ITEM 3 (M) IJB 04.12.2024 (Checked)
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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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 David Wood 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 CVS 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