10 - 2025-06-18 IJB - NHSL Winter Planning 2024-25 Debrief
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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1 REPORT Item No: 10 SUBJECT: NHSL Winter Planning 2024/25 Debrief TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Craig Cunningham, Head of Commissioning and Performance (South Lanarkshire University Health & Social Care Partnership) Kirsty Orr, Head of Planning and Development Date: 18 June 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: Reviewed by: Senior Manager, Strategy & Performance ☒ Endorsed By: ☐
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2 3. EXECUTIVE SUMMARY The report provides a debrief of the planning arrangements put in place to ensure Health and Social Care Services were prepared as reasonably as they could have been for managing the pressures associated with winter during 2024/25. Thereafter, it also provides detail as to how the additional services/initiatives introduced assisted in managing the respective pressure points and offers key learning points for inclusion in the plan for 2025/26. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.11 The winter plan for 2024/25 was shared widely across the key partners and submitted to Scottish Government by the due timescale. 6.12 Planning for Winter 2024/25 commenced in August 2024 and, as in previous years, was undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service(SAS) and NHS 24. 6.1.3 The Winter Plan was developed as a dynamic plan and one that was able to cope with change depending on the issues that emerged during the period. This had also been recognised from a Local Resilience Planning (LRP) perspective and a specific multi-agency planning exercise hosted by North Lanarkshire took Yes ☐ No ☐ N/A ☒
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3 place in Cumbernauld on 14 November 2024 to test system-wide planning. In this particular winter period, there was also the highly unusual red weather warning associated with Storm Eowyn in late January. The winter breach planning event stood the Lanarkshire LRP – including NHSL, in very good stead in that particular scenario. Additionally, the plan recognised the increasingly likely eventuality of a number of concurrent risks which may well align to create increased system pressure. This was demonstrated this year with the increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact and associated pressure on inpatient beds and demand on general practice. This is described in more detail in Appendix 1 - 6.14 National Guidance / Scottish Government Correspondence National guidance was published on 24 September 2024 which set out the national expectations for those areas that local winter plans would be expected to address. The four winter planning priorities outlined follow a journey through the health and social care system. • Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care. • Priority Two: Ensure people receive the right care, in the right place at the right time, this includes prioritising care at home, or as close to home as possible, where clinically appropriate. • Priority Three: Maximise capacity and capability to meet demand and maintain integrated health, social care and social work services, protecting planned and established care, to reduce long waits and unmet need. • Priority Four: Focus on supporting the wellbeing of our health and social care workforce, their capacity and improving retention, as well as valuing and supporting Scotland’s unpaid carers. Thereafter there was a request that a winter preparedness self-assessment be prepared which was also undertaken by the multi-agency group and duly submitted to Scottish Government. 6.1.5 Approach to Winter Planning 2024/25 Whilst the winter plan is a Lanarkshire wide plan, it was structured in two main parts. This recognised the significant work undertaken as part of Operation Flow to maximise flow through acute hospitals and associated care pathways.
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4 All other aspects of the Lanarkshire-wide winter plan – including the input of the Flow Navigation Centre Plus (FNC+) - were undertaken via the multi- sectorial/multi-agency winter planning group. Representation from acute services/Operation Flow/FNC+ forms part of the wider group to ensure all necessary synergies were recognised and planning integrated. The debrief of the Lanarkshire winter plan for 2023/24 also formed part of the planning for winter 2024/25. 6.1.6 Operation Flow: NHS Lanarkshire’s Whole System Unscheduled Improvement Plan supporting Winter Planning A separate debrief of this aspect of the plan covering the peak holiday period between the last week in December and first few weeks in January was previously shared with the NHS Board. This is attached as Appendix 1 to this paper - NHSL Board Winter Festive Period Review. 6.17 Discharge Without Delay Both North and South Lanarkshire HSCPs invested in additional support over the peak winter period to assist in maximising flow and providing additional access to care. Additionally, since the peak winter period up to the end of January, there has been a significant reduction in the number of delayed discharges up to the current time when the numbers are below (good) the national target. The introduction of the Home Assessment Teams across both North and South Lanarkshire has also seen an increase in the number of people who are being supported to be rehabilitated at home. This is often to a level of being able to manage their own care independently or, in some instances, with a reduced level of care than that which was assessed when originally in the hospital or first referred. Both HSCPs also worked closely with ‘Lanarkshire Carers’ as well as a range of voluntary organisations such that increased levels of support were available to carers to support them to be able to continue to undertake their caring roles. 6.1.8 Flow Navigation + Plus (FNC+)
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5 The introduction and expansion of the FNC also played a major role as part of the wider system response to managing winter pressures in 2024/25. Further detail of this is also provided in Appendix 1. 6.1.9 Social Care Provider Sustainability Despite the fragility in the market place, availability of packages was not unduly impacted across the winter period with the majority of providers continuing to be able to support care as required. 6.1.10 General Practice and pharmacy opening As in previous years, a local enhanced service to support general practices over the peak winter saw up to 68% of the GP practices in Lanarkshire opening at some stage over the Public Holidays on 26 December 2024 and 2 January 2025 as well as Saturday 28 December 2024 and thereafter on all the Saturdays during January 2025. The practices involved were supported in communicating this to their respective patient lists albeit some feedback suggested that there were still some patients who contacted NHS 24. In these instances, the patient was able to be redirected back to their own GP to be managed accordingly. Similarly, the respective details of which practices were open was also shared with NHS 24, the Primary Care Out of Hours Service (PCOOH) and FNC+ such that as many people as possible were able to be redirected to their own GP practice. During the two Public Holidays and Saturdays involved 3,219 patients were managed by their own GP who may otherwise have attended OOH or A&E. There was also an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, PCOOH Service, FNC+ and Emergency Departments where possible. 6.1.11 General Practice sustainability As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. Weekly reports were provided to Scottish Government on system pressures throughout the winter period and any GP practices that were unable to provide the full range of services that they would normally do were contacted by the
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6 Primary Care manager to ensure all possible support was provided to ensure sustainability issues could be managed. 6.1.12 Primary Care Out of Hours Service (PCOOH) The new clinical model operating in the Lanarkshire PCOOH service assisted the ‘Service to move to a more multi-disciplinary workforce and competency- based model of care, thereby reducing the number of occasions when alternative arrangements require to be introduced. This multi-disciplinary team was enhanced over the winter period to manage the increased demand with safety netting maintained at a very minimal level. Indeed, as described in Appendix 1, there was more scope this year to signpost people away from A&E to OOH services, either via FNC or to redirect from A&E. 6.1.13 Contingency Arrangements for Additional Deaths Whilst contingency arrangements were in place to support additional mortuary capacity, these were not required over the winter period. 6.1.14 Flu and Covid 19 Vaccine Programme Following final advice on the winter flu and Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), vaccines were offered to all the eligible groups. • Overall, it was considered that national coordination and communication functions were largely positive and local communication was based on and around the nationally agreed comms and timing of same. • Board experience of vaccine supply and control, scheduling and appointing, communication and engagement, data and reporting, clinical direction were all positive, with extended use of pop-up clinics to facilitate better access for certain cohorts. For example, the vaccination service selected areas of convenience for large population groups, reviewed SIMD, and identified areas where people would need to travel furthest for vaccines. This allowed for a greater spread of pop up clinics than in previous years. • Community pharmacy appointments were also offered for individuals aged over 80 years. This provided more local appointments and a new/additional delivery mechanism for citizens. An evaluation of this delivery mechanism is underway and feedback will be shared in due course.
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7 • Despite this, as highlighted in Appendix 2, there was a reduction in vaccination uptake in comparison to last winter and ironically, the greatest drop was in the more affluent SIMD groupings. • There was a continued reduction in the number of staff vaccinated and this will be the subject of a standalone report that will be presented with a view to increasing the uptake rate of influenza vaccine for staff in particular next year. 6.1.15 Carers Support Funding from the Carers (Scotland) Act 2016 allocation 2024/2025 was used to enhance operational services for carers across both Partnerships. This included monies from this funding being directed to support ongoing work with carers, with a particular emphasis on the Self-Directed Support (SDS) agenda; and a strengthened internal capacity within the HSCPs to enable frontline staff in managing increasing demand with regards to supporting carers. This has seen a sharp increase in the number of carers being identified and therefore able to be signposted to the respective supports. 6.1.16 Staff Wellbeing There was consistent messaging throughout the winter period with a view to ensuring that staff health and wellbeing was embedded and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to manage the dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. Council employees were also able to access a range of materials to support health and wellbeing through the respective employee programmes. 6.2 Assessment 6.2.1 Quality/ Patient Care Assessment The data available to support system monitoring and, where appropriate, opportunities for improvement was utilised daily in overseeing system pressures and where to prioritise input to support improved patient flow. This
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8 data also provided early warning of potential difficulties in relation to system flow at all levels across the Board and both Partnerships. The Public Health Scotland/NSS real time dashboards for winter planning and social work services was also available to assess performance and any emerging issues. As part of the review of services provided to support the winter plan in a primary and community care context, some high level evaluation was undertaken of the impact of each. It is suggested that a greater level of evaluation be undertaken across the range of acute and primary care services to seek to identify those with greatest impact in the vent that funding in future years is less than has been available previously. 6.2.2 Workforce Assessment Despite the previously highlighted impact of workforce challenges for health and social care – both in Lanarkshire and across Scotland – these did not have the adverse impact that may have been feared. Rather the additional staff employed over the winter period assisted in offsetting these supply-side challenges as much – if not more than – providing additional capacity beyond that normally available. All of it did however assist in supporting the system to continue to operate ‘normally’ when the level of staff leave would otherwise have been more detrimental to overall flow. 6.2.3 Learning Points for Winter 2025/26 A range of learning points were discussed specifically as part of the winter debrief and these are listed below. a) Vaccinations • More tailored awareness-raising highlighting benefits to at risk cohorts. • Sharing of evidence-based evidence on the harm of Flu of at-risk groups with the relevant clinical/medical carers to empower them to more effectively encourage their patients to come forward for vaccination. b) Staff Vaccinations This will be the subject of a separate report outlining the approach to increase uptake in 2025/26. c) Allocation of Leave Whilst recognising the desire for large groups of the workforce to look to take time off over the peak winter period, i.e. last week in December and first two weeks in January, there continues to be significant loss of productivity/flow over this period given the scarcity of staff and the
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9 compounding impact of the public holidays/associated weekends. Managers should be asked to ensure that all departments have sufficient staff available to be able to provide as ‘normal’ as service as possible. d) Operation Flow Learning and reflections from the winter period are contained in Appendix 1. Notwithstanding this, there will be continued updates on Operation Flow and respective actions shared with the CMT across the course of the year and this will guide the key contribution to the acute services winter plan for 2025/26. e) FNC + Plus/OOH Continue to expand number of pathways and associated virtual beds in keeping with LDP. This would also entail development of pathways across OOH and other community services to maximise full system flow. f) Discharge Without Delay Continue to maximise ‘back door Target Operating Model and enhance utilisation of Home Assessment Teams North and South such that patient flow is maximised at the same time as seeking to ensure optimum independence for patients. g) Lanarkshire LRP Continue effective joint working with the Lanarkshire LRP and associated bespoke BCP training sessions aimed at ensuring key agencies aware of respective roles in managing the type of issue that may arise in responding to wider winter pressures. h) Impact Assessment Seek to measure impact of the respective services/additional inputs which were introduced to mitigate the winter pressures with a view to understanding which to continue to invest in should there be a reduced level of funding in future years. 6.2.4 Route to the Meeting The debrief was discussed and contributed to at the winter planning debrief meeting held on 6 March 2025. Like the meetings for winter planning, the session was attended by representatives of NHS Lanarkshire, both HSCPs and Councils, SAS and wider partners. 6.2.5 Future Planning Arrangements
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10 For many years, the annual winter plan has been led by the Head of Commissioning and Performance in South Lanarkshire University HSCP. Given that this post holder is about to retire, the opportunity has been taken to consider future arrangements and, in this respect, the overall winter plan will be led by the NHS Planning Directorate in future years. 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A A number of funding sources were utilised to cover the cost of the additional services introduced to provide the various mitigating actions described above. In total, around £4.0m was utilised in funding all the additional services.
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11 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Medium The risk rating for winter planning was increased to very high and operated at that level through December and January. It was thereafter lowered as the impact reduced in February and March and continues to sit as ‘medium’. 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership
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12 There was an expansive series of communications at both national and local level to assist in ensuring people knew where to most appropriately access services. Additionally, a similar campaign also sought to increase the level of uptake of Covid and Flu vaccinations for both the public and staff. Communication staff from both Councils were also actively engaged in the advertising campaigns to maximise care staffing recruitment. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A An Equality and Diversity plan was previously undertaken to seek to identify areas of additional need in planning for the public vaccination campaign. In turn, there are results that show uptake rates to SIMD groups 1 and 2 (poorest) in Lanarkshire exceeded those at a national level. Detail is as attached at Appendix 2. EQIA added to website: Yes No N/A 8. APPENDICES The following appendices are included with this paper: Appendix 1 – NHSL Board Winter Festive Period Review Appendix 2 – Uptake rates across SIMD groups and Ethnic Minorities.
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13 CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following;