Item 3 - Minute of Meeting held on 23 March 2022
North Lanarkshire Council · 22 June 2022
Back to Health and Social Care Integration Joint Board — 22 June 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 23rd March 2022 at 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly (Chair) North Lanarkshire Council Nominated Councillor Councillor Jordan Linden North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Ross McGuffie Chief Officer, North Lanarkshire HSCP Marie Moy Section 95 Finance Officer Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative John Watson Employee Representative NLC Unison Officer in Attendance: Nick Brown Senior Manager, Community Solutions Stacey Connor Minute Secretary Morag Dendy Head of Planning, Performance & Quality Christine Jack IJB Board Secretary Trudi Marshall Nurse Director NLHSCP Lucy Munro Medical Director NL Des Murray Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communication Manager Euan Dickson Audit Scotland Neil Findlay NHS Lanarkshire Nominated Non Exec Director Maddie Halliday Chief Exec, VANL Third Sector Rep Heather Knox Chief Executive NHS Lanarkshire Councillor Jim Logue North Lanarkshire Council Nominated Councillor Councillor Sandy Watson North Lanarkshire Council Nominated Councillor
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ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of Special IJB on 16.2.22 The previous minutes were approved as an accurate reflection of the discussion. 4. Minutes of IJB 8.12.21 The previous minutes were approved as an accurate reflection of the discussion. Brain Moore drew note to item 7 within the minutes which refers to an IT pack coming to a future meeting, Christine Jack will add this to the action log for a future meeting. CJ 5. Minutes of Previous PFA 9.11.21 The previous minutes were agreed as an accurate reflection of the discussion. 6. Matters Arising/ IJB Action Log There were no matters arising. Christine Jack shared an updated action log to reflect the progression of work since the last committee. Some actions have been deferred to the PFA meeting but they will remain on the IJB action log until resolved. The following updates were noted by the committee: Item 9 PCIP– The engagement officer has been redeployed but is due to return to their post so the engagement events will be progressed then; this will be kept on the action log. Item 10 MH Continuing Care Contracted Beds- Linking in with National team and HIS to develop an engagement plan with an aim to complete over the next 3 months. Plan to bring a business case proposal to September IJBs for both North and South Lanarkshire.
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7. Finance Monitoring Report Marie Moy provided a report which provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 31 January 2022 (Health Care Services) and 4 February 2022 (Social Work and Housing Services). It was noted there is a net underspend of £7.818m on the core budgets within Health Care Services and there is a net underspend of £11.727m on the core budgets within Social Care and Housing Services. All covid 21/22 costs will be funded, uncommitted 21/22 covid funding will be transferred to a ring fenced reserve to meet 22/23 covid costs. Any proposed use of the Covid reserve to meet new expenditure next year that had not been funded this year will require the prior agreement of the Scottish Government in advance of the expenditure being incurred. At paragraph 8.1.3, the overspend on non-pay costs is mainly due to the payments in respect of the Strathcarron Hospice £0.474m. This has been addressed in the IJB Financial Plan 2022/2023. The Health Care underspend is £7.8m. 82% of this (£6.4m) is as a result of vacancies which were 7% at end of January 2022. It has improved slightly at the end of February 2022 – vacancies 5.8%. The significant overspend across the Immunisation Services which is £1.292m at 31 January 2022 has been reported throughout the year and is linked to 1st, 2nd and booster vaccines being rolled out. Costs are being recorded against the correct budget line to ensure fully reimbursed through the Covid funding received from Scottish Government. Harry Robertson queried what is the Scottish vacancy national average in comparison to the Lanarkshire vacancy level, rather than the funds going into reserves should we be looking at alternate models. Ross McGuffie advised it is a national wide issue in terms of recruitment challenges; smaller partnership areas are finding it more difficult. He could not advise the exact figure but advised it will never be a 0% position due to staff turnover. The Integration Joint Board committee noted the following recommendations: Note the contents of the report; Note the confirmation of the additional non-recurring Scottish Government funding to respond to the Covid-19 pandemic and to recover and remobilise health and social care services during 2021/2022; Endorse the principle that uncommitted 2021/2022 Covid-19 funding will be transferred to a ring-fenced reserve to address ongoing Covid- 19 costs in 2022/2023;
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Note that the projected outturn at 31 March 2022 is estimated to be an underspend of at least £23.242m (NHSL - £9.382m; NLC - £13.860m). This excludes the impact of further recruitment challenges and staff turnover associated with new Scottish Government funding; Note that, subject to IJB approval, the North Lanarkshire IJB Business Plan and the IJB Financial Plan 2022/2023 will each be dependent on the 2021/2022 underspend to manage on a non-recurring basis the double-running costs associated with the transformational change programme for a fixed term period and also the balance of unfunded cost pressures in 2022/2023; and Note that the IJB Financial Plan 2022/2023 is the subject of a separate report to the IJB on 23 March 2022. 8. IJB Financial Plan 2022/23 Marie Moy tabled a report which provides an update on the implications of the 2022/2023 grant settlement fop each partner and outlines the IJB Financial Plan for 2022/2023 including details of the budget pressures facing each partner, the key financial assumptions and key risks. It outlines the indicative 2022/2023 contributions from each partner and the proposed approach to address the funding gap. As highlighted at paragraph 6.4, costs are expected to increase by £56.9m. Additional funding totalling £51.396m is being received in 2021/2022. The funding gap is £5.505m. (NHSL - £2.241m; NLC - £3.264m). This will be addressed by: NLC Budget realignments (£3.264m) NHSL Prescribing efficiency savings (£0.387m) A projected recurring underspends across prescribing (£1.493m) Reliance on reserves (£0.361m). A balanced budget for 2022/2023 is therefore deliverable. The increase in cost does not include the Covid costs expected in 2022/2023. At paragraph 7.10, you will see I refer to the additional Scottish Government Covid funding of £32.102m which we are receiving in 2021/2022. Of this, we project £1.238m is required to meet the balance of the 2021/2022 costs. The remainder of the funding totalling £30.864m will be transferred to a ring-fenced reserve to meet 2022/2023 Covid costs. The recurring cost for the Strathcarron Hospice of £0.474m is accounted for. The IJB Financial Plan 2022/2023 highlights the reliance on reserves however it does not set out the complete IJB Reserves Strategy for 2022/2023. This is being prepared and will be finalised on completion of the financial year-end. Reserves are currently being updated by both partners
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and this will be reported in June 2022 and will include exit strategies as appropriate. Marie Moy acknowledged the cost pressures each partner requires to address across other services not delegated to the IJB. Notwithstanding this, both partners are continuing to support the IJB and will pass on all Scottish Government funding received for the services delegated to the IJB. The additional funding will therefore be additional and not substitutional for the services that are delegated to the IJB. Ally Boyle queried about the updated smoke alarm standard for Scotland, has this been included in the financial plan. Marie Moy advised there is not a specific budget for this project as would need to clarify who is responsible for this. Although there is funding available that could be directed to support this. Ross McGuffie advised an update for the digital work will be brought to a future committee which includes this. Brain Moore queried is the demographic growth realistic going forward if we do not utilise covid costs. There are amounts of funding to give some coverage but it is difficult to project demand in future. For covid funding we are holding the funding but need to follow Scottish government guidance when it is issued. The Integration Joint Board committee noted the following recommendations: Note the contents of the report and the cost pressures identified by North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) as set out at section 9; Note the contributions from NHSL and NLC to the IJB for the financial year 2022/2023 as detailed at section 10; Note the funding gap of 5.505mm (NLC - £3.264m; NHSL - £2.241m); Approve the financial strategy to address the funding gap of £5.505m as detailed at section 13; Approve the 2022/2023 notional set-aside budget offer as detailed at section 11; Endorse the budget transfer of £2.024m to the NLC partner in line with the third and final year of the previously agreed corporate savings programme recognising that the IJB will manage the 2022/2023 cost pressures in respect of the Adult Social Care and Housing Services; Approve the overall IJB Financial Plan for 2022/2023 as summarised at section 12; Accept the offer of the financial contributions from NLC and NHSL to the Integrated Joint Board (IJB) for the financial year 2022/2023 as set out at section 10; Note the significant financial risks as detailed at section 14 in particular the risk associated with the ongoing emergency response required to address the Covid-19 pandemic and the RMcG
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uncertainty in respect of the financial implications of the necessary actions being implemented by both partners in 2022/2023; Note that both partners will continue to monitor the financial position and regular reports will be provided by both partners to the IJB as appropriate; Note the requirement to update the IJB Medium to Long Term Financial Plan; Note the requirement to vary the directions to each partner in respect of the financial year 2022/2023 which is the subject of a separate report to the IJB; Note that a mid-year review of the 2022/2023 IJB Financial Plan will be undertaken by October 2022, in consultation with both partners, to test the original assumptions, projections and information for ongoing validity with a view to reprioritising where appropriate. Note the commitment on conclusion of the financial year 2021/2022 and pending IJB approval, to establish ring-fenced and earmarked reserves as appropriate to address projected cost commitments and to mitigate financial risks in 2022/2023; Note the ongoing review of the IJB Reserves Strategy in consultation with both partners; Approve the proposal to continue to adopt for 2022/2023 the current approach for the management of underspends or overspends by the lead partner for the Hosted Service; Note the option to jointly consider a pan-Lanarkshire approach to the establishment of reserves in respect of Hosted Services underspends on confirmation of the year-end outturns for each IJB; Note the ongoing implementation of the transformational change programme as set out in the North Lanarkshire Winter Planning and Enhanced Support Business Plan, and the commitment to ensure the actual costs of services delivered can be contained within the financial envelope available; Approve the delegation of authority to the IJB Chief Officer to finalise the 2022/2023 funding allocations as part of the budget process, in consultation with the NHSL Director of Finance and the NLC Head of Financial Solutions. This will ensure the funding received by each partner is aligned to the actual costs incurred either by the same partner or by the other partner as appropriate. 9. Covid Update Ross McGuffie provided the committee with an update on the current Covid situation for Lanarkshire to date. There are 299 in patients and 54 in off-site beds and 1 patient in level 3 ITU. There are 46 care homes with outbreaks and a further 12 care homes under going investigations. There have been very few admissions to hospital and deaths from care homes showing the vaccination programme is working.
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The figures for delayed discharges has increased with a number of patients awaiting care packages –there are 81 delays and 38 of these patients are awaiting a care home admission which is delayed due to the out breaks. The vaccination programme continues at pace for 5-11year olds roll out and the spring booster campaign has started in line with the national programme. The committee noted the report along with their thanks to all involved in supporting the response to the pandemic. 10. Chryston Business Case Ross McGuffie spoke to a paper which provide an update to the committee on the development of the Chryston community health clinic. From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. North Lanarkshire Council’s ‘The Plan for North Lanarkshire’ sets out an ambitious estates strategy that looks to develop Community Hubs / Campuses. Further to consideration of this approach, NHS Lanarkshire working in partnership with North Lanarkshire Council, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. Since 14th May 2020 all parties have been involved with site identification, stakeholder engagement and design development of the new facility. In keeping with North Lanarkshire Council’s hub programme guiding principles, there will be two discreet facilities under one roof with the benefits of shared arrangements for car parking, amenities including waste yards, a suite of bookable rooms, staff accommodation that includes touchdown space for community based staff and outdoor space that can be enjoyed by the local community. The site identified was that of Lanrig Park, located in the Chryston area of North Lanarkshire. The Chryston area provides an ideal location for the facility, as it is central and provides the best public transport links to all areas of the Northern corridor. To support the smooth transition, clinical safety and continuity of care there will be an expectation of double running costs for a period of 3 months (£522k). This would equate to an increased cost of £212k for that quarter. In conclusion, this paper confirms that Chryston Community Health Centre has been commissioned by NHS Lanarkshire in partnership with North Lanarkshire Council and will become operationally available for service delivery in August 2023.
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IJB members are asked to support the additional recurring costs of £392k, plus one off double running costs of £212k to support service transfer. The IJB approved the following recommendation: 1) Note the active involvement with the delivery of this capital programme. 2) Note that H&SCNL is progressing with the repatriation of the clinical services from NHS Greater Glasgow & Clyde 3) Approve that the recurring financial gap be built into the future revenue plan for the IJB. 11. Risk Register Christine Jack spoke to a report which provides a summary to the Integration Joint Board on risk management activity and IJB risk register, noting any amendments or additions to the current risk register. There are currently two risks rated as Very High on the IJB risk register. ▪ IJB 08/21 – Financial Implications of Responding to Covid ▪ IJB 09/21 – Impact on the Strategic Plan due to Covid These risks have each been reviewed having regard to the overall financial position and the additional confirmed Covid funding. The risks remain as Very High due to the non-recurring status of the additional funding, the uncertainty in respect of the ongoing Covid-19 pandemic and the ongoing discussions with each partner about the allocation of the available funding to cost pressures. Section 5.5 outlines risks held by NLC and NHS. Particular attention was drawn to risk 2.115 which highlights the risk to the CAMHS service delivering clinical services due to vacancies within the service. The committee is asked to consider when reviewing item 17 if this risk should be added to the IJ register as well as the corporate risk register. This was noted. The IJB noted the following recommendations: The IJB is asked to note the contents of the report which includes; the latest version of the IJB risk register (Appendix 1) and a note of risks from partner agencies that impact upon delivery of IJB business. The IJB is asked to approve the updates and additions to the IJB Risk register as set out in Record of Change (Appendix 2) and noting that the Performance, Finance & Audit Committee (PF&A) reviewed the finance and performance risks contained within the IJB Risk Register at its last meeting in November 2021. The IJB is asked to support further planned developments in 2022 around risk management of IJB business as outlined in section 5.8 of this report.
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12. Ethical Commissioning Morag advised our approach in North Lanarkshire is clearly aligned to the recommendations around ethical commissioning as set out in the Independent Review of Adult Social Care. By reviewing our approach to commissioning services and exploring ways we can award contracts for Health and Social Care without the need for competition where justification exists, demonstrates our commitments to these principles. The majority of the commissioning work sits with NLC but a further report to health approaches can be brought to a future committee if required. Under section 5.3 the Review highlights the importance of personalisation, collaborative commissioning, service design and market sustainability across the sector. The approach has been to maintain a person-centred focus at the core and ensure high quality provision is available across North Lanarkshire. Quality of service delivery that focuses on outcomes for people and not price; fair work practices that demonstrate a valued workforce and consideration of community benefits that support the local economy are key factors in how we procure services. The Market facilitation plan included within the paper supports the work. Ally Boyle asked do we have capacity to ensure contractors are delivering on their promises and also to look at what the collective different of what contractors are delivering is. Also how do we present the difference made overall. Morag Dendy advised the market facilitation plan demonstrates the robustness and tangible ways for individuals and communities. Also working with the independent sector on how to demonstrate best value. The IJB noted the following recommendations: Seeking endorsement of our approach from IJB Seeking promotion of the approach by raising awareness of the position in North Lanarkshire across National networks 13. Model Code of Conduct The purpose of this report is to note the requirement for the Integration Joint Board (IJB) to revise its Code of Conduct in keeping with the new model Code of Conduct and submit the revised Code of Conduct to Scottish Ministers for approval. A revised version has been shared which is applicable to the committee if this approved today it will be submitted to the Scottish Government and the document will be shared with the committee for reference. There were no questions raised by the committee. The IJB noted the following recommendations: The IJB Committee is asked to note the contents of the report which sets out the requirement of the North Lanarkshire IJB to revise its Code of Conduct.
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The IJB is asked to approve its revised Code of Conduct for onward submission to Scottish Ministers for approval. 14. Chief Social Work Officer Report Alison Gordon advised the report shared is the annual report for 21/22 so it contains retrospective content within the report in relation to Adult social work. It has gone through the committee structures within the council and been approved. It provides a summary of the framework for the delivery of social work services, performance and the development activity that has been undertaken. It follows a set format on how we have adapted changes due to the changes in demands throughout the pandemic. In terms of governance it updates on how services are delivered within communities with the strengthening of services through community boards and our own structures. John Watson noted there is great difficulty in filling posts on a permanent basis, what plans are being put in place to address this in particular as we start to recover from the pandemic. Alison Gordon advised there is development of comprehensive strategic plans for the broader council planning inclusive of social care. The committee will have seen some of the work outlined within the business case. In terms of Social workers, looking at working environments and staff conditions to support staff to undertake a rewarding job as well as address contractual issues. There is a strong senior practitioner scheme to support and reward staff who achieve additional qualifications. Some of the developments have been supported by recurrent funding in adult services but this is not the case in children’s services, so work is being undertaking to support this. There are short term funding challenges within the justice services also. John Watson advised unison have been involved with Scottish Government in regard to the promises made. He asked is there any focus on the trauma experienced by frontline to enable managers to have more training. Alison Gordon advised there are trauma champions within the partnership. Brian Moore asked for an update on Mental Health Officers in particular how close we are in having the number of staff required in post. He also noted in relation to substance reviews what can be done to improve service delivery to support this. Alison Gordon advised have focused on trying to build MHO capacity through sessional contracts and the creation of trainee post, which in turn will support substance reviews. Ally Boyle how do we target toward more deprived communities with the most limited opportunities. Alison Gordon noted there are huge opportunities for communities and their carers, they can have in health and social care particularly linked to the care academy.
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The committee agreed the recommendations made. 15. Letters of Direction A report was shared which seeks the approval of the IJB for the issue of the directions to each partner for 2022/2023in line with the IJB Financial Plan 2022/2023. In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board is required to issue a direction to Lanarkshire NHS Health Board and North Lanarkshire Council in respect of the delivery of integrated functions and how resources are to be allocated for the resultant services. Within annex 4 of each letter the financial information is included to back up the direction in totality, so able to set out within detail of the financial envelope in which we operate. The IJB agreed the following recommendations: (1) Approve the issue of the directions to North Lanarkshire Council for the financial year 2022/2023 attached at appendix 1; and (2) Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2022/2023 attached at appendix 2. 16. Strategic Commissioning Plan Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives in 2016. Strategic Commissioning Plans (SCP) have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020 – 23. The 2023 – 2026 SCP will be the final plan within the ten- year strategy. The SCP is crucial to achieving the strategic ambitions for people in North Lanarkshire. There is wide engagement designed to really share, listen and act is needed in the complex whole system approach. Activities throughout 2022 will be undertaken in a co-ordinated and co-operative way, aspiring to be increasingly co-productive in the future. Appendix 1 within the report illustrates the development of the plan and outlines timelines. It is anticipated that the draft plan will come to the committee by December with final comments and submission to be approved in March 2023. Priorities of the plan will be influenced by what is currently going on. Ally Boyle questioned how do we ensure participants are not confused if asked similar questions at different times for different projects. Also how does consultation work with hosted services. Morag Dendy advised involve partners from the wider NHSL planning teams and colleagues in South to
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ensure engaging effectively to ensure it is done once rather than asking a number of similar questions at different occasions. The IJB agreed the following recommendations: 1. Seeking endorsement of our approach from IJB 2. Seeking promotion of the approach to encourage wide participation in the development of the 2023 – 2026 Strategic Commissioning Plan. 17. Mental Health & Wellbeing Strategy –Progress Update on CAMGS & Psychological Therapies The purpose of this report is to provide an update on progress with the implementation of the Mental Health & Wellbeing Strategy with a particular focus on; o Adult Psychological Services o Children & Adult Mental Health Services o Neuro Developmental services for Children (NDS) Ross McGuffie advised there are new national service specifications that need to be met by the services and the paper sets out the progress against these. The demand for Mental Health services has stayed static but have seen an increase in urgent demand particularity in psychological therapies. The RTT performance is positive which is different from reality. Seeing significant number of urgent cases which are seen within 48 hours which will artificially affect the figure. The wait times for the service remains high. As of March 2023 the waiting time target will be 100% which has never been met by Health Boards previously. Seen more demands than expected but starting to see recovery also. The lower tier interventions will be vital in terms of recovery, will use the capa model for CAMHS meaning any new referrals will be seen be a senior decision maker initially to allow them to be redirected quicker to appropriate services. Brian Moore asked is this new funding recurring for both CAMHS and psychological therapies. Ross McGuffie advised at present it is not recurrent but there has been letters from the Scottish Government that advise they are fully expecting it to become recurrent and they have advised to recruit to posts on a permanent basis. The IJB agreed the following recommendations: The IJB is asked to note the direction of travel in relation to the modernisation programme for CAMHS and implementation of national specification for NDS. The IJB is asked to note progress in recovery of waiting times for adult psychological therapies and plans in place to achieve performance objectives subject to successful recruitment.
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18. National Care Service-Progress Update The purpose of this report is provide IJB members with an overview of the Scottish Government’s published analysis of the responses to its consultation on A National Care Service for Scotland published on 10 February 2022; and raise awareness of the significance and scale of the proposals ahead of legislation being brought forward. It is likely will not receive any further information on the scope of the service until after the elections The primary legislation will be at a high level and the plan is to create secondary legislations to support this at a later date which is part of learning from the current model and will allow more flexibility. Des Murray noted the Scottish Government were going to announce this earlier but there is a debate around children services; if they should be within scope going forward. The deputy 1st Minister will be launching the implementation plan around the promise which will link to the National Care Service. Brian Moore noted little reference to linkages between partnerships and the acute sector. The IJB agreed the following recommendations: The IJB Committee is asked to note the contents of the report which sets out the requirement of the North Lanarkshire IJB to revise its Code of Conduct. The IJB is asked to approve its revised Code of Conduct for onward submission to Scottish Ministers for approval. 19. Community Solutions Strategy & Investment Plan 2022-25 The purpose of this report is to: present the Community Solutions Strategy and Investment Plan 2022-25 for review and approval. The plan is presented earlier than required but this has been brought forward due to the pandemic. The report looks at what has been delivered already summary on page 8 on the range of investment managed through the funds value of £.4.5m which is a combination of recurrent and non-recurrent sources. Have attracted significant match funding. Community Solutions is a successful, HSCNL cross-sector health and social care investment and improvement programme for North Lanarkshire, established in 2012, which is improving people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources - with a focus on prevention and early intervention.
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The new Community Solutions Strategy and Investment Plan provides the basis for strengthening and expanding the reach and the impact of the programme over the next three years, building on previous progress. Ally Boyle queried in section 5 under priority groups it states people effected by cancer effecting wider family network but next part refers to only the individual should there be a difference. Morgan Dendy and Nick Brown both advised it should be inclusive so may just require some final tweaks to the wording within the report. The IJB approved the Community Solutions Strategy and Investment Plan 2022-25. 20. Risk The chair proposed to the committee to add CAMHS recruitment to the IJB risk register in relation to today’s discussion and considering the risk already on the corporate register. The committee agreed this action, Christine Jack will update. CJ 21. Date of Next Meeting 22nd June 2022 @ 2pm