09 - 2025-06-18 IJB - 2025-26 Delivery Plan – Delivering Our Health Together – NHS Lanarkshire Board - Appendix 1
North Lanarkshire Council · 18 June 2025
Back to Health and Social Care Integration Joint Board — 18 June 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Delivery Plan 2025/26 Final 19.05.25 Page 1 of 140 NHS LANARKSHIRE Delivering ‘Our Health Together’ Living our best lives in Lanarkshire Delivery Plan 2025 - 2028
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Delivery Plan 2025/26 Final 19.05.25 Page 2 of 140 Contents Background .......................................................................................................................... 5 Planning Considerations .................................................................................................... 6 Strategic Context ................................................................................................................. 7 1. Planned Care .................................................................................................................... 9 1.1 Tackling Long Waits and Backlogs ...............................................................................9 1.2 Match Outstanding Demand with Available Capacity ................................................. 13 1.3 Productivity, Efficiencies and Reducing Variation ....................................................... 14 1.4 Implementation of Digital Solutions ............................................................................ 16 2. Unscheduled Care ......................................................................................................... 20 2.1 Reducing Delayed Discharges ................................................................................... 21 2.2 Ensure Patients Received the Right Care in the Right Place ..................................... 21 2.3 Reduce Hospital Admission for Patients with Low Clinical Value ............................... 22 2.4 Optimising Assessment and Care in Emergency Departments (ED) .......................... 24 2.5 Ensure People Are Discharged as soon as they are Medically Safe .......................... 25 2.6 Deliver Rapid Assessment/Implement Frailty Units/Designated Beds at Front Door .. 26 3. Cancer Care ................................................................................................................... 28 3.1 Improving Cancer Waiting Times Standards .............................................................. 28 3.2 Increasing Diagnostic Capacity .................................................................................. 30 3.3 Optimal Cancer Diagnostic Pathways and Clinical Management Pathways .............. 32 3.4 Delivering a Single Point of Contact Services ............................................................ 33 3.5 Configuring Services .................................................................................................. 35 3.6 Supporting the Work Underway of Oncology Sustainable Services ........................... 37 4. Mental Health (MH) ........................................................................................................ 40 4.1 Building Capacity ........................................................................................................ 40 4.2 Implementing National Standards for Mental Health Services.................................... 41 4.3 Improving unplanned and Urgent Mental Health Care ............................................... 48 4.4 Delivering a more Coherent System of Forensic Mental Health Services .................. 49 4.5 Implementing the Mental Health and Wellbeing Action Plan ...................................... 50 4.6 Mental Health Built Estate .......................................................................................... 51 4.7 Mental Health Data Returns ....................................................................................... 51 4.8 Mental Health Services Priorities ................................................................................ 53 4.9 Delivering Annual Health Checks ............................................................................... 53 5. Primary & Community Care .......................................................................................... 55 5.1 Oversight of Planning of General Practice ................................................................. 57 5.2 Improving Interface Working Across Secondary and Primary Care ............................ 59 5.3 Improving the Use of Multi-Disciplinary Working ........................................................ 59
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Delivery Plan 2025/26 Final 19.05.25 Page 3 of 140 5.4 Full Provision of Appropriately Resourced Out of Hours Services .............................. 61 5.5 Working with Independent Contractor General Practices ........................................... 62 5.6 Contributing Through the Preventive and Proactive Care Programme ....................... 63 5.7 General Dental Services ............................................................................................ 64 5.8 General Ophthalmic Services ..................................................................................... 65 6. Women & Children’s Health .......................................................................................... 67 6.1 Women’s Health ......................................................................................................... 68 6.2 Maternity and Neonatal Services ................................................................................ 69 6.3 Introducing the New Pathways for Maternity Care ..................................................... 70 6.4 Implementing the New Model of Neonatal Intensive Care .......................................... 71 6.5 Continuing with Implementation of the Lancet Series Recommendations .................. 72 6.6 Tackling Racialised Health Inequalities in Maternity Care .......................................... 73 6.7 Child Health Services – Delivering High Quality Paediatric Audiology Services ........ 74 6.8 Child Health Services ................................................................................................. 75 6.9 Taking Forward Action in Local Child Poverty Action Reports.................................... 78 7. Population Health & Reducing Health Inequalities ..................................................... 80 7.1 Cross Sector Partnerships.......................................................................................... 80 7.2 Vaccination Services .................................................................................................. 81 7.3 High Consequence Infectious Diseases (HCID) Pathways ........................................ 82 7.4 Addressing Inequalities in Cancer Screening ............................................................. 83 7.5 National Mission on Drugs.......................................................................................... 83 7.6 Sexual Health and Blood Borne Virus ........................................................................ 85 7.7. Hepatitis Elimination Goals ........................................................................................ 87 7.8 Sexual Health and Blood Borne Virus ........................................................................ 88 7.9 Long-Acting Reversible Contraception ....................................................................... 89 7.10 Supporting Improved Population Health ................................................................... 90 7.11 Health Inequalities and Population Needs ................................................................ 92 7.12 Racialised Inequalities .............................................................................................. 93 7.13 Redirecting Wealth Back into Their Local Community .............................................. 94 7.14 Integration of Transport into Wider Health Planning and Reform ............................. 96 7.15 Embed the GIRFE Toolkit and the Principles into Planning and Delivery ................. 98 8. Finance ........................................................................................................................... 99 9. Infrastructure ............................................................................................................... 100 9.1 Accommodation Requests........................................................................................ 101 9.2 Infrastructure Whole System Initial Agreement ........................................................ 101 9.3 Primary Care & Community Infrastructure ................................................................ 102 10. Value Based Health & Care ....................................................................................... 103
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Delivery Plan 2025/26 Final 19.05.25 Page 4 of 140 10.1 Focus on Practising Realistic Medicine .................................................................. 103 10.2 Measuring Delivery of Value Based Health Care ................................................... 104 10.3 Developing Community of Practice Involvement and Ensure Sustainable Healthcare Models ............................................................................................................................ 105 11. Workforce ................................................................................................................... 106 11.1 Agency Staffing ...................................................................................................... 107 11.2 Achieve Reductions in Medical Locum Spend ........................................................ 109 11.3 Increasing Efficiencies Across Administrative and Support Services ..................... 111 11.4 Encourage Attendance & Support Employees ....................................................... 111 11.5 Implementation Plan for eRostering in 2024/25 ...................................................... 113 11.6 Working with Further/ Higher Education Institutions ............................................... 113 11.7 Plans to Ensure that all Relevant Staff are Face Fit Tested to an FFP3 Respirator ....................................................................................................................................... 118 12. Digital and Innovation ............................................................................................... 120 12.1 Adoption and Implementation of the National Digital Programmes ........................ 121 12.2 Cyber Resilience and Compliance with Public Sector Resilience Framework ........ 122 12.3 Executive Support and Commitment to Optimising Use of Digital & Data Technologies in the Delivery of Health Services ............................................................ 123 12.4 Working Collaboratively with Other Organisations to Scale and Adopt Innovation . 124 12.5 Alignment to Board’s Digital Strategy ..................................................................... 126 12.6 Innovation – Genetic Testing .................................................................................. 127 13. Climate ........................................................................................................................ 129 13.1 Greenhouse Gas Emission Reduction ................................................................... 129 13.2 Adapting to the Impacts of Climate Change ........................................................... 130 13.3 Waste ..................................................................................................................... 131 13.4 Sustainable Travel .................................................................................................. 132 13.5 Environmental Management System ...................................................................... 133 13.6 Improving Environmental Performance .................................................................. 134 13.7 Green Theatres ...................................................................................................... 135 14. Conclusion ................................................................................................................. 136 15. Glossary of Terms ..................................................................................................... 137 16. Planning Architecture ............................................................................................... 140
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Delivery Plan 2025/26 Final 19.05.25 Page 5 of 140 Health and Social Care reform is crucial to ensure we can deliver sustainable public services that provide value for money and help our populations experience better health and wellbeing throughout life. NHS Lanarkshire’s Healthcare Strategy, ‘Our Health Together – Living our Best Lives in Lanarkshire’ introduced an ambitious reform agenda and programme of positive change which continues across our services. This is reflected in our Delivery Plan (DP) priorities for 2025/26 - 2027/28 which aligns with the Board’s Finance, Workforce and Quality plans and incorporates the recently launched national Health and Social Care reform ambitions. The Delivery Plan responds to 80 prescribed ‘Planning Priorities’ across 13 ‘Delivery Areas’ aligned with Scottish Government (SG) policy team priorities. The actions and trajectories within our Plan are dynamic and will continue to develop responding to future SG requests or changes in local circumstances. Our Delivery Plan and actions detailed have been developed in the context of work progressing to address significant ongoing service pressures and are focused on delivering safe, quality services for patients within the constraints of available budgets and workforce. It remains an ambition that we continue to collaborate with our staff, communities and partners to deliver sustainable, affordable services that provide person-centred high-quality care. The planning architecture that aligns our planning is detailed in Section 17 at the end of the plan. Background
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Delivery Plan 2025/26 Final 19.05.25 Page 6 of 140 The planning assumptions used to inform the Delivery Plan align with those set out in NHS Lanarkshire’s Financial Plan. Historically NHS Lanarkshire has delivered a break even revenue outturn within challenging financial environments. The current version of NHS Lanarkshire’s Financial Plan has an overall budget gap of £50,488,326 (including both North Lanarkshire IJB and South Lanarkshire IJB delegated health budgets) prior to identified savings schemes. Additional planning considerations include: • We deliver services to a total population of c670,000. Our older population is increasing which brings complex healthcare needs and increasing demand for services. • We have a disproportionate number of people in poorer health with significant chronic illness linked to high levels of deprivation. Our future plans will reflect the Population Health Framework which is due to be published in Spring 2025 and will provide a blueprint for a long term focus to primary prevention. • We employ around 14,000 staff who work across our whole system. We continue to experience some recruitment and workforce challenges in particular specialities. • Our performance levels are monitored via our monthly Integrated Performance and Quality Report which includes, local trajectories and national targets. Planning Considerations
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Delivery Plan 2025/26 Final 19.05.25 Page 7 of 140 Local Context The transformation priorities set out in NHS Lanarkshire’s Healthcare Strategy, ‘Our Health Together – Living our Best Lives in Lanarkshire’ are reflected in the actions identified within this document as we build on the reform work ongoing through 2024. Work that will remain a focus and continue to evolve includes: • Whole system reform of urgent and unscheduled care, building on the work which is being progressed via our newly established Interface Directorate. • On-going review of planned care. • Primary Care Strategy and development of a future service to reflect the needs of residents, building on the engagement undertaken during 2024. • Adopting the refreshed Mental Health Strategy Delivery Plan to transform Mental Health services. ‘Getting it Right for Every Person (GIRFEP)’ approach, aligned to the 5 priorities. • Ongoing implementation of the Board’s Digital Strategy. • Finalising the Monklands replacement Full Business Case. Collaboration and Partnership Collaborative planning across established partnerships including Local Authorities, the third sector, Academia and the wider NHS system is key to delivering our priorities. Our Strategic Context
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Delivery Plan 2025/26 Final 19.05.25 Page 8 of 140 relationship with our Academic and Local Authority partners continues to flourish, and during the last year Lanarkshire’s two Health and Social Care Partnerships were recognised as university-designated operating divisions of NHS Lanarkshire. NHS Lanarkshire, South Lanarkshire Council, North Lanarkshire Council and our University partners formalised a range of agreements that detail our commitment and ambition to continue to work together to tackle key health and care challenges for the benefit of local communities. This commitment is reflective of the work the Board and our partners are progressing as local Anchor organisations. National Priorities Lanarkshire's reform agenda is cognisant of the national priorities including: • Health and Social Care Reform as described in the Cabinet Secretary’s new vision to ‘enable people to live longer, healthier and more fulfilling lives’. • The First Minister’s four clear priority areas of eradicating child poverty; growing our economy; tackling the climate emergency and improving public services underpinned by technological solutions, AI, robotics and digital enhancements. • Work to address the health challenges for Scotland now and in the future (threats from infectious disease, stalling life expectancy, widening health inequalities demand for and utilisation of health and social care services and the climate emergency affecting Scotland’s health and wellbeing). • The NHS Reform and Preventative and Proactive care programmes.
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Delivery Plan 2025/26 Final 19.05.25 Page 9 of 140 Addressing planned care pressures is a key priority within our Healthcare Strategy with work ongoing to improve access for the benefit of our patients. The recent Health and Social Care Reform plan has tasked Boards to ensure no new outpatient or inpatient/daycase patients wait over 52 weeks by March 2026. This will be incredibly challenging to achieve, however, the actions set out within the Planned Care Delivery Plan will move us towards this, building on programmes that are well established and have already delivered improvements. Cancer targets for 31 and 62 days, for example, are now consistently met. Waiting time improvement trajectories are reflected in the Planned Care Delivery Plan which is focused on: • Improvement and productivity to maximise core capacity utilisation in line with the Centre for Sustainable Delivery (CfSD) key performance indicators in the most challenged specialties. • Full utilisation of our national allocations including from the Golden Jubilee National University Hospital and National Treatment Centres (NTCs). • Implementation of national specialty plans (Imaging, Ophthalmology, Orthopaedics). • Treating the longest waiting patients, prioritising specialities with the longest waiting lists, while maintaining a focus on cancer diagnostics and treatment. We continue to work with the CfSD to provide data, information and intelligence on the impact of redesign and transformation programmes. We also remain committed to the delivery of emerging National plans for Imaging, Ophthalmology and Orthopaedics. 1.1 Tackling Long Waits and Backlogs (Focusing on key specialities including cancer, gynaecology, orthopaedics, ophthalmology, urology and diagnostics) 1.1.1 Outpatient, Inpatient and Day Case Activity trajectories are outlined in the Planned Care Delivery Plan. The primary focus is to maximise capacity for the benefit of our patients, planning and measuring against trajectories to reduce long waits for outpatients, inpatients and day case treatments across specialties. Focus continues on the achievement of cancer standards (specifically 62-day pathway) and a reduction in waits for key diagnostic tests in radiology and endoscopy. We remain well 1. Planned Care
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Delivery Plan 2025/26 Final 19.05.25 Page 10 of 140 represented on national programmes of work that relate to gynaecology, orthopaedic, endoscopy and ophthalmology, and will progress and implement improvements. This includes: • Using Delivery Plan submissions (2025/2026) and agreed modelling, determining number of long waits and capacity gap or surplus available. • Assess our ability to effectively utilise recurring investment and quantify deliverable capacity in 2025/26. This would be delivered via: o Increased productivity locally, where service initiatives identified require additional funding to address existing bottlenecks (e.g. lack of staff, equipment). o Additional activity which can be delivered locally e.g. through High Impact Lists or staffing fallow capacity. o National proposals for additionality e.g. nationally procured independent sector. Improvement Trajectories (TTG & NOP) Delivery Assessment Trajectories for new outpatients (NOPs), treatment time guarantee (TTG) and diagnostics outlined in the Planned Care Delivery Plan are based on true demand plus an element of did not attends (DNAs). Data incorporated includes: • Activity that can be delivered in core capacity including efficiencies. • Agreed modelling approach will show: o Waiting list size with number of patients waiting over 52 weeks at March 2026. o Capacity gap. Standardise data reporting formats to ensure consistency (e.g. planned care submissions,
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Delivery Plan 2025/26 Final 19.05.25 Page 11 of 140 national approach to modelling). 1.1.2 Diagnostics A focus within diagnostics is to provide resilience, sustainable imaging services for maximum patient benefit, measuring against trajectories to reduce long waits for Ultrasound, Breast Service, Magnetic Resonance Imaging (MRI) & Computed Tomography (CT). This will be addressed through implementation of: • Utilisation of our MRI national allocation at the Golden Jubilee National University Hospital (additional capacity of 5,000 patients) • Implementation of the mobile van to support 7-day service 8.00 am to 8.00pm for CT (additional capacity of 238 patients/ week). • Continuation of Locum Sonographer (2,200 scans). • New staffing models to support Breast Service Imaging. • Support from GJNH weekends and National Ultra-Sound Training Programme (NUTP) activity will continue to prioritise NHSL patients. Improvement Trajectories Delivery Assessment Assessment will be against trajectories set out in the Planned Care Delivery Plan (25/26) for the 4 key Radiology tests to achieve 95% of scans performed and reported within 6 weeks by March 2026. This is noted as a priority within the Health and Social Care Reform programme. 1.1.3 Speciality Capacity Pressures A range of specialties face specific capacity pressures including; Ear, Nose & Throat (ENT), Urology, Orthopaedics. Ophthalmology and Gynaecology. Plans and strategies will be invoked to help to address the pressures. These include: • Improved theatre efficiency/productivity.
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Delivery Plan 2025/26 Final 19.05.25 Page 12 of 140 • Maximising additional / external capacity (subject to funding). o Maximising access to Golden Jubilee for Orthopaedics, Ophthalmology, General surgery, Endoscopy and Radiology. o Targeted Insourcing (e.g. Neurology /Dermatology/Ophthalmology /Oral and Maxillofacial Surgery (OMFS)). o Waiting List Initiatives. o Support local Improvements. o Ophthalmology Advanced Clinical Nurse Specialist (ACNS) Laser clinics (250 appointments). o Trans Nasal Endoscopy Pathway (76 slots). o Urology Hub phase II (one stop diagnostic). o High Volume, Low Complexity Procedures Surgical Practitioner Role. • Establishment and delivery of local specialty improvement programmes. • Embed Specialty Delivery Group (SDG) national pathways / CfSD productive opportunities. o Optimise Active Clinical Referral Triage (ACRT) and Patient Initiated Referral (PIR) to address demand aiming to deliver the CfSD aspirations (Heatmap). o Implementation of diagnostic improvement (5 key areas and 20 Productive opportunities). o Theatre efficiency/productivity. o Improved core session Utilisation (min 85%). o Maximising theatre productivity (5% reduction in unproductive time). o Optimisation theatre lists (Infix / Scheduling process and software). o Maximise Day surgery / single procedure day surgery. • Reducing unwarranted variation by standardising service provision and pathways. • Explore new pathways with National Elective Co-ordination Unit (NECU) to maximise capacity. • Progressing a pilot of integrated DrDoctor digital system within Orthopaedics to support patient optimisation and risk stratification. • Digital assessment and optimisation. o Digital Dermatology o Digital Front Door
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Delivery Plan 2025/26 Final 19.05.25 Page 13 of 140 Risk Assessment The risks associated with tackling backlogs and achieving the ambition to eradicate waits over 52 weeks are largely related to: • The challenging financial environment forecast for the next financial year. • Recruitment challenges across professional groups which result in the inability to complete planned activity. • Utilisation of capacity to prioritise cancer and urgent care. There are challenges in accurately planning activity projections due to uncertainty around the financial position and reduction in outsourcing allocations to NHS Lanarkshire from the Golden Jubilee National Hospital (GJNH). 1.2 Match Outstanding Demand with Available Capacity (Across Scotland through regional and national working including through the National Treatment Centres (NTCs)) 1.2.1 Accessing Additional Capacity We will maximise utilisation of specialty allocations at 100% and continue to access additional capacity where this is available. Specialties will continue to develop and access new pathways and programmes through our collaborative work with the Golden Jubilee. Specifically, we will maximise Golden Jubilee allocations for: • Orthopaedic - 434 patients (including Joints). • General Surgery – 58 patients (Colorectal / Hernia). • Ophthalmology – 1868 patients (Cataracts). • Endoscopy – 1500 scopes. • Radiology (Ultrasound, CT, MRI, Dexa). Actions for 2025/26 are detailed as follows: • Collaboration with partner NHS Boards and NECU will allow access to campaigns that maximise capacity on a national / regional bases (e.g. Breast, Plastics, oral and maxillofacial surgery (OMFS), Orthopaedics). • Pilot programme – Orthopaedic see & assess programme (300 patients). Risk Assessment The risks associated with demand management and utilising capacity across Scotland are
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Delivery Plan 2025/26 Final 19.05.25 Page 14 of 140 also relevant given the challenging financial environment forecast for the next financial year. The ability to secure external capacity can be impacted by national policy which reduced NHSL allocations in previous years. We continue to highlight the implications and limitations nationally and make best use of the allocation we receive. 1.3 Productivity, Efficiencies and Reducing Variation (Such as optimising theatre utilisation) 1.3.1 Theatre Utilisation By Sept 2025 we will have established our Theatre Utilisation Board underpinned by a policy, that incorporates guidelines and principles developed by CfSD Perioperative Delivery Group during 2024: • Protecting Planned Care Principles. • Pre-Op Assessment Principles. • Scheduling Principles. • Wider Perioperative Team Development. Delivery Assessment KPI 85%-105% utilisation for scheduling; 85% productive time - Accurate and timely data capture is crucial, with theatre activity reviewed weekly by the Theatre Management and Access Team for validity and accuracy. OPERA and Milan provide real-time data and our Milan Management Dashboard enables a retrospective weekly review of utilisation and productive time across our theatres. NSS Discovery data is currently used to review and benchmark performance but is two months behind (e.g. April data available June). 1.3.2 Orthopaedic Surgery Initiatives ongoing that support productivity and efficiencies within orthopaedic surgery include: • Optimisation of protected planned care beds. o Protect 2 side rooms and 2 x 4 bedded bays for inpatient activity by April 2025. • Increase high volume lists. o 4 joint arthroplasty or equivalent with 8 surgeons delivering 8 lists per month to be in place by June 2025. • Increase Day case Arthroplasty – 6% of total list.
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Delivery Plan 2025/26 Final 19.05.25 Page 15 of 140 o Aim is for at least 25% of Uni Knee’s to be day cases. Some 4 joint lists could start with a day case. Plan is to achieve a 4% increase from 2024 saving 40 bed days. Predicted to be in place by Sept 2025. Risk Assessment In addition to risks associated with the orthopaedic improvement programme there are specific risks that relate to the initiatives detailed. • Unscheduled care pressures deplete capacity which impacts on available elective beds. Detailed planning on Length of Stay (LOS) should help to mitigate this. • Increasing high volume lists to deliver 4 joint arthroplasties, consultant availability and suitable patient cohorts might necessitate patients being treated out of date sequence. • An increase in day case Arthroplasty requires surgeons to discuss possible day case options for Uni Knees and suitable Total Hip Replacement (THR) + Total Knee Replacement (TKR) in clinic. This would require information to be added to the In-Patient Waiting List (IPWL), prioritising potential day cases to be 1st on the list where possible. This is more difficult for surgeons who do revision surgery and Bilateral Joint replacements. To mitigate there needs to be consideration of day case patients being prioritised. • Community impact for prehabilitation and post-operative recovery. • Patients treated out of sequence when bed availability is problematic on the ward. 1.3.3 Cataract Surgery The demand/capacity position for cataract surgery is currently balanced due to a substantial annual allocation from Golden Jubilee National Hospital. Demand for cataract surgery will increase substantially throughout Scotland due to an aging population. The identification and introduction of initiatives that will increase cataracts service capacity is crucial. A priority will be to deliver high volume cataract surgery in ring-fenced local anaesthetic sessions wherever practicable using new technology that will support optimisation of capacity and productivity gains to sustain high volume lists. Delivery Assessment To increase high volume lists the plan would be to increase the 7 slot lists on cataract only lists to 60% through productivity gains.
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Delivery Plan 2025/26 Final 19.05.25 Page 16 of 140 The main risk associated with this approach is that an increase in high volume lists coupled with consultant availability and suitable patient cohorts could necessitate patients being treated out of date sequence. 1.3.4 Acute Anterior Eye Service The Scottish Government is scheduled to publish a specification for a new acute anterior eye service during 2025, Following publication, NHS Lanarkshire will collaborate with key stakeholders to develop a service to meet patient need. 1.4 Implementation of Digital Solutions 1.4.1 Peri Operative Improvement Theatre throughput continues to struggle to reach levels achieved pre-pandemic and peri- operative improvement remains a priority. We have delivered significant improvement, reducing non-productive time to between 18-24%. We anticipate further improvements given our active role in the national peri-operative improvement work and the developing peri- operative strategy. We have adopted Infix a data driven electronic scheduling tool used to optimise productivity in operating theatres. Infix has demonstrated considerable gains in other Boards increasing throughput, session utilisation and reducing underruns. Infix has been implemented in 2 pilot specialties (Ear Nose and Throat (ENT) and Urology) and this will be consolidated and evaluated with a planned roll out anticipated through 2025/26 to the remaining surgical specialities in NHSL through 25/26 and 26/27. Delivery Assessment Infix will be measured against local theatre efficiency targets including reduction of unproductive time. This will include increased specialty throughput, list utilisation and a predicted reduction in theatre underruns by 10%. It is also anticipated that Infix will: • Replicate optimisation of routine lists seen elsewhere (90% optimisation achieved). • Provide improved reporting to aid with theatre scheduling and resource allocation. Risk Assessment An assessment of risks associated with the pilot and roll out are that: • The reduction or removal of funding for the programme would result in a funding gap and result in termination of the programme.
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Delivery Plan 2025/26 Final 19.05.25 Page 17 of 140 • Staff recruitment to peri op and non-compliance by some staff with the agreed optimisation levels resulting in limited improvements in efficiency and productivity. Mitigations: • Funding plan currently in place. • Full engagement with specialties and clinical staff prior to ‘go live’ and agreement of aims and ambitions. • Training programme undertaken with scheduling and clinical staff. • Ongoing support to staff post-implementation. • Cross specialty learning. • Reporting and monitoring peri-operative efficiency group and management teams. 1.4.2 Dermatology The Dermatology service remains under significant pressure due to workforce challenges and increasing demand. Demand, including Suspicion of Cancer (SoC) referrals has steadily risen year on year. Despite the demand, NHS Lanarkshire’s service has the shortest waiting times in comparison to other Boards – waiting times for urgent referral is 12 weeks wait, with routine at 34 weeks, meeting the target of no waits beyond 52 weeks. Dermatology are proactive in both service improvement and in ensuring marginal gains through efficiency. There is a track record of collaborative working and pathway development with primary care services. Central to this has been an established lesion pathway using images to provide patients with the appropriated clinical pathway in relation to suspicious skin lesions. This has proven successful in ensuring patients receive treatment without delay. The next phase of this project will be adoption of the Digital Dermatology Pathway. Developed through Accelerated National Innovation Adoption (ANIA), this will provide GPs with the ability to use their own devices to refer a range of skin conditions to Dermatology. The service can provide expert advice to patients and / or GPs, arrange for an appointment or add to a treatment pathway. Delivery Assessment NHS Lanarkshire is at an early stage in the programme and currently timetabled to be the final NHS Board to go live. It is expected that the programme will: • Provide patients and General Practitioners (GPs) with diagnosis and advice on clinical
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Delivery Plan 2025/26 Final 19.05.25 Page 18 of 140 management without delay. • Enable patients to start off treatment pathways without delay. • Reduce the requirement for new outpatient appointments. Infrastructure is currently being established, and this is expected to be implemented during Q4 2025, with the overall programme evaluated and implemented through 2025 / 2026. Risk Assessment Access to eHealth resource and delays to the national rollout could result in implementation being delayed. There is a risk that the digital pathway will not meet the standard of the current lesion pathway, leading to poor service engagement and limited improvement gains. Mitigations: • Full service / clinical engagement on the national Digital Dermatology group. • Supported pathways as agreed via Specialty Delivery Group (CfSD). • Development of local clinical pathways and process. • eHealth resource identified with NHSL. • Project initiation underway. 1.4.3 Lung Cancer Diagnostic Pathway National work is underway to develop a value case for the National roll out of an enhanced Lung Cancer diagnostic pathway, which utilises Artificial Intelligence (AI) to identify high risk Chest X-rays (CXRs) for expedited radiology review and diagnostic CT scans. Delivery Assessment Work is underway to develop: • Agreed National Standard Operating Framework: o Priority worklist- most urgent CXRs moved to top of the worklist. o Turnaround times – all AI flagged cases reported by the end of the working day. o Internal Review – AI flagged cases will be reviewed internally. • Matrix of measurement: o Patients requiring urgent assessment. o Time from CXR-to-CXR report. o Time from CXR report to CT report.
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Delivery Plan 2025/26 Final 19.05.25 Page 19 of 140 o Improved Staff and Patient experience. o Efficiencies in utilising resource (more targeted). o Cancer performance 95% for 62 days (sustaining). Risk Assessment Risks associated with the developing case and associate mitigations are noted as: • Gaps in clinical rotas / job plans to review AI-flagged “high-risk” cases within 24 hours. • Lack of resource to liaise with patients and to book follow-up CTs for urgent cases within 2 days. • Failure in coding CXR reports to notify administrative teams and create an audit trail. Mitigations: • Full service / clinical engagement. • Development of local clinical pathways and process. • EHealth resource identified with NHSL. • Project initiation/learning from neighbouring boards.
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Delivery Plan 2025/26 Final 19.05.25 Page 20 of 140 Our Health Together launched our ambitious whole system transformation programme for Urgent and Unscheduled care reform is well established. Our plans have been enhanced by learning from the Centre for Sustainable Delivery’s NHS Lanarkshire Report. Through 2025/26 & 2026/27 we continue to work to deliver the new model. We will achieve this by: • Ensuring community-based services can support living well in the community. • Providing availability of primary care and community-based services to maintain health and wellbeing • Community rehab services and equipment to keep our population well at home. • Enhanced care: o providing access to rapid short-term support to keep people well at home. o enable rapid discharge through assessment at home where possible. • The provision of virtual beds, Hospital @ Home/Hospital Based Care for specialist acute care and treatment when required. • Implementation of our Front Door Target Operating Model (TOM) directing patients appropriately. • Improve patient experience and minimise deconditioning through safe and effective flow across our physical and virtual beds. The delivery components of the new USC model will consist of: • Flow Navigation Centre Plus (FNC+). • Increased Virtual Capacity. • Establishing a Digital Front Door. • Maximising Ward Efficiency. • Primary Care Reform. We continue to identify new care pathways for patients who are high utilisers of General Practice due to unmet care needs elsewhere in the system. Three pathways (anaemia, severe headache, and hypertensive emergencies) have already been rolled out and work is ongoing on two more. (Possible Deep Vein Thrombosis (DVT) and haematuria). An aim for 2025 is to provide three symptom-based pathways which provide rapid answers to key diagnostic questions. 2. Unscheduled Care
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Delivery Plan 2025/26 Final 19.05.25 Page 21 of 140 2.1 Reducing Delayed Discharges (Supporting the Scottish Government and COSLA’s Joint Mission to Reduce Delayed Discharges) 2.1.1 Delayed Discharge Improving delayed discharge performance is intrinsically linked to improving our whole system flow and reduces any associated harm patient’s experience if they remain in hospital longer than necessary. Our whole system Flow and Delayed Discharge Improvement Plan consists of the following high level actions which we aim to implement by 30th June 2025: • Implementation of our Optimal Discharge Planning TOM. • Establishment of a Once for Lanarkshire system Home First Assessment Approach. • Demand, Capacity and Queue Analysis of Community and Social Care resources. • Pre Noon Discharges: 30% -40%. • Weekend Discharges: 20% of weekly total. • Discharge Lounge Use: 40% of total inpatient discharges. • Discharged without a Planed Date of Discharge (PDD) on Trakcare: 15% (allows for discharges within 24/48hrs). • Percentage not meeting PDD on Trakcare: 10%. • Package of Care (POC) Restart: Within 24-48hrs of referral received. • New Package start: Within 72hrs of referral received. • Delayed Discharges 10% or less of total inpatients (Acute Sites). 2.2 Ensure Patients Received the Right Care in the Right Place (Optimising Flow Navigation Centres, increasing scheduling of appointments and alternative services, increasing the route for prof to prof advice with a focus on care home support) 2.2.1 FNC+ Plus Our FNC plays an essential role in managing urgent and unscheduled care across our system. During 2024/25 we significantly enhanced the Board’s Flow Navigation Centre and established an Interface Directorate to lead on this key development. Areas of focus for FNC+ Plus are to: • Manage GP demand. • Manage Home Care Demand. • Maximise Emergency Department (ED) redirection.
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Delivery Plan 2025/26 Final 19.05.25 Page 22 of 140 • Maximise redirection and non-conveyance from SAS, NHS 24/111. • Facilitate rapid/support discharge. Improvement actions to be further progressed during 2025/26: • Maximise senior clinical decision making presence in FNC+ Plus increasing routes for professional to professional advice. • Maximise alternative FNC+ pathways of care across the system (in collaboration with OOHs/SAS/NHS 24/HSCPS/ AHPS/MH/PAEDS etc.). • Deliver and report scheduled activity across the minor’s flow across Lanarkshire. • Deliver and report on ambulant care medical, surgical and ortho pathways across the interface between primary, secondary and regional services. • Define, build and test the model of a triage GP hub both in/OOHs. • Improve on the prof to prof utilisation across all pathways using FNC+ as an inter- connection across specialisms and professions. • Ensure Care Home pathways are aligned to benchmarked best in class data (non- conveyance, direct H@H pathways, care home liaison pull out). Trajectories for Call Before your Convey under development with SAS colleagues. 2.3 Reduce Hospital Admission for Patients with Low Clinical Value (Such as those aged over 85 and end of life care by improving urgent care by improving urgent care in the community and increasing hospital at home pathways) 2.3.1 Increasing Hospital and Home Pathways We manage 105 virtual beds within our established Hospital @ Home service and have commissioned an additional 400 virtual beds, phased with 200 initially. The beds are co- ordinated and monitored through FNC+ Plus. The virtual beds are technology-enabled to optimise care for patients, support communication and enable the effective management of a patient’s condition. The learning from our existing hospital @ home service has been invaluable in developing our virtual bed model which will provide: • Clinical care delivered by a Multi-Disciplinary Teams (MDT), led by a named consultant practitioner (e.g. medic, nurse, Allied Health Professional (AHP) or GP) with clear lines of clinical responsibility or governance. • Pathways for high-volume conditions/symptoms/settings to reduce hospital occupancy levels. These include Respiratory, Breathlessness, Frailty & Paediatrics.
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Delivery Plan 2025/26 Final 19.05.25 Page 23 of 140 • Defined criteria for inclusion/exclusion supported by clinical review to provide a safe and robust service. • Patient information on who to contact if symptoms worsen, including out of hours. • Pathways to support early recognition of deterioration and appropriate escalation process in place to maintain patient safety. • Technology enabled care via mobile phones, apps, web-based tools or wearables. • Speciality advice and guidance/diagnostics equivalent to acute hospital access to enable timely clinical decision making. • Time-limited interventions/monitoring based on clinical need for a secondary care bed. • Alignment/integration with, FNC+ and developing alternative pathways to support - o Locality response to support rapid discharge pathways (hospital and virtual ward). o Emergency ambulatory care and unscheduled care services to maximise scheduling or unplanned care through direct admission processes. o Primary care, community and third sector service to support long-term condition management and reduction in emergency presentations. The first beds within the new virtual wards became available from the end of November 2024. Delivery Trajectory We have a planned phased approach to patient cohorts for virtual capacity pathways. Phase 1 pathways have been developed and implemented through Autumn / Winter 2024/25 and the patient cohorts are: • Hospital @ Home – Frailty (as described above). • Diagnostic Virtual pathways via a rapid discharge access point. • A range of specialities, which include orthopaedics, respiratory, cardiology, renal, surgical pathways supported via admission avoidance, supported discharge/ step down. Phase 2 pathways will be developed and implemented from Spring/ Summer 2025 onwards and the patient cohorts planned include: • Paediatrics. • Primary Care. • Complex Community / GP • Complex Long Term Conditions.
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Delivery Plan 2025/26 Final 19.05.25 Page 24 of 140 2.4 Optimising Assessment and Care in Emergency Departments (ED) (By improving access to ‘same day’ services, the use of early and effective triage, rapid decision-making and streaming to assessment areas) 2.4.1 Front Door Target Operating Model (TOM) Our underpinning priority is to implement all elements of our Front Door TOM, optimising and standardising processes and pathways. This will be achieved by implementation of a Rapid Emergency Assessment Care Team (REACT) on all three acute sites: • REACT/Triage within 30mins of arrival. • 95% over 65yrs Frailty Scored at REACT. • 95% Attenders have First Assessment within 120mins. Timescale for completion of this work is 31st August 2025. Improvement Trajectory Scheduling Minors/Protection of Minors Staffing Apr’ 25 May’ 25 Jun’ 25 Jul’2 5 Aug’ 25 Sept’ 25 Oct’ 25 Nov’ 25 Dec’ 25 Jan’ 26 Feb’ 26 Mar’ 26 4hr Access Perf. 55% 57% 59% 60% 62% 64% 65% 65% 65% 65% 65% 66% 8hr Access Perf. 90% 90% 91% 91% 92% 92% 93% 93% 93% 93% 93% 93% 12hr Access Perf 90% 91% 92% 93% 94% 94% 95% 95% 95% 95% 95% 95% Flow 1 Cat 4/5/6 79% 79% 80% 80% 82% 82% 84% 84% 85% 85% 86% 86%
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Delivery Plan 2025/26 Final 19.05.25 Page 25 of 140 2.4.2 Establishing a Digital Front Door We continue to prepare for implementation of eTriage across our 3 EDs. eTriage is a digital triage solution which integrates with Trakcare allowing patients (who are able to do so) to self-check-in. Having detailed information available as patients book into ED can increase opportunities to signpost/redirect, enhance processes and oversight, and improve safety metrics such as time to triage (TTT) and time to first assessment (~TTFA). To realise benefits, we must achieve clinical engagement and ownership. Collaborative work with eConsult (eTriage supplier) and Intersystem will ensure interfaces connect and achieve information transfer on implementation. The direct award with eConsult will be finalised on completion of the digital interface review and thereafter we will proceed with phased site implementation, aligned with our Front Door Target Operating Model, from Spring 2025. 2.4.3 Breach Analysis Weekly breach analysis helps us identify opportunities for improvement. Month by month improvement is anticipated by 31st March 2026. 2.5 Ensure People Are Discharged as soon as they are Medically Safe (By promoting robust and responsive operational management and providing early and effective discharge planning including rehabilitation and reablement in line with the 6 principles of good rehabilitation) 2.5.1 Maximising Ward Efficiency Maintaining a positive in/out balance and maximising outflow are key to managing demand and reducing hospital occupancy levels. We continue to implement our Flow Foundation Bundle, which is a combined set of simple rules for receiving and inpatient wards to improve patient flow and prevent unnecessary waiting for patients. The bundle consists of: • Discharge Beat for each ward. • MDT Board Rounds (x 3 times/day). • Criteria to reside assessment for every patient. • Planned date of discharge (PDD). • Criteria-led Discharge. • Pre-noon Discharge and Use of Discharge Lounge. • Real updating of patient movements on Trakcare.
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Delivery Plan 2025/26 Final 19.05.25 Page 26 of 140 To support seamless discharge, we have developed an Optimal Discharge Planning Target Operating Model which includes the Flow Foundation Bundle which will be implemented alongside a Home First assessment approach and connected pathway with Social Work/Social Care. This will allocate patients to the appropriate pathway to support the discharge planning process reducing pressure in our hospitals. We have adapted the key elements of the discharge planning pathways 1 – 4 developed by CfSD which provide eligibility criteria to structure our discharge planning processes. Patients will be allocated a discharge pathway to support forward planning and clarity regarding discharge process, reducing unnecessary delays in their journey. Embedding and implementation of the Flow Foundation Bundle and Optimal Discharge Planning TOM will continue during 2025/26 across our Acute and non-Acute estate. 2.6 Deliver Rapid Assessment/Implement Frailty Units/Designated Beds at Front Door (Aligned to dedicated enablement or discharge to assess support that will facilitate new services within 24-36 hours of request, 7 days per week to provide recovery in the community) 2.6.1 Implementation of Ageing and Frailty Model Implementation of the each of the 7 steps of the NHSL Ageing & Frailty Model by March 2026. Delivery Assessment The trajectory will be developed for each appropriate part of the 7-step model as identified through our governance structures. 2.6.2 Frailty Unit and Direct Admission Pathways Implementation of a Frailty unit with direct access to specialist Frailty teams and direct admission pathways on each of our 3 Acute sites.
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Delivery Plan 2025/26 Final 19.05.25 Page 27 of 140 Delivery Assessment Measure Apr’2 5 May’ 25 Jun’2 5 Jul’2 5 Aug’ 25 Sept’ 25 Oct’ 25 Nov’ 25 Dec’2 5 Jan’ 26 Feb’2 6 Mar’2 6 Monthly 4hr Access Perf. 55% 57% 59% 60% 62% 64% 65% 65% 65% 65% 65% 66% Monthly 8hr Access Perf. 90% 90% 91% 91% 92% 92% 93% 93% 93% 93% 93% 93% Monthly 12hr Access Performance 90% 91% 92% 93% 94% 94% 95% 95% 95% 95% 95% 95% Risk Assessment There are common risks that apply across the whole unscheduled care programme. If processes and pathways are not embedded effectively and efficiently, there is a risk that the objectives of Operation Flow may not be delivered resulting in continued deficiencies in performance, resources, finances and reduced organisational reputation. From a workforce perspective, recruitment may be a particular risk, particularly as we expand FNC. The success of internal candidates in these processes can negatively affect other parts of the service, impacting upon our ability to deliver our services and the project. The availability of candidates to fill recruitment gaps can mean that Operation Flow objectives may not be met. Risks recorded in corporate and local programme risk register.
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Delivery Plan 2025/26 Final 19.05.25 Page 28 of 140 Improving cancer care is a priority within our strategic reform agenda and we have a focus on the 8 elements of the Framework for Effective Cancer Management: • Corporate Responsibilities. • Optimal Referral. • Initiating the pathway. • Dynamic Tracking & Escalation. • Optimal Diagnostics. • Effective MDT. • Treatment. • Collective Strength. The commitment to improve our cancer performance has resulted in us achieving and maintaining both the 62 & 31-day cancer standards through the last quarter of 2024/25. The success is underpinned by effective communication, collaboration and engagement across clinical and service teams with timely escalation and action to mitigate breaches. 3.1 Improving Cancer Waiting Times Standards (Through ongoing delivery of the Framework for Effective Cancer) 3.1.1 Urology The expansion of the Urology diagnostic hub has supported a significantly improved cancer waits time, achieving 36-47% above the national average across the previous 8-months. The diagnostic hub concept was developed in line with CfSD principles, with outcomes showing a positive impact on the whole patient journey, ultimately resulting in reduced time to diagnosis and treatment. The principles enable robust stratification of patients, supporting the optimisation of capacity and importantly directing the right patient, right place right time. Diagnostics hub concept • Enhanced nursing roles. • Active Clinical Referral Triage (ACRT) with expansion of new pathways and increased workforce to maximise adherence to timeframes and pathways. • Template letters reduced administrative burden and delays. • Protected Diagnostic capacity within radiology and the service. 3. Cancer Care
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Delivery Plan 2025/26 Final 19.05.25 Page 29 of 140 • Patient initiated review (PIR)/ opt in model. • MDT Patient Targeted Lists (PTLs). • Cancer & Service Teams, Clinical and Diagnostics Teams along with Primary Care engagement and collaboration. • Working with primary care delivering teaching and training sessions to improve referral adherence to Scottish Government Suspicion of Cancer (SOC) referral guidelines. The expansion of the Diagnostic Hub project is identified as a priority action. We aim to introduce one stop biopsy capacity to build on improvements aligned to performance and Quality indicators achieving 95% Cancer Waiting time standard. Assessment Measures • Sustained reduction in diagnosed and undiagnosed backlogs. • Sustained reduction of patients over 100 days. • Improved compliance towards and against national standard. • Patient experience & outcomes. • Achieving milestones in the pathway. • Maintain performance to continue to achieve National Standard 95%. 3.1.2 Colorectal Colorectal pathway performance remains below 95% primarily due to diagnostic and clinic capacity. The service sees significant demand for USOC referrals with admin criteria led vetting across the service. Work continues to optimise clinic capacity which has improved Urgent Suspicion of Cancer (USOC) wait times. Investment coupled with endoscopy improvement work has supported reduced scoping wait times. While both initiatives have delivered some improvement, performance remains below national standard. Work is underway to introduce a non-medical workforce. Recruitment of Advanced Clinical Nurse Specialists (ACNS) with a clearly defined role will enable clinical expertise to support Active Clinical Referral Triage in line with CfSD principles enabling timely assessment and improved stratification of patients. Assessment Measures • Sustained reduction in diagnosed and undiagnosed backlogs. • Sustained reduction of patients over 100 days.
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Delivery Plan 2025/26 Final 19.05.25 Page 30 of 140 • Improved compliance towards and against national standard (95%). • Patient experience & clinical outcomes. 3.1.3 Breast Service The Breast Service works closely with Forth Valley (FV) to deliver a service model that spans across the two Health Boards, building service resilience aligned to demand. The model ensures patients referred as USOC are seen within the 2- week Cancer Waiting Time (CWT) milestone. Diagnostic advance practitioners enable a 1 stop service supporting diagnostic pathway milestone compliance. ACRT and PIR are both embedded. Theatre capacity is a challenge, and discussions are ongoing around the future service delivery model and service level agreement between NHSL and FV. We will capacity plan with FV to support a see and treat model, with aspirations to move to a single service across the two Boards. Theatre capacity planning is critical to these discussions to ensure the model is aligned to true demand. Through 2025/26 we will define the model of care and continue collaboration with theatres team to support productivity and efficiency gains. Assessment Measures • Compliance with Cancer waiting times standard (95%). • Patient experience. 3.2 Increasing Diagnostic Capacity (Including endoscopy and its new alternatives, alongside assurances of the Board’s plan to establish or maintain a Rapid Cancer Diagnostic Service) 3.2.1 Endoscopy Development of a workforce plan to support succession planning is identified as a priority action for Endoscopy services, with delivery during 2025/26. This will future proof the service delivery model and support sustainability and service provision. This work will be progressed in phases. Phase 2 involves a workforce plan review of ACRT processes to support optimisation of capacity and will be completed over 2026/28. Assessment Measures • Improve capacity availability and utilisation.
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Delivery Plan 2025/26 Final 19.05.25 Page 31 of 140 • Reduced waits aligned to milestones and improved patient experience. 3.2.2 Radiology During 2025/26, NHS Lanarkshire will implement 7 day working for MRI services. This aligns to the National Imaging Plan to increase capacity and comply with milestone aligned to achieving cancer waiting times. Phase 2 is to utilise outcomes and learning to support the development of a sustainability plan delivered over 2026/28. Assessment Measures Reduced waits aligned to milestones and waiting times and improved patient experience. 3.2.3 Rapid Cancer Diagnostic Services (RCDS) The Rapid Cancer Diagnostic Service (RCDS) service aligns with the strategy ambition to deliver earlier diagnosis. RCDS offers a pathway for patients referred from Primary Care who present with non-specific symptoms (weight loss, fatigue) with a clinical Suspicion of Cancer not aligned to a tumour specific pathway. The project has been successful delivering “rapid diagnostics” and diagnosis or reassurance to patients assessed within the pathway. The RCDS model includes: Active Clinical Referral Triage (ACRT) by the RCDS team; personalised and single point of contact provided by the patient navigator from the point of referral; Coordinated investigations including close liaison with the Radiology department; Diagnostic decision making with onward referrals for patients with an initial diagnosis to a specialist cancer pathway, or alternative pathway for significant benign diagnosis; the process is well established in NHSL. Over 2026/28, we will complete a review of the project to identify learning and will continue to collaborate with diagnostics to optimise capacity through appropriate stratification of patients. In view of increasing demand, the workforce model will be reviewed to inform a business case and suitability plan for service. Delivery Assessment We will continue to monitor adherence of pathway, milestones and conversion to cancer rate. Over the most recent two quarters the RCDS project has reported 16%/18% conversion to cancer rate which is an increase from 10%/12%.
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Delivery Plan 2025/26 Final 19.05.25 Page 32 of 140 3.3 Optimal Cancer Diagnostic Pathways and Clinical Management Pathways 3.3.1 Lung Optimal Pathways Over the period 2025/28 we will continue to utilise the National Cancer Optimal Pathway (NCOP) in collaboration with CfSD aligned to the agreed national clinical pathway. The development of Advanced Clinical Nurse Specialist (ACNS)-led virtual clinics will be progressed, aligned to a two-site model of care for low risk cancer patients. This will be underpinned within revised cancer clinical pathways. ACNS-led virtual clinics will be extended to support roll out within a second site and a sustainability funding plan will be considered. Embedding virtual and face to face pathway on both sites, supporting the stratification of high and low risk USOC referrals allow for optimisation of service capacity and patient experience. Delivery Assessment • Conversion of cancer rate aligned to High and Low risk pathways. • Diagnostics pathway measures within cancer waiting times. 3.3 2 Head & Neck (H&N) Optimal Cancer Diagnostic Pathway Our main aim was to reduce waits supporting earlier diagnosis and treatment for patients diagnosed with a H&N Cancer. The service has embraced CfSD principles and adopts a one stop service where clinically appropriate. This is underpinned by dynamic tracking and escalation across service and diagnostics supporting optimised utilisation of capacity. This work will support earlier primary diagnosis for patients, aligning to the strategic direction along with benchmarking against the 8 key elements for the Framework for Effective Cancer Management. This will be delivered by: • Rapid ACRT. • Introduction of 1 stop service with clinic based biopsy. • Increased FNA capacity for Neck Lump clinic, also 1 stop. • Implementation of MDT PTLs (clinical/Service/Diagnostics) promoting collaboration to support pathway milestones. The key focus will be to complete an ACRT review to support stratification of patients, optimise capacity and patient experience.
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Delivery Plan 2025/26 Final 19.05.25 Page 33 of 140 Assessment Measures • Compliance with Cancer waiting times standard (95%) and strive to achieve 100%. • Improved patient experience. Assessment • Finance- non recurring. • Workforce- recruitment, development, retention and absence. • Cross Board – capacity availability. (This is particularly applicable to Breast Service). • Environmental capacity within Diagnostics. • Patient experience/increased delays. 3.3.3 Scottish Cancer Referral Guidelines Primary and secondary care will collaborate to embed revised Scottish Cancer referral guidelines to improve the quality of information within referrals to enable timely and appropriate stratification of patients, aligned to key priority of initiating and optimising referrals. Delivery Assessment • Referral rate. • USOC referral rates. Risk Assessment • Non-compliance. • Increase in regrading. • Increased USOC demand. • Patient experience/delays. 3.4 Delivering a Single Point of Contact Services (For cancer patients and integrating Improving the Cancer Journey into pathways of care) 3.4.1 Single point of contact (SPOC)- Sustainability Plan Aligned to the Cancer Strategy and 3-year access plan, we supported work across 6 tumour groups within the initial pilot. The Single point of contact/Navigator roles show a positive impact in releasing clinical time to care and supporting the Cancer Nurse specialist (CNS) roles, as well as improved communication through the patient journey with continuity of
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Delivery Plan 2025/26 Final 19.05.25 Page 34 of 140 access. This work supports timely escalation, signposting and onward referral to appropriate support service. This project has demonstrated that by introducing Navigators into clinical pathways there is scope to save a minimum of 3 - 4 sessions of CNS clinical time to another role. This releases clinical capacity to develop Advanced Practice and additional nurse led activity that can shift care from Consultant to Nurse led. For example, follow up care of patients living with cancer releases consultant capacity. Patient outcomes and impact, along with the experience of patients and staff will be used to refine the role/competency framework and to support the development of a sustainability plan. If funding becomes available we will increase SPOC roles, ensuring readiness to respond by agreeing job descriptions aligned to the NES Nursing, Midwifery & Allied Health Professionals (NMAHP) career framework and national transforming roles work programmes. Over 2026/28, we will ensure equity of access across tumour groups and support improved cross cover plans. Delivery Assessment • Defining competency framework. • Refine definition to support appropriate job description. Risk Assessment • Finance- non recurring - continuation to support the project. (Sustainable funding source required with consideration of extension to other tumour sites). • Workforce- recruitment, absence and retention. • Impacts significantly on Cancer Nurse specialist teams to deliver current level of intervention and direct clinical care. • If funding is not sustained this will impact significantly on SPOC roles and consequently CNS’s ability to provide patient facing care. 3.4.2 Improving the Cancer Journey (ICJ) We will deliver equity of access and timely referral to ICJ and community support services to ensure that social, information and emotional needs are met. We will be represented at partnership forums where data and feedback are highlighted with shared learning and service improvements. We will provide evidence of ICJ impact on secondary care delivery, standardising referral processes in line with data on uptake by tumour group.
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Delivery Plan 2025/26 Final 19.05.25 Page 35 of 140 We will develop an improvement plan to share learning and ensure consistent referral processes aligned to single point of contact roles. Quarterly data which monitors referral uptake will be analysed to highlight areas for improvement and inform targeted actions to improve access and signposting to more vulnerable. Delivery Assessment • Monitoring against quarterly reports to see improved uptake. • Patient experience. Risk Assessment External funding is a risk which will have an impact to patient experience signposting. 3.4.3 Holistic Needs Assessment (HNA) The HNA pilot will be reviewed as part of Cancer Nurse Specialist clinics and Single Point of Contact roles, ensuring early adoption to support timely intervention and deliver a positive impact on a patient’s cancer journey. We will increase consistency of use of HNA across all tumour groups providing equity, improving information provision and early signposting improving support of patients’ needs and adopting a personalised approached to care. Delivery Assessment • Earlier uptake in third sector i.e. Maggie’s -The Haven through signposting. • Benchmark against ICJ data. Risk Assessment • Patient experience. • Patient complaints. • Workforce availability. 3.5 Configuring Services (Specifically, the Framework for Effective Cancer Management, Six Principles of Good Rehabilitation, Prehabilitation (Key Principles for Implementation), Psychological therapies and support framework, and the Nutrition framework for people affected by cancer in line with national guidance and Frameworks) 3.5.1 Prehabilitation Advocate Role We will work to address inequalities through implementation of the prehabilitation advocate role, building on the ‘Prehabilitation Advocate Programme’s’ work. This ensures
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Delivery Plan 2025/26 Final 19.05.25 Page 36 of 140 prehabilitation services are accessed by those in more deprived communities and in communities with lower engagement aligned to the local (Detect Cancer Early) DCE action plan. During 2025/26, we will conclude recruitment and identify priority tumour groups to review prehabilitation opportunities across tier 1, 2 and 3 from universal to specialist support. We will continue to engage with the regional team and contribute to shared learning opportunities. Over 2026/28 project outcomes will be reviewed and evaluated to share learning to support roll out across tumour groups. Delivery Assessment Define priority pathways. 3.5.2 Collaboration with Public Health and Health Improvement Teams As we work to prevent cancer, collaboration with Public Health and Health Improvement teams will support local Detect Cancer Early actions and improvements. There is an increased risk of breast cancer in patients with a higher Body Mass Index (BMI) and collaborative work between Public Health, Health Improvement and the Lanarkshire Leisure Trusts will facilitate direct referrals to the ‘weigh to go’ weight management service. A pilot will be implemented to support referrals for patients who are not diagnosed. Patients with a diagnosis may be referred as appropriate aligned to prehabilitation. We will optimise direct electronic referral from the Breast Service to the ‘Weigh to Go’ weight management service. Delivery Assessment • Use of single point of referral through weight management Trakcare community hub. • Establish pathway and test of change go live date. • Review outcomes and shared learning to support improvement. Over 2026/28, NHSL will consider opportunities aligned to alternative pathways. Risk Assessment Availability of external capacity availability.
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Delivery Plan 2025/26 Final 19.05.25 Page 37 of 140 3.5.3 Psychological Assessment Training We will develop an education programme to support staff to respond to potential needs highlighted through HNA. Working collaboratively with Maggie’s we will develop a psychological training/education programme for CNS team to support early identification and action of needs following HNA. Continue to collaborate with third sector (Maggie's) to identify opportunities to access prehabilitation services, including Psychology service. Delivery Assessment Patient experience. Risk Assessment • Finance- non-recurring. • Workforce- recruitment/retention, absence, wellbeing, training, education & skills. 3.6 Supporting the Work Underway of Oncology Sustainable Services (Including the next phase of considerations for implementation of the proposed Target Operating Model for oncology) 3.6.1 Local Day Unit Review We will undertake a Local Day unit review to inform the development of an 8-point assessment plan to support safe and effective delivery of local Systemic Anti-Cancer Therapy (SACT) services aligned to local strategy, reflective of regional and national work plans and target operating models outlined as part of the Oncology transformation programme. We will review baseline data SACT vs Supportive therapies and identify short, medium and longer term opportunities within each work stream and safe delivery treatment. The 8-point assessment plan to support local improvement is as follows: 1. Quantify current demand, capacity & utilisation. 2. Standardise scheduling processes. 3. Identify & evaluate short term site activity options. 4. Analyse rota, skill mix, patient need & schedules. 5. Develop workforce/ skill mix plan. 6. Estimate future demand scenarios.
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Delivery Plan 2025/26 Final 19.05.25 Page 38 of 140 7. Investigate & develop ooh/ community treatment options. 8. Develop single site delivery plan. Delivery Assessment • Aligned to agreed national targets – CWT. • Ongoing compliance of 2-week milestone. • Compliance of work stream aims and targets. • Clinical incident report for extravasation. Risk Assessment • Finance- non-recurring. • Workforce- recruitment/retention, absence, training, education & skills. 3.6.2 Enhancing Local Workforce Within the local acute Oncology and SACT strategy, NHS Lanarkshire prioritised enhancing local workforce as a development action, aligned to National and Regional programmes. Specific actions include: • Enhancing advanced practice - sustain the current Non-Medical Prescribing (NMP) workforce and develop further through Nursing and Pharmacy. Recruitment is underway to support senior APs in NMPs and devise job plans aligned to service pressures. • Medical Workforce- increase and stabilise the Speciality Doctor workforce to support Day Unit unscheduled events, support NMP outcomes if no Oncologist on site, Enhance Oncology workforce at clinics to support capacity. Recruitment of Specialty Doctors role and allocation of job plans aligned to service challenges. All work is underpinned by ongoing collaboration with Beatson Oncology Centre - Regional oncology centre who provide Senior Decision maker allocation aligned to Service Level Agreement (SLA). Delivery Assessment • Increase in NMP in line with regional aim of 50% of episodes. • Target Operating Models. Risk Assessment Workforce- recruitment, retention, absence, training, education & skills.
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Delivery Plan 2025/26 Final 19.05.25 Page 39 of 140 3.6.3 Acute Oncology(AO) Model A sustainable model has been developed and recruitment is progressing for a 3rd ANP to support roll out across the 3 Acute sites. The Acute oncology model supports front door activity, Day Units support for unscheduled events and support to the Cancer treatment helpline for onward referrals that require further assessment to support admission avoidance. Over 2026/28, following the establishment of an AO acute model, NHSL will progress the Cancer of unknown Primary (CUP) pathway in collaboration with palliative care and Oncology services. Delivery Assessment • Align to the National Target Operating Model aspirations. • Reduced bed days for patient experiencing neutropenic sepsis. • Enhance commination with oncology. • Clinics DNA’s. • Improved Patient experience. Risk Assessment Workforce: Risk recruitment.
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Delivery Plan 2025/26 Final 19.05.25 Page 40 of 140 Providing support and creating ways to improve mental health and wellbeing was identified as a priority from our stakeholders as we worked to develop ‘Our Health Together’. Against a backdrop of increasing demand, we have developed a set of delivery priorities focused on providing good mental health for our population. These are summarised as: • Addressing mental health inequalities • Early intervention and preventing mental health conditions • Improving/increasing access to mental health Supports and Services • Children and Young People’s Mental Health and Wellbeing Services • Specialist Mental Health Services 4.1 Building Capacity (To deliver and maintain the CAMHS 18-week waiting times standard by December 2025 on a sustainable basis) 4.1.1 CAMHS RTT Guarantee We delivered the CAMHS RTT Guarantee in September 2024, achieving 92.5% in January 2025. Trajectory modelling is ongoing to assure long term sustainability of our aim that no child should wait more than 18 weeks to be seen. The longest wait for initial Choice appointment for vetted non-urgent referrals is 9 weeks and we aim to reduce this to 4 weeks. Delivery Assessment The transformative work delivered via CAMHS and NDS Programme Board is supported by the HSCP and partners from General Practice, Education and Health Improvement. The work has successfully delivered milestones aligned with the national specification standards: • We delivered the Target of 90% Referral to Treatment (RTT) for CYP by implementation of a Choice and Partnership model of care. Our current wait for non- urgent first appointments is 9 weeks. • Age range of service was extended from 16 to 18th birthday (regardless of whether they are in or out of education). • Unscheduled CAMHS (UCAMHS) established capable of providing emergency response to new or emergent crisis. The workforce is underpinned by a skills matrix that matches patient need. 4. Mental Health (MH)
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Delivery Plan 2025/26 Final 19.05.25 Page 41 of 140 • An electronic patient referral system and record were delivered important for assurance around waits, transparency of care and risk management across a multi- site service and wider NHSL workforce (e.g., EDs). • Delivery of standardised mental health assessment, risk assessment and care planning that is inclusive of the child and the family/ carers who support them. • Robust operational and professional supervision process to assure standards of care and intervention provided and to build confidence for CYP that professionals have appropriate level of skill and competence to manage their care. • Collaborative work with regional colleagues to provide a hub and spoke model of care to children who require Tier 4 level intervention. • Work ongoing with adult colleagues to formalise transitions of care pathway between CAMHS and adult mental health. • GIRFEC training being undertaken and complex care management tool underpinned by GIRFEC methodology being trialled. Risk Assessment • Potential that reporting will change from referral to first Choice appointment to Referral to Psychological Therapy Intervention negatively impacting reporting of performance against the target. We continue to work with psychological therapy colleagues, local and national data analysts to find a solution that satisfies both asks. • There is potential that current financial fragility will destabilise maintenance of target. • Ongoing fragility in the workforce. This impacts on the ability to provide treatment trajectories and assurance of patient flow. 4.2 Implementing National Standards for Mental Health Services (Including the Core Mental Health Standards, the Specification for Psychological Therapies and Interventions, the CAMHS and Neurodevelopmental specifications and the Eating Disorder and IPCU Specifications, when published. This includes, where relevant, planning and delivery of the regional aspects of the CAMHS specification) 4.2.1 Implementing National Standards-CAMHS CAMHS has responsibility to deliver a Tier 3 mental health service for Children & Young People (CYP) inclusive of: • Severe depression and anxiety • Moderate to severe emotional and behavioural problems
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Delivery Plan 2025/26 Final 19.05.25 Page 42 of 140 • Psychosis • Obsessive compulsive disorders (OCD) • Eating Disorders • Self-harm • Suicidal Behaviours • Mental health problems with comorbid drug and alcohol use • Neuropsychiatric conditions • Attachment disorders • Post-Traumatic Stress Disorder (PTSD) • Mental health problems with co morbid neurodevelopmental problems • Mental health problems where there are mild/moderate intellectual disabilities or co morbid physical health needs • CYP in all above categories who require intensive support and treatment o Secure Care. o Learning Disability (LD) pathway. Improvement Measure Ongoing service Improvement work includes: • Implementation of a quality assurance process that provides evidence of consistent approaches to assessment, care planning and care delivery. • Delivery of collaborative care pathways with Regional Colleagues which includes: o Inpatient Care within Specialist Inpatient Regional Facility. o Forensic Hub and Spoke Model of Care. o Intensive Psychiatric Care Unit (IPCU). This work is operationally managed via: CAMHS Operational and Professional team and the Specialist Children’s Health Service Unit management team. This is assured via local Health & Social Care Partnership (HSCP) governance processes. Risk Assessment • Instability of funding arrangements has potential to impact areas of service that do not directly impact RTT which is currently the only CAMHS aligned performance target. • Consultant Psychiatry may assume increased Registered Mental Health Officer (RMHO) activity if whole system response is not enabled to support regional
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Delivery Plan 2025/26 Final 19.05.25 Page 43 of 140 commitments. This is mitigated by multidisciplinary workforce supporting reduced Consultant capacity. • Children and young people may not be prescribed medication timeously and/or reviewed at recommended frequency due to challenged capacity within Consultant Psychiatry workforce. This is mitigated by employment of 3 Prescribing Pharmacists with a plan to grow this further in coming months. 4.2.2. Neuro Developmental Service (NDS) The NDS continues to be challenged by demand that outstrips capacity. The service works collaboratively with wider health and educational partners to optimise efficiency. Two Tests of Change have been undertaken. 1. A whole school approach. Delivered within South Lanarkshire then mirrored in North, this has evidenced efficiency of the approach. Further facilitation of a blend of the NDS assessment offer requires investment and has not progressed due to financial instability. The service is considering innovative ways this could be approached. 2. A Test of Change continuing is supporting CYP in transition between P6 and S2. This is recognised as a time in a child’s life where they disengage from school resulting in a proportionate negative impact in opportunity for socialisation and education. In addition, the service has delivered an NDS website and a public facing social media presence and developed a range of family workshops to support a range of challenges common within the patient group. We are working with SG to benchmark information to inform models of care that are collaborative and tiered across health and education. We expect future national work that includes local authorities to address this widening gap. This work will continue through 2027. Work with commissioned providers has supported assessment of CYP who were nearing their 18th birthday. This has facilitated care plans being implemented prior to transfer to adult services. By March 2025 a process will see pharmacy colleagues support the increasing demand for medicated care and support. Plans are in place to grow this role. Further work is required to realise the NDS Specification in full, with a target date of March 2026. This requires central support for closer working with local authority partners to meet
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Delivery Plan 2025/26 Final 19.05.25 Page 44 of 140 the needs of CYP through a Getting It Right for Every Child (GIRFEC) model and tiered approach beyond health. (This is dependent on learning from 5 nationally funded Tests of Change and partnership working with local authorities that can be supported by national direction). In January 2025, 9027 CYP are awaiting assessment by the Neurodevelopmental Service. 91% have been waiting over 18 weeks. Demand for assessment outstrips capacity of service by an average of around 70 children and young people a month. Improvement Measure The Test of Change trialled in 2 schools evidenced the efficiencies that could be delivered from a school approach to assessment. It is estimated that this approach could release 60% capacity from the current model. Discussions have commenced on investment required to deliver this in a blended way alongside the current model. This approach does not fit needs of all CYP or their families and redirection from current model is unlikely to impact waits. Risk Assessment A Risk is included within the Operational Risk Register that recognises the ongoing potential impact of delay in assessment and care planning for CYP. 4.2.3 LD CAMHS We are collaborating with West of Scotland (WoS) colleagues to ensure a robust pathway. The focus for LD is CAMHS for children and young people who have intellectual (learning) disabilities. WoS CAMHS planning groups completed mapping exercises on services already provided by Boards. Work is paused at present due to challenges identified by Boards. Improvement Measure No trajectories are currently available. Current funding position is not in line with what is needed to assure trajectory and ongoing work. Risk Assessment • Recurring funding – Agreement will be required between MH and Specialist Children’s Health Services Unit (SCHSU) of what resource transfer is required. Continuance of
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Delivery Plan 2025/26 Final 19.05.25 Page 45 of 140 funding remains unclear. • Pausing of work streams. 4.2.4 Tertiary Eating Disorders Service (TESS) We are participating in the Core Mental Health Work Streams Specialist Group. The national specification was published in 2024 and benchmarking against Standards and current service delivery has been implemented. The current Inpatient Model requires review and redesign. Finally, the TESS service is working towards Autism Spectrum Disorder (ASD) accreditation. Improvement Measure By March 2026, a baseline audit will be completed with regards to TESS’ current position against the National Eating Disorder Specification and an associated action plan developed. Risk Assessment • Inability to deliver expected standard with current resource. • Financial implications. • CRES savings. 4.2.5 NHSL Intensive Psychiatric Care Unit (IPCU) As part of a three-year developmental membership the service is working towards the Royal College of Psychiatrists Quality Network for Psychiatric Intensive Care Units standards. We have a work-plan which focuses on five areas for development which include: patient involvement, patient outcomes, reducing restrictive practices, safeguarding, staff development and structured activity. This work will continue to evolve through to 2027. We are cognisant of Core Mental Health Standards and recognise that some of the five areas are relative strengths for the service, with others overlapping with the work-plan. This is monitored via the IPCU Clinical Quality Group and reports to Adult Clinical Quality Group. Improvement Measure It is our ambition that we deliver an exceptional IPCU service and over the next two years our service will have developed to the standard to consider an accreditation membership with the Royal College of Psychiatrists Quality Network for Psychiatric Intensive Care Units.
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Delivery Plan 2025/26 Final 19.05.25 Page 46 of 140 Risk Assessment • Difference between Scottish and English functionality and legislative requirements. • Finance Implications. • Limited resource to maintain standards. There are standards from the work-plan that may not be achievable without support of wider MH&LD Services, including recruitment of activities co-ordinators/OT, and other governance related standards. This will be risk assessed towards the end of this year as is would be a barrier to achieving future accreditation. 4.2.6 Psychological Therapies (PT) Interventions Specification The Psychological Therapies and Interventions Specification outlines 7 Overarching Quality Outcomes for Psychological Services (PS) in Scotland (with 32 sub-outcomes), emphasising the need for, “high quality psychological care and practice”. Each service in Adult PS has scrutinised the Outcomes to ensure we meet outcomes, or ensure plans are articulated to meet these as defined in the specification. Adult PS have a professional structure covering all specialties across the Board, and the service utilises an effective skill mix in its contribution to services. PS have focused attention on quality improvement and research and currently meet a significant number of the 32 Outcomes, as specified. Demand outweighs capacity within Adult PT. Demand, Capacity, Activity & Queue (DCAQ) trajectories indicate, that without an increase in resourcing, Adult PT is unlikely to achieve the 18 week RTT with a significant number of individuals waiting over 18 weeks before treatment commences. At full staffing levels and based on historic levels of demand, Addiction Psychology Service and Psychological Therapies for Older People can meet the 18 week waiting times standard. However, staff absence and vacancies impact on our ability to meet the standard. If demand rises this would also affect performance against this target. Outcome 2 – People are Fully Involved in Decisions PS can facilitate choice in appointment mode, however if demand for face-to face appointments increases, accommodation availability may impact this. Work to increase face- to-face groups continues but restrictions on room space is impacting. Limiting to digital group work can result in inequity and exclusion due to digital poverty. Within forensic clinical
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Delivery Plan 2025/26 Final 19.05.25 Page 47 of 140 psychology there are other considerations in choice of interventions. For example, within prison settings face-to-face intervention is often the only available option, whereas issues of managing risk can limit options available to individuals in a community setting. If the individual has complex, or urgent care needs, or is seen in a ward or forensic setting (e.g., those detained under the Mental Health Act, presenting to 'out of hours' care, in prison, with acute physical health needs) there may be different access pathways. All adults/older adults across acute admission wards and IPCU have access to psychological assessment and psychologically informed care. There is psychology resource providing input within rehab services, but no dedicated psychology provision for the Community Rehab Team (CRT) or adult inpatient rehab services at Cleland Hospital. The pathway for inpatient referral is direct referral through the MDT i.e. nursing, OT, psychiatry. There is a similar model in forensic clinical psychology. Psychology is embedded in the MDT providing a psychological perspective and enables direct and indirect psychological input. There is no referral system in forensic inpatient services, as referral is via the MDT. Referrals to Clinical Health Psychology can only be made for inpatients when patients are discharged to the community. There is no direct route for people presenting to out of hours to psychology unless they are already open to a psychological service. All services within Psychological Services have criteria for prioritisation of cases, to ensure urgent cases are allocated expediently. Outcome 6 – We Fully Involve People, Their Families and Carers A collaborative approach between clinicians and those accessing the service informs treatment plans. Family/carer involvement can be variable and there is no baseline within the service to determine performance. Standard service user feedback forms are routinely offered however, uptake is low. It will be important that PS develop systematic processes for involvement of Experts by Experience in service design and delivery to meet the outcome. Access: • Improve authorisation for speedier recruitment (process required to ensure a specific timeframe from submission of finance authorisation i.e. within 10 working days). • Preparations for Health and Care (Staffing) (Scotland) Act (2019) in April 2024 to ensure compliance and reporting to increase assurance measures around staffing.
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Delivery Plan 2025/26 Final 19.05.25 Page 48 of 140 Data: • Update/upgrade TRAK to enable recording of clinical outcome data and appropriate waiting list management. • Timescale (and expedite) for Psychological Services for inclusion on MORSE (online electronic patient record). Direct actions: • 2 Heads of Specialities to have leadership of Staffing Act included in job plans. One of those staff now represents Psychology at a National Level. • 1 Head of Speciality has a leadership role in implementation of the Adult PT Specification. Date for implementation to be defined by SG who have run a pilot for self-assessment for Boards. Improvement Measures We are set to implement the Adult PT Specification as soon as SG deliver a self-assessment guide - all services have reviewed their current position as of late 2024. Risk Assessment • Continued funding to support implementation of the outcomes - lack of administration support, staffing and accommodation pose the greatest risk. • Information technology and functionality inhibits collaborative work and impacts on the quality of real time data available for operational management of waiting lists. • Restrictions on group room space. 4.3 Improving unplanned and Urgent Mental Health Care (Including for those in mental distress, prioritising working with Public Health Scotland on data improvements and reviewing local Psychiatric Emergency Plans to align them to the national template) 4.3.1 Unscheduled Care We have met all requirements for Action 15 which include: • Membership of national unscheduled care network. • Expanded model of unscheduled access to mental health assessment, through development of flow navigation process. • Award winning model access to direct triage for mental health through Police Scotland,
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Delivery Plan 2025/26 Final 19.05.25 Page 49 of 140 Scottish Ambulance Service (SAS), British Transport Police (BTP), NHS 24, implemented with NHSL promoted as an exemplar for other areas. • Involvement in thematic review and recommendations for Police Scotland. • From the national unscheduled care network there are links to Public Health Scotland (PHS) to understand national data, and the wider review of PEP across all health boards. Risk Assessment • Financial Risk. • Resourcing service. • Impact on other organisations. 4.3.2 Implementation of Core Adult Mental Health Standards Baseline audit and self-assessment completed across Adult Community Mental Health Teams (CMHTs) and adult admission in-patient wards and shared with Health Improvement Scotland (HIS). A QI framework is underway to look at audit cycle and performance against the standards, with all new service developments mapped to the core standards. This work will continue through 2025/26. Improvement Measure • Baseline audit completed. • Ongoing audit cycle to be agreed. • HIS requirements to be updated. Risk Assessment • Limited dedicated QI resource to support the service compliance. 4.4 Delivering a more Coherent System of Forensic Mental Health Services (By collaborating and cooperating across Health Boards and with the Forensic Network to address the governance, capacity and placement issues raised by the independent review into such services and applying the forthcoming escalation arrangements being developed by the Forensic Network) 4.4.1 Forensic Mental Health Services • Forensic Governance group set up by Scottish Government. • Group to visit NHSL Forensic Service in February 2025.
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Delivery Plan 2025/26 Final 19.05.25 Page 50 of 140 • Report to Scottish Government by April 2025. • Capacity paper commissioned by SG prepared by the ‘Forensic Network’ with several recommendations. NHSL were involved in the narrative and conclusion of this paper. Whilst there has been no obvious progress in relation to the Barron report work is ongoing in relation to high Secure Women’s care. Improvement Measure • The national target has yet to be set and will follow presentation to SG by The Advisory group. Risk Assessment • Bed capacity risk across Scotland if there is no improvement in national collaboration. • Inequality in relation to secure female beds could result in inappropriate care provision. 4.5 Implementing the Mental Health and Wellbeing Action Plan (To support improved planning and retention of the workforce and service reform) We are progressing work to implement the Mental Health and Wellbeing Workforce Action Plan. Improvement actions include: • Quarterly workforce meetings of MH, LD and addictions nursing & AHPs. • Medical Workforce Governance Meetings taking place. • Staff Support and Well Being Services established within NHS Lanarkshire. • Newly Qualified Nurse (NQN) induction program with ongoing support. • Corporate Induction for all new staff. • Annual Turas Appraisal. • Annual iMatter Survey undertaken to identify areas of improvement. • Supervision provided on a person-centred basis. • SALUS occupational health support. • Staff Awards to acknowledge achievements. • The big shout out recognition of staff. • Care Opinion to aid service improvements.
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Delivery Plan 2025/26 Final 19.05.25 Page 51 of 140 4.6 Mental Health Built Estate (Continuing work to ensure the mental health built estate enables the delivery of high quality, person centred and safe care, with a focus on implementing the national Mental Health Built Environment Quality and Safety toolkit) 4.6.1 Implementation of the National Mental Health Built Environment Quality and Safety Toolkit There is improvement work being undertaken to enhance MH estates which includes: • Environmental walk rounds. • Health and Safety Control Book regularly updated. • Quality Group & Clinical Care Governance Group meeting regularly. • Ligature Risk Assessment and Group. • Risk Register reviews to monitor risk tolerance & mitigations. • Partnership Management Meeting. • Project teams for specific pieces of work. • Significant Adverse Event Reviews (SAER) investigations to establish learning points. • Mental Welfare Commission (MWC) Visits. • Health Improvement Scotland Audits and Inspections. • Care Assurance Audit Program. • Planning department. • Maintenance Department. • Infection Prevention and Control. Risk Assessment • Financial and capital investment requirements. • Staffing resource. • Assessments not individualised to environments. 4.7 Mental Health Data Returns (Improving data input quality and completeness of mental health returns (for example CAMHS and Psychological Therapies National dataset to PHS and workforce data to NES) and proactively engaging with Public Health Scotland for analytical advice and support) 4.7.1 Improving Date Input Quality & Analysis A series of actions are noted as follows: • Care Assurance (CAS) App to be implemented in Perinatal Mental Health to support
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Delivery Plan 2025/26 Final 19.05.25 Page 52 of 140 collation of national data. • Electroconvulsive Therapy (ECT) collection of DATA on REDCAP Auditing System supported by Public Health Scotland, audit outcomes feedback to the service on a monthly basis. • National Benchmarking Annually. • Mental Health indicators feedback to Scottish Government Quarterly. • Development of a Mental Health Outcomes framework for DATA collection. • Implementation of Mental Health Work Force Staffing Tool. • NHS Lanarkshire data collection systems support the provision of DATA. • Medication Assisted Treatment (MAT) standards. Improvement Measure Unable to implement due to Data Protection Impact Assessment (DPIA). Risk Assessment Data Protection Impact Assessment Process presenting barriers (from above). 4.7.2 Psychological Services Workforce Data PS have developed a robust procedure for triangulation of checks of workforce data through NHS Education for Scotland (NES), finance, and workforce. This is a monthly check with 2 named Heads of Specialties, admin and finance colleagues. A Standard Operating Process (SOP) has been created through the lead for Governance and monitored to ensure accuracy of all workforce data. Improvement Measure We are confident that data is accurate and checked through available systems. We have an embedded Public Health Scotland (PHS) analyst in the Board. This is a shared resource with only 2.0 days per week aligned to Adult PS. Risk Assessment • Limited PHS analyst resource may impact the ability to create trajectories in a timely manner or provide quality improvement data.
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Delivery Plan 2025/26 Final 19.05.25 Page 53 of 140 4.8 Mental Health Services Priorities (Describe mental health services priorities under the Public Sector Equality Duty, listing priority groups and those with complex needs for focus (including people affected by suicide, self-harm and addiction) and the rationale for focusing on these vulnerable groups, referencing impact assessments undertaken) 4.8.1 Public Sector Equality Duty Delivery of new projects will have an Equality Impact Assessment (EQIA) undertaken to reduce the likelihood of health inequalities. This is expected by 2026. • TESS self-assessment in line with National Spec. • Custody Suite Commissioned model. • Adult Neurodevelopmental Service/pathway. • Primary Care Model Review. • NHS Assure Ligature Reduction work. • Review and Implementation of ECT Standards. Improvement Measure Trajectory to deliver national target or waiting time, quality or local improvement target. Risk Assessment Completion of work streams with clear service actions and operational plans. 4.9 Delivering Annual Health Checks (Delivering annual health checks for all people 16+ with a learning disability known in their areas across Scotland, complying with their legal duty through the Annual Health Check Directions. This includes maintaining delivery models currently in operation as well as commencing delivery models that haven’t yet started) 4.9.1 Delivering Annual Health Checks for all People 16+ with a Learning Disability All people living in Lanarkshire who are involved with LD services, and have received a nursing assessment, have received a modified documented health check. Recruitment has commenced for a LD Mental Health Check Team is scheduled to be complete by June 2025.
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Delivery Plan 2025/26 Final 19.05.25 Page 54 of 140 Improvement Measure Due to continued discussions regarding implementation the expected delivery date has changed. Risk Assessment • Recurring Finance. • Recruitment to temporary post. • Conflict with secondary care services workforce resource due to recruitment challenges to date.
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Delivery Plan 2025/26 Final 19.05.25 Page 55 of 140 There are challenges facing primary care and, in particular, General Practice. We received feedback from our residents that we need to improve access to services, and within ‘Our Health Together’ we have set out a strategic intent to address concerns raised. Our plan will focus on patient care rather than professionals or services. The plan needs to address the provision of care patients need in an environment which does not have capacity to provide for every potential problem but still makes our population feel cared for. Challenges exist across Scotland, but the local situation merits particular attention. • There has been a small rise in GP headcount locally over the last 5 years, but evidence suggests that practice whole time equivalent is static. The General Practice Workforce Survey 2024 showed that, on average across Scotland, there were 38% more whole- time equivalent (WTE) GPs per ten thousand populations than there were in Lanarkshire. • Funding to general practice in Lanarkshire sits 12% below National Resource Allocation Formula (NRAC) levels. There is only one other Board in Scotland where funding sits below 5% under NRAC. • The NHS Scotland Health and Care Experience Survey has shown a marked decline in GP satisfaction nationally from over 90% in 2009 to 69% now. Our Primary Care Action Plan aims to address the challenge of delivering improved care and increasing patient satisfaction despite the challenges. The route map for primary care is central to planning, focusing on patient centred care as part of a system rather than one independent contractor service. We aim to address both GP access (directly and indirectly) and GP sustainability. There are restrictions on funding for GP core services and the Primary Care Improvement Plan (PCIP), and the same mechanisms are required to address workload challenges and create new capacity. For the system to be effective and meet patients' needs, it will need to integrate within the community and across the primary/secondary care interface. This means clear pathways which can be easily understood by our population. Three key mechanisms have been identified to deal with these issues: 5. Primary & Community Care
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Delivery Plan 2025/26 Final 19.05.25 Page 56 of 140 • Creating meaningful alternatives to general practice care for patients to access. • Reshaping care pathways. • Refocusing GP capacity. • There are cross-cutting supporting workstreams critical to delivery of our action plan. Our core activities will be supported by workstreams that address premises challenges, digital opportunities, and ensure patient engagement and co-design in change. There is a long-standing workstream focused on supporting General Medical Services (GMS) sustainability. Board staff meet weekly with the primary care office team to ensure practices experiencing sustainability challenges are supported. Recruitment and Retention groups are working on initiatives that help attract new GPs and create an environment which encourages those already working here to stay. Meaningful Alternatives for Patients We have offered self-referral routes for over 20 years, requiring patients to navigate our complex healthcare system. Previous work identified over 60 routes of self-referral. It is therefore unsurprising that patients report confusion and often revert to emergency departments (ED) or GP presentation. ‘Our Patient Voice’ work highlighted that some pathways, such as the Lanarkshire Eye Health Network Service (LENs) have reached a good level of public understanding and are therefore well utilised. Designing pathways which are easily understood is key to appropriately navigating patients away from general practice. This requires clarity on what a service provides, when they should use it, and building confidence that it can deliver for them, essentially a system that provides easy access in a timely basis with continuity where required. Services should have access pathways to secondary care without involving general practices, avoiding multiple hand offs for patients and providing care on an urgent basis when required. They will require to be as local as possible to patients, recognising it will not be possible to deliver every service at a locality level within a resource-constrained environment. This objective will be delivered through work: • Ensuring the efficiency and effectiveness of primary care improvement fund services, (specifically pharmacotherapy, community treatment & care (CTAC), and urgent care) using improvement approach utilising GP clusters expertise to help optimise delivery.
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Delivery Plan 2025/26 Final 19.05.25 Page 57 of 140 • Developing new primary care services. • Redesigning core community services to deliver a locality model of primary care. Reshaping Care Pathways Our ‘General Practice Access and Workload’ work in 2024 demonstrated that over 30% of GP capacity within practices is absorbed by augmenting care taking place elsewhere or dealing with the coordination of that care in the community. Patients will continue to request continuity of care with their general practitioner during key health events in their lives, but much of current patient contact and administrative action could be avoided through better care pathways. Post-pandemic backlogs of routine secondary care are creating significant workload for general practice as some patients consult their GPs on more occasions between first contact and receiving definitive secondary care. In 2024, we established the Interface Directorate to address front door challenges related to pathways between primary and secondary care (GP and the EDs). We will use this governance infrastructure to redesign pathways into secondary care, and to deliver new community assets which can be accessed by our broader clinical community without care having to flow through General Practice. Refocusing GP Capacity We have a responsibility to support practices. We know that many practices want to change the way they deliver care but lack both the time to take stock and to plan this, and the digital infrastructure to do so. We know that patients are keen to use digital alternatives to telephone and in-person contact. Over 70% of patients say that they want to access results, book appointments, and order repeat prescriptions online. We will therefore focus on delivering two programmes of work led by our Primary Care Improvement Team: • Facilitating an effective general practice front door. • Helping practices to optimise the use of their existing clinical resource. 5.1 Oversight of Planning of General Practice (Ensuring the Board Executive Teams has clear oversight of planning of General Practice within the Board territory, with approaches demonstrably supporting patients’ needs and regular monitoring of approaches in place)
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Delivery Plan 2025/26 Final 19.05.25 Page 58 of 140 5.1.1 Board Report- General Practice Workload We are committed to delivering a monthly report to the Board on General Practice workload, workforce and complaints via the Integrated Performance & Quality (IPQR) Report. This will be achieved by April 2026. Risk Assessment There is substantial risk around our ability to deliver due to the lack of either publicly available data or a contractual obligation on GP practices to provide data to NHS Boards. We are reliant on negotiating mechanisms with our Local Medical Committee (LMC) to collect data. Progress is being made but general perspective has been that if the SG felt that such data was needed by NHS Boards, they would have made contractual provision for this, and that seeking data outside an agreed national framework is overreach on the part of the Board. 5.1.2 Qualitative Reporting of General Practice Sustainability Issues By April 2026 we will delivery monthly qualitative reporting of General Practice Sustainability Issues being dealt with by our GMS Sustainability Workstream to the Board Executive Team. Risk Assessment GMS Sustainability forms part of the NHS Board Corporate Risk Register. 5.1.3 Near Real Time Measures of General Practice Activity By April 2026 we will deliver near real time measures of General Practice activity and access to our Board Executive Team on a weekly basis using data available from: • Weekly collected general practice surveys. • Metrics from board telephone systems. • Digital Asynchronous Consulting Systems. Risk Assessment There is no contractual framework with General Practice which obliges practices to either submit or give Boards access to data on their capacity. We are therefore dependent on the co-operation and collaboration of practices to achieve this.
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Delivery Plan 2025/26 Final 19.05.25 Page 59 of 140 5.2 Improving Interface Working Across Secondary and Primary Care (Improving interface working across secondary and primary care so that patient journeys and experience are prioritised, and system efficiency is optimised) 5.2.1 Develop New Pathways of Care- High Utilisers of General Practice We will build new pathways of care for patients who are currently high utilisers of General Practice due to unmet care needs elsewhere in the system. This will focus on providing symptom-based pathways which provide rapid answers to key diagnostic questions. We will aim to develop three high-impact pathways during 2025/26. Risk Assessment Availability of staff from primary and secondary care to support pathway development may pose a challenge to this timeline. 5.2.2 Develop New Pathways of Care- Community Services By 2027 we will refresh our arrangements for providing care close to where people live when they are being managed by secondary care services ensuring new pathways give easy access to community services while avoiding need for contact with patients' general practices. We will aim to develop three high-impact pathways during 2025/26. 5.2.3 Culture of Collaboration We will work with colleagues in the Area Medical Committee to create a plan for a culture of collaboration between clinicians across the primary and secondary care interface and aim to achieve this by April 2026. 5.3 Improving the Use of Multi-Disciplinary Working (To support better, patient-centred care pathways and improve service capacity in GP and frontline community services, including additional funding to support the Primary Care Phased Investment Programme) 5.3.1 Pharmacotherapy Hubs Complete the rollout of Pharmacotherapy hubs to all 10 localities by the end of 2025 ensuring Lanarkshire is the first Board in Scotland to deliver a 5 day/52-week medicines reconciliation service and remove this work from practices.
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Delivery Plan 2025/26 Final 19.05.25 Page 60 of 140 Risk Assessment • Availability of pharmacists – ongoing recruitment campaign to mitigate risk (Part of ‘Staffing’ Corporate risk). • Availability of accommodation – development of bespoke Primary and Community Care property strategy albeit lack of capital funding creates further local risk. 5.3.2 Pharmacy First & Pharmacy First Plus NHS Pharmacy First Scotland sees community pharmacies give expert help to treat minor illnesses and common conditions, offering advice, treatment or referral to other healthcare teams if needed, without having to go to their GP or A&E for non-urgent treatment. The Pharmacy First Plus service is an extension to the original Pharmacy First service, and includes the assessment and treatment of acute common clinical conditions. Risk Assessment • Capacity to support increase in Pharmacy First Plus sites. • Financial challenges related to NI cost increases. • Withdrawal of Pharmacy Champion funding dentistry. • Remuneration challenges. Mitigations: • A new Lanarkshire community pharmacy support team has been established. • Access to Health Intelligence resource to provide analysis & benchmarking on uptake. 5.3.3 Review of Treatment Rooms Complete review of treatment room services to ensure we deliver Community Treatment and Care (CTAC) services to practices. An efficiency and effectiveness approach will ensure services meet the needs of practices and their patients. Timescale for completion of the review is April 2026, with implementation of workforce changes being complete by 2027. Risk Assessment Significant service change requiring staff side involvement and adoption of new staffing models – discussion ongoing to mitigate risk. (Part of ‘Staffing’ Corporate risk).
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Delivery Plan 2025/26 Final 19.05.25 Page 61 of 140 5.3.4 Redesign of Musculoskeletal (MSK) Pathway Complete work to redesign Musculoskeletal (MSK) pathway utilising our Physio digital first point of contact, and scaling Community Appointment Days/other methods of dealing with patient care at scale to ready the service for routine care navigation to MSK service. We will take a progressive approach to service redesign and removal of this workload from GP practices, with the programme completed by March 2027. Risk Assessment • Availability of physiotherapists – ongoing recruitment campaign to mitigate risk (Part of ‘Staffing’ Corporate risk). • Availability of accommodation – development of bespoke Primary and Community Care property strategy albeit lack of central capital funding creates further risk in this area. (local risk). 5.4 Full Provision of Appropriately Resourced Out of Hours Services (Ensuring the full provision of appropriately resourced Out of Hours services, with reporting of performance to the Board) 5.4.1 Primary Care Out of Hours Services Continue established work to maintain the multi-disciplinary nature of primary care out of our service. Maintain 50/50 split between salaried and sessional hours. Continue existing approach of regular reporting of deviations and challenges to host partnership Management Team for escalation to the Executive Team and Board as required. Risk Assessment Our ability to sustain our Primary Care Out of Hours (PCOOH) Service was a long-standing risk on our corporate risk register. However, following improvement work over the last two years, in October 2024 this was removed from the corporate risk register as the risk tolerance target was achieved. The residual risk will continue to be managed by South Lanarkshire Health and Social Care Partnership Senior Management Team. Due to the oversight of the last two years, robust processes are already in place for this. 5.4.2 Diversion from the Front Door of Our Emergency Department to Our GP Out of Hours Service By April 2026 deliver a change program facilitating diversion from our EDs to GP out-of-hours
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Delivery Plan 2025/26 Final 19.05.25 Page 62 of 140 service, where initial presentation to that service would have been more appropriate. Risk Assessment Our Primary Care Out of Hours service is willing to accept diversions, and was piloted during periods of significant pressure in our emergency departments this winter. There are some potential challenges regarding changes of clinical process which would be required in our emergency departments to facilitate significant rates of diversions. 5.4.3 Development of a New Urgent Interface Care Treatment Centre By April 2026 we will utilise the skills of our PCOOH team to assist in developing a new Urgent Interface Care Treatment Centre, which can respond to the needs of the Flow Navigation Centre (FNC) and interface with General Practices to deliver clinical interventions to patients. This will be centralised and facilitate the delivery of interventions which might not be practical or clinically appropriate to deliver from our network of treatment rooms, but where it is not necessary for the infrastructure and assets of our acute sites to be used to provide that care. Risk Assessment There will be challenges accessing the workforce required to provide this service. Further scoping work is required with regard to finance required to deliver. There will be challenges ensuring that appropriate premises are available for the service and other displaced services. 5.5 Working with Independent Contractor General Practices (To (i) identify, mitigate and reduce health inequalities, particularly in areas where there are high levels of deprivation; and (ii) support workforce and sustainability planning related to the General Practitioner workforce (in all localities) 5.5.1 Mitigate and Reduce Health Inequalities & Support Workforce & Sustainability Planning - Cardiovascular (CV) Proactive Care Roll out a new approach to cardiovascular (CV) proactive care which risk stratifies patients and ensures optimal utilisation of general practice resources. This will involve using our General Practice Information Technology (GPIT) system to implement the CV need system developed by the University of Manchester, localised to a Lanarkshire context. This will ensure patients receive regular monitoring through chronic disease monitoring resources of our CTAC network, and that practices are able to target limited chronic disease management resources to patients who will most benefit from it. This work will continue through April 2026.
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Delivery Plan 2025/26 Final 19.05.25 Page 63 of 140 Risk Assessment Risks have arisen due to the administration of In Practice Systems (INPS). We depend on the INPS team to implement some aspects for us. All risks attached to GP IT and specifically around INPS administration are on the Digital Risk Register. Mitigations are being explored in terms of potential implementation of a dash board tool (e.g. Tableau) although this would be less likely to be effective due to poorer integrations with clinical software. 5.5.2 Mitigate and Reduce Health Inequalities & Support Workforce & Sustainability Planning – Respiratory We will continue to develop an integrated system of care for patients with respiratory problems between now and April 2027, which utilises the same approach taken in 5.5.1 but also links to interventions which can be offered by our community respiratory team. 5.5.3 Infrastructure By April 2026 we will deliver infrastructure to ensure better matching between practices requiring short term GP input and locums willing to work locally. This will enable us to support practices, particularly those who bring sustainability challenges, and allow us to be better sighted on the unmet demand for GP capacity and the changing patterns of GP availability. This work will be used to support GMS sustainability more generally. 5.6 Contributing Through the Preventive and Proactive Care Programme (To wider work across NHS Scotland to support and empower patients in self-care and join up services to provide early intervention on known determinants of poor health) 5.6.1 Care Navigation Resource Refresh care navigation resources, ensuring integration across our whole system, including NHS Inform/NHS 24 to ensure that re-direction only has to take place once. This work will continue to April 2026. 5.6.2 Develop a Digital Point of Contact Working through to April 2026 we will undertake collaborative work between a variety of Primary Care Improvement Plan (PCIP) and mental health funded services to develop a digital point of contact which navigates patients to self-help third sector and online intervention resources where this is appropriate. Ensure that those patients who do require managed service assistance are matched to the service which will most likely be able to meet
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Delivery Plan 2025/26 Final 19.05.25 Page 64 of 140 their needs. 5.6.3 Develop a New Care Co-ordination Model Continuity of care has been shown to be a key element and predictor of patient outcomes, but is increasingly challenging to deliver within our healthcare environment. We will develop a new Care Co-ordination model in conjunction with practices and pilot deployment directly to practice teams. This model will be trialled by April 2026 utilising FNC assets and resource to determine whether the resources can be delivered as a service to practices. 5.7 General Dental Services (Plan, organise, staff, lead and control critical Board-delivered oral health services including the Public Dental Service, and early intervention programmes such as ‘Childsmile’. Using newly acquired management information from NSS Scotland, provide local oral health needs assessments, alongside effective partnership programmes with dental contractors and bodies corporate to drive forward sustained improvements in NHS dental access in the immediate aftermath of payment reform) 5.7.1 Access to General Dental Services (GDS) Our Annual Report set out how we engage with wider system colleagues to maximise access to General Dental Services (GDS) and the benefits of the payment reform and reduced Determination I. Our Health Board Dental Team (HBDT) meet to ensure oversight on the work of our public health colleagues, health promotion teams, public dental service (who oversee targeted intervention programmes, as well as the prison service and domiciliary care to improve patient access). The team also has primary care managerial input from a regulation perspective. The HBDT found the management information provided post recovery of great benefit and initiated regular contact with all practices to gain an understanding of access to GDS in the area. The Director of Dentistry and Primary Care Improvement & Development Manager also attend meetings of the Area Dental Committee-GP Sub Committee to get “on the ground” feedback on how payment reform has been received. We will progress this interaction and strengthen local planning and oral health assessments. We had anticipated that the new national management information would have provided us with the level of detail to plan accordingly. Unfortunately, the high-level data does not lend itself to the interrogation but we are hopeful that the more detailed national reports will be
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Delivery Plan 2025/26 Final 19.05.25 Page 65 of 140 made available. Measures • General Anaesthetic: pre-assessment waiting list has decreased. New stringent, criteria have been implemented and will continue to be monitored. • Paediatric Exodontia: waiting list largely stabilised and decreased over the last five months due to validation and scrutiny of long-waiters undertaken as part of waiting list cleansing, and additional sessions being provided. • Sedation: to improve capacity general dental services practices are encouraged to undertaken sedation. The waiting list has decreased due to implementation of new referral acceptance criteria, whereby the acceptance letter goes back to General Dental Practices (GDPs) with local sedation practice details to encourage local referrals. • Out of Hours Service: numbers are historically high but remain manageable. Director of Public Dental Services (PDS) reports that NHS 24 consider NHS Lanarkshire to be performing well in terms of meeting demand and KPIs. • PDS Out-Patient: waiting list increasing monthly due to volume of referrals. Revised referral criteria now published and more stringent vetting in place. Will continue to monitor impact of new referral criteria with support of GDP collaboration. • Recruitment & sustainability: create capacity to attract a share of increased student numbers and review incentives for rural practices, supporting workforce sustainability across Scotland Risk Assessment Achievement of waiting times guarantees is part of the corporate risk register and this forms part of that generic risk. 5.8 General Ophthalmic Services (Continuing to roll out new initiatives such as the Community Glaucoma Service; where this service is live, Boards should set out planning to ensure patients are discharged by ophthalmology and registered with a CGS accredited provider. Where there is not a live service, Board Plans should set out how they intend to introduce this, and if this is not due to occur in 2025/26, the reasons behind this) 5.8.1 Community Glaucoma Service (CGS) We have implemented the new community glaucoma service (CGS) and begun registrations of ophthalmology patients discharged with optometric providers. This patient centred service
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Delivery Plan 2025/26 Final 19.05.25 Page 66 of 140 will free up acute hospital capacity. We have 12 practices providing the service and have recruited two new optometrists to the NES Glaucoma Award Training (NESGAT) programme. This addition will improve access for glaucoma patients in South Lanarkshire, East Kilbride and Larkhall communities. Practices are actively engaging with patients and we have established robust communications using Teams across the NESGAT qualified optometrists. Over 510 patients have been discharged and registered with CGS. The trajectory following initial discharge is not as expected and recent collaboration between acute colleagues, lead Optometric Advisor and the Scottish Government is examining barriers to discharge and to undertake quality improvement activity to accelerate the trajectory. One area identified is a shortage of admin support and other quality improvement measures that might help the CGS discharge process, and work is underway to address this. A further 30 patients have been identified for discharge to the service over the next few weeks. Work on this is ongoing and will continue through April 2026.
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Delivery Plan 2025/26 Final 19.05.25 Page 67 of 140 Women’s Health Plan The Women’s Health Plan set out actions to improve health inequalities by raising awareness, improving access to health care and reducing inequalities in health outcomes for girls and women, both for sex-specific conditions, and in general health. Key areas of activity were: • ensure women have access to specialist menopause services for advice and support on the diagnosis and management of menopause; • improve access to support, speedy diagnosis and best treatment for endometriosis; • improve access to information on menstrual health and management options; • improve access to abortion and contraception services; • ensure rapid and easily accessible postnatal contraception; and • reduce inequalities in health outcomes for women's general health, including work on cardiac disease. Short, medium and long term actions were developed for each priority area along with a series of cross cutting actions across all priority areas. A second national women’s health plan is in development and we will progress any actions set out particularly in relation to targeting need according to SIMD profile. We have established a SLWG of clinical experts, topic and thematic leads to review elements, consider improvement actions and plan activity with a view to establish a steering group. Women’s and Children’s Health The actions described are a combination of our Women’s and Children’s health work programmes which are well established and have delivered improvements over 2024/25. Best Start We have achieved the 32 recommendation targets, as well as a further 10 within the 76 ‘Best Start’ policy recommendations. Priorities have been agreed for 2025/26 including continuity of midwifery and obstetric care. Details of planning assumptions and resource challenges for this model (in excess of the allocated Best Start non-recurring funding) have been shared with the local governance groups. Nationally, the programme board for Best Start in Scotland was dissolved and discussions on national governance are underway with the Scottish 6. Women & Children’s Health
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Delivery Plan 2025/26 Final 19.05.25 Page 68 of 140 Perinatal Network and SG to oversee progress of the Neonatal redesign of intensive care. We participate in the West of Scotland Project Board for Neonatal redesign to progress a model for a Lanarkshire Local Neonatal Unit (LNU). Planning assumptions for maternity care interface across the policy change and local modelling for Lanarkshire as an LNU have commenced. Workforce, in particular, Consultant workforce planning, will be discussed in the regional governance group. For 2025/26, we will also continue to focus on the outstanding priorities of the ‘Best Start’ Policy. Public Health Transformation Programme During 204/25, we commenced a whole system Public Health transformation programme with innovation across several services. In terms of women’s and children’s health: • We are building local governance structures to address anti-racism guidance. The two work streams in the framework (Workforce and Population Health-based interventions) will align with national guidance to ensure this is embedded in all areas of practice. • We are focussing on ‘Global majority women’, with an opportunity to have a life course lens on change management behaviours and clinical pathways of care to aide improvement to health outcomes. Travellers are also a focus as local data intelligence indicates health inequalities and poorer outcomes for pregnancy and neonatal care for this group of women and children. We have contributed and influenced the development of new models of maternity care which will transform maternity service delivery. Early benchmarking has commenced to understand changes to care delivery at each part of the pathway. We are committed to implementing the pathway and model across the perinatal system to ensure every woman in Lanarkshire receives the same standard and quality of care, irrespective of their postcode. 6.1 Women’s Health (Taking forward the relevant actions set out in the Women’s Health Plan and take steps to ensure the particular needs of women and girls are considered in the context of NHS Board planning in all parts of the system) 6.1.1 Service Improvement Models Scope out proposed models of service improvement which target need according to SIMD profile demands which includes: • Provision of additional Long-Acting Reversible Contraceptive (LARC) through sexual
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Delivery Plan 2025/26 Final 19.05.25 Page 69 of 140 health service with additional funding. • Funding an external agency to provide LARC clinics in primary care. • Development of a Coil Hub pilot based on NHS Forth Valley –Stirling GP Coil Hub Pilot. Also • Support the development of an options appraisal to further assess the models; including, support with further financial costing for the models. • Consider recommendations on the next steps e.g. SLWG development. Trajectory • Improvement in LARC figures for Lanarkshire. • Delivering the actions/recommendations from the National women's health plan. Risk • There is no direct funding associated with implementation of women’s health plan, therefore, competing priorities for resources may slow progress. 6.2 Maternity and Neonatal Services (Continuing delivery of ‘Best Start’ policy, ensuring more women receive continuity of carer from the same midwife from pregnancy through birth, prioritising those who are most likely to benefit, such as minority ethnic women and women with additional social needs) 6.2.1 Best Start We were one of five early adopter Boards and our Maternity & Neonatal teams have worked in tandem to re design services and implement all 32 recommendations. By financial year 2026, the next transitional phase of Best Start implementation priorities are: Best Start Policy Number Implementation Priorities (1) Continuity of Carer (4, 5, 7, 22, 27, 39, 43, 49) Neonatal Model of Care (12,61) Multi-Disciplinary Staff Training (15) Choice –Place of Birth NA Maternity Triage Re-design (New)
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Delivery Plan 2025/26 Final 19.05.25 Page 70 of 140 6.2.2 Maternity Services • Continued implementation of Antenatal, Intrapartum Care & Postnatal Care. • Continued implementation of Neonatal service re-model & Bliss Accreditation with post accreditation maintenance. • Continued reporting of staff training to ensure optimal compliance with development of regular staff skill set/feedback post training. • Continued improvement work to increase numbers of women choosing & delivering in Acute Maternity Unit (AMU) or at Home. • Redevelopment of maternity triage with full testing, reporting & implementation of revised service model. Trajectory Trajectories have been developed to deliver the improvement actions by December 2026. Risks • Continuity of care: National risk also pertinent locally. Risk centred on staff availability to deliver the model. High level of attrition with model implementation. Financial investment required to provide the policy direction. Learning from early adopter signalled high turnover up to 18%. This measure is reflected in the acute risk register. • Best Start National Governance: New National governance arrangements to be confirmed which may impact progress across Scotland. 6.3 Introducing the New Pathways for Maternity Care The new maternity pathway and schedule of maternity care is due to launch Spring 2025. The pathway illustrates core care women and babies should receive based on the Best Start vision and principles of care. The pathway will have an impact locally particularly in cross boundary areas where local polices can vary and access to GP centres and clinic settings can be a challenge. The initial stage for implementation in NHS Lanarkshire is to benchmark against the current Policy and undertake a gap analysis. Trajectory • Spring 2025: National Implementation. • Summer 2025: Benchmark. • December 2025: Local Implementation.
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Delivery Plan 2025/26 Final 19.05.25 Page 71 of 140 Risk Assessment Local risks will be identified following the publication of the pathways and, thereafter, the completion of an assessment comparing the new and existing models to understand the core contacts for all women and babies. Cross cutting across primary care and acute will be required to understand the resource and deliverables. 6.4 Implementing the New Model of Neonatal Intensive Care (To improve outcomes for the very smallest and sickest babies, with the aim of having the new model in place by the end of 2025) Local Progress A project plan with timescale is complete, and a financial draft plan has been submitted. A local delivery plan was developed for submission to regional planners in early February 2025, however, data gaps nationally and locally pose planning challenges. At a national level, the Directors of Midwifery are liaising with SG policy leads to review ‘showstopper’ risks and mitigations, including availability of SAS as demand for transfers will rise exponentially. Workforce modelling for the Lanarkshire Neonatal Unit (LNU) is completed for consideration. A Local governance structure is agreed and modelling of an LNU has commenced. West of Scotland (WoS) Progress An implementation plan for the WoS service was submitted to SG in February 2025. The regional board is being reconstituted and will now include all affected Boards in the region. Trajectory Slippage across Scotland will occur with full implementation projected for calendar year 2026. Risk Assessment Ambiguity of governance arrangements, at both a regional and national levels, has delayed national consideration of risks to modelling and planning from a full system learning perspective. A renewed focus on governance nationally is expected by April 2025. 6.4.1 Executive Approval of Implementation Plans A series of actions are planned to be progressed during the current calendar year:
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Delivery Plan 2025/26 Final 19.05.25 Page 72 of 140 • Inclusion to maternity networks to participate in the creation of In-utero transfers models and pathways. • Workforce: modelling and retention across maternity and neonatal services. • Transport: SAS and Scot star model. • Progress the deliverables of the local project plan. • Continued commitment to implementation, but acknowledgement by WoS and SG that completion by 2026 is unlikely. • Finance: better understanding of costs is necessary following confirmation that the new model will present additional capacity implications. • Clinical Governance groups to be established in West, with the Director of Midwifery NHSL co-chairing with the Clinical Director of NHS Greater Glasgow & Clyde. Trajectory Calendar Year December 2026 Risk Assessment • Findings of Fatal Accident Inquiries (FAIs) may impact recommendations related to the transfer of women and babies as SAS transfers were a significant focus of the FAI. • Slippage to project plans due to interdependency with NHS Greater Glasgow & Clyde plans and progress to create capacity for Neonatal Intensive Care Unit (NICU). • Local and national maternity service modelling is required which could create slippage. • Political and protestor activity via parliament and other vehicles which could risk reputation and progress with timelines. 6.5 Continuing with Implementation of the Lancet Series Recommendations (For improvements to miscarriage care, with Boards working towards delivery of the Framework for Miscarriage Care) 6.5.1 Miscarriage Care and Facilities in Scotland Report Participate in Miscarriage care and facilities in Scotland Report as part of the programme for Government (2021/22) (complete). Trajectory Complete, and benchmarking report published by Scottish Government in April 2024. NHS
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Delivery Plan 2025/26 Final 19.05.25 Page 73 of 140 Lanarkshire was commended for work in relation to pathways and facilities for baby loss. Risk No Risk from the report, high standard of pathways. 6.5.2 Improvements to Miscarriage Care • Preventing Miscarriage – there is evidence that the use of progesterone can reduce the risk of miscarriage in women with early pregnancy bleeding and a history of miscarriage. January 2025 • Investigating Recurrent miscarriage: midwifery workforce for recurrent miscarriage clinics. Modelling complete, agreement via Women’s service Divisional Management Team (DMT) required. Consultant led clinic well embedded. Spring 2025 • Delivery of service: Scottish Government will launch miscarriage framework which will describe appropriate care model by a graded care approach. NHS Lanarkshire will benchmark once published. 2025/26 Trajectory • Following a successful business case, progesterone will be introduced January 2025. • Via Women’s services DMT and workforce planning, midwifery resource for recurrent miscarriage to be agreed and implemented from current workforce. • Awaiting Scottish Perinatal Network (SPN) publication to understand framework for Scotland against Lancet series. Risk Assessment No immediate risks identified. 6.6 Tackling Racialised Health Inequalities in Maternity Care (Boards working to develop and deliver actions in maternity services in their anti-racism plans, supported by the Scottish Government Action Plan and the associated Interpretation Toolkit) 6.6.1 Racialised Health inequalities in Maternity Care - Identifying and Monitoring Health Inequalities Across Ethnic Groups Pregnant women from minority ethnic groups are more likely to develop complications from COVID-19 which require hospital treatment and, at UK level, babies from minority ethnic
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Delivery Plan 2025/26 Final 19.05.25 Page 74 of 140 groups have the highest rates of stillbirth and infant death. Data is vital to identify and monitor health inequalities across ethnic groups, understand why they exist and address them. We will continue to work with PHS via the antenatal booking collection (ABC) data and data from Badger Net to identify the local population of inequalities and monitor health inequalities across the ethnic groups, understanding why they exist. Trajectory Continuous collaboration until 2028. 6.6.2 Racialised Health Inequalities in Maternity Care – Improving Access Work to be progressed through financial year 2026/27: • Collaborate with other Health Boards on improvement work. For example, mums matter in NHS Fife and the intrapartum improvement in NHS GGC for global majority women. • Implement actions from COVID 19 in pregnancy Scotland (COPS) study particularly for travellers where data indicates poor uptake of vaccinations offered in pregnancy. • Implement the Scottish Patient Safety Programme (SPSP) preterm prevention programme given the links with ethnicity and outcomes. • Analyse Mother and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) reports which detail benchmarking performance. • Develop a work plan to address health inequalities people from minority ethnic backgrounds face particularly for perinatal service global majority women and the Gypsy, Roma and Traveller community. • All governed in the racialized health inequalities NHS Lanarkshire group. Risk Assessment • Data accuracy with Badger Net. • Lack of input of ethnicity data by system users. 6.7 Child Health Services – Delivering High Quality Paediatric Audiology Services (Accounting for the emerging actions arising from the Independent Review of Audiology and associated DG-HSC letter of 23 February 2023) 6.7.1 Review of Audiology- Implementation of Actions We completed most actions arising from the Review of Audiology and associated DG-HSC
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Delivery Plan 2025/26 Final 19.05.25 Page 75 of 140 letter of 23 February 2023. The exceptions to this are actions 10 and 11 detailed below. The action plan has been completed with the service linking with NHS GG&C. Both Health Boards now await guidance from the national pilot for external peer review. We made considerable progress on those actions within our control. National guidance is still awaiting the remaining amber actions to allow their advancement. The two remaining actions require collaboration with external groups, and these are in progress. Action 10 - Deputy Head of Audiology is on the national working group looking to define and ensure the adoption of a consistent patient pathway for adult and paediatric audiology. This will enable consistency of care, comparative audit, and performance reporting between Health Boards. It is in progress with a targeted completion date of May 2025. Action 11- Design services based on demographics, geography, and local needs, ensuring stakeholders are key contributors to the process. This action is in progress and ongoing, and forms part of the SG strategy with a targeted completion date of August 2025. Under action 32 training for Band 4 staff, the audiology service has plans to develop current Band 3 staff to undertake the trainee position. Trajectory The waiting time for the paediatric audiology service is subject to a 12-week local target but the waiting time target is not being met at present due to workforce shortages. NHS Lanarkshire has five recently recruited newly qualified clinical audiologists and four current trainees. Work is ongoing to look at models to help reduce waiting times. Risk Assessment Delayed guidance from the national pilot for external peer review will delay progress on the two remaining actions. 6.8 Child Health Services (Ensuring that that all eligible families are offered child health reviews at 13-15 months, 27- 30 months and 4-5 years from a qualified Health Visitor or Family Nurse. That those reviews are conducted in the home and that assessment is supported by an appropriate version of the Ages and Stages Questionnaire)
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Delivery Plan 2025/26 Final 19.05.25 Page 76 of 140 6.8.1 Workforce -Child Health Reviews The required number of health visitors are in post to deliver child health surveillance visits for each age group to meet local population need: • All Health Visiting Teams produce workforce report using the common staffing method. April 2026 • Annual analysis of requirement for number of Health Visiting Trainees. • All areas are using a real time staffing tool PRAG - Purple, Red, Amber, Green. Lanarkshire's agreement of real time staffing risk to identify workforce risks and outline mitigation. Trajectory The service has a total workforce complement of 416.2 WTE of which 5.9 WTE posts are vacant and a turnover of 11%. (Dec. 2024) Risk Assessment • The current workforce demographic is of concern as 24% of the workforce are 55yrs+, with 10.6% of this being over the age of 60yrs. This presents some challenges in workforce planning as many of this cohort are part time or progressing to retirement. • Financial risk and requirement to meet financial savings plan year on year. • Proposed SG Workforce Key Performance Indicator minimum specific to Band 7 Health Visitors per 10,000 0–5-year-olds. Risk that this could influence workforce numbers once indicator is agreed. Mitigations: • A Universal Health Visiting Pathway Prioritisation and Escalation Guidance has been developed and is being tested, to support care prioritisation and delivery. • Caseload waiting tool and workforce reports are run annually and allow for identification of local workforce risk and ensure workforce profiles reflect local population need. • Staff turnover is monitored yearly to support recommendations of the numbers of trainees to be supported each year. Staff turnover, workforce demographics are monitored to also support this recommendation. • Continued to predict requirement for Specialist Community Public Health Nurse Qualification for 2024/24 both partnerships have moved to an over establishment position.
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Delivery Plan 2025/26 Final 19.05.25 Page 77 of 140 6.8.2 Child Health Reviews The percentage of Child Health Reviews (at 13-15 months, 27-30 months and 4-5 years) undertaken either maintains or increases annually. Over 2025/2026 we will increase coverage of pathway by 2% and increase meaningful reviews by 1% by March 2026. By March we will improve pathway coverage to consistently remain >90% Trajectory Coverage % • 13- 15-month reviews - NHS Lanarkshire average coverage 89.2%. • 27–30-month reviews - NHS Lanarkshire average coverage 88.5%. • 4–5-year reviews NHS - Lanarkshire average coverage 61.1%. Meaningful review % • 13- 15 months 93%. • 27-30 months 93%. • 4-5 year 88%. Our average coverage mirrors the national average with the exception of the 4-5-year reviews at 3% below. Meaningful reviews for all 3 Child Health Reviews mirror the national average. The aim in the next 12 months is to achieve 2% increase in the coverage and an increase of 1% in the 4-5 meaningful reviews. Risk Assessment • Available workforce - currently 24% of the workforce are 55yrs+, with 10.6% of this being over the age of 60yrs. • Staff understanding and utilising data for improvement. • Quality of data capture on child health surveillance forms. Mitigations: • Strengthen professional supervision including caseload discussions, planning and management. • Care Assurance processes in place to monitor uptake of Child Health Surveillance (CHS) visits and introduce local improvement actions timeously. • Monitoring in place via Support, Care and Clinical Governance Groups (SCCG) to
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Delivery Plan 2025/26 Final 19.05.25 Page 78 of 140 highlight challenges and identify any risks. • Quality control and assurance processes regarding data quality. • A Universal Health Visitor Pathways (UHVP) Prioritisation and Escalation Guidance has been developed and is being tested, to support care prioritisation and delivery. • Utilise the Ages and Stages Questionnaire (ASQ) tool at CHS pathway points. • All of the above reviews occur in home visit undertaken by a Health Visitor. • Data sources are continuing to be developed for assurance purposes. • Data quality regarding meaningful reviews - current data measure offers quantitative information. Work ongoing to develop qualitative measure such are day of care audits. • Strengthening reporting of all data including both the delivery of the pathway and quality of data capture on CHS forms. 6.9 Taking Forward Action in Local Child Poverty Action Reports (Setting out how they will work with Local Authorities to take forward the actions in their Local Child Poverty Action Report) 6.9.1 Local Child Poverty Action Plan 2025/26 To deliver on the actions described in our Local Child Poverty Action Report 25/26 we will: • Work with national agencies who review Local Child Poverty Action Reports for feedback, improve upon activity and potentially adjust our approach to initiatives to tackle child poverty. • Work with local authorities to monitor progress in relation to agreed actions committed to in both North and South Lanarkshire Local Child Poverty Action Plans. • Continue to raise awareness of the impact of poverty on our CYP and their families and ensure that frontline staff know where to signpost for support. • Participate as a pathfinder in the ‘Public Health Scotland Deep Dive into Income Maximisation in a Health Setting’. We will look to implement relevant recommendations from the Deep Dive. • Work with colleagues leading on Anchor Organisation Plans for NHS Lanarkshire to ensure that action to address child poverty continues to be a key component. Over 2026/28, we will review activity from both Local Child Poverty Action Plans (North and South) and develop evidence informed actions for NHS Lanarkshire for the next 3-year cycle.
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Delivery Plan 2025/26 Final 19.05.25 Page 79 of 140 Trajectory A national target has been set to reduce child poverty to 18% by 2024 and to 10% by 2030. Official poverty statistics released in March 2024 show that 24.2% of all children remained locked in poverty in Scotland in the period from 2020 to 2023. Across Lanarkshire the percentage of children currently living in poverty is 23.6% (South Lanarkshire) and 26.9% (North Lanarkshire) and, as with most NHS Boards and Local Authority areas, is unlikely to meet nationally set targets. Risk Assessment We are unlikely to meet the targets of reducing child poverty set by the Scottish Government. This is currently not included in a local/Board Risk Register. Mitigations: • We will continue to use the levers available to us in the form of direct patient contact to ensure that financial inclusion is raised and seen as an important part of health and wellbeing. • We will ensure our staff have access to appropriate resources and information to support families in relation to child poverty. • We will ensure that employability programmes target priority families that could benefit, thus potentially alleviating child poverty. We will ensure that tackling child poverty is a core feature of Anchor Institution activity.
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Delivery Plan 2025/26 Final 19.05.25 Page 80 of 140 The Population Health Transformation and Reform Group is progressing priorities which include: • Review weight management services and develop an action plan to tackle obesity. • Develop a health intelligence hub and support the Marmot work programme (child health, poverty, prevention). • Development of a cardiovascular prevention strategy and action plan. • Delivery of the anchor plan with an enhanced focus on the service delivery pillar. • Review Vaccination Services and implement the national framework. • Screening – focus on cancer and inequalities across all programmes. A new national Population Health Framework will be published in Spring 2025 providing details of a long term approach to primary prevention. We will undertake a gap analysis following the publication. 7.1 Cross Sector Partnerships (Working with partners to support a cross-sector approach to implementation of the Population Health Framework and its actions) 7.1.1 Population Health Framework We will undertake improvement actions which include collaborating with local stakeholders and primary care partners to produce a cardiovascular disease prevention strategy. We will develop and pilot a risk stratification tool to support prioritisation of chronic disease management resources in primary care, with an initial focus on cardiovascular disease. It is anticipated that this work will be completed by December 2025. We will continue to deliver actions across prevention, early detection and improving treatment outcomes to address cancer inequalities within the Detect Cancer Early programme of work. Actions that will be delivered by December 2025 include: • Development and evaluation of communication assets promoting early symptom recognition and early health seeking behaviour for those with lung cancer symptoms. • Review of did not attends (DNAs) across key cancer diagnostic services, implementing improvements where required. • Development and promotion of a direct referral route from cancer services to ‘weigh to go’ community weight management hub. 7. Population Health & Reducing Health Inequalities
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Delivery Plan 2025/26 Final 19.05.25 Page 81 of 140 Following an alcohol health needs assessment and review of alcohol deaths undertaken in 2024, work with partners to review, up-date and deliver the alcohol harms action plan in line with national policy, evidence-based practice and local needs by March 2028. Assessment • Social media analytics and patient feedback. • Reduction in % DNAs. • Number of referrals by SIMD quintile. • Alcohol: delivery of Alcohol brief intervention performance target and alcohol waiting time standards. (These are both HSCP targets). Risk Assessment Workforce capacity across the diagnostic and cancer pathways to support quality improvement initiatives identified by DNA activity and utilise the Weigh to Go Pathway. These are not outlined as formal risks within the public health risk register. 7.2 Vaccination Services (Demonstrating the steps for Interim National Standards for Vaccination Services) 7.2.1 Interim National Standards for Vaccination Services Proposed interim national standards are awaiting sign off by the Scottish Vaccination and Immunisation Programme (SVIP) Strategy and Planning group. Actions to meet these standards have been summarised below. • Demonstrate effective local leadership through the Area Oversight Immunisation Group (AOIG) governance establishing subgroups - Quality and Clinical Care, Workforce & Service Delivery, Monitoring & Evaluation, Inclusivity. These groups will support the AOIG providing quality assurance and oversight to deliver actions by March 2025 • In consultation with key stakeholders, complete local service mapping work. • Develop phased plan to prioritise equitable programme outcomes aligned to Scotland's 5-year Vaccination and Immunisation Framework and Delivery Plan by April 2025. • Effective implementation of the new vaccination schedule for the 0-5 childhood immunisation programme by July 2025.
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Delivery Plan 2025/26 Final 19.05.25 Page 82 of 140 Assessment • Feedback to the Board by AOIG from supportive vaccination programme and national dashboard to reflect improved service collaboration, assurance and oversight. • Uptake against 95% in 0-5 childhood immunisations and changes in vaccine uptake in routine adolescent and adult programmes, maternity and other selective programmes. Risk Assessment Risks are highlighted on AOIG risk register and other local registers i.e. Vaccination Clinical Governance. • Insufficient funding results in failure to meet service targets and national standards. • Staff capacity and competing demands of routine and new service developments. • Vaccine hesitancy resulting in lower uptake. Mitigating plans: Work closely with Scottish Government and service leads to ensure appropriate funding and measures in place to cover service needs. 7.3 High Consequence Infectious Diseases (HCID) Pathways (In place for assessment and management of suspected cases in secondary care (and for management until onward transfer of a confirmed case into the HCID network), and also ensure that any agreements with other NHS Boards in relation to HCID pathways are still relevant and up to date) 7.3.1 High Consequence Infectious Diseases Improvement actions to deliver this priority are as follows: • Complete work reviewing and merging current Viral Haemorrhagic Fever (VHF) pathway with Monkeypox (Mpox) Clade 1 pathway into single HCID pathway April 2025. • Integrate newly created High Consequence Infectious Diseases (HCID) pathway into relevant Major Incident Plan, Lanarkshire Pandemic HCID and Public Health Incident Plans by March 2026. • Conduct joint NHSL/NHSA&A multi-agency table-top exercise of PH Incident Plan by August 2025. • Ensure we meet Scottish national HCID Personal Protective Equipment (PPE) ensemble standards, including staff training by March 2026. • Conduct table-top exercise of new Lanarkshire Pandemic HCID Plan by March 2027. • Conduct live multi-agency exercise of PH Incident Plan by March 2028.
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Delivery Plan 2025/26 Final 19.05.25 Page 83 of 140 Assessment On track to meet HCID PPE ensemble standard, ahead on Pandemic HCID planning. Risk Assessment Lack of availability of 24/7 consultant microbiologist cover is a huge risk, this is currently on the Board Risk Register. 7.4 Addressing Inequalities in Cancer Screening (Reducing the difference in screening uptake between the most and least deprived quintile for each of the three cancer screening programmes) 7.4.1 Screening Uptake By March 2026 NHS Lanarkshire will: • Deliver screening conversations/raising the issue training programme to key stakeholders across the screening pathway. • Deliver targeted screening communications plan. • Implement agreed recommendations from bowel and cervical cancer screening community projects. Assessment • Targeted training sessions on national screening programmes in areas of deprivation and with key staff groups supporting under-served cohorts’. • Delivery of planned and targeted social media campaigns for each screening programme to areas of lower screening uptake which includes least deprived quintiles over the course of the year, monitoring social media analytics. Risk Assessment • Buy-in from key stakeholders given competing priorities e.g. financial inclusion, Alcohol Brief Interventions (ABIs), smoking cessation. • Targeted messages / campaigns are actioned by people from other SIMD quintiles. 7.5 National Mission on Drugs (Working with partners to maintain the progress achieved by the National Mission on Drugs. To reduce deaths and improve lives, including the implementation of MAT Standards, increasing access to residential rehabilitation and supporting sustainability planning)
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Delivery Plan 2025/26 Final 19.05.25 Page 84 of 140 7.5.1 MAT Standards Continue progress towards fully implementing and embedding all 10 Medication Assisted Treatment (MAT) Standards across Lanarkshire by March 2026. Trajectory Robust quarterly reporting and annual benchmarking processes are in place. MAT 1-5 standards are fully implemented with numerical, process and experiential evidence submitted to Public Health Scotland and SG via the Alcohol and Drug Partnership (ADP). Action plans are now in place to implement and embed Standards 6, 9 & 10, with the MAT North steering group meeting bi-monthly to maintain progress. Risk Assessment MAT 7 – All people have the option of MAT shared with Primary Care. Similar to many other areas in Scotland, this standard has not been met in Lanarkshire. Discussions are required at senior level to identify how this Standard can be met and this has been escalated through the North MAT Steering Group. 7.5.2 Residential Rehab Residential rehab will be available to anyone wishing to access this as part of their treatment and care, with timely access to rehab following referral and assessment (within 4-6 weeks) by March 2026. Assessment A residential rehab pathway has been in place since 2022, reviewed in 2024. The ADP monitored data on assessments and placements via ADPs on a quarterly basis. NL ADP commissioned and independent review of the pathway with keys findings and recommendations due to be published January 2025. Risk Assessment Limited residential rehab capacity (beds) across Scotland due to national demand that could impact on local waiting times, post-assessment. There is no local stabilisation or detox provision available in Lanarkshire.
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Delivery Plan 2025/26 Final 19.05.25 Page 85 of 140 7.5.3 Drug Deaths By March 2026 all suspected and confirmed drug deaths are reviewed with learning used to ensure drug death prevention measures are in place to improve responses and reduce harms. Assessment Drug death prevention group structures are in place with operational and strategic action plans reviewed in 2024. These set out all operational and strategic improvement priorities and key measures to support all drug death prevention efforts. This includes drug trend monitoring and links to local/national alerts systems. Risk Assessment Risk to delayed responses in the instance of a more potent drug supply outbreak due to a lack of real-time data, as seen in other countries. This is currently being mitigated through ongoing service intelligence and proactive harm reduction measures. A Standard Operating Process (SOP) is in development that links intelligence to Rapid Action Drug Alerts & Responses (RADAR) alerts locally and nationally. More work is required to understand the links between determinants of health and key drivers of problem drug and alcohol use to inform preventative approaches and mitigate future harms from alcohol and other drugs. 7.6 Sexual Health and Blood Borne Virus (Take forward the actions in the Sexual Health and Blood Borne Virus Action Plan and HIV Transmission Elimination Delivery Plan. To support sexual health improvement, reduce sexually transmitted infections and unintended pregnancies, and help achieve viral hepatitis and HIV transmission elimination goals) 7.6.1 Sexual Health & Blood Borne Virus & HIV Transmission Elimination The Scottish Government’s Sexual Health and Blood Borne Virus Action Plan (SHBBV) and HIV Transmission Elimination Delivery (HIV TEDI) Plan have 5 shared outcomes. These are: • Outcome 1: Fewer newly acquired blood borne virus and sexually transmitted infections; fewer unintended pregnancies. • Outcome 2: A reduction in the health inequalities gap in sexual health and blood borne viruses.
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Delivery Plan 2025/26 Final 19.05.25 Page 86 of 140 • Outcome 3: People affected by blood borne viruses lead longer, healthier lives. • Outcome 4: Sexual relationships are free from coercion and harm. • Outcome 5: A society where the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and blood borne viruses are positive, non-stigmatising and supportive. The Oversight of implementation of work plans is the responsibility of the 3 sub-groups of the Lanarkshire Blood Borne Virus (BBV) Prevention and Care Network (PCN), as well as our Sexual Health Clinical Services. The following key actions will be progressed by March 2026 to support the delivery of the ‘SHBBV Action Plan’ and ‘HIV TEDI’. a. Development and implementation of a BBV Prevention Work Plan. b. Development and implementation of a BBV Testing, Treatment, Care and Support Work Plan. c. Development and implementation of a BBV and Sexual Health Workforce Education and Training Work Plan. d. Monitoring and reporting of all commissioned third sector specialist BBV services with each organisation reporting on how various health inequalities are being addressed. e. Development of patient experience surveys including Patient Reporting Outcomes Monitoring tools (PROMS). f. Expansion of partnership working with key services and organisations who work with at risk populations including Alcohol Drug Partnerships, Gender Based Violence Services. g. Development of a Lanarkshire BBV PCN Communication Strategy to support workforce and population education and awareness raising. h. Our Sexual Health Services will lead on all aspects of clinical service provision and oversee the consultation with key stakeholders, and complete Lanarkshire’s Sexual Health Needs Assessment and implement its recommendations for action. Assessment The Public Health Scotland BBV and Sexual Health Dashboard has been developed and will support real time management and decision making for BBVs and sexual health in 2025 and beyond. The national Hep C Elimination Target to March 2025 will not be achieved and the Scottish Government will review the Hep C targets for 2025/26 in early 2025.
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Delivery Plan 2025/26 Final 19.05.25 Page 87 of 140 During 2026 the HIV Transmission Elimination targets will be reviewed due to a change in epidemiology. We have seen an increase in the number of new cases of HIV being diagnosed and new residents of Lanarkshire presenting who were previously known to be HIV positive. Risk Assessment The funding whether allocated from SG or locally is only sufficient to support a limited amount of work and this will impact the ability to achieve the targets. Changing demographics and drug use, specifically an increase in injecting cocaine, are key challenges in delivering BBV prevention, testing, care and treatment. 7.7. Hepatitis Elimination Goals (Work Towards Viral Hepatitis Elimination Goals, including through Achieving Board Level HCV Treatment Initiation Targets) 7.7.1 Hep C Elimination Plan The Scottish Government’s Hep C Elimination Plan (Action 14 of the SG’s Sexual Health and BBV Action Plan 2023 to 2026) will be integrated into our BBV Prevention and Care Network (BBV PCN) work plans. The oversight and implementation of plans is the responsibility of the 3 sub-groups of the BBV Prevention and Care Network (PCN) and actions to support the delivery of Hep C Elimination are noted above in section 7.6.1 and are due to be delivered by 31st March 2026. Assessment The Public Health Scotland BBV and Sexual Health Dashboard has been developed and will support more real time management and decision making for BBVs and sexual health in 2025 and beyond. SG Hep C Elimination Target to March 2025 will not be achieved and scheduled to be reviewed. Risk Assessment This work is part of the broader BBV Prevention and Care Network risks as described in 7.6.1.
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Delivery Plan 2025/26 Final 19.05.25 Page 88 of 140 7.8 Sexual Health and Blood Borne Virus (Taking forward the relevant actions in the Sexual Health and Blood Borne Virus Action Plan and HIV Transmission Elimination Delivery Plan to support improvements to sexual health and BBV service delivery, and work towards HIV transmission elimination targets, including through interventions to increase HIV prevention, detection and retention in care, and work to improve the lives of people living with HIV) 7.8.1 Sexual Health & Blood Borne Virus & HIV Transmission Elimination In consultation with key stakeholders, we will complete Lanarkshire’s Sexual Health Needs Assessment and implement its recommendations for action. SG Sexual Health and BBV Action Plan and HIV Transmission Elimination Delivery Plan (HIV TEDI) have 5 shared outcomes which are described in section 7.6.1. As previously noted, the oversight of the implementation of the work plans is the responsibility of the 3 sub-groups of the Lanarkshire BBV Prevention and Care Network (PCN), as well as Sexual Health Clinical Services. Key actions to support the delivery of the ‘SHBBV Action Plan’ and ‘HIV TEDI’ are also detailed in section 7.6.1 and will be delivered by March 2026. Assessment Completed Sexual Health Needs Assessment Measures: Incidence of Sexual Transmitted Infections (STIs), Long-Acting Reversible Contraception (LARC) provision, terminations of pregnancy, Pre-Exposure Prophylaxis for Human Immunodeficiency Virus (HIV) need and provision, service level data, & population surveys. The Public Health Scotland BBV and Sexual Health Dashboard has been developed. This will support more real time management and decision making for BBVs and sexual health in 2025 and beyond. Completed Sexual Health Needs Assessment. Measures: Incidence of Sexual Transmitted Diseases (STIs), LARC provision, terminations of pregnancy, Pre-Exposure Prophylaxis for HIV need and provision, service level data, & population surveys.
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Delivery Plan 2025/26 Final 19.05.25 Page 89 of 140 Risk Assessment There is a risk that the financial situation and pressure on existing services makes addressing the sexual health needs of the population challenging, potentially leading to worsening sexual health for the population. The funding whether allocated from Scottish Government or locally is only sufficient to support limited work and this impacts on the ability to achieve targets that have been set. Changing demographic and in drug use, specifically an increase in injecting cocaine, are key challenges in delivering BBV prevention, testing, care and treatment. There is a risk that the current financial situation and significant pressure on existing services makes addressing the sexual health needs of the population challenging, potentially leading to worsening sexual health for the Lanarkshire population. 7.9 Long-Acting Reversible Contraception (Actions to Support Improvements to Access of Long-Acting Reversible Contraception (LARC), Including Post-Abortion and Postpartum) 7.9.1 Long-Acting Reversible Contraception Work is underway to scope out proposed models of service improvement which targets need according to SIMD profile demands and includes: • Provision of additional LARC through sexual health service with additional funding. • Funding provided to external agency to provide LARC clinics in primary care. • Support the development of an options appraisal to further assess the models; including, support with further financial costing for the models. • Consider recommendations on the next steps e.g. SLWG development. Assessment • Improvement in LARC figures for Lanarkshire. • Meeting of actions/recommendations from the national women's health plan. Risk Assessment • No funding associated with implementation of women’s health plan. • Competing priorities on resources may slow progress.
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Delivery Plan 2025/26 Final 19.05.25 Page 90 of 140 7.10 Supporting Improved Population Health (Particular reference to smoking cessation and weight management) 7.10.1 Weight Management A series of actions have been identified and are being progressed that will support weight management initiatives for the population in Lanarkshire. Actions which will be progressed through 2025/26 are: • Redesign of Tier 3 adult clinical pathways to allow prescription of anti-obesity medications, to Tier 3 patients. • Integrate Tier 3 adult clinical Diabetes & Pre-Diabetes Mellitus (DM)/ Long Term Conditions (LTC) weight management pathways to increase capacity & ensure equity of access. • Reallocation of adult weight management resource from Tier 2 to Tier 2.5 to increase specialist weight management capacity. • Integration of the new Pre-DM diagnosis structured education pathway within Tier 2 community adult weight management. • Relaunch of the Diabetes Remission pathway and move from 1-1 to group delivery model to increase capacity. • Focus the Early Years and Child Healthy Weight pathways on families of children identified as severely clinically obese at the 27-30-month child health surveillance reviews and redesign & relaunch of the intervention programme. Ongoing work, locally & nationally, on the use of the P1 health surveillance to identify severely obese children and engage their families in weight management. Actions for 2026-28 will be determined by the outcome of the Weight Management Service (LWMS) review in 2025. This review will include a reconfiguration of Tier 3 adult clinical pathways to allow a ramping up of anti-obesity medications to 700+ prescriptions per year. Assessment • 100% compliance with national minimum standards for Tier 2 & Tier 3 adult weight management. • 96% compliance with national minimum standards for Tier 2 & Tier 3 child & young person weight management; shortfall due to specialist staff gaps. • Waiting time for vetting clinical referrals is within the 2-week target; all referrals are
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Delivery Plan 2025/26 Final 19.05.25 Page 91 of 140 allocated a place at a Tier 2, 2.5 or 3 interventions. Risk Assessment • Budget allocations have reduced for 3 consecutive years, impact on staffing levels, which have been reduced by 19% in recent years. • Demand rose sharply in 2023-24 and in 2024-25 the adult clinical pathways were redesigned with new access criteria to align clinical capacity with demand. • Future budget reductions present a risk for compliance with the national minimum standards and the capacity to keep up with a rising demand. • It is expected that demand for anti-obesity medications will drive demand for specialist weight management services without the ability to increase capacity to meet demand. • Focus on clinical tiers 2, 2.5 and 3 detracts from the ability to direct resource to Tier 1 preventative work. • Risks are outlined within the HSCP risk registers. 7.10.2 Smoking Cessation The following plans are being developed to support smoking cessation initiatives for the population of Lanarkshire. • Deliver a Secondary Care Action Plan based on the Scottish Government Tobacco & Vaping Framework over 2025-28. • Establish electronic referral pathways for Respiratory, Cardiology and Cancer wards/clinics via the Trakcare system over 2025- 28. • Promote and deliver Very Brief Advice (VBA) and Management of Nicotine Addiction Assessment Tool (MNAAT) training to staff working within Respiratory, Cardiology and Cancer wards/clinics over 2025-28. • Provide staff working in Respiratory, Cardiology and Cancer outpatient clinics the opportunity to attend National Centre for Smoking Cessation Training (NCSCT) and complete a mentoring programme allowing staff to supply Nicotine Replacement Therapy to clients motivated to stop smoking over 2025-28. Assessment • Contribute to Scottish Government target of 902 successful 12 week quits for 2025/26. • Contribute to the Secondary Care target of 96 successful 12 week quits for 2025/26.
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Delivery Plan 2025/26 Final 19.05.25 Page 92 of 140 Risk Assessment • Staff unable to complete VBA and MNAAT training due to time constraints or workload. Mitigation - Offer flexible training delivery options e.g. online, recorded training sessions. • Staff not applying training knowledge in practice. Mitigation-Offer regular refresher sessions, share success stories e.g. increase in referrals, identify a Smoking Cessation Champion in each of the areas. • Low referrals rates despite training. Mitigation-Share monthly data regarding successful quits to motivate staff. • High levels of sickness absence within the Quit Your Way (QYW) service resulting in potential waiting list for patients/client referred to the QYW service. Mitigation-Health Improvement Practitioners will complete the NCSCT Training and mentoring programme which will increase staff capacity within QYW service. 7.11 Health Inequalities and Population Needs (Tackling Local Health Inequalities and reflecting Population Needs and Local Joint Strategic Needs Assessment) 7.11.1 Strategic Needs Assessment Over 2024-2027, NHS Lanarkshire’s Public Health team will: • Support the evaluation of the University Health and Social Care North Lanarkshire and local carer organisations’ Carer Strategy 2024-2027. • Collaborate with South Lanarkshire University Health and Social Care Partnership (with input from Public Health Scotland’s Information Analysts) to ensure South Lanarkshire’s Strategic Needs Assessment (SNA) and Strategic Commissioning Plan are informed by population health needs and health inequalities. In addition, ensure the Priorities for Action in the Strategic Commissioning Plan (SCP) aim to address these population needs, with a focus on reducing health inequalities in South Lanarkshire. • Progress work of the strategic Public Health Action Team (PHAcT). Assessment Inclusion of health inequalities and population needs in the SCP report. Measures presented in the SNA and will be reviewed in the next SNA (3 years' time): Life and Healthy life
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Delivery Plan 2025/26 Final 19.05.25 Page 93 of 140 expectancy, health tiers of need, Long Term Conditions, Risk factors e.g. smoking & obesity, social care use, & child health measures e.g. dental health. Risk Assessment There is a risk that the current financial situation and significant pressure on existing services makes addressing the needs of the population and reducing health inequalities challenging, potentially leading to worsening inequalities. 7.12 Racialised Inequalities (Developing and delivering against anti-racism plans covering workforce and service delivery, aligning with the Scottish Government framework for action set out in the guidance) 7.12.1 Anti-Racism Plan By March 2026 NHS Lanarkshire will: • Design & implement an anti-racism framework. • Deliver an action plan based on framework, including key milestones. • Identify key leads responsible for delivery. • Undertake community and staff engagement for feedback on anti-racism plan. • Design & implement staff reporting system for experiences of discrimination. Assessment • Engage with key service leads to improve collection of data relating to ethnicity for service users, use suite of resources from Public Health Scotland. • Continue to engage with staff to improve collection of data relating to ethnicity. Risk Assessment • Engagement of service leads, considering winter/year-round service pressures & other priorities, mitigation is continued dialogue via updates/email where a service lead is unable to attend SLWG. • Risk of breaching Human Rights/Equality Act for not meeting legal requirements, mitigation is role of Equality Impact Assessments (EQIAs) in informing service delivery/design. • Staff resourcing of development of the plan, the workforce lead has competing requirements to deliver on Equality & Human Rights Commission reporting, for workforce registrar only available 2 days per week until Aug 2024.
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Delivery Plan 2025/26 Final 19.05.25 Page 94 of 140 • Mitigation will be to identify members of SLWGs to deliver in key areas and make it part of their objectives. 7.13 Redirecting Wealth Back into Their Local Community (To help address the wider determinants of health inequalities, through progressing specific, measurable objectives that align with their Anchor Strategic Plan) 7.13.1 Anchor Strategic Plan We will continue to progress delivery of year 2/3 milestones in NHSL Anchor delivery plan Oct 2023-Oct 2026 including: • Targeting employability programmes to priority groups through working with partners and raising awareness of employability programmes with NHS managers. • Encourage local procurement and delivery of community benefits through participation in Meet the buyer events and promotion of the community benefits gateway. • Further develop opportunities to use the natural environment and other assets within the NHS estate for community good. • Develop health intelligence systems and use this data to help redesign service delivery models to mitigate the impacts of wider determinants on health and wellbeing. • Participate in Public Health Scotland Deep Dive into Income Maximisation in Health child poverty programme and implement recommendations. • Target NHS credit union to NHS staff groups with a focus on lower paid staff. • Work with partners on joint community wealth building strategies and actions. • Implementation of community benefits plan for Monklands Replacement Programme and work with partners to begin planning for the regeneration of the old UHM site for community good. • Expand opportunities to develop the Healthy Working Lives (HWL) programme with a focus on Small and Midsize Enterprises (SMEs) and employers with lower paid staff. Assessment Year 2 progress measures are detailed in the 3-year strategic anchor action plan and delivery of national anchor metrics, demonstrating year on year progress. These include: • Number of employability outreach sessions delivered.
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Delivery Plan 2025/26 Final 19.05.25 Page 95 of 140 • Number of therapeutic programmes in place on NHS sites. • NHS Lanarkshire participation in Meet the Buyer events. • For all unregulated procurement (<50K) at least half the suppliers invited to quote will be locally based. • Evidence of partnership involvement in Monklands Replacement Programme and the plans for the regeneration of the existing UHM site. • Number of referrals to financial inclusion services. Risk Assessment Risks and issues have been identified for each action area and control measures are described in the 3-year strategic anchor action plan. Key risks relate to lack of comprehensive workforce and service data with respect to equalities and inequalities; capacity, resource and relevant expertise within corporate teams to lead and collaborate on anchor actions e.g. Procurement, Planning, Human Resources and Public Health/Health Improvement; capacity across clinical teams to support service redesign, and the impact of NHS financial sustainability on investment in prevention and community led models of care. These issues impact across all areas of the plan and prioritisation of actions may be required through the anchor steering group. Anchor risk register will be reviewed annually and updated. 7.13.2 Marmot Place Through to 2027 we will continue to contribute to the multi-agency work including South Lanarkshire Council the Institute of Health Equity (IHE) and Public Health Scotland (PHS) to deliver the key programme outputs for the Collaboration for Health Equity in Scotland. Collaborate on developing and implementing interventions and policies to reduce health inequalities. The focus includes embedding health equity approaches in local systems and adopting a long-term, holistic strategy for improving health equity. Assessment Reducing Health Inequalities • Collaborate with IHE and PHS to use national and local data, including qualitative data, to identify and implement evidence-based interventions to reduce inequalities in health. • Develop data packs highlighting disparities and focus areas aligned with the Marmot 8
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Delivery Plan 2025/26 Final 19.05.25 Page 96 of 140 principles. • Provide relevant data for diverse stakeholders to advocate for systemic health equity improvements. • Evaluate resource allocation and support prioritisation of issues and populations in consultation with stakeholders. Risk Assessment • Data Gaps: Lack of granular data may limit the ability to target interventions effectively. • Data Sharing: There may be gaps in the current data sharing agreements. 7.13.3 Review and Redesign of the Lanarkshire Weight Management Service (LWMS) We will continue to oversee the review and redesign of the Lanarkshire Weight Management Service (LWMS), ensuring it aligns with current evidence, new national directives (including the rollout of Anti-Obesity Medications and GLP-1 RA/GIP treatments), and population needs, while addressing resource constraints and promoting health equity. This work is scheduled to continue until December 2025. Assessment • Waiting time standards. • Standards for the delivery of tier two and three weight management services for adults. Risk Assessment • Capacity within the services to undertake a comprehensive review. • Stakeholder engagement challenges. 7.14 Integration of Transport into Wider Health Planning and Reform (Reflecting the SG Transport to Health plan published October 2024 and Section 120 and 121 of the Transport (Scotland) Act in relation to Board provision of non-emergency patient transport services) 7.14.1 Access to Health Care Transport During November and December 2024, NHSL commissioned a Fact-Finding local review into Access to Health Care Transport to scope current arrangements within the Board area and develop recommendations for the Board to consider via our governance structures, taking account of the key commitments from Transport to Health, which includes:
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Delivery Plan 2025/26 Final 19.05.25 Page 97 of 140 • Joint working with Scottish Ambulance Service (SAS) to enhance planning for scheduled transport to maintain safety and enhance flow. • Digital developments – reducing the need for patients to attend hospital for planned and scheduled appointments and consider Near Me tools and approaches. • Collaborative work with community partners to provide cost effective transport to hospital. • EQIA process underpinning all service redesign to understand the potential impact to our population. • Ensure the population in remote / rural locations have equitable access to healthcare. • Lived with and Living with communities engaged with the service development. • Effective communication and engagement to ensure all members of our population can access transport to ensure access to health care. Work is ongoing, analysing information gained via the Fact-Finding review and this will form the basis of the future improvement actions. It is anticipated this process will be concluded by 30th June 2025. Assessment Mechanisms by which to assess progress are to be confirmed. Risk Assessment Will be developed when scope of work confirmed. 7.14.2 Community Transport Hub We will further develop the local Community Transport Hub which supports members of our population to receive transport to ensure access to healthcare. Initial scoping work underway with CEO SPT to explore a regional solution to this challenge. This initial exercise is scheduled to conclude by 31st August 2025. Assessment Mechanisms by which to assess progress are to be confirmed when a plan of action is agreed.
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Delivery Plan 2025/26 Final 19.05.25 Page 98 of 140 Risk Assessment Will be developed when scope of work confirmed. 7.15 Embed the GIRFE Toolkit and the Principles into Planning and Delivery 7.15.1 GIRFE Pathfinder North Lanarkshire HSCP were a GIRFE Pathfinder meaning we already made progress in implementing aspects of the GIRFE toolkit. Work will commence to implement GIRFE across whole system. This includes: • GIRFE toolkit being used to support development of interface division, implementation of Flow Navigation Centre + Plus and virtual wards. • Embed GIRFFE within person centred care workstream. • Embed principles of GIRFE into equality impact assessment (EQIA) to ensure organisational implementation at service review/ development. • Ensure GIRFE principles implemented through Health & Social Care Partnerships Strategic Commissioning Plans. Assessment GIRFE embedded over 2025/2026. Risk Assessment There has been no agreed approach to measure progress or impact.
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Delivery Plan 2025/26 Final 19.05.25 Page 99 of 140 Full details of the financial position and plan for the coming year are detailed in the 2025-26 to 2027-28 Financial Plan for NHS Lanarkshire submitted to Scottish Government in March 2025. 2025-26 to 2027-28 Summary The Financial Plan considers the medium term strategic priorities for 2025-26 and the following two years, covering 2026-27 and 2027-28 and the NHS Lanarkshire Board’s continued aim to deliver high quality health services within a sustainable financial model. In summary: • NHS Lanarkshire Board has a balanced position in 2025-26 followed by the next two Financial Years of projected gaps after identified Sustainability & Value schemes. • In all three years both North Lanarkshire IJB and South Lanarkshire IJB have balanced positions after identified Sustainability & Value schemes. The table below summaries the financial position over the 3-year period: Financial Planning Risk Items There are a number of other material financial factors which could impact on the delivery of a break-even revenue position for 2025-26 including: • The pay award agreed for all NHS Lanarkshire staff groups not being fully funded by Scottish Government. • Supplies inflation averaging more than the Financial Plan estimates. • As all NHS Boards face gaps in their financial plans there is a risk that additional income is sought by other NHS Boards from those using their services. This is material for NHS Lanarkshire due to the extent of cross boundary flow with every 1% increase equivalent of c.£3.8m. 8. Finance
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Delivery Plan 2025/26 Final 19.05.25 Page 100 of 140 Providing safe, maintained buildings and appropriate infrastructure is a vital enabler for the delivery of services and roll out of the Boards transformation process set out in ‘Our Health Together’. The Infrastructure Business Continuity Plan submitted to SG in Jan 2025 sets out the ‘do minimum’ investment requirements for the forthcoming year which extend beyond available core capital investment funding and include: • Whole system backlog maintenance. • Monklands business continuity priorities. • Equipment replacement. • Digital infrastructure. • Operational business continuity priorities. • Environmental and Sustainability Priorities. The investment priorities identified, have been subject to robust risk assessment and stakeholder engagement processes resulting in a prioritised list of infrastructure requirements. These prioritised programmes, if funded, reduce the likelihood and impact to service continuity that would result from the failure, or insufficiency, of NHS Lanarkshire’s infrastructure. In addition to the maintenance related business continuity priorities set out in the Infrastructure Business Continuity submission, there are known pressures on our physical infrastructure/ estate associated with the implementation of both local and national strategies and priorities. This would include: • Unscheduled and Urgent Care pathway development across the whole system including the introduction of the Interface Division. • Review of planned care provision. • Delivery of the mental health priorities. • Roll out of the Primary Care Improvement Plan (PCIP). The PCIP has resulted in pressures on accommodation directly related to the expansion of the workforce and a growing number of requests for suitable accommodation. Additionally, the establishment of new clinical models and pathways that deliver a multi-disciplinary approach to care provision in Primary Care require a review and potential re-allocation of our 9. Infrastructure
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Delivery Plan 2025/26 Final 19.05.25 Page 101 of 140 community accommodation to support the new models and pathways. There is no funding to expand the accommodation footprint attached to PCIP and a more flexible approach to allocation is being adopted to address the growing pressures in this area. Risk Assessment Key risks associated with the provision of adequate accommodation and infrastructure include: • Funding to deliver adaptations to buildings to support new or different activity. • Increased cost of building works against a backdrop of a static capital allocation. Limitations on budget mean that essential backlog maintenance and business continuity requirements are prioritised over service developments. 9.1 Accommodation Requests We will review extant policy and implement a revised governance structure to oversee requests for accommodation that result from increased staffing, revised pathways or service changes. Risk Assessment • Inability to address requirements in a timely manner. • Lack of suitable vacant accommodation. • Staff engagement and buy in to adopting a more flexible accommodation model. 9.2 Infrastructure Whole System Initial Agreement Development of the Infrastructure Whole System Initial Agreement (IA) based on the requirements set out in DL 2024 (02) is currently under review nationally. It is anticipated this request will be replaced with a request for Strategic Assessment(s) that focus on known infrastructure development priorities. Risk Assessment • Capacity and In-house capability to develop and deliver a 30+ year Infrastructure model (should this continue to be the ask). • Ability to engage appropriate Stakeholders in the longer-term agenda given the short- term accommodation pressures in play.
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Delivery Plan 2025/26 Final 19.05.25 Page 102 of 140 9.3 Primary Care & Community Infrastructure Delivery of a Primary Care and Community Infrastructure (medium term) Strategy that sets out the model for the future use of accommodation across our primary care and community services based on the developing primary care strategy. (This work will inform the whole system IA if required but remains a programme of work in its own right). Risk Assessment • Capacity. • Visibility of available accommodation. • Ability to engage teams given the need for shared accommodation and flexibility of use.
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Delivery Plan 2025/26 Final 19.05.25 Page 103 of 140 The Value Based Health and Care (VBHC) Action Plan was published by SG in October 2023 and has 13 action points across 6 broad commitment areas. Our Realistic Medicine (RM) Team have drafted a plan to implement the national priorities in collaboration with the national policy team including nominated leads for each action monitored across the plan domains. Progress is satisfactory, and the plan maps the VBHC to ‘Our Health Together’ supported via a local Action Plan. The RM team includes the Clinical Lead and a program manager funded from the Department of Health and Social Care. 10.1 Focus on Practising Realistic Medicine 10.1.1 Value Based Health & Care (VBHC) We will continue to promote training and education for staff enabling delivery of VBHC and to increase awareness and evaluation for Shared Decision-Making eLearning module; Introduction to Value based Health and Care eLearning module and Unwarranted Variation SWAY. This aligns with VBH&C the following actions: • SG and NES will engage Boards, education provider and wider partners to inform the education, training and tools to support kind and careful care, and the day-to-day practise of Realistic Medicine. • SG, professional bodies, Boards and Health and Social Care Partnerships (HSCPs) will work together to increase professional awareness of Realistic Medicine and enable delivery of Value Based Health and Care. • SG will work with HIS Community Engagement, NHS Boards & HSCPs and the public to understand awareness of VBH&C and Realistic Medicine to support shared decision making, health literacy. Agency and advocacy. This work will be ongoing through to March 2026. Assessment NHS Education for Scotland quarterly report indicated approx. 500 staff having undertaken learning modules. No national target exists and locally our trajectory would be to achieve similar and to work with National Education Scotland (NES) on data capture for learning sways. 10. Value Based Health & Care
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Delivery Plan 2025/26 Final 19.05.25 Page 104 of 140 Risk Assessment Risk exists if this training and education is not seen as fundamental to professional roles and is also reliant on supporting staff (time) to undertake the self-directed learning. Ambition may commence with a specific discipline, to evaluate thus spread in the most appropriate way. 10.2 Measuring Delivery of Value Based Health Care We promote the measurement of delivery of VBHC. This includes: Shared Decision Making (SDM); Active Clinical Referral Triage (ACRT); Patient Initiated Review (PIR); Person Reported Experience Measure (PREMS); and Patient Reported Outcome Measures PROMS). This aligns with the following VBH&C actions: • SG will support development of a national PREM to improve delivery of person- centred care. • SG and delivery partners will explore digital capture and use of PROMs and specific outcome measures to drive improvement and better value care. • NHS 24, NES, HIS, CfSD, and Public Health Scotland (PHS) will continue to ensure access to high quality evidence-based knowledge and information that supports delivery of the Realistic Medicine goals of safe, person-centred care; reducing unwarranted variation and inequality; reducing waste and harm; and empowering people to make informed choices about their care through shared decisions. • SG, CfSD, NHS Boards and HIS will promote and support the use of improvement tools and approaches that help deliver VBH&C including ACRT, Effective Quality Interventions Pathways (Opt- In-Pathways), Discharge PIR (Patient Initiated Review), and digital approaches that help NHS Boards and HSCPs to manage patients by reducing or stopping lower value interventions and care. This work will be ongoing through to March 2026 Assessment National targets do not exist for all aspects, nor do the measurement tools for PREMS and PROMS. In the absence of targets, locally we continue to build on the CfSD target performance for ACRT and PIR and to spread SDM survey use (collaborate and sure) building on Benefits, Risks Alternatives & Do Nothing (BRAN) realistic interactions and to build on a central reports facility that demonstrates increase specialty engagement. The child
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Delivery Plan 2025/26 Final 19.05.25 Page 105 of 140 collaborate is in development and will enable us to measure Supported Decision Making (SDM) in children’s services. Risk Assessment As there are limitations to the measurements without national tools and or a uniform system to capture data, locally we will continue to capture data relevant to ACRT, PIR and SDM. 10.3 Developing Community of Practice Involvement and Ensure Sustainable Healthcare Models Between now and March 2026 we will continue to participate and build on our community of practice involvement and build on our promotion of a sustainable healthcare model through our participation and guidance within the Interface division FNC+ whereby virtual models of care are inclusive for realistic health and care interactions. (Technology enabled care: Near Me, Remote Monitoring, and SDM, and BRAN)). Aligns with the VBH&C actions. Assessment Locally we will establish a Community of Practice (COP) network for Lanarkshire, aligned with VBH&C actions and with the national COP group, thus enabling representation on all national teams whilst integrating our interface division into our healthcare programme, such as a member of DOCCLA (virtual hospital wards) group. Risk Assessment Membership with interface division is in place, however, there is a risk in gaining interest from all areas to join community of practice groups. This may require the approach to be refined to start with existing specialty areas and build from this.
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Delivery Plan 2025/26 Final 19.05.25 Page 106 of 140 Throughout 2024-2025, there have been improvements across NHS Lanarkshire’s workforce metrics. This includes: an increase in substantive staffing of 2.4%; a reduction in agency usage; and achieving the target of no off-framework agency usage. In addition, retention levels have improved with turnover figures at their lowest since pre-pandemic levels, currently at 6% which compares favourably to 9% in previous years. Linked to workforce retention, our Organisational Development (OD) Team developed a modelling tool for Succession Planning in 2024 and this will be implemented during 2025- 2026. This will encourage teams to scope and plan future workforce needs and be utilised in conjunction with Retire and Return. This remains popular in uptake and presents an opportunity for effective succession planning through retaining experienced staff members after retirement and taking the opportunity to develop the skills of staff who are less experienced. Encouraging staff across all services to actively engage in succession planning also mitigates the risk when staff who Retire and Return subsequently leave the organisation. Through the scope of 3-year delivery plan there are local and national strategic drivers which have implications for our workforce. This includes the Reduced Working Week (RWW) which requires changes to rosters across all Agenda for Change staff groups and has presented a challenge for services to adapt to a new way of working and rostering practice. Services are being supported by the Human Resources (HR) Team to progress this, and an Oversight Board has been established to ensure the seamless implementation of the RWW. Sickness Absence has also been an area for improvement and there are actions that will improve management and monitoring. This includes: the development of an HR Outreach model; implementation of a new case management system to record all sickness absence interventions and interactions; and monthly email prompts to managers. More information on sickness absence actions and can be found at section 11.4. Improving attendance management is of the upmost importance. This will have a positive impact on several areas including: staff wellbeing and support through absence management and return to work processes; reducing reliance on supplementary staffing to fill gaps due to high of sickness levels; and improving both staff and patient safety through continuity. We continue to engage in work to improve workforce supply through close links to 11. Workforce
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Delivery Plan 2025/26 Final 19.05.25 Page 107 of 140 higher/further education programmes and pathways for clinical roles, particularly for Nursing, Midwifery and AHP Professions to contribute towards developing a Healthcare workforce for the future. More information on current partnerships and links with universities appear in section 11.6. In addition to focussing on the workforce supply for clinical roles, work is ongoing to focus on workforce supply within non-clinical areas including the Estates Department which, due to an ageing age profile and hard to fill posts, is developing apprenticeship programmes to ensure a pipeline of qualified estates staff for future years. We will continue to develop Advanced Practitioners both within Nursing and non-Nursing staff groups including AHP Professions and Pharmacy. An Advanced Practice strategy group was established in 2024 and will work towards developing an Advanced Practice Strategy for in 2025. Following a review of Acute Nursing Workforce Planning in 2024, NHS Lanarkshire will invest £9 million into Acute Nursing Services in 2025 to improve staffing levels, and reduce the use of supplementary staffing, in particular agency nurses. Our recruitment team continue to use proactive evidence-based approaches to promote Lanarkshire as an attractive place to live and work, and to target hard to fill roles/services through a variety of recruitment initiatives including targeted campaigns, increased use of social media and increased use of media advertisements. 11.1 Agency Staffing (Achieve Further Reductions in Agency Staffing Use and to Optimise Staff Bank Arrangements) 11.1.1 Agency Staffing From March 2024 to December 2024, we decreased agency usage by 47%. We joined a West of Scotland consortium for a ‘Neutral Vendor’ for nurse agency offering Boards greater coordinated control over the chargeable rates for the supplying agencies within the West of Scotland. Our current aim is to reach zero agency shifts per week by March 2026, thereafter our aim for the subsequent two years is to maintain this position. NHS Lanarkshire will focus on the continued reduction of all Agency usage, including maintaining no Off Framework agency usage, through the following ongoing actions:
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Delivery Plan 2025/26 Final 19.05.25 Page 108 of 140 • ‘No Health Care Support Worker (HCSW) Agency’ use was implemented from March 2024, in line with DL issued from Chief Nursing Officer (CNO) and Director of Health Workforce advising that use of HCSW agency should cease unless clinical safety and/or the delivery of the service would be compromised. Executive sign-off is required for any exemptions. • ‘Agency usage by exception only’ from October 2024 was implemented following letter from Chief Nursing Officer Directorate (CNOD) to Boards. • Agency governance meetings continue to agree actions for a reduction in Framework Agency, and to monitor progress through the Acute Nurse Governance Group. • Focus on shifts becoming available to Staff Bank workers at the earliest opportunity. • Agency escalation period remains at 24 hours prior to shift start time, to increase the opportunity for the shift to be filled by Bank prior to being escalated to Agency. • A focus on Rostering and improving rostering practices and an understanding of rostering responsibilities across the organisation, with the support of eRostering to improve effectiveness, visibility and fairness when applying key Rostering principles. • Implementation of the findings from the Acute Nursing Workforce Planning Review, with NHS Lanarkshire investing approx. £9 million into Acute Nursing Services during 2025 to increase staffing levels. It is anticipated that this will reduce the use of supplementary staffing, in particular agency nurses and bank nurses. (Inpatient ward funded establishments were reviewed to consider increased bed occupancy in comparison to pre pandemic levels coupled with an increase in the acuity of patients presenting at emergency departments). This work will continue through March 2026. Assessment Target for Agency usage continues to be zero. Risk Assessment • Operational Service Delivery: Implications on service delivery if the reduction in agency does not correlate to an increase in uptake of Bank shifts, this may exacerbate staffing gaps. • Financial Risk to the organisation if downward trend doesn’t continue and starts increasing. These risks are being mitigated through delivering on the actions set out above.
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Delivery Plan 2025/26 Final 19.05.25 Page 109 of 140 11.2 Achieve Reductions in Medical Locum Spend 11.2.1 Medical Local Spend We achieved savings in supplementary staffing through initiatives implemented during 2024/25, resulting in a saving of £1.8m (22%) and a reduction in the Consultant vacancy rate by 2.4%. We aim to achieve further reductions in medical agency locum spend for all specialties, except for Mental Health and Learning Disabilities. (see Action 11.2.2 below). Actions to assist achieving the target: • Continuation of the Sustainability and Value Group that oversees the process for supplementary medical and dental staffing, which includes monitoring spend. • Refreshing our procedure which includes the escalation process for high-cost locums and a more robust process for short term usage. • Enhance/promote bookings via medical staff bank and the first port of call in our escalation process before agency is sought. • Proactive Consultant/SAS recruitment to drive down the need for Bank/Agency Locums, which includes international recruitment drives and working with the Centre for Workforce Supply (CWS). • Apply a greater scrutiny of requests and monitoring at department level. • Work collaboratively with the West of Scotland Consortium and Neutral Vendor Litmus to reduce agency rates. This work will continue to progress through March 2028 Assessment NHS Lanarkshire has developed a phased approach to the above action with key implementation dates of March 2026 and March 2027. 11.2.2 Mental Health and Learning Disability Specialities Only NHS Lanarkshire saw an increase in Agency spend for Mental Health & Learning Disability during 2024/2025. It may not be possible to reduce this due to workforce availability within Scotland. The aim, however, is to achieve a reduction in Agency spend by: • Continuation of the Board’s Sustainability and Value Group as above. • Considering alternative working models for Mental Health Services.
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Delivery Plan 2025/26 Final 19.05.25 Page 110 of 140 • Proactive Consultant/SAS recruitment to drive down the need for Bank/Agency Locums. This includes international recruitment drives and working with the Centre for Workforce Supply to find recruitment solutions and recruitment pathway options for Psychiatry. • Refreshing our procedure which includes the escalation process for high-cost locums and a more robust process for short term usage. • Enhance/promote bookings via the medical staff bank and the first port of call in our escalation process before agency is sought. • Apply a greater scrutiny of requests and monitoring at department level. • Work collaboratively with the West of Scotland Consortium and Neutral Vendor Litmus to reduce agency rates. This work will continue through March 2028 Assessment NHS Lanarkshire has developed a phased approach to the above actions with key implementation dates of March 2026 and March 2027. Risk Assessment • We may not be able to achieve a reduction as this is recognised as a shortage specialty with concerns on workforce availability within Scotland. • Possible risk of additional Mental Health medical locum spend. This is based on current recruitment trends, which may have an impact on the overall reduction to locum spend. • Risk of services destabilising, and exacerbating existing consultant vacancy position, of which NHSL has one of the highest % of consultant vacancies in Scotland. • If all Scottish Health Boards are asked to reduce costs this may result in locum staff moving to NHS England. • If many Scottish Health Boards, choose to work with the CWS then this could see potential candidates choosing to take up employment in neighbouring Boards where the staffing position is more favourable. • High introduction fees and continuing Agency costs for initial cross over.
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Delivery Plan 2025/26 Final 19.05.25 Page 111 of 140 11.3 Increasing Efficiencies Across Administrative and Support Services 11.3.1 Sustainability & Value Programme- Administrative & Support Services As part of the Sustainability and Value Programme, we have a workstream that will focus on increasing efficiencies across administrative and support services. Actions to focus on efficiencies and productivity will include: • A proposal for a pan Lanarkshire review of Administrative and Support Services. • Establishing a clear baseline position of current roles and staffing figures within these Staff Groups. • An understanding of the distribution of staff to a granular level (broken down to sites and service level). • This will inform the review and support the identification of areas where there could be potential efficiencies through considering Digital solutions, including automation or different ways of working to develop a more digitally enabled flexible workforce. It is acknowledged that a review may also identify inconsistencies in staffing for similar areas. Assessment A trajectory will be developed once the groups have been established to commence the review of Administrative and Support Services. Risk Assessment A risk that any staffing review that could result in potential reduction in staffing will be met with resistance from Trade Unions. 11.4 Encourage Attendance & Support Employees (where health issues impact on their ability to be at work, through implementing the NHS Scotland Attendance Policy) 11.4.1 Implementing NHS Scotland Attendance Policy We aim to achieve an initial reduction of 1% to bring performance in line with national average and a target of no more than 20 sickness absences cases exceeding 12 months. A revised approach has been developed and driven by HR to support services to achieve an
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Delivery Plan 2025/26 Final 19.05.25 Page 112 of 140 improvement in attendance and policy compliance. This includes: • Active reach out to service from HR at key stages for short and long term absence, ensuring timely interventions. • Active reach out to staff triggering long term absence signposting to support services available. • Monthly email to managers advising of staff absences with tailored recommendations for action. • Review of EASY service focussing on MH/MSK absences, which are amongst highest reasons to ensure targeted and focussed support. • Introduction of Governance/Attendance Meetings within every directorate covering all job families led by the service, including HR/OH to ensure timely interventions. • Introduction of an Attendance Management System to track all absence cases that trigger internal thresholds with automated reminders for follow-up. • Continuation of training, both scheduled and bespoke, and identification of appropriate delegates by each service. • Revised Staff Wellbeing Plan aligned to NHSL Strategy, proactively promoting awareness of support services available to managers and staff. Target for completion of this work is March 2026 Assessment An initial reduction of 1% to bring in line with national average. The target for 2026/27 will be determined once the impact of the 2025/26 actions is known. There is a target of no more than 20 sickness absences cases exceeding 12 months for 2025/26, with a further target of no more than 10 cases for 2026/27. Risk Assessment Absence remains unpredictable, particularly short-term absence during winter months which could impact on the Board’s ability to achieve the target. We would seek to mitigate this through increased awareness of support services available to try and prevent absence and/or reduce duration of absences and increase awareness of benefits of annual vaccinations to reduce absence associated with ‘winter illnesses.
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Delivery Plan 2025/26 Final 19.05.25 Page 113 of 140 Vaccination uptake has reduced across UK and, if the uptake does not increase, this could impact on short-term absences during peak periods for sickness absence and service pressures. Demands on Services/Managers remains high, which could impact on manager’s ability to dedicate required time to attendance management and take timely interventions. 11.5 Implementation Plan for eRostering in 2024/25 (with a view to implementing across all services and professions by 31st March 2026) NHS Lanarkshire’s eRostering Project commenced May 2023 and is currently on track to complete roll out by March 2030. Consideration was given to increasing the size of the current roll out team to accommodate a March 2026 delivery, however, this would be both prohibitively expensive as well as impractical from a recruitment, training and development perspective. A condensed roll out programme would rely on clinicians being available to receive training from the eRostering team which would be challenging. Rollout to Nursing/Midwifery by March 2026, with full roll out by March 2030. Assessment Full roll out by March 2030, with a focus on ensuring Nursing/Midwifery are rolled out by March 2026. Risk Assessment The implementation of eRostering across all services and professions by 31st March 2026 has been deemed as not feasible. This conclusion is based on financial implications and additional risks including the upscaling of the team that would be required within a relatively short time frame to complete the roll out. A further risk is the impact of having significant numbers of staff on Fixed Term contracts at the end of March 2026 who would be eligible for Redeployment. 11.6 Working with Further/ Higher Education Institutions (Working with Further/Higher Education Institutions to improve the way we plan education needs of our workforce, and what collaboration takes place to ensure education curriculums
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Delivery Plan 2025/26 Final 19.05.25 Page 114 of 140 offered can respond to the changing population health needs both locally and nationally) 11.6.1 Nursing / Midwifery We will continue to work in partnership with Further/Higher Education Institutions to improve planning for education needs in relation to the future supply of Nursing/Midwifery staff: New College Lanarkshire/South Lanarkshire College Collaborative development of Professional development award (PDA) for assistant practitioners: • Curricula design for above PDA. • Curricula design and development for Modern apprentice and SVQ work programmes. • Support curricula design in collaboration for Higher National Certificate (HNC) Healthcare practice. • Fully utilise the HNC endorsed route into preregistration nursing. • Provide practice learning experiences and placements for all above programmes. North Lanarkshire Council only: Joint curricula development and delivery for Employability programmes and provision of practice learning experiences to enable participants to meet programme outcomes. NCL / SLC / University of West Scotland (UWS): Working with SQA to develop the HND in Healthcare as a programme to support Assistant practitioners. The ambition is that the successful completion of the qualification will assist articulation into 18 months of a preregistration nursing programme. University West of Scotland (UWS) Part of strategic planning for preregistration Nursing and Midwifery C25 curricula development- • Provide input into curricula content development delivery. • Provide input to student support for student sessions in placement. • Provide placement and practice learning experiences that support and enhance student learning – Adult and mental health nursing, Midwifery, Operating Department Practitioner and paramedic science. • Provide input into programme approval and validation events with internal and external bodies as part of university academic process.
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Delivery Plan 2025/26 Final 19.05.25 Page 115 of 140 • Commission post registration programmes of education as part of a Service level agreement. Glasgow Caledonian University Provide input to curricula design and development for preregistration programmes- • Commissioning programmes of post registration education through memorandum of understanding process. • Provide input into curricula content development – pre and post registration. • Provide practice learning experiences for preregistration NMAHP students – Learning disabilities Nursing, Children's nursing and AHPs (please see Action 11.6.2 for AHP information). • Regular discussions regarding working relationships and development of approaches to be responsive to service need. • GCU providing Quality Assurance (QA) to some NHSL programmes – MINTS, Paediatrics in ED, Deteriorating patient. Ongoing actions throughout 2025 -2028 11.6.2 Allied Health Professions We will continue to work in partnership with Further/Higher Education Institutions to improve planning for the education needs of future Allied Health Profession staff: Allied Health Professionals (AHPs) Involvement in University Partnerships • Through the NHS Lanarkshire university partnerships, our AHPs collaborate with partnered universities: University of the West of Scotland (UWS), Glasgow Caledonian University (GCU), and the University of Strathclyde (UofS). • These partnerships enhance education, research, and clinical practice while addressing workforce challenges. • Glasgow Caledonian University (GCU) offers key AHP courses, including Dietetics, Occupational Therapy, Orthoptics, Physiotherapy, Podiatry, and Radiography. • The University of Strathclyde (UofS) offers Orthotics, prosthetics, and Speech and Language Therapy courses. NHS Lanarkshire also offers Sports and Activities student placements to support initiatives like the Falls Strategy and Active Wards work. • The University of the West of Scotland (UWS) mainly focuses on Paramedic education, and NHS Lanarkshire facilitates diverse clinical placements across the
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Delivery Plan 2025/26 Final 19.05.25 Page 116 of 140 county. Additional Placement Partnerships: • Edinburgh Napier University (ENU) MSc courses for Occupational Therapy and Physiotherapy graduates. • Robert Gordon University (RGU) physiotherapy placements. • Queen Margaret University (QMU) requests NHS Lanarkshire placements for Occupational Therapy, Podiatry, and Speech and Language Therapy students. • These partnerships ensure a continuous supply of skilled professionals, facilitating knowledge exchange and enhancing AHP services. Key Collaboration Areas: • Placement Opportunities: Comprehensive clinical placements for GCU, University of Stirling and UWS students. • Curriculum Development: AHP leads help shape curricula to align with clinical demands. • Graduate Recruitment: High-quality placements increase the likelihood of employment within NHS Lanarkshire. Research and Innovation: • Collaboration with Herriot Watt University, National Centre for Robotics, focusing on robotic systems in rehabilitation within Blantyre Life Centre in South Lanarkshire. • The Falls Team is collaborating on remote delivery of the Falls Management Exercise (FaMe) program to help those who cannot attend in-person classes. • The Sir Jules Thorn Centre works on technology-enhanced rehabilitation at University Hospital Wishaw. Additional grant funding has been received which will support the expansion of this approach to Blantyre Life, a community facility in South Lanarkshire. • Establish new partnerships. New College Lanarkshire (NCL) Engagement with NCL has commenced and may include: • Guest lectures, either in person or online. • Question & Answer sessions. • Seminars. • A facilitated site visit.
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Delivery Plan 2025/26 Final 19.05.25 Page 117 of 140 • An opportunity to form part of a panel to witness student presentations. • Opportunities to attend celebration events and showcases. University of Stirling • Currently, Stirling is progressing post-graduate M.Sc. courses in Physiotherapy and Podiatry. • NHS Lanarkshire is working with the University to support the registration of the courses with professional bodies and the Health and Care Professions Council, the Allied Health Professions, a professional regulator. • NHS Lanarkshire has also agreed to offer student placements once the courses are live. City of Glasgow College • Support placement experiences for staff undertaking HNC in Occupational Therapy (OT). Ongoing actions will continue throughout 2025 -2028 Assessment The trajectory remains fluid for both 11.6.1 and 11.6.2 as the number of staff NHS Lanarkshire can recruit from the outturn of Pathways/Programmes will depend on the level of vacancies and available funding to recruit at that time. Risk Assessment Potential risks (11.6.1 and 11.6.2) may include the following: • The outturn of newly qualified staff from Allied Health Profession Programmes will be at one or two points each year. • For professions, NHS Lanarkshire may not be their first choice of employing NHS Board. • Insufficient funded establishment to recruit newly qualified staff. • Where teams already have workforce challenges including high vacancy and/or sickness levels, the service may be unable recruit the staff they required due to the capacity commitments to support new staff.
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Delivery Plan 2025/26 Final 19.05.25 Page 118 of 140 11.7 Plans to Ensure that all Relevant Staff are Face Fit Tested to an FFP3 Respirator (To support business as usual patient care and in the event of responding to an incident such as Mpox Clade1 and Measles) 11.7.1 Face Fit Tested During 2025-2026 NHS Lanarkshire will: • Seek ongoing compliance with Health & Safety Executive (HSE) guidance document INDG479 (rec1) March 2019, ‘Guidance on respiratory protective equipment (RPE) fit testing’. • Provide respiratory protective equipment (RPE) to all staff, students, volunteers, etc., who are required to use Respiratory Protective Equipment (RPE) as a control measure under Health Care Guidance including the National Infection Prevention and Control Manual (NIPCM), applicable health and safety. • Provide free fit testing clinics to all staff, students, volunteers, etc., working for NHS Lanarkshire who require fit testing for FFP3 masks. This work will continue through March 2026 Assessment • Provide accessible guidance on accessing face fit testing for all staff to access. • Provide Face Fit Testing Clinics 3 days per week, throughout every week of the year, with the option to increase capacity where demand exceeds appointments. • Advertise available clinics to staff to promote awareness and uptake of face fit testing. • Record every fit test on an NHS-wide database on LanQIP that can identify every staff member fit tested, mask type(s), and any fail on fit testing and act as a compliance record with HSE guidance document INDG479 (rec1) March 2019. • Provide access to re-testing where a staff member must be re-fit tested due to changes in facial features and/or availability of FFP3 mask supplies previously tested. • Fit test RPE to every staff member required to wear a tight-fitting FFP3 mask. • Provide alternative RPE to disposable FFP3 masks should there be no suitable disposable FFP3 mask suitable to fit test to staff. • Work with Infection Prevention Control (IPC) to ensure decontamination procedures are in place for non-disposable RPE. • Liaise with Divisional management, service and clinical leads on fit testing.
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Delivery Plan 2025/26 Final 19.05.25 Page 119 of 140 • 40% uptake of available fit testing places provided. 2026/27 Trajectory • Provide 1000 face fit testing appointments. • Aim for 300 additional staff to be fit-tested. Risk Assessment • Requirement for Procurement and NSS to continue to ensure appropriate level and range of supplies of FFP3 masks that have been fit tested to NHS Lanarkshire staff. • Retesting of affected staff where mask types are discontinued and/or unavailable from the supply chain. • Ensure fit testing meets the indicated availability of available FFP3 masks. • Ongoing liaison with Procurement and National Services Scotland (NSS), including ongoing reviews and dialogue to highlight changes in FFP3 supplies or low levels of stock holding affecting FFP3 mask selection and availability.
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Delivery Plan 2025/26 Final 19.05.25 Page 120 of 140 A core principle of NHSL’s Digital Plan 2023-2028 – Empowering people to enhance care for everyone is to maximise the benefits of technology and in line with Our Health Together, maximise the opportunities to transform services with digital as a key enabler. We will innovate and exploit the potential for digital technology to transform service delivery and measure the benefits to track progress. We will achieve this while supporting and training staff, to ensure they have the necessary skills to use the digital systems and maximum potential. We will build on existing digital tools and implement new technology to maximise value, for example virtual pathways including appointments and remote care of patients to support earlier discharge from hospital where appropriate. We will design for digital equality from the start, including Equality Impact Assessments for individual programmes and the requirement for non-digital alternatives where needed to avoid digital exclusion. We will support clinical services to expand the reach and grow the uptake of virtual consultations and remote monitoring. We will support the development of the national Digital Front Door within NHS Scotland as the lead Board for the CivTech Challenge. We will continue to support the NHSL recovery plan by providing data, information and live dashboards to help clinical services monitor and optimise the delivery of planned and unscheduled care. We will work with Mental Health to support the new Child and Adolescent Mental Health Service and Psychological Therapies National Dataset (CAPTND) and associated reporting. New digital tools to support a Health Records Transformation Programme, including a shift from analogue to digital and a reduction in in the scanning volumes across the acute sector. Digital Innovation is a key component in NHS Lanarkshire’s approach to transformation and reform. Services continue to work in partnership with the (CfSD) and Accelerated National Innovation Adoption (ANIA) pathway to aid in the development and adoption of systems and pathway that will not only improve services but enable access to treatment by the most appropriate person, without delay. Acute care clinical and managerial staff are fully engaged with the CfSD Specialty Delivery Groups, developing clinical pathways and supporting innovation through national collaboration across NHS Scotland. 12. Digital and Innovation
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Delivery Plan 2025/26 Final 19.05.25 Page 121 of 140 Most recently this has included the peri-operative workstream- scheduling and theatre optimisation. This led to the adoption of Infix (Theatre Optimisation Digital System) scheduling system which will roll out over 2025/26. In addition, through ANIA we adopted the Digital Dermatology pathway to expand and augment current systems, with planned implementation through 2025/26. Representation and collaboration are maintained through the West of Scotland innovation hub offering test bed facilities and access to clinical expertise and clinical environments. This is managed through our clinical research department which continues to develop a range of programmes. The five Digital and Innovation Planning & Transformation Priorities commonly referenced in current SG guidance can be summarized as follows: • Digital Access – Enabling patients and service users to access and manage health services digitally via a new online app, increasing convenience and reducing barriers. • Data-Driven Insights – Harnessing data and analytics for real-time intelligence, service planning, and continuous improvement. • Digital Infrastructure & Cybersecurity – Establishing secure, resilient, and interoperable systems that underpin all digital health services. • Digital Workforce & Skills – Equipping staff with the knowledge and capabilities needed to leverage digital tools effectively. • Innovation & Transformation – Adopting and scaling new technologies and approaches (e.g., virtual care, AI) to modernize and improve healthcare delivery. These five priorities guide how NHS Boards plan, develop, and implement digital initiatives that align with the national vision for a more responsive, efficient, and person-centred health service. 12.1 Adoption and Implementation of the National Digital Programmes 12.1.1 National Digital Programmes We will incorporate national digital programmes into the local digital delivery plan. This may require the development of a local business case to secure the necessary resources to ensure successful delivery. Key Programmes include: • GP IT Re-provisioning. • Child Health Systems.
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Delivery Plan 2025/26 Final 19.05.25 Page 122 of 140 • Scottish Wide Area Network 2 (SWAN2). • Picture Archive Communications System (PACS) Re-provisioning. • Digital Front Door (CivTech Challenge). • Microsoft 365. • Infix Support (Theatre Optimisation Digital System) scale up. • OpenEyes Ophthalmology Digital System. Assessment These programmes will be incorporated into our digital delivery plan. Projects will be delivered in line with the Programme Management Office (PMO) principles at all stages. Benefits realisation and lessons learned activities will be completed at the key stages. Risk Assessment There is a risk that NHSL has insufficient digital resources to deliver the local and national programmes 12.2 Cyber Resilience and Compliance with Public Sector Resilience Framework 12.2.1 Public Sector Cyber Resilience Framework We are fully committed to compliance with the Network and Information Systems regulations in accordance with the refreshed Scottish Government Public Sector Cyber Resilience Framework (PCSRF). We will ensure Network and Information Systems (NIS) and Cyber Workplan is updated to account for the refreshed Public Sector Cyber Resilience Framework (PSCRF). This will be developed via the NHSL Cyber Group and presented via initially to the Information Governance and Cyber Assurance Committee. We will collaborate with Cyber Centre of Excellence (CCoE) seeking opportunities to improve our Cyber Security posture adopting national products and standards when available. Assessment The NIS and Cyber Workplan is reviewed at every Cyber Group and Information Governance and Cyber Assurance Committee meeting. The work plans will be updated in line with the availability of the revised PCSRF.
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Delivery Plan 2025/26 Final 19.05.25 Page 123 of 140 Risk Assessment If the NIS and Cyber Workplan is not updated in line with the revised PCSRF—or lacks the necessary resources, governance, or technologies—NHSL risks compliance failures, cyber vulnerabilities, and potential harm to patient care and organisational reputation. 12.3 Executive Support and Commitment to Optimising Use of Digital & Data Technologies in the Delivery of Health Services (Ongoing commitment to developing and maintaining digital skills across the whole workforce, including promotion of Digital and Data Capabilities Framework and Digital Learning Pathways) 12.3.1 Optimising Digital & Data Technologies Maintain executive sponsorship of digital solutions in healthcare by continually developing workforce skills through the Digital and Data Capabilities Framework and Digital Learning Pathways, supported by ongoing monitoring to track progress and refine approaches. All NHSL staff have access to the national Microsoft 365 (M365) ‘Skills Hub’ which provides guidance and access to training on the M365 toolset. We continue to build the library of learning resource improve signposting and develop opportunities to support staff in getting maximum value from M365 and clinical systems. NHSL will engage with NES to maximise development and sharing of learning resources. A series of digital learning sessions will be delivered, targeted to specific roles to deliver training for specific topics including, use of data, dashboards, reporting and clinical systems. We will develop a Workforce Digital Literacy & Skills Programme. The programme will include learning and education for staff to use existing and emerging digital tools to ensure that maximum benefit is achieved. Assessment These will be developed to support the programme. Risk Assessment There is a risk that insufficient workforce engagement, or inadequate training resources will prevent staff from fully adopting and utilising digital tools and skills. This could result in
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Delivery Plan 2025/26 Final 19.05.25 Page 124 of 140 underused investments, decreased efficiency, and missed opportunities to improve patient care and operational performance. 12.4 Working Collaboratively with Other Organisations to Scale and Adopt Innovation (particular reference to the adoption of Innovation Design Authority (IDA) approved innovations as part of the Accelerated National Innovation Adoption (ANIA) pathway) 12.4.1 Innovation Adoption Theatre throughput continues to struggle to reach levels achieved pre-pandemic. To address this Peri-operative improvement continues to be priority. A range of actions delivered improvements reducing non-productive time to between 25-28%. This will continue as we play an active role in the national peri-operative improvement work streams and the developing Peri-operative strategy. In line with these ambitions, we adopted Infix to provide a data driven electronic scheduling tool. This has demonstrated considerable gains in NHS Lothian and Forth Valley increasing throughout, session utilisation and reducing underruns. To date this has been implemented in 2 pilot specialties (ENT and Urology) and impact is currently being assessed through the Peri-operative improvement programme. Assessment • Infix will measure local theatre efficiency targets including reduction of unproductive time. This will include increased specialty throughput, list utilisation and a reduction in theatre underruns by 10%. • Expectation is that 90% optimisation of routine lists will be achieved, as seen elsewhere. • Provide an improved reporting system to aid with theatre scheduling and resource allocation. • Planned roll out through 2025 / 26 of Infix to the remaining surgical specialties in NHSL through 25/26 and 26/27. Risk Assessment • There is a risk that any change to central funding of the programme would result in a funding gap and result in termination of the programme. • There is a risk of non-compliance by some staff with the agreed optimisation levels resulting in limited improvements in efficiency and productivity.
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Delivery Plan 2025/26 Final 19.05.25 Page 125 of 140 Mitigations: • Funding plan currently in place. • Full engagement with specialties and clinical staff prior to ‘go live’ and agreement of aims and ambitions. • Training programme undertaken with scheduling and clinical staff. • Ongoing support to staff post implementation. • Cross specialty learning. • Reporting and monitoring Peri-operative efficiency group and management teams. 12.4.2 Adoption of National Digital Dermatology Pathway Dermatology has a track record of collaborative working and pathway development with primary care services as described in the planned care section of this document. Central to this has been an established lesion pathway using images taken by medical Illustrations to provide patients with the most appropriated clinical pathway in relation to suspicious skin lesions. This has been successful ensuring patients receive treatment without delay. NHSL has agreed that the next phase of this project will be adoption of the national Digital Dermatology Pathway. Developed through ANIA this will provide GPs with the ability to use their own devices to refer skin conditions to Dermatology. The service can provide expert advice to patients and / or GPs, arrange for an appointment or add to a treatment pathway. Assessment We are at an early stage in this programme and are timetabled to be the final Board to go live. It is expected that it will: • Provide diagnosis and advice on clinical management without delay. • Enable patients to start off treatment pathway without delay. • Reduce the requirement for new outpatient appointments. Infrastructure is currently being established and this is expected to be implemented during Q4 2025, with the programme evaluated and implementation through 2025 / 2026. Risk Assessment Access to NHSL eHealth resource and delays to the national rollout could result in implementation being delayed into 2025 / 2026.
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Delivery Plan 2025/26 Final 19.05.25 Page 126 of 140 There is a risk that the digital pathway will not meet the standard of the current lesion pathway, leading to poor service engagement resulting in limited improvement gains. Mitigations: • Full service / clinical engagement on the national Digital Dermatology group. • Supported pathways as agreed via Specialty Delivery Group (CfSD). • Development of local clinical pathways and process. • eHealth resource identified with NHSL. • Project initiation underway. 12.4.3 Digital Weight Management Programme The Scottish Government has recently announced that, before the end of 2025/26, patients with newly diagnosed type 2 diabetes will be supported with a new national digital intensive weight management programme to put their type 2 diabetes into remission. Assessment The above programme has been developed in partnership with ANIA and confirmation of the programme scope/expectations of Boards is awaited. Risk Assessment The scope of the programme has yet to be confirmed and there is a risk that NHSL will have insufficient staff resources to support patient engagement. We currently offer structured education sessions and self-directed support options and it is unclear at this early stage how the new digital programme will align with existing services. A tailored communication strategy and education programme will be key to optimising patient participation and commitment through the course of the programme. 12.5 Alignment to Board’s Digital Strategy (How Analysis of Digital Maturity Assessment Updates Informs Planning, Priority Setting and Progress Reporting Aligned to the Board’s Digital Strategy) 12.5.1 Digital Maturity Assessment (DMA) Report The 2023 Digital Maturity Assessment (DMA) Report showcased areas of good practice which will be sustained. We will update the DMA and present it via the Digital governance
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Delivery Plan 2025/26 Final 19.05.25 Page 127 of 140 structure. Further work will be undertaken to align the local digital program to the DMA. New and emerging business cases should incorporate a section referring to DMA and highlight impact of investment in improving digital maturity. We have has also undertaken a Healthcare Information Management Systems Society (HIMSS) digital maturity assessment as part of the journey towards the New Monklands Hospital. Assessment • Review DMA at Digital Executive Group. • Present DMA through governance structure/s. Risk Assessment Risk that the Digital Maturity Assessment (DMA) model and/or findings will not be regularly updated or integrated into NHSL’s business cases and governance processes, which could undermine digital maturity efforts, result in misalignment with national targets, stall innovation, and create readiness gaps for major projects like the New Monklands Hospital. NHS Lanarkshire will also progress non-digital innovations. 12.6 Innovation – Genetic Testing We will work with ANIA and the Centre for Sustainable Delivery to rollout approved genetic testing programmes to deliver improved clinical outcomes and targeted medications for specific patient groups. This includes: • Genetic Testing Stroke Patients – ensures that patients who cannot metabolise clopidogrel are prescribed an alternative, preventing an estimated 900 strokes over a 5-year period. • Genetic Testing New-born Babies with Bacterial Infections - ensures neonates with a rare gene variant are not given an antibiotic that can cause irreversible hearing loss, preventing 31 babies (approx.) from becoming deaf over a 5-year period. Delivery Assessment Both programmes have been approved for national rollout over an 18-month implementation period. Successful trials have been concluded in NHS Tayside and NHS Manchester University Foundation Trust, respectively, and infrastructure is currently being established to
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Delivery Plan 2025/26 Final 19.05.25 Page 128 of 140 progress the programmes. Risk Assessment Board capacity to implement will be a consideration for both programmes in relation to capacity, costs, staff recruitment/training, Data Protection Impact Assessment (DPIA) approval, infrastructure and governance. Mitigations: • The Stroke genetic testing service will be a regional service implemented over an 18- month timeframe and costs will be top sliced from NHSL’s budget. • The genetic testing of new-born babies with bacterial infections service will be rolled out over an 18-month implementation period. While there is no national strategy, a Programme Delivery Board will be established with recruitment to a national Point of Care Testing (POCT) team. National Adoption Guidelines will be developed and Board education and awareness/readiness assessments undertaken.
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Delivery Plan 2025/26 Final 19.05.25 Page 129 of 140 It is our ambition to be net zero by 2040. The various targets to reach this goal, across they key areas, can be found detailed in (DL 2021) 38. In total there are 68 separate actions detailed within the DL, many with multiple sub actions. These are covered across the various sections throughout this document. Actions are split across 7 climate planning & transformation priorities. 13.1 Greenhouse Gas Emission Reduction (in Line with National Target with Focus on Building Energy Use Reduction, Transport and Travel and Medical Gases) 13.1.1 Greenhouse Gas Emission Reductions 25/26 Through 25/26 there are a series of objectives set the will realise a reduction in greenhouse gas emissions. Progression of some initiatives is funding dependent and there is currently no dedicated budget for environmental sustainability projects. Future work includes Energy • We will continue to engage with stakeholders (monthly meetings with maintenance teams and estates leads to discuss exceptions). • Ensure all sites have AMR (automatic meter readers) for gas, electricity and water. • Increase sub metering capabilities through improved BMS. • Deliver energy reduction projects as and when capital is available (£16million pipeline of projects identified). Transport & Travel • Electric Small Vehicle Transition (EV) currently outstanding: Out of Hours (OOH) x 6 – Current lease due to expire Sept & Nov 25 - Electric vehicle will be sought for replacement. • HGV Decarbonisation target 2035 –HGV vehicles, consisting of 6 -@ West of Scotland Laundry, 3 @ Procurement based at UHH. Costs for vehicles is currently significantly higher. Lease arrangement for these vehicles will be subject to a tendering process. • Greater level of detail now available for business travel. Programme of works to identify largest users, then engage with key stakeholders to understand if this can be 13. Climate
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Delivery Plan 2025/26 Final 19.05.25 Page 130 of 140 reviewed with efficiencies identified. Medical Gasses • New prescribing guidance to be released around metered dose inhalers. • Greater engagement with medical teams to understand why certain gasses are used ahead of others, this will help build the narrative around this. • Increase granularity of reporting around use at site and departmental level – then engage stakeholders further to discuss exceptions. Increase granularity of available data within the board, and help disseminate information around this. Risk Assessment Energy • Large scale capital investment is required for the transition to a net zero future. • Local electrical grid constraints. • Increase operational costs from switching to electricity as a primary heat fuel. Transport & Travel • Resourcing across the board of subject matter experts with capacity. • Access to information. Medical Gasses • Resourcing across the board of subject matter experts with capacity. • Economical cost v. environmental benefit. 13.2 Adapting to the Impacts of Climate Change (Enhancing the Resilience of Healthcare Assets and Services of NHS Boards) 13.2.1 Resilience of Healthcare Assets & Services The key actions focussed on adaption and resilience for the short, medium and long term. In 2025/26 we will: • Review and update our climate change risk assessment. • Meet with key partners to understand wider Lanarkshire plans (North Lanarkshire Council, South Lanarkshire Council, Police Scotland, Scottish Fire & Rescue). • Understand any current plans within NHSL and ensure this information is disseminated to the appropriate parties.
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Delivery Plan 2025/26 Final 19.05.25 Page 131 of 140 Over the medium term we will continue to develop our vision/strategy/policy linked to adaption and resilience in relation to climate change. (26/27). Progress is likely to be external funding dependant. Assessment Measures Limited data is currently held on adaption and resilience around; • Flood risk • Fire risk (linked to increased temperature through climate change). There are national tools which may be available. These will be reviewed and presented to colleagues internal to see how these are best suited for use within NHS Lanarkshire. Risk Assessment • Resourcing across the board of subject matter experts with capacity. • Lack of capital funding to implement any climate adaption projects. 13.3 Waste (The achievement of national waste targets, local targets for clinical waste, and engagement with local procurement, waste leads and clinicians to progress Circular Economy programme within Boards) 13.3.1 Waste Targets The waste improvement programme is embedded in the work of our Property Support Services Division. Improvement planning in the current and year is noted as follows: • Reduce domestic waste by a minimum of 15%, and greater where possible by 2025 – at March 2024 we had achieved a 13.29% reduction. • Ensure that no more than 5%, and less where possible, of all domestic waste is sent to landfill by 2025 – Achieved. • Reduce the food waste produced by 33% by 2025 – Won’t achieve. We have reduced waste by 70 tonnes but have a further 74 tonnes to achieve this target and have seen an increase in the last reporting year. Greater sign posting and communication plans have been deployed and additional waste segregation points installed where possible. • 70% of all domestic waste is recycled or composted by 2025 – Won’t achieve – 100% of domestic waste is either recycled, composted or incinerated for energy recovery; o 21% of domestic waste generated is recycled, the remaining 79% is used for
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Delivery Plan 2025/26 Final 19.05.25 Page 132 of 140 energy recovery by incineration; o 13% reduction in the amount of domestic waste Since 14/15; o 150% Increase in recycled waste since 14/15. o NHS Lanarkshire now compost all its grounds waste. Assessment We have already delivered against some national targets and will continue to review data and monitor against national targets. Risk Assessment • Resources are limited . • Lack of accurate, granular data available from supplier. 13.4 Sustainable Travel (Implementation of the sustainable travel approach for business travel, commuting and patient and visitor travel, linking to other strategy areas such as greenspace and adaptation) 13.4.1 Sustainable Travel The sustainable travel workstream have progressed a travel survey during 2024 that is being used to inform priorities. Current areas of focus include: Business Travel • Programme of works to identify largest users, then engage with key stakeholders to understand if this can be reviewed with efficiencies identified. • Develop potential EV salary sacrifice scheme. Commuting • Communications programme promoting active travel, local cycle infrastructure, showering facilities, public transport options. • Explore season ticket loan scheme. Patient & visitor travel • Communications programme around parking constraints, encouraging use of active travel or public transport where appropriate. We are in the latter stages of developing a proposal to introduce a salary sacrifice scheme for low emission vehicles in the first quarter of 25/26 for our staff.
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Delivery Plan 2025/26 Final 19.05.25 Page 133 of 140 Assessment Business Travel We will develop a programme of works to identify largest users, then engage with key stakeholders to understand if this can be reviewed with efficiencies identified. Risk Assessment Lack of control around how patients & visitors travel (i.e. mode of transport). 13.5 Environmental Management System (Use of EMS, including increasing biodiversity and improving greenspace across NHS Scotland estate) 13.5.1 Environmental Management There is a substantial and longstanding programme in place that relates to our green spaces and how these are used to best effect by our staff, patients and visitor. During the last year the Board has invested in the appointment of a Head Groundsperson who is appropriately qualified to lead on biodiversity work. Coupled with this we have been taking several of our grounds team through a development programme to develop and enhance capacity in this area and provide some job enrichment to the team. The progression of an Environmental Management System is currently highlighted on the corporate risk register that NHS Lanarkshire is non-compliant with DL 2021 38 in relation to EMS due to lack of funding and lack of resource. Increasing biodiversity • Work planned for improvements to Kirklands and Udston to increase biodiversity in key areas. • Other sites to be identified for improvement works • Publish NHSL Greenspace & Biodiversity vision. Improving greenspace • Trial areas for ‘no mow may’ and create appropriate communications. (Q1 25/26). Assessment • EMS - Not delivering, due to lack of funding and resource. • Increasing biodiversity - Increasing understanding where possible through site surveys, tree surveys etc.
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Delivery Plan 2025/26 Final 19.05.25 Page 134 of 140 • Improving greenspace - Awaiting output of national greenspace mapping. Risk Assessment • Funding and required ongoing investment • Limited resource 13.6 Improving Environmental Performance (Through improved stewardship of capital and assets and identified opportunities through the Business Continuity Planning process) 13.6.1 Environmental Performance As with other areas of sustainability, improving the performance and efficiency of our buildings has been a key area of focus and we have made some improvements in the current year funded through the SG Green Energy Grant Scheme. This scheme is currently suspended and this presents significant risk to delivery given the identified level of capital investment required to address and improve energy efficiency across the estate. There are no firm plans in place for the coming year due to capital restrictions, however £3million of solar has been added to the Business Continuity Plan (BCP) for 25/26. We have ambitions to be Net Zero from heat by 2038 as outlined in DL 2021 (38). To achieve this, it is anticipated that all heat must come from renewable sources and at present this will lead to the adoption of air, ground or water source heat pumps or direct electric heating. By installing renewable energy generation assets (such as solar PV), this will help offset the increase in operational costs from switching from natural gas to electricity as the primary fuel source. The central belt of Scotland is currently the most electrical constrained area in Scotland. This is a mix of aging national and local electrical infrastructure, and an increase in demand for electricity (EV charging, Solar PV connections, heat pumps etc.) By installing renewable generation assets, we will increase energy security as demand on the national grid continues to increase. Assessment • If funding becomes available, delivery of projects identified under the BCP application would help reduce NHS Lanarkshire’s overall carbon emissions. Risk Assessment • Lack of internal resource to manage and deliver projects.
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Delivery Plan 2025/26 Final 19.05.25 Page 135 of 140 • Increased operational costs if delivered. • Lack of available capital funding to deliver projects is the most significant risk to delivery. 13.7 Green Theatres (Reducing environmental impact through adopting the National Green Theatre Programme actions, supporting the implementation of the Quality Prescribing Guides and adoption of the sustainability in quality improvement approach) 13.7.1 National Green Theatre Programme We are waiting for the next phase of actions from National Green Theatres Programme (NGPT). This will dictate any new actions for the following years. At present, actions for delivery in 2025/26 are as follows; • Automated switch off out of hours of Heating Ventilation Conditioning (HVAC) – SOP under review. • Automated switch off out of hours of Anaesthetic Gases Scavenging Systems - SOP under review. • Installation and implementation of alternative surgical fluid collection and disposal system – SBAR awaiting approval and circulation on the economic impact of this solution. • Continue to identify opportunities to change peri-operative paracetamol from intravenous to oral. • Fully embed waste segregation. • ‘Rub, don't scrub!’- replaces traditional scrubs solutions with Alcohol Based Hand Rubs (ABHR) within surgical environments. Assessment Progress against the identified actions is monitored via our Green Theatre Delivery Group with regular reporting to the national team. Risk Assessment • Lack of engaged subject matter experts. • Lack of internal resource to manage and deliver the range of projects being identified. • Lack of capital funding to deliver projects.
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Delivery Plan 2025/26 Final 19.05.25 Page 136 of 140 The detail outlined in our Delivery Plan sets out actions that progress our ambitious reform agenda launched as part of ‘Our Health Together’. The resulting programme of positive change continues across our whole healthcare system and is aligned with Scottish Government Policy Team priorities; the recently launched Health and Social Care Reform agenda and our 5 identified strategic areas of focus. It is our intention to continue to deliver improvements as part of our reform agenda, move our services to a more sustainable position and in doing so ensure a better experience for patients and service users. The actions and trajectories within our Plan are dynamic and will continue to be developed in response to future SG requests and changes in local circumstances. 14. Conclusion
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Delivery Plan 2025/26 Final 19.05.25 Page 137 of 140 Glossary of Acronyms A ABC – Antenatal Booking Collection ABI – Alcohol Brief Interventions ACNS - Advanced Clinical Nurse Specialist ACRD – Active Clinical Referral Triage ACRT - Active Clinical Referral Triage ADP - Alcohol and Drug Partnership AHP - Allied Health Professional AMR – Automatic Meter Readers AMU – Acute Maternity Unit ANIA - Accelerated National Innovation Adoption AOIG - Area Oversight Immunisation Group ASD – Autism Spectrum Disorder ASQ - Ages and Stages Questionnaire B BBV - Blood Borne Virus C CAMHS – Child & Adult Mental Health Services CAPTND - Child and Adolescent Mental Health Service and Psychological Therapies National Dataset CFSD - Centre for Sustainable Delivery CGS - Community Glaucoma Service CHS – Child Health Surveillance CNO – Chief Nursing Officer COP – Community of Practice CTAC – Community Treatment & Care CT - Computed Tomography CTAC – Community Treatment and Care CUP – Cancer Unknown Primary CV – Cardiovascular D DCE – Detect Cancer Early DP - Delivery Plan DMA - Digital Maturity Assessment DNA – Did Not Attend DVT – Deep Vein Thrombosis E EQIA - Equality Impact Assessments EV – Electrical Vehicle F FNC+Flow Navigation Centre Plus G GDS - General Dental Services GIRFE – Getting It Right for Everyone GIRFEC – Getting It Right for Every Child GIRFEP - Getting it Right for Every Person GPIT – General Practice Information Technology H HCID - High Consequence Infectious Diseases HSCW – Health Care Support Worker H&N – Head & Neck HIMSS – Healthcare Information Mgmt Systems Society 15. Glossary of Terms
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Delivery Plan 2025/26 Final 19.05.25 Page 138 of 140 HIV - Human Immunodeficiency Virus HIV TEDI - HIV Transmission Elimination Delivery HNA – Holistic Needs Assessment HVAC – Heating Ventilation Conditioning I ICJ – Improving the Cancer Journey IHE – Institute of Health Equity IPCU - Intensive Psychiatric Care Unit INPS – In Practice Systems J K L LARC - Long-Acting Reversible Contraception LOS - Length of Stay LNU – Local Neonatal Unit LWMS - Lanarkshire Weight Management Service M Magnetic Resonance Imaging – MRI MBRRACE- Mother and Babies: Reducing Risk through Audits and Confidential Enquiries MDT - Multi-Disciplinary Teams MNATT - Management of Nicotine Addiction Assessment Tool Musculoskeletal - MSK N NCSCT - National Centre for Smoking Cessation Training NDS – Neurodevelopmental Services NECU - National Elective Co-ordination Unit NIPCM - National Infection Prevention and Control Manual NOP – New Out Patient NTC - National Treatment Centres O OMFS - Oral and Maxillofacial Surgery P PACS - Picture Archive Communications System PCIP – Primary Care Improvement Care PCSRF - Public Sector Cyber Resilience Framework PCN - Prevention and Care Network PDA – Professional Development Award PDS – Public Dental Services PCOOH – Primary Care Out of Hours PHAcT - Public Health Action Team PH PHS – Public Health Scotland PIR - Patient Initiated Review POC - Package of Care POCT – Point of Care Testing PREMS - Person Reported Experience Measure PROMS - Patient Reporting Outcomes Monitoring PT - Psychological Therapies PTL -Patient Targeted List Q QYW - Quit Your Way R RADAR - Rapid Action Drug Alerts & Responses RCDS – Rapid Cancer Diagnostic Services REACT - Rapid Emergency Assessment Care Team RWW – Reduced Working Week S SDM - Shared Decision Making SG – Scottish Government
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Delivery Plan 2025/26 Final 19.05.25 Page 139 of 140 SME – Small and Midsize Enterprise SNA - Strategic Needs Assessment SOC - Suspicion of Cancer SOP - Standard Operating Process SPOC – Single Point Of Contact SPSP – Scottish Patient Safety Programme STI - Sexual Transmitted Infections SWAN2 - Scottish Wide Area Network 2 SVIP - Scottish Vaccination and Immunisation Programme T TESS - Tertiary Eating Disorders Service THR - Total Hip Replacement TOM –Front Door Target Operating Model TTFA -Time To First Assessment TTG – Treatment Time Guarantee TTT – Time To Triage U UHVP - Universal Health Visitor Pathways V VBA - Very Brief Advice VBHC - Value Based Health & Care W WOS – West of Scotland
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Delivery Plan 2025/26 Final 19.05.25 Page 140 of 140 16. Planning Architecture