15 - 2025-09-17 IJB - LD Workforce
North Lanarkshire Council · 17 September 2025
Back to Health and Social Care Integration Joint Board — 17 September 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: 15 SUBJECT: Learning Disabilities Unit Nursing Workforce TO: Lead Officer for Report: Joanne Jenkins North HSCP Nurse Director Author(s) of Report Marie Rooney North HSCP Associate Nurse Director, Mental Health Learning Disabilities and Addictions DATE: 17 September 2025 1. PURPOSE OF REPORT Update the IJB to an increase in the funded establishment of Kylepark Learning Disability Assessment and Treatment Unit, based in Kylepark on the Kirklands site. This request is the result of concerted work to reduce reliance on supplementary staffing and in the context of a national shortage of Learning Disability Nurses and projected reliance on supplementary staff, in the absence of additional investment. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been through Senior Management Team Finance for approval. Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☒ 3. EXECUTIVE SUMMARY Kylepark, NHS Lanarkshire’s inpatient Learning Disability (LD) assessment and treatment centre, has faced critical nursing staffing challenges that compromise care quality, staff wellbeing, and financial sustainability. Despite targeted recruitment
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2 efforts, the unit has remained heavily reliant on supplementary staffing, including agency Health Care Support Workers (HCSWs), which contravenes national policy and incurs significant overspend. The current staffing model is under review. This proposal aimed to increase the funded establishment of Registered Learning Disability Nurses (RNMD) and Health Care Support Workers (HCSW), alongside initiatives to develop internal talent pipelines and improve retention. This strategic investment aims to: Enhance continuity and quality of care Reduce reliance on costly supplementary staffing Improve staff wellbeing and retention Align Kylepark Learning Disabilities in-patient unit with similar areas. There will continuous review to ensure future workforce planning 4. RECOMMENDATIONS 4.1 Note the contents of this 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 6.1 Kylepark is a 12-bedded standalone unit on the Kirklands site, providing specialist care for individuals with learning disabilities and co-morbid mental illness. One individual with complex autism requiring intensive 4:1 nursing support. Plans to support this patient have been delayed due to lack of a suitable community placement meaning ongoing supplementary staffing costs to the unit. 6.2 There are also other delays within the unit, due to deficits in Social Care provision. These can and have resulted in patients who are well enough for discharge being delayed. We are also working within Mental Health and Learning Disability services to support people with Learning Disabilities to be looked after in their own Communities, in keeping with Scottish Governments Yes ☐ No ☐ N/A ☒
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3 Coming Home Implementation report (2022). This work is being progressed by a refreshed Out- of Area Group, chaired by a Clinical Director in North HSCP. 6.3 A more detailed update on the progress of this group will be brought to a future IJB. There are currently 7 delayed discharges within the Learning Disabilities in-patient unit, which increases our supplementary staffing usage due to the level of care and complexity of interventions required. 6.4 The unit faces persistent staffing challenges due to; National shortage of Registered Learning Disability Nurses, (23.9% drop in student intake from 2015–2023) Decline in Health Care Support Workers entering LD services (20.6% reduction) High levels of patient acuity requiring intensive observation ratios (1:1 to 3:1) Delayed discharges due to lack of community based Learning Disability care. These factors have led to a cycle of supplementary staffing, poor continuity of care, and staff burnout. 6.5 Actions Taken Shift pattern adjustments to support work-life balance Recruitment campaigns targeting Registered LD Nurses and experienced HCSWs Reduced agency use where possible However, despite these efforts, staffing gaps persist due to the complexity and acuity of the patient group. Analysis, over a 5-year period, by NHS Workforce colleagues, has demonstrated a deficit of on average 15 whole time equivalents within Kylepark, for the level of complexity and acuity, when compared to other NHS Boards. Following the recent Agenda for Change pay deal NHS boards are required to offset the impact of the reduced working week which will be implemented in May 2026. This will result in net loss of hours equivalent to 2.5 whole time equivalents for the LD in-patient unit. Taking all of these points into consideration, the following actions have been taken forward. Increase funded establishment Develop succession planning: o Support HCSWs to train as Nursing Associates (Band 4). o Participate in Glasgow Caledonian University’s “Earn-as-you-learn” RNLD initiative (2 candidates identified). Improve retention:
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4 o Enhance e-rostering and skill mix. o Promote work-life balance and wellbeing. There will be ongoing monitoring and review of supplementary staffing to ensure that we have the correct workforce model going forward 6.6 Strategic Impact Reduces reliance on agency staff and associated costs Improves continuity and quality of care Supports national workforce development goals Align LD Nursing workforce in Kylepark with best practice across Scottish Boards 6.7 Further Information The Annual Health Checks for People with Learning Disabilities (Scotland) Directions 2023 provide the legal basis for these checks: Eligibility: All individuals aged 16 and over with a learning disability must be offered an annual health check, this includes those who self-identify, regardless of formal diagnosis or severity. Responsibility: Health Boards must take all reasonable steps to identify eligible individuals and ensure they are offered a physical health check. Delivery: a Registered Nurse or Medical Practitioner must carry out physical Health checks. Data Reporting: Boards are required to submit relevant data to the Scottish Ministers. The Scottish Government committed recurring funding in January 2025 and issued guidance to support health checks. Recruitment has been completed and 3 members of staff are now in post. There are currently 2000 patients currently known to Learning Disabilities specialist services. The physical Clinics will commence in early October and 240 appointments have been offered, at the time of writing 48 appointments are confirmed. 7. SUMMARY OF KEY ISSUES 1. National shortage of Learning Disability Nurses
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5 2. Ongoing complexity and acuity in the patient group: requirement for continuity of care and workforce stability. 3. Financially unsustainable reliance on supplementary staffing and contravention of Scottish Government directive, making the Board an outlier. 8.CONCLUSIONS To ensure good financial governance, and a stable and suitably skilled workforce, we have secured an increase in the funded establishment as detailed above. However, this is currently under further review due to patient complexity and interventions required to ensure safe care delivery. The additional staffing will offer improved continuity of care for patients with complex needs. It will begin to bring NHS Lanarkshire into alignment with equivalent services in other Board areas, meaning that we are no longer in breach of Scottish Government directives, in relation to the use of non-registered Agency staff. 9.IMPLICATIONS This paper is primarily an overview of nursing workforce within the in patient Learning Disability workforce for noting, and is a spend to save in the longer term. This will mean a move from excess spending on supplementary staffing, to a stabilised workforce and improve the service for the residents of NHS Lanarkshire. 9.1NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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6 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner NHS Lanarkshire Corporate Risk Register High Trudi Marshall 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings
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7 ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute)
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8 Members seeking further information about any aspect of this report, please contact the following; Marie Rooney, Associate Nurse Director marie.rooney2@lanarkshire.scot.nhs.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed