commissioning Plan and the IJB Financial Plan. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐
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2 2.1 This paper has been prepared by the Head of Planning, Performance and Quality Assurance and has been reviewed by the Chief Officer and Chief Financial Officer. 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: 3.1.1 Approve the issue of the directions to North Lanarkshire Council for the financial year 2025/2026 attached at Appendix 1 3.1.2 Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2025/2026 attached at Appendix 2 4. VARIATIONS TO DIRECTIONS? 4.1 The directions to each partner for 2025/2026 are detailed within Appendix 1 and 2 of this report. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board is required to issue a direction to Lanarkshire NHS Health Board and North Lanarkshire Council in respect of the delivery of integrated functions and how resources are to be allocated for the resultant services. 6. CONCLUSIONS 6.1The letters of direction are attached at Appendix 1 and Appendix 2 and, following the approval of the IJB, will be issued to North Lanarkshire Council and Lanarkshire Health Board by 31st March 2025. 6.2The focus for the year ahead will be on implementation of the programme of work of the IJB’s Strategic Commissioning Plan 2023-26. 6.3 The financial resources available are detailed in Annex 4 of each direction. The budget for 2025/26 is indicative at this stage. A range of estimates have been agreed Yes ☒ No ☐ N/A ☐
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3 by the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions of North Lanarkshire Council in respect of the preparation of the IJB Financial Plan 2025/2026 which will be updated during the course of 2025/2026 when costs and additional funding, as appropriate, are confirmed. As part of the detailed budget setting process, the financial allocations to each partner will therefore be finalised by the IJB Chief Financial Officer, in consultation with the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions for North Lanarkshire Council. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.2.1 A comprehensive performance framework is established across the health and social care partnership to monitor progress in respect of the achievement of agreed outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.3.1 Budget monitoring reports will be submitted to the Performance, Finance and Audit Committee and the IJB in accordance with the Financial Regulations. Yes ☒ No ☐ N/A ☐
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Financial Risk High Chief Finance Officer 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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5 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1- Letter of Direction to North Lanarkshire Council Appendix 2 - Letter of Direction to NHS Lanarkshire. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Claire Rae Claire.Rae@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 Appendix 1 Councillor Jim Logue Leader of North Lanarkshire Council 31st March 2025 Dear Councillor Logue As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct North Lanarkshire Council to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2025/2026 is therefore set out in Annexes 1, 2 and 3. North Lanarkshire Council is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (a) The Integration Delivery Principles (b) The Integration Scheme (c) The Strategic Commissioning Plan 2023 - 2026 (d) The National Health and Wellbeing Outcomes (e) All Legal and Regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2025/2026. The budget allocation for the delegated functions is outlined in Annex 4 and reflects the financial planning principles agreed at the IJB on 19th March 2025. The detailed budget setting process for the financial year 2025/2026 is being finalised. Once this
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7 work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2025. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved on the 19 March 2025 covering the period 2025-2028. The directions correspond to the revised responsibilities delegated to the IJB which exclude Children and Family Services and Justice Services. In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high- level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank North Lanarkshire Council for the continued support during this period of significant change. We will continue to ensure that Elected Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Claire Rae Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ann McCrory, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board;
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8 Des Murray, Chief Executive, North Lanarkshire Council; Colin Lauder, Interim Chief Executive, Lanarkshire Health Board.
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9 DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: NORTH LANARKSHIRE COUNCIL 31 MARCH 2024 1. The North Lanarkshire Integration Joint Board is required to give Direction to North Lanarkshire Council on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1 April 2025. 2. The North Lanarkshire Integration Joint Board is required to set out in writing how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used. 3. North Lanarkshire Council must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs North Lanarkshire Council: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and programme of work as set out in Annex 2; c. that the carrying out of all functions will be delegated to North Lanarkshire Council on the express understanding that North Lanarkshire Council will delegate those functions to Officers of the Council in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them.
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10 Signed on behalf of the North Lanarkshire Integration Joint Board Claire Rae Chief Officer North Lanarkshire Integration Joint Board Date: 19 March 2025 1 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 2 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 3 Section 27(1)(a), (b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 4 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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11 FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Column A Enactment conferring function Column B Limitation National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45 (Recovery in cases of misrepresentation or non-disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 (Powers of Secretary of State.) So far as it is exercisable in relation to another integration function. Section 8 (Research.) So far as it is exercisable in relation to another integration function. Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function.
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12 Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Column A Enactment conferring function Column B Limitation Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Section 27ZA
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13 (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) So far as it is exercisable in relation to another integration function. Column A Enactment conferring function Column B Limitation Section 80 (Enforcement of duty to make contributions.) Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of
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14 assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions. Column A Enactment conferring function Column B Limitation The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Section 12 (Investigations.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.)
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15 Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Column A Enactment conferring function Column B Limitation Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation outwit Scotland.) Section 6 Deferred payment of accommodation costs.) Section 14
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16 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co-operation.) Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.) Section 259 (Advocacy.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Column A Enactment conferring function Column B Limitation Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.)
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17 Section 6 (Duty to consider importance of providing advocacy and other.) Section 7 (Visits) Section 8 (Interviews) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk) Section 18 (Protection of moved person’s property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.) Section 43 (Membership.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.) Column A Enactment conferring function Column B Limitation
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18 Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self-directed support.) Carers (Scotland) Act 2016 (b) Section 6 (Duty to provide Adult carer support plan Section 21 (Duty to set local eligibility criteria) Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers)
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19 Column A Enactment conferring function Column B Limitation Section 35 (short breaks services statements) Part 2 Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services; h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services;
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20 q) Re-ablement services’ r) Smart technology, equipment and telecare NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 and the Programme of Work are both available on the following web-site: https://hscnl.org.uk/about-us/ The progress report and the update in respect of the Programme of Work for the North Lanarkshire Health and Social Care Partnership is available on the following web-site: https://hscnl.org.uk/about-us/ The report outlining the Winter Planning and Enhanced Supports for North Lanarkshire Health and Social Care Partnership is available on the following web- site: att97950.pdf (northlanarkshire.gov.uk) SCHEME OF DELEGATION TO OFFICERS OF NORTH LANARKSHIRE COUNCIL ANNEX 3 This is the Appendix 1 referred to in the foregoing Authorisation of the Chief Officer to Officers of North Lanarkshire Council Column A Enactment conferring function Column B Limitation Column C National Assistance Act 1948 Section 48 (Duty of Councils to provide temporary protection for property of persons admitted to hospitals etc.). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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21 The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Provisions relating to performance of functions by local authorities.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Research.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AZA (Assessments under Section 12A – assistance) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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22 Section 12AA (Assessment of ability to provide care.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AB (Duty of local authority to provide information to carer.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13A (Residential accommodation with nursing.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13B (Provision of care or aftercare.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Home help and laundry facilities.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29
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23 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Chief Social Work Officer Chief Accountable Officer Head of Housing Property Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 3 (Assessment by local authorities of needs of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C welfare enactments within the meaning of Section 16 and which have been delegated. Head of Adult Social Work Services Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in Section 16 of that Act) which are integration functions. Chief Social Work Officer Chief Accountable Officer Head
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24 of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Investigations.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Column A Enactment conferring function Column B Limitation Column C Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44
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25 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered social landlord for housing purposes.) Only in so far as it relates to an aid or adaptation. Head of Housing Services Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 5 (Local authority arrangements for of residential accommodation outwit Scotland.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 Except in so far as it is exercisable in relation to Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Care and support services etc.) the provision of housing support services. Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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26 Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 33 (Duty to inquire.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 34 (Inquiries under Section 33: Co-operation.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 228 (Request for assessment of needs: duty on local authorities and Health Boards Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 259 (Advocacy.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Head of Housing Services The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Co-operation.) Chief Social Work Officer
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27 Column A Enactment conferring function Column B Limitation Column C Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Duty to consider importance of providing advocacy and other.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Assessment Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Removal Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 18 (Protection of moved person’s property.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Right to apply for a Banning Order.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Urgent cases.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Adult Protection Committees.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 43 (Membership.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 Chief Social Work Officer
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28 Column A Enactment conferring function Column B Limitation Column C (Choice of options: Adults.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Choice of options under Section 5: assistances.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Choice of options: Adult Carers.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Provision of information about self-directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Local authority functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Eligibility for direct payment: review.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under Section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Misuse of direct payment: recovery.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19
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29 (Promotion of options for self- directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services National Assistance Act 1948 Section 45 (Recovery in cases of misrepresentation or non- disclosure) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Matrimonial Proceedings (Children) Act 1958 Section 11 (Reports as to arrangements for future care and upbringing of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 5 (Powers of Secretary of State) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6B (Local authority inquiries into matters affecting children). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27ZA
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30 (Advice, guidance and assistance to persons arrested or on whom sentence deferred) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 78A Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Recovery of contributions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Enforcement of duty to make contributions) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 81 (Provisions as to decrees for ailment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 83 (Variation of trusts) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 86 (Adjustment between authority providing accommodation etc. and authority of area of residence) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children Act 1975 Section 34 (Access and maintenance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Reports by local authorities and probation officers) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Notice of application to be given to local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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31 Section 50 (Payments towards maintenance of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Health and Social Services and Social Security Adjudications Act 1983 Section 21 (Recovery of sums due to local authority where persons in residential accommodation have disposed of assets) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Arrears of contributions charged on interest in land in England and Wales) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Arrears of contributions secured over interest in land in Scotland) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Foster Children (Scotland) Act 1984 Section 3 (Local authorities to ensure wellbeing of and to visit foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Notification by persons maintaining or proposing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Notification by persons ceasing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8
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32 (Power to inspect premises) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Power to impose requirements as to the keeping of foster children) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Power to prohibit the keeping of foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children (Scotland) Act 1995 Section 17 (Duty of local authority to child looked after by them) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Local authority plans for services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 20 (Publication of information about services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 21 (Co-operation between authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Promotion of welfare of children in need) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23
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33 (Children affected by disability) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24 Chief Social Work Officer Chief Accountable Officer Column A Enactment conferring function Column B Limitation Column C (Assessment of ability of carers to provide care for disabled children) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24A (Duty of local authority to provide information to carer of disabled child) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 (Provision of accommodation for children etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Manner of provision of accommodation to child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26A (Provision of continuing care: looked after children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Day-care for pre-school and other children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Aftercare) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 30 (Financial assistance towards expenses of education or training and removal of power to guarantee indentures etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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34 Section 31 (Review of case of child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 32 (Removal of child from residential establishment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 36 (Welfare of certain children in hospitals and nursing homes etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 38 (Short term refuges for children at risk of harm) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 76 (Exclusion orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Criminal Procedure (Scotland) Act 1995 Section 51 (Remand and committal of children and young persons) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 203 (Reports) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 234B (Drug treatment and testing order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 245A
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35 (Restriction of liberty orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Column A Enactment conferring function Column B Limitation Column C The Adults with Incapacity (Scotland) Act 2000 Section 40 (Supervisory bodies) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 (Accommodation more expensive than usually provided) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Deferred payment of accommodation costs) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Management of Offenders etc. (Scotland) Act 2005 Sections 10 (Arrangements for assessing and managing risks posed by certain offenders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Review of arrangements) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Adoption and Children (Scotland) Act 2007 Section 1 (Duty of local authority to provide adoption service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Local authority plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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36 Section 5 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 6 (Assistance in carrying out functions under sections 1 and 4) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Urgent provision) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Power to provide payment to person entitled to adoption support service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Notice under Section 18 local authority’s duties) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Looked after children - adoption is not proceeding) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Adoption support plans) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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37 Section 47 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Family member’s right to require review of plan) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Other cases where authority under duty to review plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Re-assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 51 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 71 (Adoption allowance schemes) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Permanence Orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 90 (Precedence of certain other orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 99 (Duty of local authority to apply for variation or revocation) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 101 (Local authority to give notice of certain matters) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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38 Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 105 (Notification of proposed application for order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adult Support and Protection (Scotland) Act 2007 Section 7 (Visits) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Interviews) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Medical examination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Examination of records etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Right to remove adult at risk) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Children’s Hearings (Scotland) Act 2011 Section 35 (Child assessment orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37
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39 (Child protection orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 Chief Social Work Officer Column A Enactment conferring function Column B Limitation Column C (Parental responsibilities and rights directions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Obligations of local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Notice of an application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 60 (Local authority’s duty to provide information to Principal Reporter) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 131 (Duty of implementation authority to require review) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 144 (Implementation of a compulsory supervision order: general duties of implementation authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 145 (Duty where order requires child to reside in a certain place) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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40 Section 153 (Secure accommodation regulations) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 166 (Review of requirement imposed on local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 167 (Appeal to Sheriff Principal: section 166) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 180 (Sharing of information: panel members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 183 (Mutual Assistance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 184 (Enforcement of obligations of health board under section 183) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 8 (Choice of options: children and family members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of information: children under 16) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4
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41 (The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to North Lanarkshire Council (NLC) for the financial year 2025/26 are as follows: 1. The NLC recurring budget allocations for in-scope social care services and housing services. For 2025/26, the total allocation is £209.517m based on the net budget as at January 2025. This budget will be uplifted as appropriate to reflect the 2025/26 additional funding of £8.093m, subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets, including agreed budget realignments, will be confirmed following the detailed budget setting process for 2025/26. 2. The additional funding highlighted at paragraph 1 allocated to NLC in 2025/26 is to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the uplift of the free personal care rate and the contribution to the payment of the Scottish Living Wage. 3. NLC will implement as appropriate any agreed efficiency savings plans, budget realignments and management actions for 2025/26 as detailed in the IJB Financial Plan 2025/26. 4. Additional funding received in-year by the NLC and NHSL partners which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 5. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2025/26 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and NLC’s Chief Officer (Finance).
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42 Appendix 2 Mr Martin Hill Chair of NHS Lanarkshire Health Board 31st March 2025 Dear Mr Hill, As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct NHS Lanarkshire to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2025/26 is therefore set out in Annexes 1, 2 and 3. NHS Lanarkshire is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (f) The Integration Delivery Principles (g) The Integration Scheme (h) The Strategic Commissioning Plan 2023 - 2026 and Programme of Work (I) The National Health and Wellbeing Outcomes (j) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan and Programme of Work at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2025/2026. The budget allocation for the delegated functions is outlined in Annex 4 and reflects the financial planning principles agreed at the IJB on 19 March 2025. The detailed budget setting process for the financial year 2025/2026 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2025.
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43 The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved on the 19 March 2025 covering the period 2025-2028. For completeness, the Health Board are advised that the directions to North Lanarkshire Council continue to correspond to the revised responsibilities delegated to the IJB by North Lanarkshire Council. In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high- level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank NHS Lanarkshire for the continued support during this period of significant change. We will continue to ensure that Health Board Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Claire Rae Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ann McCrory, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Colin Lauder, Interim Chief Executive, Lanarkshire Health Board. Des Murray, Chief Executive, North Lanarkshire Council;
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44 DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: LANARKSHIRE HEALTH BOARD 31 MARCH 2025 1. The North Lanarkshire Integration Joint Board is required to give directions to Lanarkshire Health Board on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1st April 2025. 2. The North Lanarkshire Integration Joint Board is required to set out in writing how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used. 3. Lanarkshire Health Board must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs Lanarkshire Health Board: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and commissioning summary as set out in Annex 2; c. that the carrying out of all functions will be delegated to Lanarkshire Health Board on the express understanding that Lanarkshire Health Board will delegate those functions to Officers of the Health Board in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them.
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45 Signed on behalf of the North Lanarkshire Integration Joint Board Claire Rae Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2025 5 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 6 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 7 Section 27(1)(a), (b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 8 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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46 FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function The National Health Service (Scotland) Act 1978 Column B Limitation All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB ((Functions of Health Boards outside Scotland); section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal medical or dental services); section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 (care of mothers and young children); section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation); section 55 (hospital accommodation on part payment);
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47 section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses); section 75B (reimbursement of the cost of services provided in another EEA state); section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114; The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135;
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48 The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183; The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. Except functions conferred by— section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co-operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital);
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49 section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer); section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall); section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions).
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50 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36. Part 2 Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours’ period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004; and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine;
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51 (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided out with a hospital in relation to an addiction or dependence on any substance. 10. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 11. The public dental service. 12. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C (2) of the National Health Service (Scotland) Act 1978. 13. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 14. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 15. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 16. Services providing primary medical services to patients during the out-of- hours period. 17. Services provided out with a hospital in relation to geriatric medicine. 18. Palliative care services provided out with a hospital. 19. Community learning disability services. 20. Mental health services provided out with a hospital. 21. Continence services provided out with a hospital. 22. Kidney dialysis services provided out with a hospital. 23. Services provided by health professionals that aim to promote public health.
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52 NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 is available on the following web-site: https://hscnl.org.uk/about-us/ SCHEME OF DELEGATIONS ANNEX 3 That the carrying out of integrated functions that relate to the services set out in 1 and 2 below will be delegated to Officers of Lanarkshire Health Board by the Chief Executive of Lanarkshire Health Board at his discretion, in accordance with all applicable legal requirements; 1. Accident and emergency services provided in a hospital; 2. Inpatient hospital services relating to the following branches of medicine: • General medicine; • Geriatric medicine; • Rehabilitation medicine; • Respiratory medicine; • Palliative care services provided in a hospital; That the carrying out of integrated functions that relate to the services set out in 3 to 29 below will be delegated to Officers of Lanarkshire Health Board by the Chief Accountable Officer for the Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 3. Inpatient hospital services relating to the following branches of medicine: • Paediatrics; • Psychiatry of learning disability; • Inpatient hospital services provided by general medical practitioners; • Services provided in a hospital in relation to an addiction or dependence on any substance; • Mental health services provided in a hospital except regionally or nationally organised forensic mental health services.
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53 4. District nursing services; 5. Health Visiting; 6. Allied health professionals in an outpatient department, clinic, or out with a hospital; 7. Public dental services; 8. Primary medical services; 9. General dental services; 10. Ophthalmic services; 11. Pharmaceutical services; 12. Primary care out-of-hours; 13. Geriatric medicine; 14. Palliative care; 15. Community learning disability services; 16. Kidney dialysis services provided out with a hospital; 17. Services provided by health professionals that aim to promote public health; 18. Care Home Liaison; 19. Community Children’s Services; 20. Dietetics; 21. Psychology; 22. Sexual and Reproductive health and Blood Borne Viruses; 23. Speech and Language Therapy; 24. Prisoner Health Care; 25. Podiatry; 26. Mental Health and Learning Disability services; 27. Community Paediatrics; 28. Continence Services; 29. Addiction Services. That the carrying out of integrated functions that relate to the services set out in 30 to 38 below will be delegated to Officers of Lanarkshire Health Board by the Chief
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54 Accountable Officer for the South Lanarkshire Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 30. Community Dental Services; 31. Diabetes Services; 32. Health & Homelessness; 33. Primary Care Administration; 34. Palliative Care; 35. Physiotherapy; 36. GP Out of Hours; 37. Traumatic Brain injury; 38. Occupational Therapy. BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to NHS Lanarkshire (NHSL) for the financial year 2025/26 are as follows: 1. The NHSL recurring budget allocations for in-scope health care services including hosted services. For 2025/26, based on the budget as at December 2024, the total allocation for directly managed services, including hosted services, and the set aside budget of £74.537m is £603.785m. It includes non- recurring funding as at December 2024. This budget will be uplifted as appropriate to reflect the 2025/26 additional funding of £12.654m, subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets will be confirmed following the detailed budget setting process for 2025/26. Non-recurring budgets will be adjusted as appropriate as part of this exercise. 2. NHSL will implement as appropriate agreed efficiency savings plans in 2025/26. 3. Additional non-recurring funding received in-year from NHSL which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 4. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2025/26 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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55 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
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56 11 Date direction will be reviewed
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ITEM 14.1 Version Control Date Summary of Changes 1 20/03/2023 North Lanarkshire Integration Joint Board DIRECTIONS POLICY
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Contents 1. Purpose and Scope .......................................................................................................................... 1 2. Policy Aims ...................................................................................................................................... 1 3. Legislative/Policy Framework ......................................................................................................... 1 4. Definition and Purpose of Directions .............................................................................................. 2 5. Policy Implementation .................................................................................................................... 2 6. Monitoring and Review ................................................................................................................... 3 Appendix 1: Directions Procedure .......................................................................................................... 4 Appendix 2 :Process for Issuing Directions ............................................................................................. 5
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1. Purpose and Scope This policy sets out the process for formulating, approving, issuing and reviewing directions from North Lanarkshire Integration Joint to NHS Lanarkshire and North Lanarkshire Council. This policy has been developed in line with the Public Bodies (Joint Working) (Scotland) Act 2014 and Scottish Governments Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on Integration Authorities (IJBs) to develop a strategic commissioning plan, for integrated functions and budgets under their control. An Integration Authority requires a mechanism to action their strategic commissioning plan, this mechanism takes the form of binding directions from the Integration Authority to one or both of NHS Lanarkshire and North Lanarkshire Council. Directions are also the means by which a record is maintained of which body decided what and with what advice, which body is responsible for what, ad which body should be audited for what, whether in financial or decision making terms. In January 2020, the Scottish Government issued Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. The North Lanarkshire Joint Board must issue a direction in respect of every function that has been delegated to it by NHS Lanarkshire and North Lanarkshire Council which must provide relevant budget information. Directions are the means by which the IJB informs the Health Board and the Local Authority what is to be delivered using the integrated budget and for the IJB to improve the quality and sustainability of care, as outlined in its strategic commissioning plan. Directions are also the legal basis on which the Health Board and Local Authority deliver services that are under the control of the IJB. 2. Policy Aims This policy seeks to enhance governance, transparency and accountability between the IJB, NHS Lanarkshire and North Lanarkshire Council by clarifying responsibilities. This policy has been developed to ensure compliance with the Scottish Governments Directions from Integration Authorities to health boards and local authorities: statutory guidance. 3. Legislative/Policy Framework The Public Bodies (Joint Working) (Scotland) Act 2014 states that an Integration Joint Board must give a direction to constituent authority to carry out each function delegated to Integration Authority. Revised statutory guidance on directions was issued by Scottish Government in January 2020. This statutory guidance has informed the development of this policy, to ensure that the IJB can meet the key requirement of the guidance to improve governance, transparency and accountability between all partner organisations.
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4. Definition and Purpose of Directions It is essential that directions are understood to be the end point of a process of decision making by the IJB. Directions should not contain surprising or completely unknown information about service change or redesign and should follow a period of wider engagement on the function(s) that are the subject of the direction. This should normally be part of the service planning and design phase of strategic commissioning. Directions are legally binding, which is why they come at the end point of a process of planning and decision making. The delivery partners are required to comply with all directions received from the IJB, and the law is clear that they may not amend, ignore, appeal or veto any direction. Neither NHS Lanarkshire nor North Lanarkshire Council may use resources allocated via the Integration Joint Board in pursuit of a direction for any other purpose than that intended. The content of Directions should be sufficiently detailed to ensure the intention of the IJB is adequately captured. Directions should include information on the required delivery of the function and the financial resources that are available for carrying out the function. Directions may specify what the Health Board, Local Authority or both are to do in relation to carrying out a particular function. Lack of detail in a direction may cause difficulties in performance monitoring and hamper the effective delivery of the function. To assist with monitoring and reviewing directions issued, the IJB may seek information from either the Health Board or Local Authority or both about the delivery 5 of a function that is the subject of a direction, including when issues are identified in implementation and delivery of a direction. Specific directions can be given to NHS Lanarkshire, North Lanarkshire Council, or both (Health and Social Care Partnership (H&SCP)) depending on the services to be provided. However, directions should not be issued unnecessarily and should be proportionate. A direction will remain in place until it is revoked, varied or superseded by a later direction in respect of the same function. In summary, the purpose of directions is to set a clear framework for the operational delivery of the functions that have been delegated to the IJB. All directions must be in writing. Functions may be described in terms of delivery of services, achievement of outcomes and/or the priorities set out in the strategic commissioning plan. 5. Policy Implementation This Policy has been developed in line with the Public Bodies (Joint Working) (Scotland) Act 2014, Scottish Governments Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities as published in January 2020. This Policy defines what a direction is and is underpinned by the Directions Procedure (Appendix 1) which supports the development of new and revised directions. Directions are informed by a number of factors, including but not limited to: • Content of the IJB Strategic Commissioning Plan • Specific service redesign or transformation programmes
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• Financial changes or developments • A change in local circumstances • A fundamental change to practice or operations. 6. Monitoring and Review Directions: The IJB has agreed that Directions will be monitored on a quarterly basis via the IJB Committee structure. This will ensure that the relevant Committee will assume responsibility for maintaining an overview of progress with the implementation of directions, via detailed reports, and escalating any issues to the IJB. A full set of directions, will be presented to the IJB at the start of the financial year following confirmation of budget setting arrangements, however, other directions will be brought forward throughout the year to reflect strategic developments and service transformation. Policy: This policy will be reviewed every two years by the IJB, or earlier if Scottish Government release further guidance.
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Appendix 1: Directions Procedure This procedure sets out the process for formulating, approving, issuing and reviewing directions for the North Lanarkshire Integration Joint Board to NHS Lanarkshire, North Lanarkshire Council or both constituent authorities. A process map is attached at Appendix 2 of this document. 1. Directions Directions are the mechanism by which the IJB delivers its Strategic Commissioning Plan. When a Direction is presented to the IJB, the report author must ensure that the content of the Direction include details of the function to which it is the subject of, budget information which has been delegated to deliver it, the impact on workforce, any legal or risk implications, impact on IJB outcomes, priorities or policy, details of consultation and an Equalities Impact Assessment if required. The final page of the report template (attached at Appendix 3) provides a standard format for outlining the requirements for each direction to be issued; all sections of this must be completed. Following approval at the IJB a Direction will then be issued on behalf of the Chief Officer to the Chief Executive of NHS Lanarkshire, the Chief Executive of North Lanarkshire Council, or both. This will take the form of a letter together with the IJB report, including Direction template. Directions will be copied to the Chair and Vice Chair of the NHS Board and the Leader and Deputy Leader of the Local Authority. Directions should be issued within 7 days of IJB approval where possible. The details of each Direction issued by the IJB are entered into the IJB Register of Directions. An update on Directions will be provided quarterly to the IJB. A Direction will remain in place until it is varied, revoked or superseded by a later direction in respect of the same functions. 2. Implementation and Monitoring of Directions NHS Lanarkshire and North Lanarkshire Council are responsible for complying with and implementing all directions issued by the IJB. As the issuing of directions is a legally binding process any issues with this should be brought to the attention of the Chief Officer. An annual report on all current Directions will be presented to the IJB.
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Appendix 2: Process for Issuing Directions If any of the following cicrumstances are detailed within the report being submitted to the IJB, then a direction should be issued as per process detailed below.. o Specific service redesign or transformation o Financial changes or developments o Strategic Commissioning Plan o Changes in local circumstances o Fundamental changes to practice or operations When issuing a direction consideration must be given to: • Scope and scale of function • Finance involved • Scale and nature of change • Timescale for delivery • Those impacted by the change - Patients - Service users Paper presented to IJB/IJB PFA for discussion IJB agree the directions required based on paper Directions issued to relevant partner(s) to carry out the functions relating to the directions Assurance provded via the IJB on the delivery of the function to which the Direction related to on a quartly basis
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- Carers - Local communities - Staff - Others
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Appendix 3 -Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number This will be provided by IJB Administration Support Team 2 Report Title Title of Report 3 Date direction issued by IJB Date of IJB meeting that direction was issued 4 Date from which direction takes effect Date of when the direction should begin to be implemented or date direction issued by IJB 5 Direction to: This can be either: - NHS Lanarkshire - North Lanarkshire Council - H&SCP 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) This can be provided by IJB Administration Support Team 7 Functions covered by direction List all the functions to which the direction related e.g. Occupational Therapy, Mental Health. 8 Full text of direction Detail what the authorities are being asked to carry out. 9 Budget allocated by Integration Joint Board to carry out direction Detail if any funding has been allocated by IJB to carry out direction. 10 Performance Management / Governance arrangements Directions will be reported to the relevant IJB committee quarterly and an annual report of all current directions presented to IJB. Detail if any other groups etc will be involved in the performance management of the direction e.g. Core/ SLT.
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11 Date direction will be reviewed Date at which the next review of the direction is due (e.g. at next IJB meeting).
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1 REPORT Item No: 15 SUBJECT: IJB Integration Scheme TO: Integration Joint Board Lead Officer for Report: Claire Rae: Chief Officer Author(s) of Report Morag Dendy: Head of Planning, Performance and Quality Assurance Contact details for Author(s) of Report Morag Dendy: dendym@northlan,gov.uk DATE: 19 March 2025 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: Morag Dendy Head of Planning, Performance ☒ Reviewed By: Health and Social Care Partnership Core Team ☒ Endorsed By: ☐
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2 and Quality Assurance 3. EXECUTIVE SUMMARY This paper confirms Cabinet Secretary approval for the revised North Lanarkshire Integration Scheme for the period 2024 - 2029. This updated version reflects the outcome of the review and update process undertaken to meet the 5-year review timeline 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report. (1) Note that the Integration Scheme has Cabinet Secretary approval; (2) Note that the Integration Scheme is available on the HSCP website, Council website and NHSL website (3) Note that the paper will be presented to Policy and Strategy Committee on the 13 March 2025 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 Yes ☐ No ☐ N/A ☒ 6. BACKGROUND 6.1 The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. The Integration Scheme sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. 6.2 Section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014, notes that “the local authority and the Health Board must carry out a review of the integration scheme before the expiry of the relevant period for the purpose of identifying whether any changes to the scheme are necessary or desirable”. The legislation clarifies the “relevant period” as “the period of five years beginning with the day on which the scheme was approved. 7. SUMMARY OF KEY ISSUES
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3 7.1 The Integration Scheme and its associated paper underwent thorough review by IJB members in November 2023 and was also presented to the NHS Lanarkshire Board and North Lanarkshire Policy and Strategy Meeting in December 2023. 7.2 After receiving approval from the Integration Joint Board, Policy and Strategy Committee, and the NHS Board in late 2023, the revised Integration Scheme underwent a comprehensive public consultation process from January 15th, 2024, to February 11th, 2024. This process included dissemination through the Health and Social Care partnership website, various social media channels, and direct distribution to stakeholders such as health and social care professionals, service users, caregivers, third-sector bodies, and locality representatives. 7.3 With the final Scheme was presented to the Integrated Joint Board, the Policy and Strategy Committee, and the NHS Lanarkshire Board for formal approval in March 2024. Following this approval, the North Lanarkshire Integration Joint Board submitted the Integration Scheme to the Cabinet Secretary for endorsement. 7.4 Following some minor amendments and a final alignment to the wording of hosted services arrangements with the South Lanarkshire Integration Joint Board Integration Scheme, Cabinet Secretary approval was confirmed. 8. CONCLUSIONS 8.1 Cabinet Secretary approval for the revised North Lanarkshire Integration Scheme for the period 2024 – 2029 was confirmed in November 2024. The Integration Scheme is available on the website. 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 ☒
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4 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 x 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 11. APPENDICES 11.1 The North Lanarkshire Integration Scheme 2024- 2029 is attached at Appendix 1
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6 Please include a glossary of terms if not already included. Morag Dendy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; dendym@northlan.gov.uk
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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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Appendix 1 Health and Social Care Integration North Lanarkshire Integration Scheme 2024 Version 3 Version Control Version Date North Lanarkshire Integration Scheme 2014 V1 April 2014 North Lanarkshire Integration Scheme 2019 V2 April 2019 North Lanarkshire Integration Scheme 2024 V3
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Contents 1. Introduction .................................................................................................................................. 1 2. The Parties ................................................................................................................................... 3 3. Integration Model ............................................................................................................................. 3 4. Local Governance Arrangements .............................................................................................. 4 5. Delegation of Functions ............................................................................................................. 5 6. Local Operational Delivery Arrangements ............................................................................... 8 7. Corporate Service Support ........................................................................................................ 9 8. Supporting Strategic Planning ...................................................................................................... 9 9. Performance Measurement ........................................................................................................ 9 10. Support, Care and Clinical Governance ............................................................................... 10 11. Clinical and Professional Governance Framework ............................................................. 11 12. Chief Officer .............................................................................................................................. 13 13. Workforce .................................................................................................................................. 15 14. Finance ...................................................................................................................................... 15 15. Communication, Participation and Engagement .................................................................. 19 16. Information-Sharing and Data Handling ................................................................................ 20 17. Complaints ................................................................................................................................ 21 18. Claims Handling, Liability and Indemnity .............................................................................. 22 19. Risk Management ..................................................................................................................... 23 20. Dispute Resolution Mechanism .................................................................................................. 24 Annex 1 – Delegated Functions ................................................................................................... 26
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Part 2- Integrated Services ............................................................................................................... 33 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board .................................................................................................................................................... 35 Health and Social Services and Social Security Adjudications Act 1983 .................................. 39 Part 2 -Services currently provided by the Local Authority which are to be integrated ....... 48 Annex 3 – Hosted Services Arrangements................................................................................. 50 Annex 4 – Health and Wellbeing Outcomes ............................................................................... 51
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1 1. Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 (the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. This document sets out the agreement through which The Health Board and The Local Authority do this. The creation of an integrated partnership required The Local Authority and The Health Board to undertake a significant change agenda with the aim of creating services and supports which build on a solid foundation of success to date. The overall aim of the arrangement is the creation and continuation of a partnership which further improves Outcomes for people who use health and social care services and their carers. Therefore, a primary focus of the partnership will be delivering on the nine National Health and Wellbeing Outcomes (the “Outcomes”) of: • 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, 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 their 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 provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing; • 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; and • Resources are used effectively and efficiently in the provision of health and social care services. From a North Lanarkshire perspective, our local vision reflects and underpins the higher level national Outcomes. This is evidenced by the progress towards a personal Outcomes approach which involves working with people to jointly agree how we support them to meet their aspirations and goals in life. Consequently, this drive towards supporting people to meet their Outcomes has resulted in a shared partnership vision based upon: “Working together to improve health and wellbeing in the community – with the community” In pursuit of this vision, and central to our philosophy, will be the following commitments;
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2 • We will focus on promoting health improvement and tackling the underlying causes of ill – health • We will continue to develop a health and social care system which is integrated around the needs of individuals, their carers and family Members • We will be working with people, their carers and families who have a range of complex support needs to identify the Outcomes they want to achieve in life. In doing so, our aim will be to provide care and support to help them realise these Outcomes • We will put the leadership of clinicians and professionals at the heart of service delivery for people who require support and their carers • We will work with partners in the third and independent sectors to remove unhelpful boundaries and using combined resources to achieve maximum benefit for patients, service users, carers and families; and • We will work with a range of agencies and partners to address health and social inequalities and the subsequent impact of this experienced by people in their communities. The following detail provides information relating to ‘how’ the partnership has been created to deliver against the national Outcomes and intentions of the Act. This Integration Scheme is the vehicle through which assurance is given to the Local Authority, the Health Board and the Scottish Government that the intentions of the Act are being delivered by the Integration Joint Board. This Integration Scheme forms the basis of a legal agreement with the Scottish Government and lasts for a maximum duration of five years, after which point it will be refreshed. However, in circumstances where there is agreement between the Parties, this Integration Scheme can be refreshed within an earlier timeframe. This Integration Scheme first came into effect in April 2016, with a refresh of the North Lanarkshire Integration Scheme implemented in April 2019.
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3 2. The Parties North Lanarkshire the Local Authority, established under the Local Government etc. (Scotland) Act 1994 and having its principal offices at the Civic Centre, Windmillhill Street, Motherwell, North Lanarkshire And NHS Lanarkshire Health Board, established under Section 2(1) of the National Health Service (Scotland) Act 1978 and having its principal offices at Kirklands Hospital, Fallside Road, Bothwell, Lanarkshire (together referred to as “the Parties”) In implementation of their obligations under the Act, the Parties hereby agree as follows: Definitions and Interpretation “The Act” means the Public Bodies (Joint Working) (Scotland) Act 2014. “The Parties” means The Health Board and North Lanarkshire the Local Authority. “The Health Board” means NHS Lanarkshire Health Board. “The Local Authority” means North Lanarkshire Council. “The Scheme” means this Integration Scheme. “Integration Joint Board” or “IJB” means the Integration Joint Board to be established by Order under Section 9 of the Act. “Members” means Members of the Integration Joint Board. “Outcomes” means the Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under Section 5(1) of the Act. “Integration Board Order” means the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. “Integration Joint Board, Performance, Finance and Audit Committee” (IJB PFA) means the committee which the Integration Joint Board has delegated authority for business relating to performance, finance and audits reports/updates. “Strategic Plan ” means the plan which the Integration Joint Board is required to prepare and implement in relation to the delegated provision of health and social care services in accordance with Section 29 of the Act. 3. Integration Model In accordance with Section 2(3) of the Act, the Parties have agreed that the integration model set out in Sections 1(4)(a) of the Act will be put in place for North Lanarkshire,
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4 namely the delegation of functions by the Parties to a body corporate that is to be established by Order under Section 9 of the Act. 4. Local Governance Arrangements 4.1 The Integration Joint Board will be responsible for the Strategic Planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within this Scheme. 4.2 The regulation of the Integration Joint Board’s procedures, business and meetings will follow the IJB’s own standing orders which may include additional matters to those set out within the Integration Board Order. 4.3 The Integration Joint Board and the Parties will collaborate and interact in order to contribute to the Outcomes. However, the Integration Joint Board, when established, will have distinct legal personality and the consequent autonomy to manage itself. 4.4 There will be eight Voting Members on the Integration Joint Board comprising four elected Members from The Local Authority and 4 Members from the Health Board. 4.5 The Non-Voting Membership prescribed in the Integration Board Order is as follows; • The Chief Officer of the Integration Joint Board • The Chief Social Work Officer of the Local Authority appointed by it in terms of Section 3 of the Social Work (Scotland) Act 1968 • The proper officer of the Integration Joint Board appointed under Section 95 of the Local Government (Scotland) Act 1973(a) i.e. the Chief Finance Officer • A registered Primary Care medical practitioner; whose name is included in the list of primary medical service performers prepared by the Health Board in accordance with the regulations made under Section 17P of the National Health Service (Scotland) Act 1978’ • A registered Nurse who is employed by the Health Board or by a person or body with which the Health Board entered into a general medical services contract; and • A registered medical practitioner employed by the Health Board who does not provide primary medical services.
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5 4.6 Once the Integration Joint Board is established it must appoint, in addition, at least one member in respect of each of the following groups in terms of the Integration Board Order: • Staff engaged in the provision of services provided under integration functions • Third Sector bodies carrying out activities related to health or social care in North Lanarkshire • Service users residing in North Lanarkshire; and • Persons providing unpaid care in North Lanarkshire. 4.7 The Integration Joint Board may appoint such additional Members as it sees fit. 4.8 The responsibility for appointing the Chair and Vice Chair will alternate between the Parties and the appointments will be made for a period of 3 years. Within this period, each Party may change its appointment as Chair or Vice Chair at any time and it is entirely at the discretion of the Party which is making the appointment to decide who it shall appoint. 4.9 The term of office of a member of the Integration Joint Board is a maximum of three years. The Integration Joint Board Voting Members appointed by the Parties will cease to be Members of the Integration Joint Board in the event that they cease to be a Non-Executive or Executive member of The Health Board or an elected member of The Local Authority. At the end of a term of office a member may be reappointed for a further term of office. The Chief Social Work Officer, Chief Officer and Chief Finance Officer remain Members of the Board for as long as they hold the office in respect of which they are appointed. 4.10 Whilst serving on the Integration Joint Board its Members carry out their functions under the Act on behalf of the Integration Joint Board itself, and not as delegates of their respective Heath Board or Local Authority. 4.11 In accordance with good practice, it is expected that the Integration Joint Board will establish an audit committee to support the overall governance and scrutiny arrangements. The Parties recognise that the establishment of any committees by the IJB are a matter to be determined by the IJB. The North Lanarkshire Integration Joint Board, Performance, Finance and Audit Committee has been established within North Lanarkshire to fulfil this purpose. 4.12 Detailed protocols and reporting arrangements will be established to ensure the Parties and the Integration Joint Board have free access to all relevant information for the purposes of planning and decision making. 5. Delegation of Functions The functions that are to be delegated by the Health Board to The Integration Joint Board are set out in Part 1 of Annex 1. These functions are delegated only to the extent
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6 that they relate to the listed services. The services to which these functions relate, which are currently provided by the Health Board and which are to be integrated, are set out in Part 2 of Annex 1. Broadly these are as follows; 5.1 Hospital Services The functions in relation to the hospital services noted below will be delegated in respect of adults and children 5.1.1 Accident and emergency services provided in a hospital 5.1.2 Inpatient hospital services relating to the following branches of medicine: • General medicine • Geriatric medicine • Rehabilitation medicine • Respiratory medicine • Palliative care services provided in a hospital • Paediatrics • Psychiatry of learning disability • Inpatient hospital services provided by general medical practitioners; • Services provided in a hospital in relation to an addiction or dependence on any substance; and • Mental health services provided in a hospital except regionally or nationally organised forensic mental health services. 5.2 Community Services The functions in relation to the community health services noted below will be delegated in respect of adults: • District nursing services • Health Visiting • Allied health professionals in an outpatient department, clinic, or out with a hospital • Public dental services • Primary medical services • General dental services • Ophthalmic services • Pharmaceutical services • Primary care out-of-hours • Geriatric medicine • Palliative care • Community learning disability services • Kidney dialysis services • Mental health services • Continence services • Community paediatrics
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7 • Community children’s services • School nursing services; and • Services provided by health professionals that aim to promote public health. 5.2.1 The functions delegated by The Local Authority to the Integration Joint Board are set out in Part 1 of Annex 2. The services to which these functions relate are set out in Part 2 of Annex 2 and relate to adult services only: • Social work services for adults and older people • Services and support for adults with physical disabilities and learning disabilities • Mental health services • Drug and alcohol services • Adult protection and domestic abuse • Carers support services • Community care assessment teams • Support services • Care home services • Adult placement services • Health improvement services • Aspects of housing support, including aids and adaptions • Day services • Local area co-ordination • Respite provision • Occupational therapy services; and • Re-ablement services, equipment and telecare. 5.3 Annex 3 sets out arrangements for hosted services. This relates specifically to health services which spans more than one Integration Joint Board and are subject to Integration Joint Board approval. 5.4 The Integration Joint Board is a Category 1 responder under the Civil Contingencies Act 2004, as per the amendment to the Act in 2021. This ensures that where there is a risk of an emergency which will impact functions delegated to the Integration Joint Board, there will be formal coordinated and appropriate arrangements in place for emergency planning; information sharing and cooperation with other responders; and joined up information sharing and advice for the public. The IJB is represented at the Local Resilience Partnership by the Chief Officer.
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8 6. Local Operational Delivery Arrangements 6.1 The Integration Joint Board meets a minimum of four times per year in public and publishes all agendas, papers and minutes with responsibility for the delivery of integrated functions as set out in annexes 1,2 and 3 and provides operational oversight of integrated services delegated to them. 6.2 The operational role of the Chief Officer is set out within Section 12. 6.3 The Health Board will retain direct operational oversight of the acute services as set out in annexes 1,2 and 3 and will provide information on a regular basis to the Integration Joint Board about the delivery of these services. 6.4 The Integration Joint Board is responsible for the development of a Strategic Commissioning Plan as per Section 29 of the Act. This plan sets out arrangements for carrying out the integration functions and how these contribute to achieving the Outcomes as outlined in Annex 4. 6.5 A locality model has been developed by the Integration Joint Board to underpin the development of the Strategic Commissioning Plan. 6.6 From an acute hospital service perspective, operational plans for integrated acute service delivery are subject to directions from the Integration Joint Board about the exercise of delegated functions in relation to these services. These will also be informed and directed by the Strategic Commissioning Plan. 6.7 The Chief Officer is responsible for directly implementing the Integration Joint Board’s directions to locality delivery on the ground. 6.8 From an operational and performance management perspective, the Integration Joint Board/ The Integration Joint Board, Performance, Finance and Audit Committee will receive regular reports from the Chief Officer and other responsible officers of the parties on the delivery of integrated services and will issue directions in response to those reports to ensure improved performance. This includes a range of thematic reports will include, but are not limited to, the following: • Finance Reports • Performance against the National Health and Wellbeing Outcomes • Regulation and scrutiny activity • Inspection Outcomes • Support, Care & Clinical governance reports to be assured of the delivery of safe and effective services • Public Protection reports • Engagement and community co-production reports from each of the Locality Management teams • Annual staff governance and workforce planning report
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9 • Improvement plans and reports; and • Risk reports/management plans. 6.9 The Act requires the Integration Joint Board to publish an Annual Performance Report by July of each year. 7. Corporate Service Support 7.1 The Parties will support the work of the Integration Joint Board by supplying all relevant information, data and corporate support services such as financial, legal, human resources, IT, planning, risk management, audit, administrative etc. for the Integration Joint Board to carry out its functions. This will include information on cross boundary flow into and out with the Health Board. 7.2 The current arrangements for providing corporate support services in respect of delegated functions and the associated service provision will be reviewed by the Chief Officer and the responsible officers of the Parties on an ongoing basis. 8. Supporting Strategic Planning 8.1 As outlined in Section 30(3) of the Act, the Integration Joint Board must have regard to the effect that their Strategic Commissioning Plan will have on facilities, services or resources which are used in relation to arrangements set out or being considered to be set out in a Strategic Plan prepared by another Integration Joint Board. 8.2 In assessing the health element of this, The Health Board will provide the necessary activity and financial data for services, facilities and resources that relate to the planned use of services provided by other Health Boards by people who live within the area of the Integration Joint Board. 8.3 In circumstances where The Health Board or The Local Authority intend to change service provision of non-integrated services that will impact directly on the Strategic Commissioning Plan, they will advise the Integration Joint Board of this. 9. Performance Measurement 9.1 Through the development of the Strategic Commissioning Plan, the Outcomes are used to develop a performance reporting framework which underpins the Plan. 9.2 The Parties have established an integrated performance reporting framework which considers and develops a local suite of measures and targets that relate to the provision of integration functions. The measures and targets are aligned to the Outcomes and any subsequent guidance/core suit of indicators. The Parties develop the targets, measures and other arrangements that are devolved to the Integration Joint Board. In developing this, the Parties share with the Integration
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10 Joint Board other relevant the Health Board and the Local Authority targets and measures which the Integration Joint Board must take account of. 9.3 The Parties, in conjunction with the Integration Joint Board also consider and develop a list of targets, measures and arrangements that relate to the functions that are not delegated which the Integration Joint Board must take account of when it is preparing the Strategic Plan. 9.4 The work in respect of 9.2 and 9.3 takes into account: • The Outcomes • Delegated performance targets related to the commissioning and delivery accountabilities of the Health Board and the Local Authority; • Delayed discharge • Recovery activity • Locally agreed Outcomes and targets identified through Community Planning and from the Local Outcomes Improvement Plan and attributable to Health and Social Care Outcomes and targets, including Health Improvement, for each of the localities identified and agreed in line with local needs determined for each population; and • The Nationally prescribed core suite of integration indicators. 9.5 The reporting of information against this suite of indicators is provided by the Parties to the Integration Joint Board as a means of measuring progress and impact. 9.6 Where responsibility for the target is shared, the Parties set out in a document the accountability and responsibility of each of them. 9.7 Where the responsibility for the targets spans integrated and non-integrated services, the Health Board, the Local Authority and the Integration Joint Board will work together to produce and deliver the measures and targets which assess performance. This will be evidenced through a standing performance item on Integration Joint Board meetings and also picked up through the Integration Joint Board Annual Performance report. 9.8 The Integration Joint Board Performance, Finance and Audit Committee which is accountable to the Integration Joint Board has been established as a decision making body to provide further scrutiny on matters related to finance, risk, performance and audit matters. 10. Support, Care and Clinical Governance 10.1 The Parties and the Integration Joint Board are accountable for ensuring appropriate support, care and clinical governance arrangements are in place for their duties under the Act. 10.2 The Parties remain individually responsible for the support, care, clinical and professional accountability of the services which the Integration Joint Board
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11 has directed the Parties to deliver and for the services delivered in respect of functions that are not delegated to the Integration Joint Board. 10.3 The Parties remain individually responsible for the assurance of the quality and safety of services commissioned from the third and independent sectors in line with the requirements set out within the Strategic Plan and any directions issued by the Integration Joint Board that relate to or have an impact on, integrated and non-integrated service provision. 10.4 The Integration Joint Board will have regard to the support, care and clinical framework that is set out in Section 6.6 when developing and agreeing its Strategic Plan and corresponding directions to the Parties. 10.5 As set out in Section 9 the Integration Joint Board will receive regular reports from professional leadership Members for medical; nursing, AHPs; and Social Work to assure itself that support, care and clinical governance requirements are being met through these existing arrangements and that safe, effective person centred care is being consistently delivered. 11. Clinical and Professional Governance Framework 11.1 The Parties have in place support, care and clinical governance arrangements to provide assurance that the services that are delivered are safe, effective, person centred and focussed on personal Outcomes. 11.2 The Parties recognise that the establishment and continuous review of the arrangements for support, care and clinical governance and Professional Governance are essential in delivering their obligations and quality ambitions. 11.3 In the Health Board this is overseen by the Healthcare Governance Committee, a committee of the Health Board which supports the Health Board in its responsibilities, with regards to issues of clinical risk, control and governance and associated assurance in the area of quality assurance and improvement through a process of constructive challenge. 11.4 The Healthcare Governance Committee is responsible for the development of a strategic approach to quality assurance and improvement across the Health Board, ensuring that quality standards are being set, met and continuously improved for clinical activity. It ensures that effective arrangements for supporting, monitoring and reporting on quality assurance and improvement are in place and working, demonstrating compliance with statutory requirements in relation to clinical governance and authorising an accurate and honest annual clinical governance statement. 11.5 In The Local Authority the Chief Social Work Officer holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected Members of the Local Authority in respect of professional social work matters. He/she is responsible for
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12 ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services the Local Authority. 11.6 The Parties are committed to developing a shared support, care and clinical governance framework for integrated services. The professional leadership of the Parties will work together to develop and agree this support, care and clinical governance framework. In the first instance this will be based on a self- assessment exercise to help identify areas of common practice, provide opportunities to learn from one another and streamline processes. 11.7 The existing process, procedures and reporting structures for support, care and clinical governance of integrated services will be reviewed in light of the agreed support, care and clinical framework. The framework will encompass the following: • Professional regulation, workload and workforce development • Information assurance • Service user experience and safety and quality of integrated service delivery and personal Outcomes • Person Centered Care • Management of clinical risks; and • Learning from adverse events. 11.8 Each of these domains will be underpinned by mechanisms to measure quality, clinical and service effectiveness and sustainability. They will be compliant with statutory, legal and policy obligations strongly underpinned by human rights values and social justice. Service delivery will be evidence- based, underpinned by robust mechanisms to integrate professional education, research and development. 11.9 The Parties and the Integration Joint Board will be asked to approve the framework and will then be responsible for ensuring that it is embedded within service planning, delivery and performance reporting mechanisms. The Integration Joint Board will be responsible for ensuring effective mechanisms for service user and carer feedback and for complaints handling. 11.10 The Area Clinical Forum, Managed Clinical Networks, GP Sub Committee, Area Medical Committee; Medical Staff Committee and any other appropriate professional groups, and the Adult Protection Committees will provide advice directly to the Integration Joint Board or through its professional Members. 11.11 The Healthcare Governance Committee and the Chief Social Work Officer (or the appropriate delegates) will provide advice, oversight and guidance to the North Lanarkshire Strategic Planning Group in respect of support, care, clinical and professional governance, for the delivery of health and social care services and to the localities identified in the Strategic Plan. 11.12 The Chief Officer will have access to professional advice from the Chief Social Work Officer of the local authority and the Medical Director and the Nursing Director
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13 of the Health Board in both their operational role as a senior officer of the parties and as the accountable officer to the Integration Joint Board. 11.13 Explicit lines of professional and operational accountability are essential to assure the Integration Joint Board and the Parties of the robustness of governance arrangements for their duties under the Act. They underpin delivery of safe, effective and person centred care in all care settings delivered by employees of The Health Board and The Local Authority and of the third and independent sectors. 11.14 The Health Board is accountable for Clinical Governance. Professional governance responsibilities are carried out by the professional leads through to the health professional regulatory bodies and Scottish Ministers. 11.15 The Chief Social Work Officer in North Lanarkshire holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected Members of the Local Authority in respect of professional social work matters. He/she is responsible for ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services the Local Authority. 11.16 The Medical Director and/or the Director of Nursing, Midwifery and Allied Health Professions, through delegated authority, hold professional accountability for the delivery of safe and effective clinical services within The Health Board and report regularly on these matters to the Health Board. 11.17 The Integration Joint Board will have three health professional advisors. These Members of the Integration Joint Board will be professionally accountable to the Medical Director and the Nurse Director as appropriate. 11.18 This arrangement does not limit the ability of the Medical Director and/or the Nurse Director to provide advice directly to the Integration Joint Board. Where this advice is offered, the Integration Joint Board must respond in writing and notify the Parties. The Chief Social Work Officer can provide advice directly through their Membership of the Integration Joint Board. 11.19 The Chief Social Work Officer, through delegated authority holds professional accountability for the delivery of safe and effective social work and social care services within the Local Authority. An annual report on these matters will continue to be provided to the relevant The Local Authority committee and will also be made available to the Integration Joint Board. 11.20 The Chief Social Work Officer will provide professional advice to the Integration Joint Board in respect of the delivery of social work and social care services by The Local Authority staff and commissioned care providers in North Lanarkshire. 12. Chief Officer
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14 12.1 The Integration Joint Board will appoint a Chief Officer in accordance with Section 10 of the Act. 12.2 The Chief Officer reports to the Local Authority’s Chief Executive and the Health Board ’s Chief Executive. The Chief Officer ’s formal contract of employment is with one of the Parties and whichever holds the contract of employment, manages the Chief Officer on a day to day basis. 12.3 The Chief Officer will be operationally responsible with regards to the delivery of the delegated services (as set out in Annex 1 & 2) that do not relate to the acute medicine and Accident and emergency services provided for within NHS Lanarkshire Hospitals. These services will continue to be operationally managed by the Health Board, through the Director of Acute Services, in line with the Integration Joint Board’s Strategic Plan to ensure coherence across integrated and non- integrated hospital service provision. 12.4 The Acute Director will be a single point of managerial responsibility for NHS Lanarkshire hospitals. The Acute Director will provide updates to the Chief Officer on the operational delivery of integrated functions delivered within the acute hospital and the set aside budget on a regular basis. 12.5 The Chief Officer may also have responsibility for managing services that are hosted by the Integration Joint Board across North and South Lanarkshire. These arrangements will be determined by the North Integration Joint Board and the South Lanarkshire Integration Joint Board through the Strategic Planning process. 12.6 The Chief Officer will be a member of the Corporate Management Teams of the Health Board and Local Authority. 12.7 The Chief Officer will establish a senior management team to oversee day to day operation of the integrated services. 12.8 The Chief Officer ’s objectives will be set annually. This will form the basis of the Chief Officer ’s performance appraisal with the Local Authority’s Chief Executive and the Chief Executive of the Health Board. 12.9 The Heads of Service will deputise for the Chief Officer as and when required. At the request of the Integration Joint Board the Heads of Service will carry out the functions of the Chief Officer if/when the Chief Officer is absent or otherwise unable to carry out their functions. 12.10 The Chief Officer has established and maintains effective working relationships with a range of key stakeholders across the Health Board, the Local Authority, the third and independent sectors, services users and carers, the Scottish Government, trade unions and relevant professional organisations. 12.11 Current hosted services arrangements are set out in Annex 3. However, with regards to the future shaping of these services from a Strategic Planning perspective, the Integration Joint Board discusses with relevant neighbouring
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15 Integration Joint Boards how these are shaped now and in the future. The Chief Officer takes direction from the Integration Joint Board in respect of this. 13. Workforce 13.1 Human resource services and workforce planning information will continue to be provided by the appropriate corporate human resource functions within the Local Authority and the Health Board. 13.2 The Parties, with the involvement of the Chief Officer, will identify appropriate officers to develop a joint Workforce Development and Support Plan. In doing so the officers will be required to consider professional views and previous workforce modelling etc. However, there may be opportunities to adapt these plans when considering an integrated workforce. This will also have to build in consideration around Third Sector and Independent Sector capacity. The Workforce Development and Support plan will be regularly updated to ensure it remains contemporary. 13.3 An Organisational Development strategy (“OD Strategy”) will be maintained in relation to teams who will deliver integrated services. Through an intense focus on locality modelling, locality based focus groups and action learning sets, we have identified significant potential for harnessing the positivity and enthusiasm of frontline staff to achieve better Outcomes for the public, the organisation and the staff. We intend to continue this process combined with other aspects of our plan which focuses on: • Integration Joint Board Development • Key Leaders Development Programme • Integrated Locality Team Development; and • Wider Stakeholder Development. 13.3.1 In all cases, we will endeavour where appropriate, to carry out development work which is inclusive of all partners. Considerable progress has been made to develop an OD strategy, but it will need to be reviewed and revised over time. The Integration Joint Board will be given the opportunity to provide comment on the draft strategy upon its establishment. The strategy will be updated over the period of the Strategic Planning process. 13.4 Joint HR/OD processes have been agreed by the Parties over a number of years and many joint policies already exist which will assist in the process of integration. This Scheme has no effect on these joint policies so, for example, any joint appointments will continue to report to one-line manager, except for the Chief Officer where different provision is made within this scheme. 14. Finance
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16 14.1 Contributions from the Parties for delegated functions to the Integration Joint Board will be overseen by the Chief Officer and the Integration Joint Board Chief Financial Officer. They will develop a resource plan and budget based on available resources. The Integration Joint Board Chief Financial Officer will be responsible for the preparation of the annual financial statements as required by Section 39 of the Act. 14.2 The Chief Officer and Chief Financial Officer will develop an Integrated Budget based on the Strategic Plan and present it to the parties for consideration as part of both of their annual budget setting processes. The Parties will evaluate the case for the Integrated Budget against their other priorities and will agree their respective contributions accordingly. The outcome of this work will be presented to the Integration Joint Board. Following on from the budget process, the Chief Officer and the Integration Joint Board Chief Financial Officer will prepare a financial plan supporting the Strategic Plan. 14.3 The budget will be evidenced based with transparency of assumptions including, but not limited to pay award, contractual uplift, savings requirements etc. 14.3.1 The method for determining the amount set aside for hospital services will follow guidance issued by the Integrated Resources Advisory Group and be based initially on the notional direct costs of the relevant populations use of in scope hospital services as provided by Information Services Division (ISD) Scotland. The NHS Director of Finance and Integration Joint Board Chief Financial Officer will keep under review developments in national data sets or local systems that might allow more timely or more locally responsive information, and if enhancements can be made, propose this to the Integration Joint Board. If the Strategic Plan sets out a change in hospital capacity, the resource consequences will be determined through a bottom up process based on: • Planned changes in activity and case mix due to interventions in the Strategic Plan • Projected activity and case mix changes due to changes in population need; and • Analysis of the impact on the affected hospital budget, taking into account cost-behaviour i.e. fixed, semi fixed and variable costs and timing difference i.e. the lag between reduction in capacity and the release of resources. 14.4 Each partner will agree the formal budget setting timelines and reporting periods as defined in the Financial Regulations. 14.5 A schedule of notional payments will be provided by the Parties to the Integration Joint Board following the approval of the Strategic Plan and the financial Plan. 14.6 It will remain the duty of the Local Authority Section 95 Officer and the Health Board Accountable Officer to monitor and regulate the financial performance of
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17 their respective share of the resources available to the Integration Joint Board during each reporting period, throughout the financial year. 14.7 It will be the responsibility of the Local Authority Section 95 Officer and the Health Board Accountable Officer to comply with the agreed reporting timetable and to make available to the Integration Joint Board Chief Financial Officer the relevant financial information, including the sum set aside in line with 9.4.15, required for timely financial reporting to the Integration Joint Board. This will include such details as may be required to inform financial planning of revenue expenditure. 14.8 The frequency of reporting is set out in the Financial regulations and will be at least on a quarterly basis. In advance of each financial year a timetable for financial reporting will be submitted to the Integration Joint Board for approval. 14.9 Regular management reports will be prepared in line with the financial regulations which will be agreed by the Integration Joint Board, and will include actual and projected outturns. The existing budgetary control frameworks adopted by each of the Parties will form the basis of generating the required information. 14.10 The Integration Joint Board Chief Financial Officer will manage the respective financial plan so as to deliver the agreed Outcomes within the Strategic Plan viewed as a whole. 14.11 The Parties do not expect that there will be a schedule of cash payments, but rather annual accounting entries for the agreed budgets. There may be a requirement for an actual cash transfer to be made between the Parties to reflect the difference between the payment being made and the resources delegated to the party by the Integration Joint Board. Any cash transfer will take place at least annually. Any change to frequency will be jointly agreed by the Integration Joint Board and the Parties. 14.12 The process for managing any in-year financial variations will be detailed within the Financial regulations and are summarised below: 14.12.1 If the Integration Joint Board’s Chief Financial Officer is advised that a significant change is likely to the Integration Joint Board's overall financial position and the deviation involves a change of policy of the Integration Joint Board or results in revenue implications for future years, a report will be provided for the Integration Joint Board in good time detailing the financial consequences to enable appropriate action to be taken timeously. 14.12.2 If an overspend is forecast on either Parties in scope budget, the Chief Officer and the Integration Joint Board’s Chief Financial Officer will aim to agree a recovery plan with the relevant Party to balance the overspending budget and determine the actions required to be taken to deliver the recovery plan. If the overspend arises from assumptions in the Integration Joint Board’s Strategic Plan on the impact of service changes that are not realised as anticipated this should be subject to a report and corrective action. This corrective action may include a recovery plan
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18 which should consider revisions to the commissioning of services and / or financial plans to account for the changed circumstances, and the use of any available reserves. 14.12.3 If the recovery plan is unsuccessful then the parties have the following options: • the relevant partner provides additional resources to the Integration Joint Board which is then recovered in future years from subsequent underspends in that partner’s contribution, (subject to scrutiny of the reasons for the overspend and assurance that there is a plan in place to address this); or • the relevant partner makes additional one-off adjustment to the resources that it is making available to the Integration Joint Board. 14.12.4 Unplanned underspends that arise due to material differences between assumptions used in setting the budget and actual events effectively represent an overfunding by the Parties with respect to planned Outcomes. The circumstances surrounding the action required to address unplanned underspends is set out in the Financial regulations and Reserves Policy, which will be subject to agreement by the Parties and the Integration Joint Board. The options will include the underspend either being returned to the relevant party in year through an adjustment to their respective contributions, or maintained by the Integration Joint Board to be carried through the General fund balance. 14.13 The Parties do not expect to reduce the in-year payment, or the services delegated to the Integration Joint Board without the consent of the Integration Joint Board and the other Party out with the following circumstances: • Unplanned underspends as defined above and the Financial regulations and Reserves Policy; or • Where the budget assumed a specific allocation from the Scottish Government which did not materialise in year to the extent anticipated. (The converse of this also applies in that should a specific allocation pertaining to a delegated function exceed the anticipated level, an additional payment to the Integration Joint Board may be agreed). 14.14 Monitoring arrangements will include the impact of activity on set aside budgets. 14.15 The Accounting Standards as adapted for the public sector will apply to the Integration Joint Board. The Code of Practice on Local Authority Accounting in the UK will be the applicable guidance for their interpretation. 14.16 The financial statements of the Integration Joint Board will be completed to meet the audit and publication timetable specified in regulations (Regulations under Section 105 of the Local Government (Scotland) Act 1973). 14.17 Initially, recording of financial information in respect of the Integration Joint Board will be processed via the Local Authority ledger. The means for recording financial
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19 information will be reviewed by the Chief Financial Officer to ensure this method remains appropriate giving due regard to the needs of the Integration Joint Board. Should an amendment to this method be required the Chief Financial Officer will consult with both parties and present recommendations to the Integration Joint Board for approval. 14.18 The financial ledger transactions relating to the Integration Joint Board will be carried out prior to the end of the financial year with post year-end adjustments for material information only. Year-end balances and transactions will be agreed timeously in order to allow completion of the Accounts in line with required timescales. This date will be agreed annually by the Integration Joint Board and the Parties. 14.19 From an asset management and capital planning perspective, in the short term, the Integration Joint Board will not be empowered to own capital assets and the regimes of the Parties will apply to capital assets used to provide the delegated services. Ownership of assets and associated liabilities will remain with the Parties. 14.20 The Chief Officer will consider all of the resources which are required to deliver the integration Outcomes including the relevant non-current assets owned by the Parties. The Chief Officer will consult with the Parties to make best use of existing resources. 14.21 Should the Integration Joint Board believe there is a requirement to develop assets in order to facilitate the delivery of the Strategic Plan ’s Outcomes, then the Chief Officer must present a business case to the Parties for consideration. This should be submitted as part of the partner’s capital planning process. Partnership discussion would be required at an early stage for jointly funded projects. 14.22 Detailed Financial regulations governing the Integration Joint Board will be agreed between the Parties and approved by the Integration Joint Board before functions and resources are delegated. 15. Communication, Participation and Engagement 15.1 Communication, participation and engagement with all stakeholders is central to the development of the Scheme and is stated requirements as outlined in Section 6 (2) of the Act. The stakeholders who have been directly engaged with to date include: • Health & Social Care Professionals; • Service Users & Carers; • Non Commercial Providers of Health & Social Care; • Non Commercial Providers of Housing; • Independent Sector; • Third Sector; • Staff likely to be affected by the integration; and
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20 • Other Local Authorities operating within the area of the Health Board. 15.2 The Parties have well-established local arrangements for involving and engaging with service users, carers, patients and communities. These have become embedded within North Lanarkshire and include the Public Partnership Forum. North Lanarkshire Integration Joint Board collaborates with the nationally recognised Third Sector Interface, and as such provides a seat on the IJB in order to develop and coordinate activity with third sector partners. 15.3 This public engagement activity will adhere to national standards for community engagement and participation. 15.4 The Integration Joint Board has an existing participation and engagement plan, supported via access to the corporate/directorate communication teams of both parties and a dedicated Communications Officer and support from staff who work directly in the field of community engagement/public involvement. 15.5 In preparing its Strategic Plan, the Integration Joint Board has established mechanisms to seek the views of key stakeholders, including a Strategic Planning group in accordance with the requirements of the Act. 16. Information-Sharing and Data Handling 16.1 The Parties agree to continue to operate under the existing Lanarkshire Information Sharing Protocol and the agreed procedures for sharing information, which is governed by the Lanarkshire Data Sharing Partnership, until such time as any necessary changes are made by the process outlined below. The Lanarkshire Data Sharing Partnership Board is the key multi-agency forum with current partnership arrangements and includes representation from the Local Authority, South Lanarkshire Council and the Health Board, Police Scotland, Fire Service and Third Sector. All staff employed by the Parties will continue to comply with all current polices and protocols with regards to information sharing. 16.2 The protocol and procedures for sharing information will be regularly reviewed and updated to reflect the new governance arrangements that pertain to health and social care by the Lanarkshire Data Sharing Partnership. The Chief Officer of the Integration Joint Board chairs the Local Data Sharing Partnership: and the revised protocol has been provided to the Parties and the Integration Joint Board. 16.3 The Lanarkshire Information Sharing Protocol is reviewed regularly by the Lanarkshire Data Sharing Partnership. If the Parties or the Integration Joint Board have concerns about the Lanarkshire Information Sharing Protocol or agreement, or the processes for sharing information, they may request a review. Any such changes or amendments must be agreed by the Integration Joint Board and the Parties.
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21 16.4 It is the intention to ensure that any resultant information sharing agreement will be established and maintained within legislative or regulatory requirements in place at that time, primarily with respect to confidentiality, data protection and privacy. 16.5 The Parties entered into an information sharing protocol (Scottish Accord on the Sharing of Personal Information) in relation to health and social care integration, primarily to support Strategic Planning, commissioning and service design. 17. Complaints 17.1 The Parties agree the following arrangements in respect of complaints by service users and those complaining on behalf of service users. 17.2 The Parties agree that feedback, comments, concerns and complaints should be viewed with a positive attitude and valued as feedback on service performance leading to a culture of learning from complaints. 17.3 The Parties agree the principle of frontline resolution to complaints wherever possible and have existing mechanisms in place to achieve this. 17.4 The Parties agree that irrespective of the point of contact the Parties will show a willingness to appropriately direct complaints to ensure an appropriate response. 17.5 Due to different legislative requirements the Parties agree that complaints will continue to be dealt with according to the procedures and policies in place for the Local Authority and the Health Board. 17.6 Where complaints cross the boundaries of health and social care the Parties will work together to achieve, where possible, a joint response to a complaint. 17.7 The Parties agree that complaints by patients, service users or carers will be managed and responded to by the lead organisation responsible for the delivery of the service to which the complaint refers in accordance with the procedures and policies in place for that Party, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.8 There are two established processes a complaint will follow depending on the lead organisation, these are the Statutory Social Work Complaints process; and the health Board’s complaints process. 17.9 These processes, together with the timescales for acknowledgement and response, are widely publicised by the respective organisations. Complaints to the Local Authority can be made through their website Make a complaint | North Lanarkshire Council using the online form or by telephoning the Local Authority. The arrangements for making complaints to the Health Board are set out on their website
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22 Complaints | NHS Lanarkshire (scot.nhs.uk) or can be made by telephoning the Health Board. 17.10 External service providers are required to have a complaints procedure in place. Where complaints are received that relate to a service provided by an external service provider the lead organisation will either arrange for investigation or refer the complainant to the external service provider for resolution of their complaint. 17.11 All complaints will be investigated and responded to according to the lead organisation’s procedure, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.12 The Chief Officer will have an overview of complaints related to integrated functions and will provide a commitment to joint working, wherever necessary, between the Parties when dealing with complaints about integrated services. 17.13 If a complaint remains unresolved through the defined complaints-handling procedure, complainants will be informed of their right to go either to the Scottish Public Services Ombudsman for services provided by the Health Board, or to the Social Work Complaints Review Committee following which, if their complaints remains unresolved, they have the right to go to the Scottish Public Services Ombudsman for services provided by the Local Authority. 17.14 This arrangement will respect the statutory complaints-handling processes currently in place for health and social care services. This arrangement will benefit service users and carers by making use of existing complaints procedures and will not create an additional complaint handling process. 17.15 Data sharing requirements relating to any complaint will follow the Information and Data sharing protocol set in the Information and Data Handling Section of this Scheme. 17.16 Relevant performance information and lessons learned from complaints will be collected and reported in line with the support, care and clinical governance Section of this Scheme. 17.17 A joint performance report will be produced annually for consideration by the Integration Joint Board. 18. Claims Handling, Liability and Indemnity 18.1 The Parties and the Integration Joint Board recognise that they could receive a claim arising from or which relates to the work undertaken on behalf of the Integration Joint Board. 18.2 The Parties agree to ensure that any such claims are progressed quickly and in a manner which is equitable between them.
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23 18.3 So far as reasonably practicable the normal common law and statutory rules relating to liability will apply, however it is also noted that decisions relating to claims and liabilities will also be subject to any requirements, obligations or conditions of any relevant insurance policies held by the Parties. 18.4 In the event of any claim against the Integration Joint Board in respect of which it is not clear which Party should assume responsibility, the Chief Officer (or his/her representatives) will liaise with the Chief Executives of the Parties (or their representatives) to determine which Party should assume responsibility for progressing the claim. 18.5 Where a claim has been settled by one of the Parties, and it thereafter transpires that liability (in whole or in part) should have rested with the other Party, then that Party shall indemnify the Party that settled the claim. 18.6 Claims regarding policy and/or strategic decisions made by the Integration Joint Board shall be the responsibility of the Integration Joint Board. For such claims, the Integration Joint Board will require to assess the need for, and if appropriate, obtain appropriate insurance cover. It may also require to engage independent legal advice. 18.7 If a claim has a “cross boundary” element whereby it relates to another Integration authority area, the Chief Officer s of the Integration authorities concerned shall liaise with each other until an agreement is reached as to how the claim should be progressed and determined. 18.8 Each Party will ensure that appropriate risk financing arrangements are put in place and maintained, to meet the cost of claims and other associated costs. 18.9 Claims which pre-date the establishment of the Integration Joint Board will be dealt with by the Parties through the procedures that were in place prior to Integration. 19. Risk Management 19.1 The Parties and the Integration Joint Board have an agreed risk management strategy and methodology in relation to Health & Social Care Integration. The shared strategy and methodology ensures: • Identification, assessment, prioritisation and pro-active management of risk related to the delivery of services, particularly those which are likely to affect the Integration Joint Board's delivery of the Strategic Plan • Identification and description of processes for mitigating these risks • Mechanisms in place for risk sharing between the organisations; and • Agreed reporting standards. 19.2 The risk management strategy and methodology sets out: • Roles and Responsibilities for managing risk
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24 • How the Parties and the Integration Joint Board prepare risk registers, and arrangements to amend and update such registers • Risks that should be reported from the date of delegation of functions and Resources • An agreed risk monitoring framework • An agreed risk reporting framework to senior management and those charged with governance • An agreed process for sharing risks between partners • The process for agreeing changes with the Integration Joint Board; and • Protocols for communication and sharing risk information between the Parties. 19.3 The Parties and the Integration Joint Board will work collectively to support three risk registers: • IJB strategic register • The Health Board’s operational register for health services, as part of the Health Board’s corporate risk processes; and • The Local Authority operational register for social work services, as part of the Local Authority’s corporate risk processes. 19.4 The Integration Joint Board regularly reviews and updates its Risk Register, with more detailed analysis through the Performance, Finance and Audit Sub Committee. 19.5 In addition to the above, the Health Board, the Local Authority and Integration Joint Board will consider and agree which risks should be taken from their own risk registers and placed on the shared risk register. Where these risk change, the Health Board, the Local Authority and Integration Joint Board will notify each other of where they have changed. This will be done formally through the Risk Register reports to Integration Joint Board and its Finance, Performance and Audit Sub Committee. 19.6 A risk sharing form has been agreed with both partners so that joint risks can be identified and shared timeously. 20. Dispute Resolution Mechanism 20.1 In the event of a failure by the Parties to reach agreement between themselves in relation to any aspect of this Scheme or any of the duties or powers placed on them by the Act then they will follow the process laid out below: 20.2 Either Party can invoke this Dispute Resolution Mechanism by serving written notice of their intention to do so on the other Party. Such notice will be deemed to be received on the day following the issuing of the notice. The date following the issuing of the notice is herein referred to as “the relevant date”.
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25 20.3 The Chief Executives of the Health Board and the Local Authority will meet, within 7 days of the relevant date, to attempt to resolve the issue. 20.4 If unresolved, and within 21 days of the relevant date, the Parties will each prepare a written note of their position on the issue and exchange it with the each other. 20.5 In the event that the issue remains unresolved, representatives of the Parties will proceed to mediation with a view to resolving the issue. 20.6 Within 28 days of the relevant date, duly authorised representatives of the Parties will meet with a view to appointing a suitable independent person to act as a mediator. If agreement cannot be reached, then a referral will be made to the President of the Law Society of Scotland inviting the President to appoint a person to act as mediator. The mediation process shall be determined by the mediator appointed and shall take place within 28 days of the mediator accepting appointment. 20.7 Where the issue remains unresolved after following the processes outlined above, the Parties agree that they will notify Scottish Ministers that agreement cannot be reached. 20.8 The notification will explain the nature of the dispute and the actions taken to try to resolve the dispute including any written opinion or recommendations issued by the mediator. 20.9 The Parties agree to be bound by this determination of this dispute resolution mechanism.
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26 Annex 1 – Delegated Functions Part 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by The Health Board to the Integration Joint Board as set out in the Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. Functions prescribed for the purposes of Section 1(8) of the Act Column A Enactment conferring function Column B Limitation The National Health Service (Scotland) Act 1978 All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— Section 2(7) (Health Boards); Section 2CB (Functions Boards outside Scotland); of Health Section 9 (local consultative committees); Section 17A (NHS Contracts); Section 17I (use of accommodation); Section 17J (Health Boards’ power to enter into general medical services contracts); Section 28A (remuneration for Part II services); Section 38A (breastfeeding); Section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); Section 48 (provision of residential and practice accommodation); Section 55 (hospital accommodation on part payment);
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27 Section 57 (accommodation and services for private patients); Section 64 (permission for use of facilities in private practice); Section 75A (remission and repayment of charges and payment of travelling expenses);
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28 Section 75B (reimbursement of the cost of services provided in another EEA state); Section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); Section 79 (purchase of land and moveable property); Section 82 use and administration of certain endowments and other property held by Health Boards); Section 83 (power of Health Boards and local health the Local Authorities to hold property on trust); Section 84A (power to raise money, etc., by appeals, collections etc.); Section 86 (accounts of Health Boards and the Agency); Section 88 (payment of allowances and remuneration to Members of certain bodies connected with the health services); Section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001
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29 The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004 The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2018; The National Health Service (Discipline Committees) Regulations 2006 ; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006
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30 The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009 The National Health Service (General Dental Services) (Scotland) Regulations 2010 and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. Except functions conferred by— Section 22 (Approved medical practitioners); Section 34 (Inquiries under Section 33: co-operation); Section 38 (Duties on hospital managers: examination notification etc.); Section 46 (Hospital managers’ duties: notification); Section 124 (Transfer to other hospital);
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31 Section 228 (Request for assessment of needs: duty on local authorities and Health Boards); Section 230 (Appointment of a patient’s responsible medical officer); Section 260 (Provision of information to patients); Section264 (Detention in conditions of excessive security: state hospitals); Section 267 (Orders under Sections 264 to 266: recall);
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32 Section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Except functions conferred by— Section 31(Public functions: duties to provide information on certain expenditure etc.); and Section 32 (Public functions: duty to provide information on exercise of functions). Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012
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33 Part 2- Integrated Services Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions the Local Authority; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical the Local Authority; “general medical services contract” means a contract under Section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by Section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours’ period” has the same meaning as in regulation 3 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018; and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine; (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by general medical practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided out with a hospital in relation to an addiction or dependence on any substance 10. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 11. The public dental service. 12. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under Section 17C of the
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34 National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of Section 2C (2) of the National Health Service (Scotland) Act 1978. 13. General dental services provided under arrangements made in pursuance of Section 25 of the National Health (Scotland) Act 1978. 14. Ophthalmic services provided under arrangements made in pursuance of Section 17AA or Section 26 of the National Health Service (Scotland) Act 1978. 15. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of Sections 27 and 27A of the National Health Service (Scotland) Act 1978. 16. Services providing primary medical services to patients during the out-of-hours period. 17. Services provided out with a hospital in relation to geriatric medicine. 18. Palliative care services provided out with a hospital. 19. Community learning disability services. 20. Mental health services provided out with a hospital. 21. Continence services provided out with a hospital. 22. Kidney dialysis services provided out with a hospital. 23. Services provided by health professionals that aim to promote public health. 24. Health visiting Services – denotes that this is in addition to the statutory list as outlined in points 8-23 above.
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35 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by The Local Authority to the Integration Joint Board. Schedule Regulation 2 Part 1 Functions prescribed for the purposes of Section 1(7) of the Public Bodies (Joint Working) (Scotland) Act 2014 Column A Enactment conferring function Column B Limitation National Assistance Act 1948 Section 48 (Duty of the Local Authorities to provide temporary protection for property of persons admitted to hospitals etc.) Section 45 (Recovery in cases of misrepresentation or non- disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 (Powers of Secretary of State.) So far as it is exercisable in relation to another integration function.
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36 Section 8 (Researc h.) So far as it is exercisable in relation to another integration function.
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37 Column A Enactment conferring function Column B Limitation Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under Section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.)
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38 Column A Enactment conferring function Column B Limitation Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 So far as it is exercisable in relation to another integration function. (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) Section 80 (Enforcement of duty to make contributions.) Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.)
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39 Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.)
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40 Column A Enactment conferring function Column B Limitation Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 In respect of the assessment of need (Persons discharged from hospital.) for any services provided under functions contained in welfare enactments within the meaning of Section 16 and which have been delegated. Section 8 In respect of the assessment of need (Duty of local authority to take into for any services provided under account abilities of carer.) functions contained in welfare enactments (within the meaning set out in Section 16 of that Act) which are integration functions. The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Section 12 (Investigatio ns.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.) Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions
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41 Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions
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42 Column A Enactment conferring function Column B Limitation The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Section 5 (Local authority arrangements for of residential accommodation out with Scotland.) Section 6 Deferred payment of accommodation costs.) Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well- being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under Section 33: Co- operation.)
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43 Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.)
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44 Column A Enactment conferring function Column B Limitation Section 259 (Advocac y.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Section 4 (The Local Authority’s duty to make inquiries.) Section 5 (Co-operation.) Section 6 (Duty to consider importance of providing advocacy and other.) Section 7 (Visits) Section 8 (Interview s) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.)
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45 Section 16 (Right to remove adult at risk) Section 18 (Protection of moved persons’ property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.)
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46 Column A Enactment conferring function Column B Limitation Section 43 (Membershi p.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 5 (Choice of options: adults.) Section 6 (Choice of options under Section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self- directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under Section 5 or 7 of the Social Care (Self- directed Support) (Scotland) Act 2013 . Section 16 (Misuse of direct payment: recovery.)
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47 Section 19 (Promotion of options for self- directed support.) Carers (Scotland) Act 2016 Section 6 (Duty to provide Adult carer support plan) Section 21 (Duty to set local eligibility criteria)
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48 Column A Enactment conferring function Column B Limitation Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers) Section 35 (short breaks services statements) Part 2 -Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below ‘ Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services; h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services;
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49 o) Respite Support; p) Occupational therapy services; q) Re-ablement services’ r) Smart technology, equipment and telecare.
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50 Annex 3 – Hosted Services Arrangements Hosted Services Proposed Arrangements between North and South Lanarkshire Integration Joint Board. Where a Health Board spans s more than one Integration Joint Board, one of them might manage a service on behalf of the other(s). This Annex sets out those arrangements which the Parties wish to put in place. Such arrangements are subject to the approval of the Integration Joint Board but will not be subject to Ministerial approval. Services to be hosted by the South Lanarkshire Integration Joint Board Services to be hosted by the North Lanarkshire Integration Joint Board Brain Injury Unit Blood Borne Viruses Service Diabetic Services Children and Adolescents Mental Health Services Occupational Therapy Services Children’s Services Palliative Care Services Continence Services Physiotherapy Services Dietetics Services Primary Care Services Hospital at Home Services Primary Care Out of Hours Services Immunisation Services Primary Care Improvement Fund Integrated Equipment and Adaptations Store Public Dental Services Mental Health and Learning Disability Services Podiatry Services Prisoner Health Care Services Sexual Health Services Speech and Language Therapy Services
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51 Annex 4 – Health and Wellbeing Outcomes Outcome 1- People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 2- People, including those with disabilities, 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. Outcome 3- People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4- Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5- Health and social care services contribute to reducing health inequalities. Outcome 6- People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. Outcome 7 – People who use health and social care services are safe from harm. Outcome 8- 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. Outcome 9 – Resources are used effectively and efficiently in the provision of health and social care services.
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52 Appendix 2 – Consultation Process North Lanarkshire Health and Social Care Partnership Integration Scheme 2024- 2029 Consultation Process Key Meetings Integration Scheme was presented for Consultation 18th October 2023- 1st Draft of Integration Scheme submitted to the NL H&SCP Integrated Joint Board Performance, Finance and Audit Committee. 22nd November 2023- 2nd Draft of Integration Scheme submitted to the NL H&SCP Integration Joint Board – Draft Approved. 7th December 2023- Draft Integration Scheme submitted to The Local Authority Policy and Strategy Committee – Draft approved. 19th December 2023- Draft Integration Scheme submitted to NL H&SCP Senior Leadership Team Meeting. 20th December 2023- - Draft Integration Scheme submitted to The Health Board Meeting – Draft approved. Public Consultation 15th January 2024 to 11th February 2024 The consultation added to the North Lanarkshire Health and Social Care Partnership Website, The Health Board Website, and circulated via social media channels (Facebook and X). The consultation was also sent to all The Health Board and NL HSCP news subscribers (circa 10k). The consultation was emailed to a range of consultees based on North Lanarkshire Health and Social Care Partnership Strategic Planning Group. Consultees included health professionals, users of health care and social care, carers of users of health care and social care, commercial providers of health care and social care, social care professionals, staff of health board and local authority, non-commercial providers of social housings, third sector bodies and locality representatives, as necessitated by the Act. Final Sign Off Process 14th March 2024 – The Local Authority Policy and Strategy Committee 27th March 2024 – NHS Lanarkshire Board Meeting
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53 27th March 2024 – North Lanarkshire Integration Joint Board
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1 REPORT Item No: 16 SUBJECT: IJB Membership TO: Integration Joint Board Clr Claire Rae; Chief Officer Author(s) of Report Morag Dendy; Head of planning, Performance and Quality Assurance Contact details for Author(s) of Report Morag Dendy; dendym@northlan.gov.uk DATE: 19 March 2025 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: ☐ Prepared on behalf of the Chair and Chief Officer. 3. EXECUTIVE SUMMARY
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2 3.1 This paper notes the handover of the IJB Chair from North Lanarkshire Council to NHS Lanarkshire Board from June 2025. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note the contents of the report. (1) Note the handover of the IJB Chair from North Lanarkshire Council to NHS Lanarkshire Board from June 2025. (2) Note the revised membership of the voting members of the IJB from June 2025. (3) Approve the recommendations for Chair & Vice Chair of the Performance, Finance & Audit Committee (P, F&A). 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 rules about IJB membership are contained in statutory instruments and reflected in the Integration Scheme and Standing Orders. These state that Board members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. When a member resigns or otherwise ceases to hold office, the person shall be appointed for the unexpired term of the person being replaced. 7. SUMMARY OF KEY ISSUES 7.1 The Chair of the IJB should alternate between the voting representatives of North Lanarkshire Council and NHS Lanarkshire. Since 2022, the Chair has been nominated from North Lanarkshire Council from the cohort of elected members. From June 2025 the chair of the IJB should be nominated by the Board of NHS Lanarkshire. 7.2 The rules around IJB membership applies to all members except for the Chief Officer, Financial Officer and the Chief Social Work Officer who remain on the Board as long as they hold their respective posts. Therefore, all members of Yes ☐ No ☐ N/A ☐
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3 the IJB require to be renewed in 2025. An established process is in place to seek nominations for stakeholder members. 7.3 The Voting members of the IJB and PF&A have been nominated by their respective bodies and are noted as follows. Mr Brian Moore, Non-Executive Director, NHS Lanarkshire Board – Chair IJB Phillip Couser Non-Executive Director, NHS Lanarkshire Board Nauman Dar Non-Executive Director, NHS Lanarkshire Board Siobhan White Non- Executive Director, NHS Lanarkshire Board Cllr Ann McCrory – Elected Member, North Lanarkshire Council - IJB Vice Chair Cllr Claire Barclay – Elected Member, North Lanarkshire Council Cllr Bob Burgess – Elected member, North Lanarkshire Council Cllr Paul Kelly - Elected member, North Lanarkshire Council 7.4 The proposals for the Chair and Vice Chair of the PF&A committee are as follows; Chair: Cllr Ann McCrory, Elected Member, North Lanarkshire Council Vice Chair: Mr Brian Moore, Non-Executive Director, NHS Lanarkshire Board 8. CONCLUSIONS 8.1 The Chair of the IJB alternates between North Lanarkshire Council and NHS Lanarkshire. From June 2025, chair of the IJB will handover to NHS Lanarkshire Board for a three-year period to 2028. 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 ☒
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4 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 x 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 x EQIA added to website: Yes No N/A x 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included.
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6 . CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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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