Combined Meeting Papers Pack
North Lanarkshire Council · 21 September 2022
Back to Health and Social Care Integration Joint Board — 21 September 2022 and its agenda
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A meeting of the IJB will be held on Wednesday 21st September 2022 at 2pm – 4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: AGENDA No Item Action Attachment Reporting Indicative Timings 1. Welcome and Apologies 2pm 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes of the Meeting of the IJB held on 22.6.22 For Approval Attachment Chair 4. IJB Action Log For Approval Attachment Ross McGuffie PERFORMANCE & AUDIT 5. Finance Report For Noting Attachment Amanda Kilburn 6. Internal Audit Review – Due Diligence Review For Noting Attachment Tony Gaskin Ken Adamson 7. Covid Update For Noting Attachment Ross McGuffie 8. Primary Care Out of Hours GP service For Endorsement Attachment Soumen Sengupta Lesely Thomson 9. Child & Adolescent Mental Health Services Attachment Lucy Munro 10. Alcohol & Addiction Services For Approval Attachment Morag Dendy GOVERNANCE 11. Risk Register For Approval Attachment Ross McGuffie 12. Participation & Engagement For Approval Attachment Morag Dendy STRATEGIC PLANNING 13. Strategic Commissioning Plan For Noting Attachment Morag Dendy
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2 14. National Care Service – Progress Update For Noting Attachment Ross McGuffie FOR INFORMATION 15. Tackling Poverty For Noting Attachment Morag Dendy 16. Financial Inclsuion Team Activity For Noting Attachment Morag Dendy 17. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls 18. Date of Next Meeting 7th December 2022 @2pm For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 22nd June 2022 at 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Tracy Carragher (Chair) North Lanarkshire Nominated Councillor Neil Findlay NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Kirsten Larson 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 (Left at 3pm) Head of Children & Families & Justice Services CSWO of NLC Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative Officer in Attendance: Stacey Connor Minute Secretary Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddie Halliday Chief Exec, VANL Third Sector Rep Nicola Lynch (Item 5) Business Finance Manager Christine Jack IJB Board Secretary Trudi Marshall Nurse Director NLHSCP Gillian McCreadie Audit Scotland Marie McFadden Audit Scotland Lucy Munro Medical Director NL Des Murray (Left at 3pm) Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communication Manager
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2 Euan Dickson Audit Scotland Heather Knox Chief Executive NHS Lanarkshire Marie Moy Section 95 Finance Officer James Muir NHS Lanarkshire Nominated Non Exec Director John Watson Employee Representative NLC Unison ACTION 1. Welcome and Apologies Christine Jack welcomed everyone to the meeting and introductions were made; apologies were as noted above. She then passed the meeting over to the new Board Chair, Councillor Tracy Carragher. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB 23.3.22 The previous minutes were approved as an accurate reflection of the discussion. 4. 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 5- Category 1 Responder- Awaiting Scottish Government guidance, through West of Scotland RRP have agreed an audit of the local resilience partnerships (LRPs) who will do a review of IJBs against all 7 asks within the Act which needs to be completed by August. An update will be brought back to the Board in due course. Item 9 PCIP- The committee previously queried details for any further engagement events. Dr Lucy Munro advised just starting to stand up programme after covid so this is on-going. Item 10 Mental Health Continuing Care Contracted Beds - Plan to bring update to the next IJB in September. Item 11 Reserves Strategy- An update will be brought to the August IJB PFA.
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3 Item 14 Integration review - Chief Financial Officer – Recruitment process is ongoing with a preferred candidate chosen and going through appointment process. Items deferred due to Covid Item 7 Primary Care Implementation/GP OOH - Ross McGuffie advised there has been work undertaken with Scottish Government and NHS, plan to hold a joint IJB session to brief all members, to review challenges and look at future direction of the service. Details will be shared with the committee when available. Brian Moore noted need to capture outstanding action around reserves and exit strategy. Ally Boyle also noted to add community alarms update to action log as per discussion at previous committee. Christine Jack to update action log. CJ 5. Unaudited Accounts A report was shared with the committee which provides an overview of the unaudited IJB Annual Accounts for the financial year 2021/2022 in line with the legislative requirements. The IJB is specified in legislation as a “section 106” body under the terms of the Local Government Scotland Act 1973. It is therefore expected to prepare Annual Accounts in compliance with the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the “Code of Practice”) and the International Financial Reporting Standard (IFRS). The main risk associated with the IJB is that one or both partners could overspend. The risk has been closely managed by each partner during the financial year under review. The budget monitoring arrangements in place ensured that corrective action could be taken including the use of the contingency reserve as appropriate to address increases in demand for health and social care services. Nicola Lynch presented the report in the absence of Marie Moy. She drew the committee’s attention to pages 9-12 of report which outlines the annual accounts for 2021-2022. The final year end underspends at 31st March 2022 is £74.670m which will be transferred into reserve funding; full details of this is outlined on page 58 of the report. It is anticipated that a further report will be brought to the September IJB committee to detail the plans for the ear marked reserves, this report will review current uses of reserves and if any changes are required.
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4 Ally Boyle queried for the details of the underspend should a link be provided to the finance report tabled under the next item, as if read in isolation it will not illustrate the full circumstances. Ross McGuffie and Nicola Lynch will work together to amend the wording prior to the final version being submitted. The IJB committee agreed the following recommendations: (1) that the Annual Governance Statement and the continuous improvement actions included in the IJB Annual Accounts for 2021/2022 are endorsed; (2) that the unaudited IJB Annual Accounts for 2021/2022, as appended to this report, be noted; (3) that the arrangements for publication of the IJB Annual Accounts for 2021/2022 in line with the legislative requirements be noted; and (4) that authority is delegated to the Acting Chief Financial Officer to amend the IJB Annual Accounts for 2021/2022 before the publication date of 30 June 2022 to reflect feedback from the IJB. RMcG/NL 6. Finance Report-2021/22 The report shared 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 March 2022. Based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. This is the final financial monitoring report presented in respect of the financial year 2021/2022. The financial position as at 31 March 2022 is summarised as follows: there is a net underspend of £58.697m on the core budgets within Health Care Services; details of which are provided at Appendix 1. there is a net underspend of £15.973 on the core budgets within Social Care and Housing Services; details of which are provided at Appendix 2 The total underspend of £74.670m represents approximately 9% of the total financial envelope available. Ross McGuffie advised additional funding has been included to allow services to over recruit but there have been significant recruitment challenges across all areas which is a Scotland wide issue.
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5 The IJB committee agreed the following recommendations: (1) Note the contents of the report; (2) 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; (3) 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; (4) Note that the financial outturn at 31 March 2022 is an underspend of £74.670m (NHSL - £58.697m; NLC - £15.973m). 7. Covid Update As at 8th June, the seven-day case rate within North Lanarkshire is 103 per 100k population, which is a significant decrease to the figures last presented to the IJB PFA on 15th March when it was 1,334 per 100k. Ross McGuffie noted the reporting mechanisms for tests has changed so it is more challenging to monitor numbers- today is at 153.6 per 100k. There are 90 covid positive inpatients and a further 19 in off-site facilities, 0 deaths and 0 in level 3 ITU. On 4th May, NHS Lanarkshire moved out of black status back to red, with the supporting command structure stood down. This has been replaced with a Service Remobilisation and Oversight Group, with the aim of: Overseeing service remobilisation approaches Identifying unintended consequences of service recovery and remodelling Taking a whole system approach to the resolution of issues Providing assurance on progress In care homes starting to see some degree of impact today 4 care homes have outbreaks which is affecting 17 residents and 35 staff. Delayed discharge number have improved as of today the numbers are in the 70s, this is mainly due to issues around care home discharges and impact of covid absence. Further 22 discharges planned for today, there is a positive flow of discharges across all hospital sites. Work is being undertaken as part of the discharge without delay programme to review how many patients are discharged on time. Vaccination programme continues to deliver – awaiting future JCVI guidance on autumn programme for boosters, which is thought to be aimed at those in the immunosuppressed category.
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6 Cllr Kirsten Larson queried if any uptake issues with the vaccination programme. Ross McGuffie advised can see lower uptake in younger age group with 5-11year olds being the lowest uptake group. Cllr Paul Kelly asked is there is any indication of when the JCVI will confirm future arrangements as if the programme only focuses on immunosuppressed categories as may start to see an impact on staff absence levels if their protection is reduced. Issues around communicating and supporting immunosuppressed patients. Ross McGuffie was unable to give any concrete indication around timescales for JCVI to confirm the content of the Autumn programme, but noted it is expected soon. It was noted that funding within care homes ends in June in the report but Ross McGuffie advised funding has been confirmed until next year now so care home assurance work will continue for the financial year ahead. The IJB committee noted the below recommendations: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 8. Equalities Mainstreaming Report The Equality Act 2010 stipulates that all public bodies across Scotland are required to produce and deliver a set of equality outcomes to further one or more of the three needs of the Public Sector Equality Duty (PSED/also known as General Duty). The duty has two parts – a General Duty and Specific Duties. The General Duty came into force in April 2011 and applies to any organisation which carries out a public function, requiring due regard to be given to the need to: Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited under this Act Advance equality of opportunity between persons who share a relevant characteristic and persons who do not Foster good relations between people who share a protected characteristic and those who do not Morag Dendy noted the report is acknowledging the impact of Covid 19 and making services more accessible for communities. The refresh of priorities is detailed within the report they will be reviewed in line with the new SCP. Maddy Halliday offered to link with Morag Dendy to provide additional information on community’s solution for inclusion in the report. Also Maddy Halliday noted the impact of cost of living crisis and the impact on inequalities in future. She queried if this is something for consideration on the IJB risk register, the committee noted this and will discuss further under the risk item.
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7 Neil Findlay asked how will we evidence delivery of this work, Morag Dendy drew attention to appendix 1 within the report which provided a breakdown of key actions which involved development of matrix to look at quality control. Ally Boyle noted it’s about understanding the measurements of success with a focus on digital inequalities; the committee noted this. The IJB committee noted the following recommendations: Endorse the Mainstreaming Report Endorse the equality outcomes as agreed by the partner organisations Request progress updates via the Performance, Finance and Audit Committee Note the requirement to meet the 2 year cycle for future Mainstreaming Reports 9. Risk Register Christine Jack spoke to a report which provide a summary to the Integration Joint board (IJB) on risk management activity, noting any amendments or additions to the current risk register. There are currently three 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 IJB 14/22 – Children and Adolescent Mental Health Services (CAMHS) and ability to recruit to service vacancies following investment in funding. These risks were reviewed in March 2022 having regard to the overall financial position and the additional confirmed Covid funding. At that point, it was agreed that the risks should 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. The risks will be reviewed as part of the financial planning exercise for 2022/23 with the new IJB Chief Financial Officer. There are four high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing One new risk has been added to the IJB Risk Register (IJB14.2022 – CAMHS service) following discussion at the last IJB meeting held in
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8 March 2022. Christine Jack advised due to CFO absence and not having budget information available have not been able to close off any financial risks and create new relevant financial risk. An updated position will be taken to the IJB PFA in August. As discussed under the previous item Maddy Halliday again raised the risk of the impact of cost of living which may lead to increased pressures for staff. The committee agreed will need to consider any mitigations. Cllr Jordan Linden queried if the IJB should have a similar risk as noted on the Heath Board risk regarding patient flow issues and any associated issues. Ross McGuffie advised doing planning work around urgent care with the health board and south IJB to manage this. so need to ensure the 3 plans are brought together in synergy. Brian Moore asked if the risk for services users losing service when community alarms move from analogue to digital should be added. Ross McGuffie advised have gone out to procurement to get digital compatible alarms to manage the risks. There is national work being undertaken around alarms which have also been connected, can bring a fuller report to a future committee. Maddy Halliday noted there is a risk for the community voluntary sector as there are a high number of factors beyond the HSCPs control. Particularly around the proposed transition to NCS should this be included in the risk register. Christine Jack noted need to review risks around 3rd sector funding and for NCS were awaiting more details so we could articulate a risk but will now look to add. Christine Jack will work up risks discussed. The IJB Committee noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. CJ 10. IJB Membership The rules about IJB membership are contained in statutory instruments and reflected in the Integration Scheme and Standing Orders. These state that Board members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. When a member resigns or otherwise ceases to hold office, the person shall be appointed for the unexpired term of the person being replaced.
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9 The Chair of the IJB should alternate between the voting representatives of North Lanarkshire Council and NHS Lanarkshire. Since 2019, the Chair has been nominated from NHS Lanarkshire from the cohort of Non-Executive Director members of the IJB. From June 2022 the chair of the IJB should be nominated from North Lanarkshire Council. The new chair for the IJB committee will be Councillor Tracy Carragher and Vice Chair will be Brian Moore. Christine Jacked noted we also need to update our stakeholder representation prior to the next meeting. The IJB committee agreed the following recommendations: 1. Note the handover of the IJB Chair from NHS Lanarkshire Board to North Lanarkshire Council from June 2022. 2. Note the revised membership of the voting members of the IJB from June 2022. 3. Approve the recommendations for Chair & Vice Chair of the Performance, Finance & Audit Committee (P, F&A). 11. Investment in IT Infrastructure to Support Care Delivery Contracts for the supply and support of GP Clinical Systems within Scotland are currently held separately by each territorial NHS Board. These are coming to end of life and in NHS Lanarkshire began to expire in May 2019. In the meantime, a National procurement/re-provisioning exercise has been undertaken with representatives from Scottish Health Boards. As a result, NHS Scotland has put in place a National GP IT Managed Services contract, signed and managed by NSS on behalf of the NHS Boards. This Multi- Supplier Framework Contract, which will replace the existing individual NHS Board contracts, was signed on 1st February 2019. Three suppliers, EMIS, Cegedim (Vision) and Eva Health Technologies were appointed to this framework. There have been significant delays and Eva have withdrawn from the framework, with a system from Emis not being available for at least another year. The current system poses significant challenges for the development of primary care services; in particular, the challenges of shared access to GP clinical systems has acted as a rate limiter on the implementation of the Primary Care Improvement Programme and remote access to GP clinical systems requires the exclusive use of a physical desktop PC in the practice, making efficient use of estate challenging. A process was therefore initiated in Lanarkshire in June 2021 to examine the feasibility of a Direct Award to Cegedim as soon as their system was available in Spring 2022 and a cohort of GP practices formed. All except two practices have agreed to join this cohort, which covers 99.5% of Lanarkshire’s population.
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10 Brian Moore noted there is already an earmarked reserve for digital enabled tech so how does this link to this; being mindful we need to ensure developments relate to updates for NCS too. Ross McGuffie noted have already agreed need to review existing reserves to see what is still relevant. NHS Scotland funded 365 implementation which was not planned, funding was already in reserves as part of the digital enabled tech so this can be redirected to support this work. Neil Findlay queried will these be fixed price costs or will there be additional costs as the work progresses. Dr Lucy Munro advised national procurement work started a number of years ago. Would expect that these are the prices as the companies don’t get paid until they deliver. If NHS Lanarkshire signs up with another board signing up it would take it over 55% so costs would be covered. The IJB committee agreed the recommendations made: Note the progress which has been made in procuring a reprovisioned IT system for General Practice and the opportunity this provides for providing an infrastructure for the work of integrated teams Note the opportunity to improve the quality and co-ordination of care by further investment in broader IT infrastructure That a ring-fenced reserve is created of £1.5m, including 0.301m to fund shared services linked to General Practice IT systems until 2029/30 12. Strategic Commissioning Plan Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, 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. Morag Dendy advised it is planned to have engagement events in late August to focus on the detail of the plan. It is an opportunity for committee members to also join and input; details will be shared with the committee in due course. Brian Moore noted the community nursing review has not been discussed at this committee, he asked if it will be in future as seen the other work outlined in the plan. It has been included in winter planning as part of the business case. Ross McGuffie noted can bring a more detailed report to a future committee when the work is ready. Ally Boyle questioned do we currently map out communities we have engaged with and look at some areas that are missed out and consider how to engage with them to improve their skill set. Morag Dendy noted we do this currently but also will work with universities to promote research work going forward.
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11 Recommendations agreed by IJB committee are: 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 13. National Care Service- Progress Update Ross McGuffie advised the bill was published yesterday currently working on a briefing for Board members, IJB member and NLC colleagues. There will be a change for social work and adult social work to sit under care boards. It’s likely to be a Lanarkshire wide care board but it has not been confirmed. There is some provision in the act to move some health functions but no health staff will be managed via care boards. There will be co- production work undertaken over the summer to get into the detail of the plan; with a planned implementation date in 2026. Brian Moore noted it doesn’t directly refer to Primary Care services is there any indication of direction of travel for this. Ross McGuffie advised commissioning may be included but contractor arrangements remain unclear. Cathy McGinty asked where does this leave the IJBS and integration. Ross McGuffie noted there will be anxieties for staff with changing employment status so will look at supporting staff working with trade unions. The committee noted Ross’s updated and look forward to future updates. 14. Annual External Audit Plan The Public Bodies (Joint Working) (Scotland Act) 2014 established the framework for health and social care in Scotland and the formation of Integration Joint Boards (IJBs). Each IJB is required to prepare annual accounts and have them audited in accordance with Part VII of the Local Government (Scotland) Act 1973.Aduit Scotland was appointed by the Accounts Commission and the Auditor General as the external auditors of the North Lanarkshire IJB. Marie McFadden advised the report contains planned overview and scope of the work. It was noted no formal reliance on work of financial audit. She asked if any committee members have any knowledge of any fraud that Audit Scotland should be aware of. Ross McGuffie confirmed no fraud to report.
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12 The IJB Committee is asked to agree the following recommendations: (1) That the content of the report is noted; (2) That the proposed revised timescale for annual accounts is noted as referenced in page 11, paragraphs 29-31. (3) That the audit fee of £27,960 is approved. 15. Risk Christine Jack will update the risk report from the discussion under the risk item. 16. Date of Next Meeting 21st September 2022 @ 2pm
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy M Moy To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. June 2021 November 2021 – deferred to IJB December 2021 deferred to March 2023. Complete Ongoing – Detailed review of reserve strategy to be undertaken by new CFO and reported to December IJB.
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2 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review M Moy Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Ongoing – Update be provided by September 2022.
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3 meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Ongoing Ongoing- delegated to PFA to complete action Update to be provided in
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4 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives September 2022 to cover off all outstanding actions 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. March 2021 September 2021 December 2021 Item to remain on action log pending further guidance being issued by S.Govt. All other local actions completed. We have submitted self-assessment to West of Scotland Regional Resilience Partnership outlining progress against Cat One Responder remit to be reviewed at Oct meeting. Will report back to Dec IJB. 6. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB December 2021 December 2022 Ongoing
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5 March 2022 – draft guidance shared with NLC and awaiting comment 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 1. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared December 2021 Verbal update to be provided- September 2022 Remove Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final business case to Dec IJB. 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Delegated to PF&A for completion – August 2022 Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed March 2022 Complete
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6 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. June 2022 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. tbc 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care Community Alarms (Analogue to digital) National Care Service September 2022 Included in risk register report for Sept committee Complete 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP tbc Add to Dec IJB 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Add to Dec IJB 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Report delayed due to a delay in Audit Scotland process Special meeting on 21st Sept to be cancelled and later
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7 date to go into October ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 2.1 24.9.19 Item 7 Primary Care Implementation/GP OOH L Munro Updated report on GP OOH services to be provided that outlined options for a more sustainable two centre model. June 2022 – verbal update on actions noted with full report to be presented in September 2022 March 2020 (revised to December 2020) Deferred due to Covid – 19 Agenda Item 21.9.22
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1 REPORT Item No: 5 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB): For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 31 July 2022 (Health Care Services) and 22 July 2022 (Social Work and Housing Services). 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; (2) Note that the financial position in July 2022 is an underspend of £3.801m (NHSL - £2.313m; NLC - £1.487m). This excludes the impact of further recruitment challenges and staff turnover and any potential new Scottish Government funding. 4. VARIATIONS TO DIRECTIONS SUBJECT: Financial Monitoring Report 2022/2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 21st September 2022 Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 The financial position as at July 2022 is summarised as follows: there is a net underspend of £2.313m on the core budgets within Health Care Services there is a net underspend of £1.487m on the core budgets within Social Care and Housing Services The total underspend of £3.801m represents approximately 0.5% of the total financial envelope available. 6.2 The Covid-19 pandemic has created significant financial management and financial planning challenges for both partners and the IJB. These challenges have centred around the difficulties in predicting the costs associated with the recovery from the Covid-19 pandemic. 6.3 In 2021/22 a ring-fenced reserve was created from uncommitted Covid-19 funding received from Scottish Government and will be used to support the continuation of costs as a direct result of Covid-19. This funding meets in full the 2022/23 Covid- 19 costs included in the Lanarkshire Remobilisation Plan for both partners. 6.4 Any proposed utilisation of the earmarked reserves to meet new expenditure that had not been funded in 2022/2023 will require the prior agreement of the Scottish Government in advance of the expenditure being incurred. It also remains important that reserves are not used to fund recurring expenditure, given the non- recurring nature of Covid-19 funding. The Covid-19 financial position is being closely monitored. 6.5 The budget variance is analysed by care services at appendix 1 and the main factors contributing to the financial position are summarised below. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES 7.1 Locality and Other Services 7.1.1 There is a net underspend of £0.739m. 7.1.2 The net underspends on pay costs totals £1.066m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within Mental Health and Children’s services totalling 132.5 WTE. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. 7.1.3 In respect of non-pay costs, there is a net overspend totalling £0.327m. The overspend is mainly due to payments in respect of Strathcarron Hospice
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3 (£0.190m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. 7.2 Prescribing 7.2.1 A break-even position is reported at this stage. 7.2.2 The prescribing budget has reduced by £0.657m since 31 March 2022. The majority of the budget reduction relates to an agreed savings target and a change in Scottish Government tariff prices. The budget reductions have been partly offset by a 2% inflation uplift. 7.2.3 Prescribing activity figures for the period from April 2022 to May 2022 have been received. Prescribing cost per item reflects a lower value when compared to the same period last year, however, activity level is 1.47% higher. There continues to be significant risk in respect of prescribing activity and the costs, and it is highly likely that the uncertainty and volatility experienced throughout 2021/22 will continue for the foreseeable future. Prescribing costs will continue to be closely monitored. 7.3 Area Wide Services 7.3.1 There is a net underspend of £0.044m mainly in respect of Pharmacy Services. 7.3.2 Area Wide Services include central nursing services, corporate services, health promotion services, pharmacy services and winter planning services. 7.4 Hosted Services Led by North Lanarkshire 7.4.1 The hosted services which are led by the North Lanarkshire HSCP are outlined at Appendix 2. There is a net underspend of £1.426m which includes the following significant variances: Mental Health and Learning Disability Services £0.354m underspend Children and Adolescents Mental Health Services £0.705m underspend Speech and Language Therapy Services £0.329m underspend Immunisation Service (£0.216m) overspend 7.4.2 The net underspends of £0.354m within Mental Health and Learning Disability Services is due to 65.57 WTE vacancies mainly in nursing posts with some vacancies in psychology and administration. The underspend has been partly offset by an overspend in locum costs across Medical Services and the use of bank aide across the inpatient areas and incremental increases within the community areas. 7.4.3 The net underspend within Children and Adolescents Mental Health Services is £0.705m and is due to vacancies (£0.691m) across nursing and administration posts (39.03 WTE). 7.4.4 There is an underspend of £0.329m within Speech and Language Therapy Services which is mainly due to 28.65 WTE posts (£0.293m) and an underspend across non-pay costs of £0.036m.
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4 7.4.5 There is an overspend within Immunisation Services of £0.216m which is partly due to an overspend on pay costs (£0.070m) but mainly due to an overspend on non-pay costs in respect of the cost of drugs (£0.146m). 7.4.6 In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset the overspends. This arrangement has been in place since 1 April 2016. 7.4.7 The IJB was previously advised that the hosted services principal is currently being reviewed. The outcome of the review will be reported to future meetings of both the North Lanarkshire IJB and the South Lanarkshire IJB for approval. 7.5 Hosted Services Led by South Lanarkshire 7.5.1 The hosted services which are led by the South Lanarkshire HSCP are outlined at Appendix 3. In-line with the hosted services agreement, a break-even position is reported. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.5.2 Primary Care Services are a hosted service which is led by the South Lanarkshire IJB. The Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund are ring-fenced funding allocations. Any underspend is therefore retained for use across Lanarkshire and is not used to offset other overspends incurred by the South Lanarkshire IJB. 7.5.3 A breakeven position is reported in respect of the Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund. 7.6 Covid-19 Pandemic – Additional Health Costs 7.6.1 The additional health costs which have been incurred in response to the Covid-19 pandemic continue to be reported to the Scottish Government through the Lanarkshire Mobilisation Plan. The year-to-date costs of £1.263m are included within the financial position reported and will be met by the existing IJB Covid-19 reserve. 7.7 Average Vacancy Factor 7.7.1 The vacancy position against the funded establishment at 31 July 2022 is summarised as follows: Establishment Actual Variance 2,796 WTE 2,629 WTE 167 WTE vacancies 100% 94% 6% 7.7.2 To help cover the current vacant posts, additional hours are worked through bank aide, overtime and excess part time hours, the cost of which is included within the financial position reported.
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5 7.8 Notional Set-Aside Allocation 7.8.1 The set-aside budget is a notional budget which represents the consumption of hospital resources by North Lanarkshire residents. Based on the 2020/2021 activity data from the Information Services Division (ISD) at the 2021/2022 prices, the budget was restated to £65.164m. 7.8.2 In respect of the financial year 2022/2023, the notional set-aside budget is restated to reflect the 2% inflationary uplift on the recurring baseline (£1.303m) and National Insurance uplift (£0.391m). The notional set-aside budget for 2022/2023 is therefore £66.858m. 7.8.3 In line with the accounting policy previously agreed, this notional set-aside budget will be included in the IJB Annual Accounts 2022/2023 as an estimate of expenditure. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB however it has been endorsed as an acceptable approach pending further updates from Information Services Division (ISD). 8. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES 8.1 Employee Costs 8.1.1 Additional staff and overtime costs are being incurred due to the Covid-19 pandemic. Demand for Home Support Services has also increased. These additional employee costs however are being offset by Covid-19 funding and also underspends as a result of vacancies. A net underspend across employee costs of £0.929m is therefore reported. 8.2 Administration Costs 8.2.1 An underspend of £0.284m is reported in respect of administration costs. The underspend is mainly due to the additional funding received from the Scottish Government for carers pressures in 2022/2023 which as at 22 July 2022 remains unallocated. As pressures become evident within Social Care budgets, the funding will be moved to the relevant care package. 8. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES (CONT.) 8.3 Payments to Other Bodies 8.3.1 There is an underspend of £0.382m across payments to other bodies. The underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the Self-Directed Support commissioning framework. It is anticipated that these are in-year underspends only and these budgets will be required in full in 2023/2024. 8.3.2 A breakeven position is reported in respect of independent care home at this stage of the financial year.
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6 8.4 Income 8.4.1 Income is under-recovered by £0.113m. This is partly due to the under-recovery of income from the community alarm charge, Home Support Services and Integrated Day Care Services which is lower than anticipated as a result of the Covid-19 pandemic. The implementation of the charge for community alarms was delayed due to the impact of the Covid-19 pandemic. The charge is now in place. Social Care Services continue to closely monitor the changes in the uptake of this essential service and are pro-actively responding to enquiries. The previously agreed NHS Lanarkshire partner contribution to the Integrated Equipment and Adaptations Service is also less than the actual cost of the service. This is currently being monitored. 8.5 Covid-19 Pandemic – Additional Social Care Costs 8.5.1 The additional social care costs which have been incurred in response to the Covid-19 pandemic are also continuing to be reported to the Scottish Government through the 2022/2023 Lanarkshire Mobilisation Plan. Based on the information available as at July 2022, the projected cost for 2022/2023 is expected to be £2.838m. This forecast will continue to be funded by Scottish Government support. 8.5.2 The main factors contributing to the projected Covid-19 outturn are as follows: 9. 2022/2023 SAVINGS 9.1 Financial Strategy 2022/2023 9.1.1 On 23 March 2022, the IJB approved the financial strategy for 2022/2023. The funding gap of £5.504m will be addressed by various measures, summarised as follows: 9.2 Health Care Savings 9.2.1 No health care savings have been agreed for 2022/2023. Description Projected Outturn £m Personal Protection Equipment (PPE) 0.396 Sustainability Payments to Care Providers 2.106 Loss of Income from Closure of Day Services 0.250 Expected Unachievement of Savings 0.086 Total 2.838 Description £m £m 2022/2023 Funding Gap 5.504 Budget Realignments 3.264 Recurring Prescribing Underspend 1.493 Prescribing Efficiency Saving 0.387 Drawdown of Reserves 0.36 5.504 2022/2023 Revised Funding Gap -
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7 9.3 Social Care Savings 9.3.1 This financial year is the last year of the three-year Efficiency Programme approved by the IJB and NLC partner in March 2020. The gross savings target is £2.025m. 9.3.2 To date £0.653m has been achieved (32%) against the target, with £1.372m currently outstanding in relation to changes to LA services. The remaining balance will be funded from reserves this financial year until anticipated closure in 2023/2024. 10. RESERVES 10.1 The reserves balances as at 31 March 2022 were as follows: 10.2 As at 31 July 2022 £16.133m has been drawn down from reserves, leaving a remaining balance of £103.319m. The 2022/2023 IJB Reserves Strategy will continue to be monitored and an updated version presented to the December board. 11. RISK 11.1 Risk management arrangements are in place for the IJB and each partner. The IJB risk register has been reviewed and updated. The reassessment of the strategic financial risks is included in a separate report to the IJB. The main risk associated with the in-scope budget is that either or both partners may overspend. However as detailed within this report the financial outturn for this year is projected to be an underspend. 11.2 Although a non-recurring underspend is being reported, health and social care services continue to face demand pressures including home support, self-directed support, direct payments, independent care home placements, hospice care and health care services recovery plans. 11.3 The operational and financial impact of the response to the Covid-19 pandemic is being monitored by the IJB and both partners in line with their agreed emergency response arrangements and also the recovery, redesign and remobilisation work to reinstate services. The whole system approach continues to be adopted by NHSL, NLC and South Lanarkshire Council. 11.4 Risk management arrangements are in place for the IJB and each partner. The respective risks are managed by both NHSL and NLC through their detailed budget management processes. In addition to these mitigating actions, the IJB Financial Plan 2022/2023 is closely monitored and the IJB Medium to Long Term Financial Plan is being updated. Description £m % Ring-fenced Reserves 45.718 38% Earmarked Reserves 70.05 59% Contingency Reserves 3.684 3% TOTAL 119.452 100%
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8 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 11. The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 12.5 PEOPLE None 12.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the North Lanarkshire IJB. 12.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 12.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 13. BACKGROUND PAPERS None.
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9 14. APPENDICES North Lanarkshire Health and Social Care Partnership Budget 2022/2023 Appendix 1 Hosted Services Led by North Lanarkshire Appendix 2 Hosted Services Led by South Lanarkshire Appendix 3 ........................................... CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126363.
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10 Expenditure Annual Budget Budget Actual General Ring-Fenced Total 2022/2023 July 2022 July 2022 July 2022 July 2022 July 2022 £m £m £m £m £m £m Health Care Services Locality and Other Services 48.165 16.101 15.362 0.739 0.000 0.739 Addiction Services 3.063 0.926 0.816 0.110 0.000 0.110 Medical and Nursing Directorate 4.455 1.485 1.452 0.033 0.000 0.033 Prescribing 69.582 23.194 23.194 0.000 0.000 0.000 Out of Area Services 4.571 1.524 1.563 (0.039) 0.000 (0.039) Area Wide Services 10.359 3.081 3.037 0.044 0.000 0.044 Hosted Services 157.322 50.118 48.692 1.426 0.000 1.426 Family Health Services 106.882 38.425 38.425 0.000 0.000 0.000 Set-Aside Budget 66.858 22.286 22.286 0.000 0.000 0.000 Covid-19 1.263 1.263 1.263 0.000 0.000 0.000 IJB Operating Costs 0.000 0.000 0.000 0.000 0.000 0.000 Total Expenditure - NHSL 472.521 158.404 156.090 2.313 0.000 2.313 Social Care Services Social Care Services Gross Expenditure 241.482 52.314 50.713 1.601 0.000 1.601 Social Care Services Gross Income (Including Covid-19 Income) (2.539) 1.385 1.499 (0.113) 0.000 (0.113) Social Care Services Net Expenditure 238.943 53.699 52.212 1.487 0.000 1.487 Housing Revenue Account Expenditure 1.870 0.683 0.683 0.000 0.000 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 241.364 54.552 53.064 1.487 0.000 1.487 IJB Operating Costs 0.000 0.000 0.000 0.000 0.000 0.000 Social Care and Housing Services Sub-Total 241.364 54.552 53.064 1.487 0.000 1.487 Total Expenditure - NHSL and NLC 713.885 212.956 209.155 3.801 0.000 3.801 Year To Date Year To Date Variance North Lanarkshire Health and Social Care Partnership Budget 2022/2023 Appendix 1
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11 North Lanarkshire Health and Social Care Partnership Budget 2022/2023 (Cont.) Appendix 1 (Cont.) Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (456.388) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.799) Scottish Government Funding - Covid-19 and Remobilisation (1.263) Transfer from Reserves (Approved) (14.870) Total Funding - NHSL (525.705) NLC Funding - Social Care Services (185.759) NLC Funding - Housing Services (1.870) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (188.180) Total Funding - NHSL and NLC (713.885)
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12 Hosted Services Appendix 2 Led by the North Partnership Annual YTD July 2022 YTD July 2022 YTD July 2022 Annual YTD July 2022 YTD July 2022 YTD July 2022 Annual YTD July 2022 YTD July 2022 YTD July 2022 Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 2.763 0.934 0.906 0.028 1.409 0.476 0.448 0.028 1.354 0.458 0.458 0.000 Continence Services 2.361 0.787 0.789 (0.002) 1.204 0.401 0.403 (0.002) 1.157 0.386 0.386 0.000 Immunisation Services 1.898 0.464 0.680 (0.216) 0.968 0.237 0.453 (0.216) 0.930 0.227 0.227 0.000 Speech and Language Therapy Services 6.078 2.029 1.700 0.329 3.100 1.035 0.706 0.329 2.978 0.994 0.994 0.000 Children and Adolescents Mental Health Services 16.448 3.753 3.048 0.705 8.388 1.914 1.209 0.705 8.060 1.839 1.839 0.000 Childrens Services 11.565 3.859 3.816 0.043 5.898 1.968 1.925 0.043 5.667 1.891 1.891 0.000 Integrated Equipment and Adaptations Store 0.567 0.189 0.183 0.006 0.289 0.096 0.090 0.006 0.278 0.093 0.093 0.000 Dietetics Services 3.737 1.250 1.216 0.034 1.906 0.638 0.604 0.034 1.831 0.613 0.613 0.000 Podiatry Services 4.315 1.449 1.393 0.056 2.201 0.739 0.683 0.056 2.114 0.710 0.710 0.000 Prisoner Healthcare Services 1.698 0.566 0.563 0.003 0.866 0.289 0.286 0.003 0.832 0.277 0.277 0.000 Blood Borne Viruses Services 1.529 0.510 0.461 0.049 0.780 0.260 0.211 0.049 0.749 0.250 0.250 0.000 Hospital at Home 2.225 0.736 0.699 0.037 1.135 0.375 0.338 0.037 1.090 0.361 0.361 0.000 Mental Health and Learning Disability Services 71.887 23.810 23.456 0.354 36.662 12.143 11.789 0.354 35.225 11.667 11.667 0.000 TOTAL 127.071 40.336 38.910 1.426 64.806 20.571 19.145 1.426 62.265 19.765 19.765 0.000 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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13 Hosted Services Appendix 3 Led by the South Partnership Annual YTD July 2022 YTD July 2022 YTD July 2022 Annual YTD July 2022 YTD July 2022 YTD July 2022 Annual YTD July 2022 YTD July 2022 YTD July 2022 Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 6.894 2.368 2.182 0.186 3.516 1.208 1.208 0.000 3.378 1.160 0.974 0.186 Brain Injury Unit 1.638 0.538 0.635 (0.097) 0.835 0.274 0.274 0.000 0.803 0.264 0.361 (0.097) Out of Hours Services 8.961 2.866 2.822 0.044 4.570 1.462 1.462 0.000 4.391 1.404 1.360 0.044 Palliative Care Services 6.958 2.343 2.393 (0.050) 3.549 1.195 1.195 0.000 3.409 1.148 1.198 (0.050) Physiotherapy Services 10.132 3.390 3.145 0.245 5.167 1.729 1.729 0.000 4.965 1.661 1.416 0.245 Primary Care Services 0.748 0.253 0.230 0.023 0.381 0.129 0.129 0.000 0.367 0.124 0.101 0.023 Occupational Therapy Services 7.852 2.659 2.658 0.001 4.005 1.356 1.356 0.000 3.847 1.303 1.302 0.001 Diabetic Services 4.937 2.428 2.384 0.044 2.518 1.238 1.238 0.000 2.419 1.190 1.146 0.044 Sub Total 48.120 16.845 16.449 0.396 24.541 8.591 8.591 0.000 23.579 8.254 7.858 0.396 Ring Fenced Funding Primary Care Improvement Fund 11.196 2.336 2.336 0.000 5.710 1.191 1.191 0.000 5.486 1.145 1.145 0.000 Primary Care Transformation Fund 0.000 0.000 0.002 (0.002) 0.000 0.000 0.000 0.000 0.000 0.000 0.002 (0.002) Sub Total 11.196 2.336 2.338 (0.002) 5.710 1.191 1.191 0.000 5.486 1.145 1.147 (0.002) TOTAL 59.316 19.181 18.787 0.394 30.251 9.782 9.782 0.000 29.065 9.399 9.005 0.394 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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1 REPORT Item No: 6 SUBJECT: Internal Audit Annual Audit Report 2021/2022 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ken Adamson Head of Audit and Risk (North Lanarkshire Council) Tony Gaskin Chief Internal Auditor (NHS Lanarkshire) DATE: 21st September 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB): For approval For endorsement To note 1.2 This report provides details of the Internal Audit Annual Audit Report for the financial year 2021/2022 which also contains the independent annual opinion of the IJB’s Chief Internal Auditors on the adequacy and effectiveness of the IJB’s governance, risk management and internal control arrangements for the year ending 31 March 2022. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; and (2) Endorse the opinion of the Chief Internal Auditors that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control for the year ended 31 March 2022. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 A Scottish Government Advisory Group - the Integrated Resource Advisory Group (IRAG) – produced professional guidance on integration and the responsibilities of the IJBs. This guidance included the responsibility of the IJB to establish Prepared by: Head of Audit and Risk (North Lanarkshire Council) Chief Internal Auditor (NHS Lanarkshire) Reviewed by; Chief Officer
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2 adequate and proportionate Internal Audit arrangements for review of the adequacy of arrangements for risk management, governance and control of the delegated resources. 5.2 The internal audit arrangements for the IJB are provided jointly by the internal audit teams of North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL)
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3 5. BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.3 In order to comply with the Public Sector Internal Audit Standards (PSIAS) and the approved Internal Audit Charter for the IJB, the Chief Internal Auditors of NLC and NHSL, acting jointly as the appointed Chief Internal Auditor for the IJB are required to present to the IJB an annual summary of the work undertaken by the Internal Audit teams and to provide an annual opinion on the adequacy and effectiveness of the IJB’s corporate governance, risk management and internal control arrangements. 5.4 The Internal Audit Annual Audit Report 2021/2022 is based on a body of work contained within the Internal Audit Plan for 2021/2022 which was previously approved by the IJB Performance, Finance and Audit Committee. 6. CONCLUSIONS 6.1 The Internal Audit Annual Audit Report for 2021/2022, a copy of which is attached, presents a high-level overview of the activity undertaken by the Internal Audit teams during the year and which are reflected in the annual opinion. 6.2 Based on the work undertaken directly on behalf of the IJB and being informed by internal audit work undertaken independently by each respective internal audit function within NLC and NHSL, it is concluded that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls for the year ending 31 March 2022. 6.3 A number of recommendations and improvement actions have been agreed with senior management arising from audit work undertaken during the year. Internal Audit will, as part of the 2022/2023 workplan, develop and agree arrangements to undertake follow-up work on the implementation of actions agreed in response to relevant audit recommendations and report on this work to the IJB Performance, Finance and Audit Committee during 2022/2023. 6.4 Internal Audit staff appreciated the help and co-operation extended to them by the officers of the IJB and the staff within the partnership. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) The IJB and both partners are required to establish effective governance arrangements across the partnership. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Failure to operate an effective Internal Audit function consistent with the Public Sector Internal Audit Standards (PSIAS) could impair the Council’s compliance with its Code of Corporate Governance 7.5 PEOPLE
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4 None. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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5 INTERNAL AUDIT ANNUAL AUDIT REPORT 2021/2022 Appendix 1 1 Purpose of Report 1.1 To report the activities undertaken by Internal Audit on behalf of the IJB for the year 2021/2022 and to present an independent annual opinion on the adequacy and effectiveness of the IJB’s internal controls based on the work undertaken during the year. 2 Background 2.1 Internal Audit is an independent and objective assurance function designed to add value and improve the IJB’s operations. It helps the IJB accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of the IJB’s risk management, internal control and governance processes thereby assisting the IJB, the Performance, Finance and Audit Committee (‘the Committee’) and the senior management team to effectively discharge their role and responsibilities. 2.2 Internal Audit’s purpose, authority and responsibilities are set out in more detail in the Internal Audit Charter, which was previously approved by the Performance, Finance and Audit Sub- Committee. 2.3 Internal Audit reports its outputs to the Committee which also approves Internal Audit’s annual audit plan and monitors the performance of the function. 2.4 Internal Audit activity is planned to enable an independent annual opinion to be given by the Chief Internal Auditors on the adequacy and effectiveness of internal controls within the IJB, including the systems that achieve the corporate objectives of the IJB and those that manage the material risks they face. It should be noted, however, that the presence of an effective internal audit function contributes towards, but is not a substitute for, effective control and it is primarily the responsibility of line management to establish internal controls so that the IJB’s activities are conducted in an efficient and well-ordered manner, to ensure that management policies and directives are adhered to and that any relevant assets and records are safeguarded. 3 High level overview of Internal Audit activity during 2021/2022 3.1 We are pleased to confirm that Internal Audit operated throughout 2021/2022 with no impairments or restrictions in scope or independence. Internal Audit activity during the year was undertaken in accordance with the Internal Audit Annual Plan which was approved by the IJB Performance, Finance and Audit Committee. 3.2 Action plans are agreed with management in response to all recommendations made within Internal Audit reports. These actions will be followed up to ensure that actions agreed by management in response to audit recommendations have been successfully implemented. 3.3 Both Internal Audit functions operated throughout 2021/2022 in accordance with the Public Sector Internal Audit Standards (PSIAS).
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6 INTERNAL AUDIT ANNUAL AUDIT REPORT 2021/2022 (Continued) Appendix 1 (Continued) 4 Issues arising from Internal Audit activity during 2021/2022 4.1 Three Internal Audit assignments were planned during the year. The status of these reviews are detailed in the table below. Report title Status Date issued Level of Assurance (see Appendix 4 for definitions) Follow up of actions previously agreed by management in response to Audit recommendations Complete March 2022 N/A Response to Covid-19 Pandemic - Strategic Planning In progress Expected October 2022 To be confirmed Value For Money Audit – Joint Equipment Store Projec t Deferre d Project Deferred N/A 4.2 The limited progress by the Project Group established in respect of the potential joint equipment store has meant that no specific audit work was undertaken this year. Internal Audit will ensure that consideration is given to including value for money work in this area in future work programmes when appropriate. 4.3 In addition to the above work, NLC and NHSL undertook a range of audit work within their respective organisations. For NLC this included work undertaken on a range of systems and activities (such as business continuity planning, procurement, risk management and key financial systems such as creditors and payroll) which also provide assurance in respect of NLC operations for which the IJB has delegated responsibility. Of particular note for NHSL were the Internal Control Evaluation and Annual Internal Audit report, both of which provided a holistic view of the adequacy and effectiveness of Internal Controls across NHSL, including delegated functions. Whilst these NHSL reviews provided positive assurance, they highlighted the demand, financial and workforce challenges facing the Board and the need for a strategic response to be developed, with partners. Other relevant areas covered by NHSL included resilience, adverse event management, Staff governance, clinical governance, risk management, health strategy and a range of Information governance reviews. 4.4 Internal Audit recognises that Integration Authorities are functioning within a challenging environment and that delivering the key national and local objectives around integration, whilst managing demand for services within available budgets, continues to be a significant challenge. The additional challenges presented in 2021/2022 by the COVID-19 pandemic further increased the scale and complexity of issues facing the IJB. Overall, however, the findings and results of our work, including evidence obtained as part of audit reviews which have not yet been formally completed and audit work undertaken as part of work done within NLC and NHSL, support a generally positive view of the IJB’s governance and internal control arrangements.
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7 4.5 NHS Fife, Tayside and Forth Valley Internal Audit Service (FTF) have developed and now trialled a Strategy Development Checklist, which has been shared with management and will be used to assess the IJB’s approach to developing a strategic response to the challenges posed by Covid as part of the process of updating the Strategic Plan. This audit was delayed to allow the checklist to be tested and enhanced and the work is being conducted as part of a tri-partite approach including reviews of Strategy development within South Lanarkshire IJB and NHS Lanarkshire, as well as North Lanarkshire IJB.
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8 INTERNAL AUDIT ANNUAL AUDIT REPORT 2021/2022 (Continued) Appendix 1 (Continued) 4.6 Work on the follow up of IJB actions previously agreed by management in response to audit recommendations was generally positive. However, the impacts of the pandemic has required priorities to be reassessed, which has in turn had an impact on the time and resources allocated to progress agreed actions and on the ability of management to achieve many of the original timescales which had been set. We were pleased to note that management have, however, committed to revised timescales to complete the identified actions to appropriately address the weaknesses/improvement areas in audit outputs. We will continue to follow-up management implementation of all agreed actions during 2022/2023. 4.7 The results from our work suggest that there are no matters that we require to highlight and that compliance with the requirements of the corporate governance framework adopted by the IJB continues to be positive with no significant weaknesses, areas of concern, material frauds or irregularities resulting in financial loss to the IJB identified in 2021/2022 that require to be brought to your attention. 5 Annual Internal Audit Opinion 5.1 There is a formal requirement for the Chief Internal Auditors to prepare an annual opinion on the organisation’s internal control system. The opinion is presented to members of the IJB Performance, Finance and Audit Committee and the Chief Officer for Health and Social Care Integration and is intended to provide independent and objective assurance to these different stakeholders as to the adequacy and effectiveness of internal controls within the IJB. 5.2 The evaluation of the control environment is informed by a number of sources and in bringing these together, consideration has been given to whether there is evidence that any key controls are absent, inadequate or ineffective and whether the existence of any weaknesses identified, taken independently or with other findings, significantly impairs the IJB’s overall systems of internal control. Wider issues relating to the IJB’s corporate governance and risk management arrangements have also been considered. 5.3 The nature of individual audit assignments is such that most Internal Audit reports identify some weaknesses or areas where scope for improvement exists. However, we are pleased to report that, generally across the IJB, there continues to be a strong recognition amongst management of the importance of appropriate governance arrangements and proportionate but effective internal controls. 5.4 During work undertaken in 2021/2022 there have been instances where Internal Audit has made recommendations to further improve the systems of control and compliance, but Internal Audit do not consider these weaknesses significant enough to require to be highlighted in the Annual Audit Report. 5.5 The formal annual Internal Audit opinion on the soundness of the IJB’s internal control systems is presented at Appendix 2. Overall, the results of the work of Internal Audit in 2021/2022 taken with other information available did not lead us to conclude that the IJB’s overall systems of internal control were significantly or materially impaired. 5.6 I would like to thank all IJB staff who have assisted Internal Audit during the course of our work throughout 2021/2022 and to thank senior management and IJB Members for the consideration and due regard given to our work.
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9 Ken Adamson Tony Gaskin Head of Audit and Risk Chief Internal Auditor (NHS Lanarkshire) North Lanarkshire Council NHS Lanarkshire 7 September 2022 7 September 2022
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10 INTERNAL AUDIT OPINION 2021/2022 Appendix 2 To the members of North Lanarkshire IJB’s Performance, Finance and Audit Committee and the Chief Officer for Health and Social Care Integration As Joint Chief Internal Auditors, we are pleased to present the annual statement on the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control for the year ended 31 March 2022. Respective responsibilities of management and internal auditors in relation to governance, risk management and internal control It is the responsibility of the IJB’s senior management to establish appropriate and sound systems of governance, risk management and internal control and to monitor the continuing effectiveness of those systems. It is the responsibility of the Chief Internal Auditors of the IJB to provide an independent annual opinion on the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control. The IJB’s framework of governance, risk management and internal controls The main objectives of the IJB’s framework of governance, risk management and internal controls are to ensure that resources are directed in accordance with agreed plans, policies and priorities and to ensure that there is sound decision-making and clear accountability for the use of those resources in order to achieve the desired outcomes for service users and communities. This will include ensuring that appropriate internal controls and risk management arrangements are in place to effectively manage issues which might impact on the delivery of delegated functions, the achievement of corporate objectives and public confidence in the IJB. The IJB also requires effective internal controls and risk management arrangements to safeguard its employees, to protect its assets, to maintain effective stewardship of public funds, to ensure good corporate governance, to ensure compliance with statutory requirements and to ensure it continues to deliver best value. The work of Internal Audit Internal Audit is an independent and objective assurance function established by the IJB designed to add value and improve the IJB’s operations. It helps the IJB accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of the IJB’s risk management, control and governance processes and by providing an independent and objective opinion on the IJB’s internal control environment. It also objectively examines, evaluates and reports on the adequacy of the control environment as a contribution to the proper, economic, efficient and effective use of the IJB’s resources. The Internal Audit teams operated throughout 2021/2022 in accordance with the Public Sector Internal Audit Standards (PSIAS). Internal Audit undertakes an annual programme of work formally approved by the IJB Performance, Finance and Audit Committee. The audit plan is revised on an ongoing basis to reflect an ongoing assessment of the evolving risks and changes within the IJB.
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11 All Internal Audit reports identifying system weaknesses and/or non-compliance with expected controls are brought to the attention of management and include appropriate recommendations and agreed action plans. It is management’s responsibility to ensure that proper consideration is given to Internal Audit reports and that appropriate action is taken on audit recommendations. Internal Audit is required to ensure that appropriate arrangements are made to determine whether action has been taken on Internal Audit recommendations or, where appropriate, that management has understood and assumed the risk of not acting. Significant matters (including non-compliance with audit recommendations) arising from internal audit work are, when required, reported to the Chief Officer and to the IJB Performance, Finance and Audit Committee.
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12 INTERNAL AUDIT OPINION 2020/2021 (Continued) Appendix 2 (Continued) Basis of Opinion The evaluation of the control environment is informed by several sources: ▪ the audit work undertaken by Internal Audit during the year to 31 March 2022; ▪ the assessment of risk completed during the preparation of the 2021/2022 and 2022/2023 annual plans; ▪ our wider knowledge of the IJB’s corporate governance, risk management and performance management arrangements; ▪ other relevant reports issued by NHSL and NLC Internal Audit teams during 2021/2022; and ▪ reports issued by the IJB’s external auditors during 2021/2022, together with reports from other external review and inspection bodies. Opinion It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the North Lanarkshire Health and Social Care Integration Joint Board’s framework of governance, risk management and internal control for the year ended 31 March 2022. Ken Adamson CPFA Tony Gaskin Head of Audit and Risk Chief Internal Auditor (NHS Lanarkshire) North Lanarkshire Council NHS Lanarkshire 8 September 2022 8 September 2022
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13 RESPONSIBILITIES OF MANAGEMENT AND INTERNAL AUDIT Appendix 3 It is the responsibility of the IJB’s senior management to establish and maintain appropriate and sound systems of governance, risk management and internal control and to monitor the continuing effectiveness of those systems. It is the responsibility of Internal Audit to provide an independent opinion on the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control. Internal audit work should not be seen as a substitute for management’s responsibilities for the design and operation of these systems. We endeavour to plan and undertake our work so that we have a reasonable expectation of detecting significant control weaknesses and, if detected, we shall carry out additional work. However, internal audit procedures alone, even when carried out with due professional care, do not guarantee that all weaknesses, fraud or irregularities will be detected. Accordingly, our examinations as internal auditors should not be relied upon solely to disclose weaknesses, fraud, defalcations or other irregularities which may exist Engagements are conducted in accordance with the ‘Public Sector Internal Audit Standards’.
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14 LEVEL OF ASSURANCE DEFINITIONS Appendix 4 Audit Grading Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion Level of Assurance Definition Substant ial assuran ce Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Adequa te assuran ce The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited assurance The systems for risk, control and governance have some satisfactory aspects, but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse. Recommendation priority Priority Definition Red Significant weaknesses which management needs to address to achieve objectives. Amber Weaknesses which require prompt action to avoid exposure to risks in achieving objectives. Green Action advised/area for improvement to enhance control or improve efficiency.
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1 REPORT Item No: 7 SUBJECT: Covid-19 Update TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 21st September 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB: For approval For endorsement To note 1.2 This paper sets out the actions taken to date during the pandemic response. 2. ROUTE TO THE IJB 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 COVID-19 was declared a pandemic by the World Health Organisation on 12 March 2020, with spread of COVID-19 within all communities in the UK in the intervening period. 5.1.2 Command structures were immediately put in place in both North Lanarkshire Council and NHS Lanarkshire, with the Health and Social Care Partnership fully participating in both. In addition, the pan Lanarkshire Resilience Partnership has supported cross-agency developments. Yes No N/A
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2 5.1.3 An overview of the current developments around Covid-19 is included below: 5.2 Update on Numbers 5.2.1 As at 12th September, the seven-day case rate within North Lanarkshire is 66.8 per 100k population, which is a continued decrease to the figures last presented to the IJB on 22nd June when it was 103 per 100k. 5.2.2 The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at 12th September, there are 64 covid positive inpatients and a further 24 in offsite facilities. 5.2.3 On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. 5.3 Care Homes 5.3.1 One of the greatest areas of focus has been around supporting the Care Home sector, covering key areas of work such as: Testing, outbreak management and ongoing surveillance Infection, prevention and control including PPE and cleaning requirements Education and training Supportive reviews and visits. Workforce requirements and supply of mutual aid 5.3.2 Across Lanarkshire, work began to strengthen the management and oversight of outbreaks in care homes in March 2020, enhancing the supports we had offered routinely up until then. This included: Social Work Quality Assurance Section – existing contact Care home Liaison Team Support – existing weekly contact HPT Management of outbreaks – daily contact during outbreaks Weekly conference calls with sector by HSCP, established March 2020 Established early contact with Care Inspectorate Care home Assurance Group, meets daily, established 23rd April 2020 Bronze care home sub group, meeting twice weekly, established 24th April 2020 Development of Care Home Strategy 23rd April 2020 Access to staff bank to enable sustainable rotas with supporting governance framework Enhanced PPE recommendations that sector move to table 4 on 1st May 2020 Prioritised programme of testing for care homes commenced 5th May 2020 Workforce group established to support screening programme established 14th May 2020 Additional support arrangements for Care Homes confirmed until June 2022, with £1,326,353 allocated as part of the Remobilisation Plan funding in June 2021. 5.3.3 Following communication from the Cabinet Secretary on 17th May 2021, which outlined the additional requirements regarding accountability for provision of nursing leadership; professional oversight; implementation of infection prevention control measures; use of PPE; and quality of care; we have undertaken significant work to
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3 map our current provision of support and ongoing workforce and resource requirements to deliver this new request: Care Home Assurance Group – initially established on 23rd April 2021, group was expanded to include Chief Social Work Officers, Chief Officers and the Medical Directors. The group has also undertaken a thematic analysis of Care Homes, identifying support needs around access to updated HPS guidance; management of outbreaks; standard infection prevention and control measures; and staff support around mental health and wellbeing. Huddle - All 93 care homes in Lanarkshire have registered to use the national safety huddle template hosted on TURAS. There is a daily safety huddle meeting involving social work, care inspectorate, health protection team and nursing staff where they review this information and respond to any escalations or concern’s raised. Work continues with the Care Homes to improve completion rates, particularly at weekends. Enhanced support from Social Work Quality Assurance – including coordinated timetable of audits for each Care Home; supporting action plan development; coordinating links with colleagues in Care Home Liaison, Infection Prevention and Control, Care Inspectorate etc; and support for Homes to claim financial assistance where appropriate. Care Home Liaison – establishment increased by 0.8wte B7 and 3.4wte B6 to move to a 7 day service and enhance contact with each home in Lanarkshire. The team have undertaken visits; managed daily data returns; acted as an escalation point for PPE issues; and participated in the prioritised engagement visits as required. Health Protection Team – To enhance the outbreak management and screening testing in Care Homes, an additional 0.6wte B7, 3wte B5, 1wte B4 and 3wte B2 staff have been brought into the team. Testing – All staff continue have access to weekly asymptomatic PCR staff testing through either the social care portal or NHS laboratory testing. In addition to weekly PCR testing care home staff are now also requested to undertake twice weekly Lateral Flow Testing. Infection, Prevention and Control – In conjunction with Care Home Liaison, the IPC team provide advice and support covering virtual visits, attendance at Care Inspectorate unannounced inspections and providing support to Homes as required. Senior Nursing Leadership – a team is being developed under the leadership of a Deputy Chief Nurse to provide an immediate response during early stages of an outbreak similar to acute care setting where the focus is on early containment. This team would build on the existing care home liaison team and would have additional workforce requirements as detailed below, including IPC expertise. The outbreak testing team would be embedded within the team. 5.3.4 In November 2020 a Care Home Outbreak Oversight Group was established, chaired by a Public Health Consultant, to provide oversight of all active outbreaks. To date, Fifty-six care home outbreaks have been recorded and 37 IPC outbreak supportive visits have been undertaken by IPC specialist nurses. As an outbreak is declared the care home assurance team deploy an IPC nurse to support the care home manager to review practice and identify any immediate issues. This is in addition to routine IPC audits and support visits. Feedback from these outbreak visits is provided to the Oversight Group and common themes recorded. This supports the targeting of messaging, education and support for care homes.
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4 5.3.5 As at 12th September, there are 6 outbreaks in care homes covering 35 residents and 22 members of staff cumulatively. 5.4 Personal Protective Equipment (PPE) 5.4.1 One of the biggest challenges during the early phases of the pandemic was the supply of PPE to frontline staff. The national PPE guidance has evolved over time, but overall the service has been able to maintain supplies to frontline staff in line with guidance. 5.4.2 There are no ongoing issues to report. 5.5 Delayed Discharge/System Pressures/Home Support 5.5.1 Following the first wave of Omicron, delayed discharge performance improved significantly and in early February has gone back down to 50s and 60s, as it had been in October and November. However, the second Omicron wave created significant challenges across the system, with delays returning to the 70s and 80s. 5.5.2 Despite very positive performance in June and through to mid-July, delays have become a greater challenge as acute and service pressures increase, averaging in the low to mid 70s. 5.5.3 As at 12th September, delays are 83, with 26 discharges lined up for the day. Performance has been reasonably consistent in the mid-70s over the last couple of weeks. 5.5.4 The winter business case was approved at a special meeting of the IJB on 16th February 2022, with recruitment underway to support the development of the new models proposed, including: Home Assessment Teams in each Locality to support early discharge as well as admission prevention Expanded Home Support and Reablement capacity in each Locality New resource in District Nursing teams to proactively support Care Managed patients (those identified as being at the highest risk of admission) Expanded Integrated Rehabilitation Teams to create additional rehabilitation capacity for both discharge support and admission prevention 5.5.5 A short evaluation of the first 75 cases through the Home Assessment Teams in Cumbernauld and Wishaw has shown some strong promise: o 12% moved on to reablement o 3% moved on to a mainstream Home Support package o 1% required intensive support for end of life care o 84% required no input at the end point 5.5.6 Recruitment has continued to improve and it is anticipated that the Cumbernauld and Wishaw teams will be fully established by end Sept/early October. A soft launch will commence in Airdrie and Motherwell Localities in October with the aim of being at full capacity by the end of the year and finally Bellshill and Coatbridge will commence with a soft launch in December with the aim of being fully established by February 2023. 5.6 Testing
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5 5.6.1 Staff testing has continually evolved in line with the Scottish Government guidance throughout the pandemic. We have seen a gradual reduction in testing requirements over recent months and continue to follow the national guidance in full. 5.7 Covid Vaccination 5..1 The Covid vaccination programme continues at pace, with uptake as at 6th June as follows: Total doses administered 1,599,865 Individuals with at least 1 dose 556,259 Partially vaccinated 27,814 Fully vaccinated 95,271 Boosters 435,191 5.7.2 The winter flu and covid vaccine delivery has now commenced. The following groups will be offered both vaccinations: aged 50 or over a resident or staff working in a care home for older adults a younger adult in long stay nursing and residential care settings a frontline health or social care worker aged 5 to 49 years with an eligible health condition, including those with poorly controlled asthma aged 5 to 49 years and are a household contact of someone with a weakened immune system an unpaid carer or a young carer (16 years or over) pregnant 5.7.4 In addition, the following groups will be eligible for the flu vaccine individually: people aged 16 to 49 with an eligible health condition, including well controlled asthma children aged 6 months to 2 years with an eligible health condition all children aged 2 to 5 (not yet at school) all primary or secondary school pupils non-frontline health or social care workers nursery, primary or secondary school staff or pupil-facing support workers in local authority or independent settings prison officers or support workers who deliver direct front-facing detention services. 6. CONCLUSIONS 6.1 There has been a tremendous effort across the whole system (including third and independent sectors, communities and public partners) in building our response to the pandemic. 6.2 The dedication, bravery and commitment of all of our frontline staff should be commended in supporting us to continue to deliver a strong service to our residents in North Lanarkshire.
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6 6.3 The delivery of the Covid Vaccination campaign is now at an advanced stage, with Lanarkshire comparing very positively against the Scottish averages. 6.4 NHS Lanarkshire moved back into black status on 27th July due to sustained staffing and bed pressures, with command structures proportionately in operation. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and is currently rated at very high. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 8 SUBJECT: Lanarkshire Primary Care Out of Hours Service – Key Challenges and Next Steps TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Soumen Sengupta, Chief Officer South HSCP Ian Beattie, Head of Health & Social Care (South Lanarkshire) Dr Linda Findlay, Medical Director (South Lanarkshire) DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement X To note 2. ROUTE TO THE BOARD This paper has been: Prepared Chief Officer, South Lanarkshire IJB Reviewed Chief Officer Endorsed NHS Lanarkshire Population Health & Primary and Community Services Governance Committee 2.1 One of the challenges of partnership working is that not always possible to discuss issues and share papers with everyone at the same time. Therefore, we ask members of the IJB to be understanding and respectful of the fact that due to the scheduling of meetings, South Lanarkshire IJB (as host) is scheduled to be presented with the substance of this report at its meeting of 20th September 2022.
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2 3. RECOMMENDATIONS 3.1 IJB members are asked to: Note the position, performance and challenges facing the Primary Care Out of Hours Service in Lanarkshire, reflective of the issues Scotland-wide. Note the activities to progress the previously confirmed refreshed clinical model and supporting project. Endorse the development of an updated whole system Urgent Care Model. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Context 5.1 The Main Report of the National Review of Primary Care Out of Hours Services highlighted that across Scotland: The introduction of the 2004 General Medical Services Contract – where the responsibility for delivery of general practice services during the Out of Hours period transferred from GPs to territorial Health Boards - resulted in a number of unforeseen and adverse consequences, including insufficient participation of GPs in Out of Hours services. The demand for urgent care was growing - particularly for rapidly increasing numbers of frail older people with multiple long-term conditions and complex care needs. The (then) present situation for Primary Care Out of Hours services was fragile, not sustainable and would worsen, unless immediate and robust measures were taken to promote the recruitment and retention of sufficient numbers of GPs working in both daytime and Out of Hours services. 5.2 The Review’s proposals included that: Future urgent care be delivered by well-led and trained multi-disciplinary and multi-sectoral teams. GPs would no longer be the default health care professionals to see patients for urgent care, but they must continue to be an essential part of multi-disciplinary urgent care teams, providing clinical leadership and expertise, particularly for complex cases. People seeking help need to see the right professional at the right time, according to need. An enhanced capacity multi-disciplinary Primary Care Out of Hours workforce should be rapidly built up, including advanced nurse practitioners (ANPs), community nursing staff, paramedics and other allied health practitioners (AHPs), clinical pharmacists, and social care staff. The contribution of administrative and support staff is crucial and must be clearly valued and recognised. Future provision of Primary Care Out of Hours and urgent care services should not be constrained by traditional boundaries or demarcations. Yes No X N/A
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3 NHSL Primary Care Out of Hours (PCOOH) 5.3 The NHSL Primary Care Out of Hours (PCOOH) service is hosted within South Lanarkshire Health & Social Care Partnership (SLHSCP). The PCOOH Hub is based in the Primary Care Centre, Douglas Street Community Clinic, Hamilton. 5.4 Clinical services are provided at: The main primary care centre (PCC) at Douglas Street, Hamilton (as above) Airdrie Community Health Centre when safe staffing levels allow, with telephone contact via the PCOOH Hub. 5.5 The PCOOH service covers a population of around 580000 (i.e. all of Lanarkshire excluding Rutherglen/Cambuslang locality and the Northern Corridor) between the hours of 6pm until 8am Monday to Thursday; and between 6pm on Fridays and 8am on Mondays at weekends. 5.6 Ninety percent of calls to the PCOOH service are referred by NHS 24, with the remainder being professional-to-professional calls from community nursing, the Scottish Ambulance Service, community pharmacy and community hospitals. 5.7 Calls from NHS 24 are received as three case types: PCC (approx. 50% of cases) Doctor Advice (approximately 45% of cases) Home Visit (approximately 5% of cases) 5.8 Each call is allocated to one of three time dispositions by NHS24: within 1 hour; 2 hours; or 4 hours. 5.9 Approximately 23% of calls from NHS 24 are for the more urgent 1 and 2 hour dispositions. National targets are set for each case type and time disposition. 5.10 Professional-to-professional calls are also given standard time dispositions: 4 hours for community pharmacy; and 1 hour for other callers. 5.11 The service operates with the Adastra IT system. We are currently moving to an updated and cloud-based version of the system. 5.12 Most calls are received electronically from NHS 24 via Adastra; and professional-to-professional calls are logged in Adastra by the Hub dispatchers. Following NHS24 triage the service will conduct clinical consultations, which with additional local knowledge frequently change the disposition of those referrals (approximately 50% of PCC calls and 67% of home visits). 5.13 Following clinical consultation many are closed but some are forwarded to face-to-face assessment at either the main PCC in Hamilton or (when staffing
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4 allows) in Airdrie, both operating a timed appointment system. A minority of cases require home visits (HV). 5.14 Call volumes at peak periods during weekends are around 35 to 40 calls per hour, with occasional peaks of 50 calls per hour. On public holidays, call volumes tend to be higher with around 50 calls per hour at peak periods. The peak period at weekends and public holidays is between 8am and 2pm, with a slow decline in demand up until 9pm to 10pm (by which time demand usually drops below 20 calls per hour). Lowest demand is between 3am and 5am both weekdays and weekends. 5.15 The average weekly call volumes in 2022 thus far (excluding public holidays) are 1343, with weekend call volumes being 883 on average. This is on par with levels pre-pandemic, although there is a rising trend in demand notably at the weekends. 5.16 As with other areas of primary and urgent care there is an ongoing need to engage with public to raise awareness of the role of the service; and where and when to seek support for their health care needs. 5.17 The service performance against targets is broadly positively, but workforce availability and more consistently high levels of referrals have proven challenging. I was given an appointment with the out of hours service on a Saturday afternoon in April, with a suspected bad bout of tonsillitis. I was seen very promptly by an Advanced nurse practitioner who was fantastic, checking me over making sure she hadn’t missed anything. She then got a second opinion from the doctor who was working at this time. He made me feel comfortable during his examination and ensured he explained everything in depth to me before explaining the next steps. His bedside manner was next to none and his calm attitude put me at ease. He was actually finished his shift but decided to stay extra to ensure I was checked over before referring me for hospital treatment. This was a very daunting time and
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5 the staff made sure I felt as comfortable as possible and really went above and beyond in terms of my care. Just a few of a very hard-working team over at NHS Lanarkshire's Out of Hours. 5.18 The median duration of PCC consultations is 20 minutes. The median duration of GP advice calls is 15 minutes. 5.19 Home visiting is time consuming, taking 1 hour on average (including travel time). Home visits for mental health cases requiring emergency detention are particularly time consuming and can take 3 to 4 hours (or more). 5.20 At present PCOOH clinical staffing is based on a ratio of 70% GPs to 30% other clinicians. 1 HOUR PRIMARY CARE CASES 2 HOUR PRIMARY CARE CASES 1 HOUR HOME VISITS 2 HOUR HOME VISITS
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6 Challenges 5.21 It may be helpful to picture the PCOOH service as a medium scaled GP practice with a list of circa 570,000 patients. At the peak demand periods the available appointments are quickly filled and a queue builds within the virtual waiting room with call rate of 35-50 new patients per hour at peak times. The median duration of GP advice calls is 15 minutes; and the median duration of PCC cases is 20 minutes. Therefore, at peak times the optimum workforce of (12 - 14 GPs/ANPs on weekdays; and 18 at weekends) is required to match capacity with demand. Like a GP practice, PCOOH has a closing time business and the service endeavours to see all patients they can within the session. 5.22 For a considerable period, and similar to most Scottish OOH services, the NHSL service has had to operate with fewer GP’s than is desirable, due to the challenges of recruiting either into salaried or sessional posts. The Service is typically unable to fill 25% to 30% of GP sessions over each month based on the current clinical model. This issue is most prevalent at weekends and over public holidays. 5.23 The intention has been work towards a rebalanced multi-disciplinary workforce model (as per the recommendations of the National Review) by: Seeking to employ a greater proportion of salaried GP’s who can be rostered over all of the shifts (noting that given the national shortage of GPs, that this will take time to achieve) and so reduce the reliance on the number of sessional GPs required (who understandably opt into shifts which suit their circumstances). Moving to a revised ratio of 50% GPs to 50% other clinicians (50:50 ratio), initially by seeking to increase ANP capacity. 5.24 In the PCOOH, ANPs provide assessment, clinical care and management of both the stable and acutely unwell patient and their family. They are trained to make complex and autonomous decisions using advanced skill and knowledge; and have overall responsibility for the assessment of care needs and the delivery of advanced care. They are able to assess patients face-to- face, remotely (telephone and video consultations) and during house visits. 5.25 Due to legislative and competency-based limitations, ANP practice is restricted in the following areas: Low age paediatric presentation (age might vary between ANPs due to individual stages of development and dependence on access to support/overview by senior clinician when there is need for indirect supervision) – starting with under 4-year olds Capacity assessment (Adults with Incapacity – AWI) Mental Health Detention Acute Mental Health Certification of Death Obstetrics (maternity and pregnancy related presentations)
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7 5.26 In circumstances where competency or legislative restrictions limit the ANPs practice, care of patients is navigated or escalated accordingly and in line with locally agreed processes to a relevant professional with the required competency, whether Senior ANP, GP or relevant acute care speciality. 5.27 As a senior clinician within the PCOOH the Senior ANPs play an important part in leadership and teaching for both AHP, nursing and junior medical staff, making appropriate referrals to, and co-ordination the contribution of other members of the multi-disciplinary team. The Senior ANPs participate in the GP rota as appropriate, with indirect consultant / GP or advanced care practitioner lead supervision as appropriate. 5.28 Realising the potential of Senior ANPs as senior clinical decision makers and Clinical Service Duty Holders aligns with workforce modernisation and strategic workforce planning and the overall aim of NHSL to maximise the potential of resources, ensuring excellence in care and better outcomes. NHSL has developed and maintains robust organisational processes and governance in relation to Advanced Practice roles. These governance processes are guided and informed by the West of Scotland Advanced Practice Academy. Assurance around Advanced Practice roles is outlined in NHSL Advanced Practice Governance framework. 5.29 The existing ANP workforce working with PCOOH have their core roles in daytime General Practice; and are pivotal to the implementation of the Primary Care Improvement Plan (PCIP). Consequently, for example, they cannot be secured on a Sunday night as they are already rostered for the Monday in their core role. It is also important to ensure the wellbeing of this scarce ANP workforce to ensure there is good retention and future recruitment to these posts which support a considerable amount of urgent care activity across the system. These posts are critical to and focused on the delivery of the PCIP and contributing to the sustainability of General Practice (which is another risk area within NHSL). Their support to PCOOH cannot therefore be to the detriment of their core function; and from a recruitment perspective, the PCOOH requirement for the role is a further demand into a limited supply line. 5.30 Strengthening the multi-disciplinary workforce is dependent not only on nursing but the development of an advanced practice strategy for Lanarkshire - incorporating AHPs, paramedics and pharmacists, amongst others. 5.31 There are already approvals in place for a new clinical model and supporting project which will move the PCOOH service to a more multi-disciplinary workforce and competency-based model of care. A clinical lead for a session may therefore be a doctor, nurse/AHP consultant, or a senior ANP who possess the agreed competencies to provide safe and effective patient care. This approach to care continues to support best practice where patients receive person-centred, safe, high-quality care and enhances the traditional medical/GP leadership model of service delivery.
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8 5.32 Given the realities of workforce availability, it continues to be challenging to routinely operate from two centres, so and the imperative for safe service delivery has necessarily limited the scope to operate from the Airdrie PCC. 5.33 There has also been increasing need to invoke the redirection procedure whereby patients are directed to attend the emergency department (ED) at one of the three main NHSL acute sites. This occurs for two reasons: either there are rota gaps for particular clinicians (e.g. GP or ANP), and for example children under four cannot be seen by the service; or there is an increase in demand during a session and the waiting times become unsafe requiring a redirection of some patients. 5.34 Redirections will be requested when the queue builds to the extent that: Further patients referred in will not be seen before the service closes The queue has built up to a level where the capacity to manage them safely at even the subsequent session is compromised, i.e. the available capacity is already fully committed and the waiting list continues to grow with new referrals (noting that there will be fewer staff on a weekend overnight for example relative to the day shift) 5.35 When the redirection procedure is invoked, new referrals are directed to EDs allowing PCOOH to work through the existing queue. Redirected patients who do not attend ED will refer themselves to PCOOH on a subsequent shift; some go to their GP; and a cohort do not present anywhere immediately. 5.36 It should be noted that when redirection is invoked, the majority of patients (on average 76%) do not present at their local ED. Where there is a redirection, the number of patients who present at an individual acute site are in (typically low) single figures. The redirections occur over the weekend period. Of the 76% who do not present to ED, approximately half of these patients do not go anywhere; and the other half either recall NHS 24 or call their in-hours practice. 5.37 As with other parts of the NHSL system, PCOOH are frequently presented with patients with low acuity; and about matters that should have been addressed earlier in the day /week. Similar to ED, PCOOH is not always used appropriately. An example was over one of the recent public holidays where there were numerous calls about prescriptions that patients had not dealt with via their local pharmacy or GP practice. 5.38 In common with other services which receive referrals from NHS 24, the PCOOH service has concerns about some of the unintended outcomes of the current model of and algorithms used for NHS 24 triage. When patients are reviewed through telephone consultation by our PCOOH service, up to 50% of PCC cases and up to 67% of home visit cases can be managed by means other than a face-to-face assessment. Engagement with NHS24 is planned. 5.39 The current identified risk is that there could be sessions where it is not possible to operate due to workforce availability. As noted in this report the
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9 risk arises at weekends and is subject to active mitigation as has been separately reported within the Health Board risk register: by the ongoing review of workforce capacity; the concentration on the main PCC; the escalation process for redirections; and the programme plan which support the Horizon 1 and 2 (see below). Meeting the Challenges 5.40 Pre-pandemic, a Project Board – with a project plan - had been established to strengthen the PCOOH service. Given the ongoing challenges in running the service and as endorsed by the Health Board in autumn 2021, SLHSCP undertook a further process to seek external feedback on the nature and currency of the work undertaken to-date; and identify areas for potential learning from other Health Boards. The PCOOH management team and members of SLHSCP Senior Management Team engaged with colleagues from other Health Boards and the Scottish Government Primary Care team who agreed to be ‘critical friends’, offering an informed external perspective on the content and vision of the project plan to ensure that it was realistic and representative of a contemporary service. 5.41 Overall, the feedback was positive and supportive of the work that has been completed and was planned by the PCOOH team. The discussions noted that the challenges in Lanarkshire reflect those of other Health Board areas; that we the PCOOH are following best practice; and have demonstrated innovative thinking. 5.42 These engagements have reinforced the importance of investing in multi- disciplinary clinical leadership; staff wellbeing; communication; and positive marketing of the service. These are all elements which are currently being addressed - as far as it possible and realistic - within Horizons 1 and 2. For example, work is underway with the NHSL Communications team to improve the marketing of roles in PCOOH. The embedded video clip is an example of this: https://vimeo.com/699727148/1aca2c9bd9 5.43 Fundamentally though – and looking forward - a more ambitious (and potentially Scotland-leading) “solution” is required. Urgent Care 5.44 Urgent care in the community is that which requires a response before the next routine care service (or appointment). The over-riding principle is “right care, in the right place, at the right time”. 5.45 Nationally, urgent care is being redesigned - phase one of this saw the introduction of Flow Centres in December 2020. 5.46 At a time when there is increasing demand on primary care (where it is estimated 90% of urgent care is delivered), workforce challenges and GP sustainability issues, we need to look to radically change urgent care delivery to ensure sustainable services in Lanarkshire.
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10 5.47 There is much to commend a model which would bring together the co- ordination of a number of existing urgent care services together under the auspices of an overall co-ordinating multi-disciplinary hubs. Such an approach should incorporate consideration of primary care out of hours provision, to reinforce and strengthen its important contribution to a whole system approach to delivering urgent care for local people. 5.48 Given the above then, a three horizons approach - as illustrated below - is proposed for moving the service forward: Horizon 1 - Stabilisation Horizon 2 - Implementing a new Clinical Model Horizon 3 - Developing an updated whole system Urgent Care Model Horizons 1 and 2 are broadly described though the existing project plan for moving the service forward; and via the new Clinical Model and workforce modelling which supports this intention. A future paper will be brought forward setting out proposed destinations for Horizon 3, taking into account the role of PCOOH within the wider approaches to GP sustainability and urgent care redesign. Horizon 1 5.49 As noted throughout this report, Horizon 1 needs to continue a focus on stabilising the service – with key actions being to: Deliver a safe and urgent primary care service for patients Ensure that the PCOOH team are appropriately supported as part of the wider NHSL system Strengthen the interface with the wider system Focus on the main PCC, with Airdrie PCC opened when safe and when possible to do so Continue public communication and engagement about the role and use of the service Engage with NHS24 in respect of the triage algorithms
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11 Horizon 2 5.50 Horizon 2 is about fully establishing the rebalanced multi-disciplinary clinical model, notably: Develop the competency-based clinical leadership model Recruit to the rebalanced multi-disciplinary team clinical model Horizon 3 factors in the timeline to recruit and fully train an ANP/Senior ANP workforce; and having the competency-based clinical leadership model fully up and running. Horizon 3 5.51 Horizon 3 is about developing, consulting upon, agreeing and then establishing an updated Urgent Care Model, within which primary care out of hours delivery would be a key and integrated element. This is required to more substantially address the current and growing risks to the delivery of PCOOH; and contribute to mitigating the significant risks to general practice sustainability. 5.52 In terms of proceeding with Horizon 3, an immediate action would be to establish a New Urgent Care Model workstream within the Urgent Care Recovery structures; and thereafter to update the NHSL Board and both South and North Lanarkshire IJBs accordingly of the issues within this report and the developmental work to be progressed. 6. CONCLUSIONS 6.1 The paper has provided an overview of the Lanarkshire PCOOH; the challenges it faces; its positive performance despite these challenges; the summary feedback from the review of the existing project plan; and next steps proposed to manage these challenges moving forward. 6.2 A three horizons approach is proposed for moving the service forward: Horizon 1 - Stabilisation Horizon 2 - Implementing a new Clinical Model Horizon 3 - Developing an updated whole system Urgent Care Model 6.3 In terms of proceeding with Horizon 3, IJB members are asked to endorse the proposal to establish an Urgent Care Model Development workstream within the NHSL Urgent Care Recovery structures subject to approval from the South Lanarkshire IJB (as host). 6.4 Further reports will be provided to South and North Lanarkshire IJBs and the Board of NHS Lanarkshire of the issues within this report and the developmental work being progressed. 7. IMPLICATIONS
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12 7.1 NATIONAL OUTCOMES People who use Health and Social Care Services have positive experiences of those services, and have their 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 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) 7.2.1 Performance Measures are reported weekly and monthly on 1, 2 hours and 4 hours targets (as described above). 7.3 FINANCIAL This paper has been reviewed by Finance: Yes X No N/A 7.3.1 For Horizon 2, the additional posts and required spend plan to support the growth and development of the rebalanced multi-disciplinary clinical model will be managed within the existing budget. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 This report concerns – and the proposals would contribute to the further mitigation of – the following items on the NHSL Corporate Risk Register: 2126 – Sustaining Out of Hours Primary Care Service (Current Risk Very High – Target Medium) 2150 – Sustaining GP Services (Current Risk Level High – Target Medium) 7.5 PEOPLE 7.5.1 This report has reinforced the importance of investing in multi-disciplinary clinical leadership; staff wellbeing; communication; and positive marketing of the service. As described, these are all elements which are currently being addressed - as far as it possible and realistic - within Horizons 1 and 2. For example, work is underway with the NHSL Communications team to improve the marketing of roles in PCOOH. The embedded video clip is an example of this: https://vimeo.com/699727148/1aca2c9bd9 7.5.2 Communication support will be enlisted in respect of the three horizon approach, notably: In relation to Horizon 1 the Communication team are devising and distributing ongoing public messaging to encourage people to engage with PCOOH appropriately. Work is ongoing - both locally and nationally - to target
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13 audiences; support ‘right care, right place’ messaging; and encourage personal responsibility (for matters such as having adequate medication supplies before bank holiday periods, for example). In relation to Horizon 2, the Communication team are progressing work to improve the marketing of roles in PCOOH. In relation to Horizon 3, a comprehensive communication plan would be required to be developed to support consultation and engagement activities. This would seek to ensure optimised stakeholder awareness and involvement whilst, crucially, also ensuring the requirements of the national Planning with People guidance are met. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A X 7.6.1 EIAs will be undertaken as part of Horizon 3, to inform on-going developments. 8. BACKGROUND PAPERS Main Report of the National Review of Primary Care Out of Hours Services https://www.gov.scot/publications/main-report-national-review-primary-care- out-hours-services/ 9. APPENDICES None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Soumen Sengupta, Chief Officer - South Lanarkshire Integration Joint Board on telephone number 01698 453700.
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1 REPORT Item No: 9 SUBJECT: NHS Lanarkshire Children and Adolescent Mental Health Services (CAMHS)- CAMHS Improvement Programme TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Owen Watters, Interim General Manager Specialist Children’s Health Services Unit DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the Integration Joint Board For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: the Specialist Children’s Health Services Unit 3. RECOMMENDATIONS 3.1 It is recommended that Integration Joint Board: Note the progress of the programme and note further development steps (appendix 1) 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 In January 2021, the Specialist Children’s Health Services Unit (SCHSU) was formed bringing a centralised approach to the operational delivery of children’s specialist health services across Lanarkshire. In April 2021, North HSCP Yes No N/A
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2 received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 5.1.2 The CAMHS Modernisation Strategy 2021-23 articulates how CAMHS in Lanarkshire will implement the National CAMHS Service Specifications in addition to SG directives by March 2023. This has been previously presented to the IJB. 5.1.3 In order to co-ordinate the further development of the Child and Adolescent Mental Health Services (CAMHS), NHS Lanarkshire has established the CAMHS Recovery and Renewal Programme Board with broad representation (appendix 2). This is chaired by the Health and Social Care Partnership Medical Director and has support from a Professional Adviser from the Scottish Government. The service has produced a service improvement plan (provided in appendix 2) which covers workforce; CAPA; accommodation; eHealth; communication and engagement; finance; and performance. The Programme Board will monitor timescales and key milestones. 5.1.4 A new fulltime Clinical Director for each CAMHS service has been appointed to work alongside business managers to ensure equitable access and clinical accountability for delivery of targets for CAMHS. 5.1.5 The main areas of focus of the CAMHS Modernisation Strategy are: Implementation of the Choices and Partnership Approach service transformation model for CAMHS by March 2023. Full implementation of the national CAMHS Specification to include extension of age range, requirements for eating disorder patients and planning for transition of care by March 2023. Numbers of children and young people in CAMHS already nearing the age of 18 requires to be gathered and numbers of patients who wish to remain under the care of CAMHS requires to be quantified in order to inform demand. Timelines for this activity are contained within the project plan. CAMHS South Lanarkshire accommodation went ‘live’ on Monday 5 September 2022 with the first patients visiting this centre to see both South Locality CAMHS teams, Eating Disorder Team and the South Neurodevelopmental Team. The new building hosts bright and renovated accommodation to suit all age ranges and includes an in house treatment room, playroom, suitable staff workspace and several clinic spaces including rooms to facilitate group sessions and service meetings and workshops. This site is in addition to the remainder of some satellite clinics across South Lanarkshire health centres allows for patients and ensure local access for those who are unable to travel. An official opening for this facility is currently being scheduled and organised. A workforce review and associated recruitment campaign utilising the allocated monies from SG Recovery & Renewal Fund (RRF) which for CAMHS is £3.3 million is planned between June and December 2021. Additional monies will also be secured via SG to support implementation of the Neuro Developmental Pathway (NDP). Recruitment has been planned in
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3 two phases to coincide with allocation of funding streams. Phase 1 is currently underway and the aim is to have recruited to these posts by Summer 2022. Phase 2 will commence once confirmation of NDP budget is received. 5.1 Workforce Demand and Capacity 5.1.1 CAMHS are currently receiving improvement support from the Scottish Government Mental Health Directorate and work has been completed with the Scottish Government Improvement Advisor and Professional Advisor to analyse CAMHS capacity (based on current funded establishment) against demand (numbers of referrals per head of population). From this analysis, it is evident that in order to meet RTT trajectory, CAMHS requires 131 WTE of which 90 WTE must deliver services that contribute to the RTT. Recruitment continues and the attached information in appendix 3 describes the current recruitment situation. 5.1.2 A local exercise to establish CAMHS capacity is underway with this scheduled to be reviewed in September. An expected outcome of this is the design and implementation of a CAPA calculator/timetable to provide an even spread of choice and partnership appointments across teams, with regular review (every 12 weeks) of capacity against demand to allow enhanced/sufficient capacity for new/return patient appointments, with the correct ratio for staff groups to ensure waiting time management. It is anticipated that this will be in place following the waiting list initiative described below to ensure seamless transition. Waiting List Management and Initiative 5.1.3 Detail is provided within the Project Plan in relation to a completed Waiting List validation exercise which saw a reduction in the list by 15%. These patients either no longer wanted treatment or did not opt in to remain on the waiting list as per NHS policy. 5.1.4 A waiting list initiative commenced at the end of August 2022 to provide additional sessions to complete new patient assessments both in and out of current working hours. Initial results have taken 123 patients from the waiting lists. Workforce & Allocation of RRF Monies 5..1.5 Following funding provided by the Scottish Government’s mental health renewal and recovery fund (RRF), NHS Lanarkshire’s CAMHS reviewed current staffing levels and sought to recruit a total of 102 positions to provide additional capacity to all parts of CAMHS. This included the establishment of a new nursing team, as well as the introduction of other allied health professional roles, to support the work carried out by CAMHS. As with other health boards, NHS Lanarkshire has had challenges in recruiting to some specialities, such as psychology. Some recruitment took place internally which saw a shift in post-holders moving from one position to another, rather than new post-holders coming into the service. That said, NHS Lanarkshire has
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4 been successful in recruiting 59 posts, all of which contribute to the wider system. Please refer to appendix 3 for more information on breakdown of posts recruited. 5.2 Choices & Partnership Approach 5.2.1 A crucial working group is being set up to review the CAPA approach and design and implement the aspects of this way of working required for CAMHS in Lanarkshire. As noted above a capacity calculator that demonstrates the requirement for choice and partnership appointments to meet demand, flexibility in the management of appointments every 12 weeks as well as consideration of urgent/unscheduled demand (duty system) is to be reviewed in more detail by this working group. 5.2.2 Detail on the specific work and timelines required to implement this model is provided in the CAMHS Programme Plan (appendix 1). Implementation of this model is wholly dependent on our ability to recruit workforce and secure accommodation, IT and supportive administrative infrastructure. 5.2.3 The project plan provided gives further detail on planned activity required to allow CAMHS to expand service age range from 18-25 and to implement the transition care protocol. As already mentioned, assessment of the current age range of children and young people in CAMHS is required with further work required to ascertain numbers of young people choosing to remain under the care of the CAMHS team. 5.2.4 A series of workshops attended by representatives from the Directorate for Mental Health at SG have already been held and outcomes of these cascaded to staff across the service and support services. These workshops included CAPA engagement sessions for the CAMHS management team, a CAPA Master Class for CAMHS clinicians and a separate information session for HSCP leaders. 5.2.5 CAMHS in Lanarkshire visited CAMHS colleagues in NHS Grampian to establish a supportive network and learn lessons from their implementation of the CAPA model. 5.2.6 CAMHS are currently in receipt of improvement support via the SG Mental Health Division Performance Unit Liaison Lead, Professional Advisor and Improvement Advisor. This support will continue for the duration of the modernisation programme. 5.3 Accommodation 5.3.1 A major development within the CAMHS service plan was the development of a new South Lanarkshire CAMHS facility, supporting CAMHS teams, Eating Disorders and the Neurodevelopmental service. 5.3.2 The site was developed in conjunction with children and young people, ensuring it creates a welcoming and appropriate environment for all service users. 5.3.3 The Udston site went live on 5th September for patients.
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5 5.3.4 Significant improvements have also been made with North Lanarkshire sites, with the final goal of creating a consistent set of core facilities across Airbles Road, Coathill Hospital and Udston Hospital based on the principles co- designed with our children and young people. 5.4 eHealth 5.4.1 As part of the modernisation of CAMHS in Lanarkshire, NHS Lanarkshire has undertaken a cleanse exercise of its patient management system, Trakcare. This includes a refresh of the options available for staff to book patients in different locations and under specific clinicians. Once completed, this will have a positive impact on the data being extracted which will be used to report 18-week referral to treatment performance to Public Health Scotland. We are confident that this will also allow management staff to understand capacity versus demand more robustly, which in turn will allow better planning and leaner pathways for children and young people. 5.4.2 In addition to this, NHS Lanarkshire is working with its largest referrer group, General Practitioners, to enable electronic referrals to be sent to CAMHS using the national system. 5.4.3 Work is also underway to move GP referrals onto the SCI Gateway system. The benefits in using this system means that information is available to referrers about the services CAMHS provides, as well as other support services and accurate/robust information at the point of referral. This will ultimately allow CAMHS to make decisions at the point of vetting more timeously and clinically appropriate. 5.4.4 All our mental health inpatient estate has embedded ward Quality Groups which has supported development of local outcomes around meaningful activity for individuals within our acute admission areas. 5.4.5 The Triangle of Care model has been embedded within all of our inpatient wards to support family and carer involvement wherever possible. 5.4.6Further eHealth work includes moving current paper records to an electronic patient record (MORSE). This will release time for clinicians and administrative staff as well as enhance information governance security. Interfaces between systems are also key to allow a more streamlined approach to working with the necessary information between electronic referrals, appointments and record systems. 5.5 Communication and Engagement 5.5.1 Extensive staff consultation in conjunction with Human Resources and Partnership is required in order to embed this Modernisation Strategy with particular reference to the CAPA transformation model. 5.5.2 Stakeholder engagement events were organised in 2021 to include HSCP CORE and Strategic Leadership Teams. We were supported through these events by NHS Grampian who facilitated question and answer sessions via MS Teams.
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6 5.5.3 It is important that frontline staff are on board with direction of travel and that their experience and knowledge inform the development of new ways of delivering services. Staff engagement events are part of the action plan. 5.5.4 A CAMHS Communication and Engagement Task Group has been established to develop a Communication and engagement plan to set out the communication and engagement requirements for the delivery of the programme. 5.5.5 The programme also has a dedicated engagement officer to support and lead on engagement activities and events with key stakeholders, partners and local communities. A significant programme of engagement is being developed. 5.6 Finance 5.6.1 With extensive new recurring investment from Scottish Government, a finance group is in place to review progress with recruitment and ensure all posts are fully aligned within the service budget. 5.6.2 CAMHS has been underspent in recent years due to the inability to recruit to all vacancies and with the Recovery and Renewal Funding arriving in full from day one, this has led to further underspends, though we have ring-fenced this to allow for future developments such as accommodation improvements. 5.7 Performance 5.7.1 A paper was presented to the IJB Performance, Finance and Audit Committee in August 2022, outlining plans to create an extended performance framework that better focuses on the whole system nature of performance. 5.7.2 What we measure matters; things we measure invariably become prioritised and conversely, what we don’t measure become deprioritised. 5.7.3 The HSCP is currently commencing a programme of work aimed at refreshing the performance framework, with CAMHS as an early example of how this will work. At present, CAMHS performance reporting focuses on only the tier 3 service waiting times. Moving forwards, we aim to extend the performance reporting to cover the whole system, starting with the community mental and health and wellbeing funded projects based within the third sector; school counselling throughput and outcomes; Distress Brief Interventions (DBI); CAPA approach (early review of referrals, onward signposting and CAMHS referrals); finalising with the CAMHS referrals and waiting times. 5.7.4 By taking this much broader view of service provision, we will ensure equal value is placed on all aspects of the system and have a much better understanding of how the system as a whole is working and the outcomes achieved for individuals. 6. CONCLUSIONS 6.1 The CAMHS service has been heavily impacted by the pandemic, with increased urgent case demands and a significant backlog of cases. As part of the recovery process, the service has been working alongside colleagues in the Scottish Government’s Mental Health directorate to formulate plans that aid recovery and meet the new national service specification.
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7 6.2 The Scottish Government Mental Health Recovery and Renewal Fund (RRF) provides scope to expand the workforce to create the capacity required to recover to 90% performance by March 2023, alongside the roll out of the new national service specification. 6.3 The recovery plans for the Lanarkshire service are included in the appendices. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES CAMHS services impact on a number of national outcomes and children’s outcomes. 7.2 ASSOCIATED MEASURE(S) CAMHS performance forms part of the NHS Board Annual Operational Plan against a 90% Referral to Treatment standard 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT CAMHS performance sits on the North HSCP operational risk register as well as the IJB’s risk register. 7.5 PEOPLE Post pandemic, it is clear that additional staffing is required to support the service to meet its operational targets. New SG funding will have a big impact on performance, but will also importantly provide much needed support to the existing staff group. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). A significant programme of engagement is detailed within the project plan. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A If EQIA/Fairer Scotland Impact Assessment Form completed, please detail below the main issues and plans to mitigate; 7.8 CARBON MANAGEMENT IMPLICATIONS None noted. 8. BACKGROUND PAPERS The following papers are available upon request:
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8 Letter from SG Mental Health Directorate to NHS Boards SG RFF spend CAMHS Referral Process ‘as is’ CAMHS CAPA Referral Process 9. APPENDICES Appendix 1: CAMHS Modernisation Programme Plan Appendix 2: Programme Organisation and Governance Appendix 3: CAMHS & NDS Data – Recruitment ............................................................................ CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Owen Watters on telephone number 01698 361 100.
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ID Task Name Start Finish RAG Status Resource Names 1 CAMHS Improvement Programme Mon 01/02/21 Sun 31/12/23 2 Proposal Stage Mon 01/02/21 Thu 13/04/23 3 Project Scope Fri 21/05/21 Fri 21/05/21Complete 4 1st CAMHS Development Workshop Fri 21/05/21 Fri 21/05/21 Complete Emer Shepherd 5 Project Brief Wed 26/05/21 Fri 10/09/21 6 Project Brief drafted Wed 26/05/21 Wed 26/05/21Complete Programme Team 7 Project Brief Reviewed Mon 20/09/21 Mon 20/09/21Complete Emer Shepered 8 Project Brief issued for comment Wed 26/05/21 Wed 26/05/21Complete Emer Shepered 9 Governance Wed 02/06/21 Tue 08/03/22 10 Appoint Programme Board Wed 02/06/21 Wed 02/06/21Complete CAMHS Mgt Team 11 Agree membership of Programme Board Wed 02/06/21 Wed 02/06/21Complete CAMHS Mgt Team 12 Draft Terms of Reference Wed 02/06/21 Wed 02/06/21Complete Project Manager 13 Agree terms of reference Wed 02/06/21 Wed 02/06/21Complete Project Manager 14 Establish Monitoring and Reporting Wed 02/06/21 Wed 02/06/21Complete CAMHS Mgt Team 15 Funding Fri 21/05/21 Thu 01/12/22 16 Strip funding bid paper to reduce figures to meet SG RRF Wed 02/06/21 Fri 02/07/21 Complete CAMHS Mgt Team 17 Review and engage with Scottish Government regarding funding bids paper – ask for entire list costs to be met. Fri 21/05/21 Fri 21/05/21 Complete Emer Shepered 18 Confirm a substantive funding for ND Wed 13/07/22 Wed 20/07/22Complete Mhairi Ward 19 Confirm RRF2 Money Fri 21/05/21 Fri 21/05/21 Complete Mhairi Ward 20 Initiation Stage Tue 01/06/21 Thu 10/06/21 21 Project Plan Tue 01/06/21 Tue 30/08/22 Complete 22 Project Plan drafted Fri 18/06/21 Fri 30/07/21 Complete Project Manager 23 Project plan issued for comments Thu 03/06/21 Wed 30/06/21Complete Project Manager 24 Project plan approved Tue 13/07/21 Tue 13/07/21 Complete Emer Shepered 25 Project Plan circulated Tue 20/07/21 Tue 20/07/21 Complete Project Manager 26 Project Plan to be review and updated Wed 24/08/22 Wed 24/08/22On track CAMHS Mgt Team 27 Implementation stage (Full implementation of the Child and Adolescent Mental Health Service (CAMHS) Specification – Community CAMHS) Tue 01/06/21 Sun 31/12/23 28 Programme Tasks Tue 01/06/21 Sat 19/08/23 29 Update Nursing options paper following workshop held on 21/05/21 Fri 21/05/21 Fri 02/07/21 Complete Mhairi Ward/Karen McCaffrey 30 Update draft process maps (for referral's into service/AS IS and TO BE) Fri 21/05/21 Fri 02/07/21 Complete Laura Jack/Mhairi Ward 31 Schedule further workshops (arrange agenda's etc.) Fri 21/05/21 Fri 04/06/21 Complete Project Team/SIM/GM 32 Complete and report on activity census Tue 01/06/21 Tue 01/06/21 Complete Project Team/SIM/GM 33 CAPA Implementation Mon 15/08/22 Sat 31/12/22 34 Establish Short Life Working Group for CAPA Implementation/TOR Mon 15/08/22 Fri 09/09/22 On track CAMHS Mgt Team 35 Review teams timetables/scheduled/job plan for capacity and design Mon 15/08/22 Fri 09/09/22 On track CAMHS Mgt Team 36 CAPA Workshop 1 Mon 15/08/22 Mon 26/09/22On track CAMHS Mgt Team 37 CAPA Workshop 2 Mon 15/08/22 Mon 26/09/22Not started CAMHS Mgt Team 38 Agree CAPA implementation Thu 01/12/22 Fri 30/12/22 Not started CAMHS Mgt Team 39 Implement fully the national CAMHS specification Fri 30/12/22 Fri 30/12/22 Not started CAMHS Mgt Team 40 Evaluate/measure CAPA implementation Fri 30/12/22 Fri 30/12/22 Not started CAMHS Mgt Team 41 Workforce & Recruitment Mon 01/02/21 Fri 31/03/23 42 Project Start Mon 01/02/21 Wed 23/02/22 43 HR & Workforce working group established Wed 23/02/22 Wed 23/02/22Complete Jan Hamill 44 Membership of group confirmed Wed 23/02/22 Wed 23/02/22Complete Jan Hamill 45 TOR signed off Mon 01/02/21 Mon 01/02/21Complete Jan Hamill 46 CAMHS and NDS Workforce and Recruitment Sun 31/10/21 Fri 31/03/23 47 Recruitment to fill vacancies and new posts ongoing Fri 31/03/23 Fri 31/03/23 At risk Jan Hamill 48 3 WTE HR Recruitment Administrators recruited and in post on a FTC until 31/3/23 to support CAMHS Managers Sun 31/10/21 Sun 31/10/21 Completed Jan Hamill 49 Ability to source qualified workforce Fri 01/04/22 Fri 31/03/23 At risk Jan Hamill 50 Not all CAMHS recruitment will impact on reducing waiting list targets. Part of this might include the high vacancy figures within locality teams which may be somewhat masked by recruitment to other areas of CAMHS.Fri 01/04/22 Fri 31/03/23 At risk Jan Hamill 51 CAMHS / NDS Communication Mon 01/02/21 Mon 01/02/21 52 Engagement Officer started in post aligned specifically to CAMHS / NDS Mon 01/02/21 Mon 01/02/21Completed Lorina Gilroy 53 Communications Manager link with Service to update Staff on ongoing changes and progress regarding recruitment/eHealth progress/accommodation changes Mon 01/02/21 Mon 01/02/21Ongoing Mark Dell 54 Accommodation for more information please refer to separate Project Plan) Mon 01/02/21 Fri 31/03/23 55 Review Capacity Plan/use of clinical space across North and South Mon 01/02/21 Mon 01/02/21Complete Clinical Managers/Mgt Team/CD 56 Scope out accommodation detail i.e. number of rooms/layout/ratio of utilisation (North and South) Mon 01/02/21 Mon 01/02/21Complete Estates/CAMHS Mgt/Unit Mgt 57 CAMHS Accommodation Workshop Fri 02/07/21 Fri 02/07/21 Complete Estates/CAMHS Mgt/Unit Mgt 58 Refurbishment of Douglas Ward within Udston Hospital Tue 02/02/21 Mon 05/09/22Complete Estates/CAMHS Mgt/Unit Mgt 59 Go Live - Udston CAMHS Mon 05/09/22 Mon 05/09/22Complete Estates/CAMHS Mgt/Unit Mgt CAMHS Improvement Programme Appendix 1
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ID Task Name Start Finish RAG Status Resource Names 60 Set up design group for upgrade of North CAMHS accommodation Mon 15/08/22 Fri 30/12/22 Complete Clinical Managers/SIM/OSM 61 Provide report of costs for North upgrade re accommodation Mon 15/08/22 Fri 30/12/22 On track Estates/CAMHS Mgt/Unit Mgt 62 eHealth Tue 01/06/21 Mon 18/09/23 63 Project Start Thu 07/10/21 Thu 04/11/21 64 eHealth working group established Thu 07/10/21 Thu 21/10/21 Complete Laura Jarvie 65 Membership of group confirmed Thu 07/10/21 Thu 21/10/21 Complete Laura Jarvie 66 TOR signed off Thu 21/10/21 Thu 04/11/21 Complete Laura Jarvie 67 Planning Tue 01/06/21 Tue 02/01/24 68 Information Gathering work started Thu 04/11/21 Thu 02/12/21 Complete Laura Jarvie 69 Information Gathering Workshops (1st Meeting) Thu 09/12/21 Thu 09/12/21 Complete Laura Jarvie 70 Information Gathering Workshops (2nd Meeting) Thu 16/12/21 Thu 16/12/21 Complete Laura Jarvie 71 Information Gathering Workshops (3rd Meeting) CAPA discussion Thu 05/05/22 Thu 05/05/22 Complete Laura Jarvie 72 TrakCare Build Thu 09/12/21 Tue 11/10/22 73 Change Controls agreed & submitted Thu 09/12/21 Tue 02/08/22 Complete Laura Jarvie 74 TrakCare Letters Mon 07/03/22 Wed 06/04/22Complete Laura Jarvie 75 TrakCare Outcomes Tue 21/12/21 Tue 07/06/22 Complete Laura Jarvie 76 CAPA demo with Grampian Tue 19/04/22 Tue 19/04/22 Complete Laura Jarvie 77 TrakCare Specialties build Tue 21/12/21 Fri 03/06/22 On track Laura Jarvie 78 TrakCare Testing Mon 17/01/22 Fri 02/09/22 On track All 79 Clinic Build review/CAPA calculator - Pilot Sites Fri 11/03/22 Fri 05/08/22 On track Laura Jack 80 Clinic Build on TrakCare - Pilot Sites Fri 12/08/22 Mon 05/09/22Not started Joyce Galloway 81 Clinic Build review/CAPA calculator - rest of service Mon 19/09/22 Fri 30/09/22 In progress - awaiting job schedules/timetable for whole services 0 deadline 12/8 Laura Jack 82 Clinic Build on TrakCare Mon 03/10/22 Tue 11/10/22 Not started Joyce Galloway 83 SCI Gateway Build Wed 01/06/22 Tue 02/01/24 84 SCI Gateway Protocol documented and signed off Wed 01/06/22 Sat 31/12/22 Not started Scott McLaughlin 85 SCI Gateway Protocol Build Wed 01/06/22 Sat 31/12/22 Not started Scott McLaughlin 86 SCI Gateway testing Wed 01/06/22 Sat 31/12/22 Not started Scott McLaughlin 87 Interface work Mon 04/04/22 Fri 14/10/22 88 Functional Specification documented and signed off Mon 04/04/22 Mon 25/04/22Complete Julie McCulloch 89 Suppliers meet with NHSL to discuss Technical Specification options Mon 22/08/22 Wed 31/08/22Not started Julie McCulloch 90 Interface Build Thu 01/09/22 Wed 07/09/22Not started Julie McCulloch 91 Interface Testing Mon 05/09/22 Fri 16/09/22 Not started Julie McCulloch 92 Functional Testing Mon 05/09/22 Fri 14/10/22 Not started Julie McCulloch 93 Morse Build Fri 26/08/22 Thu 01/09/22 94 Team Build Fri 26/08/22 Thu 01/09/22 Not started Robert McTear 95 Form Build Fri 26/08/22 Fri 02/09/22 Not started Robert McTear 96 User accounts created Fri 26/08/22 Fri 26/08/22 Not started Robert McTear 97 Staff Training & Support Mon 29/08/22 Fri 07/10/22 98 TrakCare Refresher Training - Pilot Sites Mon 29/08/22 Fri 02/09/22 Not started Laura Jarvie 99 Trakcare Refresher Training - Rest of Service Tue 27/09/22 Fri 07/10/22 Not started Laura Jarvie 100 User Accounts reviewed Mon 29/08/22 Fri 02/09/22 Not started Laura Jarvie 101 Staff Support - Pilot Sites Mon 29/08/22 Fri 02/09/22 Not started Laura Jarvie 102 Staff Support - rest of service Tue 27/09/22 Fri 07/10/22 Complete Laura Jarvie 103 Reporting Tue 01/06/21 Tue 01/06/21 104 Reporting requirements documented and signed off Tue 01/06/21 Tue 01/06/21 Not started Stewart Welsh 105 Communications Sun 31/07/22 Sun 31/07/22 106 Children's Services Newsletter (will be monthly going forward) Sun 31/07/22 Sun 31/07/22 Ongoing Laura Jack 107 NDS Build Mon 20/12/21 Wed 31/08/22 108 TrakCare Change Controls agreed & submitted Mon 20/12/21 Fri 22/07/22 Complete Laura Jarvie 109 TrakCare Build Inc. outcomes and appointment types Mon 10/01/22 Sun 31/07/22 Complete Laura Jarvie 110 TrakCare Back Keying Referrals under new code Mon 01/08/22 Wed 31/08/22On track Suzanne Shields 111 TrakCare Clinic Review Mon 01/08/22 Wed 31/08/22On track Suzanne Shields 112 Communication & Engagement Mon 02/05/22 Fri 14/04/23 113 Project Start Mon 02/05/22 Mon 02/05/22 114 Comms & Engagement working group established Mon 02/05/22 Mon 02/05/22Complete Mark Dell/Lorina Gilroy 115 Membership of group confirmed Mon 02/05/22 Mon 02/05/22Complete Mark Dell/Lorina Gilroy 116 TOR signed off Mon 02/05/22 Mon 02/05/22Complete Mark Dell/Lorina Gilroy 117 Communication Mon 02/05/22 Fri 14/04/23 118 Website content to be reviewed and refreshed Tue 15/03/22 Tue 15/03/22 Complete Mark Dell 119 Social media Mon 02/05/22 Mon 02/05/22Complete Mark Dell 120 Communication Plan Mon 13/06/22 Thu 13/06/24 On Track Mark Dell 121 Newsletter for staff Fri 02/09/22 Tue 02/05/23 Ongoing Mark Dell CAMHS Improvement Programme
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ID Task Name Start Finish RAG Status Resource Names 122 Newsletter for service users Fri 02/09/22 Tue 02/05/23 Ongoing Mark Dell 123 Media releases - key milestones Fri 02/09/22 Tue 02/05/23 Ongoing Mark Dell 124 Pulse articles Fri 02/09/22 Tue 02/05/23 Ongoing Mark Dell 125 Partnership Newsletter Fri 02/09/22 Tue 02/05/23 Ongoing Mark Dell 126 Engagement Activities Mon 02/05/22 Fri 14/04/23 127 Engagement Plan Fri 31/03/23 Fri 14/04/23 On Track Lorina Gilroy 128 Parent Forum Fri 14/04/23 Fri 14/04/23 Ongoing Lorina Gilroy 129 Youth Forum Mon 27/06/22 Fri 14/04/23 Ongoing Lorina Gilroy 130 Working Together: CAMHS (NHS Lanarkshire) and CVS Workshop Tue 16/08/22 Tue 16/08/22 On Track Lorina Gilroy 131 Attendance at local youth engagement events Tue 16/08/22 Fri 14/04/23 Ongoing Lorina Gilroy 132 REACH OUT TEAM logo and brand identity workshop and 1:1s Mon 24/01/22 Fri 14/04/23 On Track Lorina Gilroy 133 CAMHS Eating Disorder Team logo and identity/engagement focus groups Wed 15/06/22 Fri 14/04/23 On Track Lorina Gilroy 134 Udston Engagement Mon 10/01/22 Mon 10/01/22On Track Lorina Gilroy 135 Stakeholders Thu 03/03/22 Fri 03/03/23 136 Increase South Lanarkshire representation which is currently low Mon 24/01/22 Tue 03/01/23 On Track Lorina Gilroy 137 Stakeholder Analysis Thu 03/03/22 Thu 03/03/22 On Track Lorina Gilroy 138 SLWG Mon 15/08/22 Sat 31/12/22 139 SLWG for Education Mon 15/08/22 Sat 31/12/22 On track Lorina Gilroy 140 Agree Membership Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 141 Produce a brief Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 142 Schedule meetings Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 143 SLWG for GPs Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 144 Agree Membership Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 145 Produce a brief Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 146 Schedule meetings Mon 15/08/22 Sat 31/12/22 Not started Lorina Gilroy 147 Other Activities Mon 24/01/22 Mon 02/01/23 148 EQIA Mon 11/07/22 Fri 30/09/22 At risk Lorina Gilroy 149 CAMHS Logo and identity Mon 24/01/22 Mon 02/01/23On Track Lorina Gilroy 150 Implementation Stage (Expansion of community CAMHS from age 18 up to the age of 25 years old for targeted groups and those who wish it) Mon 01/02/21 Mon 30/01/23 151 Obtain definition re expansion of age group from Scottish Government Fri 02/07/21 Mon 30/01/23Not started Unit Mgt/CAMHS Mgt 152 Revisit transition documents with associated actions – consider staff/workforce for this Tue 01/06/21 Mon 30/01/23Not started Unit Mgt/CAMHS Mgt 153 Engage with North/South Social Work departs re LAAC extension involving service user groups Tue 01/06/21 Mon 30/01/23Not started Unit Mgt/CAMHS Mgt 154 Engage with adult mental health services re extension to age range Tue 01/06/21 Mon 30/01/23Not started Unit Mgt/CAMHS Mgt 155 Needs assessment to be undertaken for age range 18-25 years Tue 01/06/21 Mon 30/01/23Not started Unit Mgt/CAMHS Mgt 156 Implementation Stage (Clearance of any backlogs on waiting lists for CAMHS) Mon 01/08/22 Mon 31/10/22 157 Waiting List monitoring to be undertaken via WLC Mon 01/08/22 Mon 31/10/22On Track Unit Mgt/CAMHS Mgt 158 Planning stage re WLI/Options appraisal for triage/hub Mon 01/08/22 Mon 31/10/22On Track Unit Mgt/CAMHS Mgt 159 Implement WLI clinic Mon 01/08/22 Mon 31/10/22On Track Unit Mgt/CAMHS Mgt 160 Data capture re new/return ratio per clinic Mon 01/08/22 Mon 31/10/22On Track Unit Mgt/CAMHS Mgt 161 Workshops /Key Events Mon 01/02/21 Fri 19/05/23 162 3rd CAMHS Workshop CAPA Master Class Thu 15/07/21 Thu 15/07/21 Complete CAMHS Mgt Team 163 Management Team Fri 30/07/21 Fri 30/07/21 Complete CAMHS Mgt Team 164 CAMHS CAPA Master Class session for all CAMHS Staff Thu 19/08/21 Thu 19/08/21 Complete CAMHS Mgt Team 165 Consultation & Engagement Fri 10/09/21 Fri 10/09/21 Complete CAMHS Mgt Team 166 CAMHS Implementation Strategy for sign off by NHSL and IJB - Cancelled Thu 30/09/21 Thu 30/09/21 Complete CAMHS Mgt Team 167 Working Together: CAMHS and CVS Workshop Tue 16/08/22 Tue 16/08/22 On Track CAMHS Mgt Team 168 North Lanarkshire IGB Meetings Tue 22/06/21 Wed 22/09/21 169 NL IJB Meeting Tue 22/06/21 Tue 22/06/21 Complete CAMHS Mgt Team 170 NL IJB Meeting Wed 22/09/21 Wed 22/09/21Complete CAMHS Mgt Team 171 172 Closure Stage Fri 29/12/23 Fri 29/12/23 180 Review Stage Mon 01/01/24 Mon 01/01/24 CAMHS Improvement Programme
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Appendix 2
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CAMHS Posts (Appointed) When/Comments NDS Posts (Appointed) When/Comments 1.0 WTE Senior Nurse (CAMHS) Band 8a Dec-21 1x Band 7 Dietician Aug-22 1.0 WTE Practice Improvement and Development Nurse (CAMHS) Band 7 Dec-21 1x Band 4 Dietician Aug-22 1.0 WTE Band 7 Service Improvement Manager Dec-21 SLT 1.0 WTE Band 5 CAMHS Waiting List Co-ordinator (CAMHS/NDP) and Partnership WLC Nov-21 1x Band 7 (ND) SLT Apr-22 1.0 WTE HR Recruitment Assistant Band 4 Oct-21 1x Band 6 (ND) SLT Apr-22 1.0 WTE HR Recruitment Assistant Band 3 Oct-21 OT 1.0 WTE HR Recruitment Assistant Band 3 Oct-21 1.0 Band 7 OT May-22 1.0 WTE Band 5 CAMHS Admin Operational Manager (AOM) Dec-21 2.0 Band 5 OT May-22 1.0 Engagement Officer (comms) Band 6 Jan-22 Management & Admin 1.0 Band 5 Governance Manager Feb-22 1.0 Clinical Manager May-22 1.0 Management Team Secretary Offer Made. PEC Ongoing Psychology 2.0 Psychology assistants (recruited from Phase 1) Mar-22 7.0 WTE Band 4 Admin Support for CAMHS Localities and functional teams Apr-22 5.0 Lead Medical Sec Jul-22 3.5 WTE Consultant in Child & Adolescent Psychiatry RRF, but recruited to Funded Establishment in place. Interviews scheduled end of Feb 22 due to eligibility timeframe. Appointments can take up post until 0.5 WTE Consultant in Child & Adolescent Psychiatry Recruitment took place (not filled to RRF, but recruited to Funded Establishment in place. Interviews scheduled end of Feb 22 due to eligibility timeframe. Appointments can take up post until 2.0 SCN Band 7 Sep-21 3.0 WTE Band 6 Charge Nurse (Outreach) Feb-22 2.0 WTE Charge Nurse CAMHS Locality Band 6 Apr-22 2.0 WTE Charge Nurse CAMHS CAYP Band 6 Apr-22 10.0 WTE Band 5 Staff Nurse Sep-21 4.0 WTE Band 3 CSW Sep-21 0.8 Clinical Psychologist (Band 8b) for Eating Disorders Jan-22 4.8 WTE Clinical Psychologists (Band 8a) for Locality Teams Sep-22 1.0 WTE CAMHC Band 8a for Eating Disorders Jan-22 4.0 WTE CAAPS (Band 7) Dec-21 1.0 WTE CAMHC TL (Band 8a) for CAYP Jan-22 0.8 WTE Consultant Psychologist for CAYP (Band 8c) Dec-21 6.0 WTE Band 5 Psychology Assistants Jan-22 CAMHS/SCSHU Management Team Administration Bid Medical Nursing Dietetics Psychology/Psychological therapists Appendix 3
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1.0 WTE Band 4 Practitioner Dec-21 1.0 WTE Band 7 Dietician to support ED's Jan-22 2.0 WTE Band 7 OT Feb-22 2.0 WTE Band 6 OT Feb-22 2.0 WTE Band 5 OT Feb-22 2.0 WTE Band 4 Feb-22 2.0 WTE Band 8a Pharmacists to cover North and South Jul-22 1.0 WTE Band 7 Pharmacist Aug-22 1.0 WTE Band 7 CAAP Feb-22 2.0 WTE Band 5 Assistant Psychology (fixed term) Jan-22 1.0 WTE Band 5 Learning Disability Nurse Apr-22 0.5 Band 7 Advanced SLT for CAMHS LD Jan-22 1.0 WTE Band 7 OT Feb-22 CAMHS Posts Currently Advertised Comments NDS Posts Currently Advertised Comments Management Team Secretary Complete 1 appointed 1 x Band 6 Dietician Clinical Services Secretary Complete 1 appointed Child and Adolescent Mental Health Clinician Interview Child and Adolescent Mental Health Clinician Interview Specialist Nurse - Children’s Services Job Closed – No appointable candidates Specialist Clinical Psychologist Job Closed – No appointable candidates CAMHS Clinician (Higher Level) Job Closed – No appointable candidates Consultant Clinical Psychologist Unconditional (start date agreed) Clinical Psychologist Job Closed – No appointable candidates Clinical Psychologist Job Closed – No appointable candidates Specialist Clinical Psychologist CAMHS Team PEC in progress (1wte) Clinical Psychologist PEC in progress (1wte) Consultant Clinical Psychologist Shortlisting Advanced Speech & Language Therapist Complete – Candidate Hired CAMHS Clinician Complete 1 appointed Waiting List Co-ordinator Complete 1 appointed CAMHS Clinician Complete 1 appointed Clinician CAMHS Complete 1 appointed DieteticsCAMHS/SCSHU Management Team Psychology/Psychological therapists Speech & Language Therapy Nursing Pharmacy Internal Dietetics Speech & Language Therapy Physiotherapy
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Clinical Associated in Applied Psychology Complete 1 appointed CAMHS Clinician Job Closed – No appointable candidates Child and Adolescent Mental Health Clinician Interview Child and Adolescent Mental Health Clinician Interview CAMHS Posts to be Advertised Comments NDS Posts to be Advertised Comments 3.0 WTE Management Team Support for CAMHS No suitable applicants - possible recruitment from above post 93641 29/04 *Still with redeployment 1.0 Band 7 - Transition Co-Ordinator 1x Admin Band 3 Currently completing job train process 1x Clinic Coordinator Band 8A Currently completing job train process 1.0 WTE Clinical Psychologist (Band 8a) for Eating Disorders NES Recruitment - live 28/03/22. Closed no suitable applicants 4.8 WTE Clinical Psychologists (Band 8a) for Locality Teams Unable to recruit 1x Clinical Psychologist Band 8B Currently completing job train process 1.0 WTE Speciality Dr in C&A Psychiatry 1x Paediatrician Currently completing job train process Dietetics 1x Clinical Psychologist Band 8A Currently completing job train process 2.0 WTE Band 6 Dieticians re ad - live closing 13/04 no applicants - extend closing date closed 20/4 with no applicants. Speech & Language Therapy 3 x SLT Band 6 Currently completing job train process 3.0 WTE Band 6 Specialist SLT No successful candidates at interview. Not progressing PD will reassess in due course 4 x OT Band 6 Currently completing job train process 1 x Paediatrician Currently completing job train process CAMHS/SCSHU Management Team Psychology/Psychological therapists Management Team Psychology/Psychological/ Pediatrics Speech & Language Therapy Occupational Therapy
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REPORT Item No: 10 SUBJECT: North Lanarkshire ADP – Self-Assessment TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran, Strategic Lead for North Lanarkshire ADP DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval x For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed X Endorsed
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3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Note the key actions to support the strategic direction of NLADP structures to deliver on the priorities in line with additional investment; (3) Note the additional investment and ring-fenced budget for each priority area; Medication Assisted Treatment (MAT) Standards Residential Rehab Assertive Outreach and Crisis support Harm reduction – including Naloxone provision Whole Family Approach and Family Inclusive Practice Lived and Living Experience (4) Approve NLADP Self-Assessment completion setting out the appropriate governance is in place to deliver the National Mission priorities and The Partnership Delivery Framework objectives. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on alcohol and drugs use issues locally. Members include agencies with an interest in providing treatment and intervention for people experiencing problem alcohol and drug use, and other key stakeholders. 5.2 The NLADP Strategic Lead has been working closely with strategic partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence, regional scoping work and learning from commissioned services including the voices of lived experience 1. Prevention, Early Intervention, & Education Yes No N/A
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2. Treatment, Care & Recovery 3. Whole Family Approach 4. Public Health Approach to Justice 5. Reducing Alcohol Harms Group 5.3 All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. It will do this by: providing fast and appropriate access to treatment and support through all services improving frontline drugs services (including the third sector) ensuring services are in place and working together to react immediately for people who need support and maintain that support for as long as is needed increasing capacity in and use of residential rehabilitation implementing a more joined-up approach across policy and practice to address underlying issues. 5.4 A Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. 5.5 The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes 5.6 The self-assessment is designed to ensure key relationships are in place and that the local system is supporting the work of the ADP. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders 5.7 The self-assessment will set out where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic planning 2. Financial arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight 5. The relationship between the ADP and the Integration Authority
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6. CONCLUSIONS 6.1 The range of work to scope strengths and challenges in current arrangements, place the experience of people with lived experience and families at the centre of developments and engage with all stakeholders will significantly reshape the commissioning intentions, create a robust response to the challenge of preventable drug deaths in North Lanarkshire and inform the proposed Investment Plan. 6.2 The following actions have been taken to progress NLADP response locally (1) ADP Strategic Lead and support team have established the appropriate structures/representation required to support approval and delivery of the ADP strategy in keeping with national priorities (2) Rapid Review of treatment and care services undertaken (Feb – May 2022) setting out key recommendations, actions and priorities to inform NLADP investment and planning (3) Additional investment for 2022 aligned with new funding streams and allocated (4) Residential Rehab oversight and operational groups established to review/establish robust pathways and processes with spending arrangements in place - details published (5) Residential Rehab training sessions complete with further briefings taking place throughout Autumn (6) Pan-Lanarkshire arrangements in place for MAT standards. Oversight and governance group established in September 2022 to drive forward plans to realise target to implement by March 2024. (7) Proposals and commissioning priorities identified by each sub-group to allow NLADP to configure and commission the most appropriate services beyond 2023 (8) Workforce Development needs analysis launched to shape the learning and development programme required to realise the collective skills, knowledge and expertise required to deliver on our priorities (9) Additional funds allocated to support ongoing Test of Change initiatives, local stigma action fund and wellbeing support to tackle some of the root causes of problematic substance use in collaboration with VANL 6.3 The strategic vision and proposed subgroups will carry forward the programme of work to be led by NLADP until 2024. The proposed priorities and structures will support the ADP to report on ministerial priorities given the increased scrutiny that will come with the additional investment directly or indirectly via integrated authorities. 6.4 All actions and progress of the ADP to be recognised in the Self-Assessment setting out any work still to be done.
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7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper impacts on all of the national outcomes. 7.2 ASSOCIATED MEASURE(S) • Medication Assisted Treatment (MAT) standards – 1-5 implemented and embedded by March 2024 (6-10 beyond) • Residential rehab – assessment and access for anyone who chooses/where appropriate as part of their care and treatment. Each ADP/Health Board should now publish rehab pathways online setting out how people can access residential rehab. • Harm reduction – consistent approaches and increase workforce confidence/capacity to deliver HR. Includes Naloxone provision. • Assertive Outreach – ADPs should define their approach for increased support with commissioning for effective assertive outreach/crisis support expected in 2023. • Treatment Targets – increase engagement by 9% (113) by 2024 • Whole Family Approach – increase/widen Family Inclusive Practice (FIP) across all treatment and care settings • Recovery – Lived and Living Experience (LLE) involved in design, delivery and evaluation of services. LLE Panels to be established. • Mental Health – Complex needs are fully considered and met via trauma informed workforce • Stigma – tackled at local level • Human Rights – are at the heart of how substance use services and wider supports are designed and offered. NLADP Reporting requirements 2022 MAT standards benchmarking supplementary appendix 27th June – complete Residential rehab pathways processes publish – end of July 2022 – complete
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ADP Annual review 5th August – complete Treatment Target projections – 17th August – complete MAT standards Self-Assessment - 19th September 2022 - in progress Note: NLADP commissioned services are due to submit a 6-month performance and engagement report in October 2022 - service delivery reviews will take place shortly after. 7.3 FINANCIAL Nationally, a commitment has been made to rolling investment for the next 5 years. ADPs are expected to use any reserves in full in addition to the new investment having to account for any reserve or carry forward fund year on year. All funding will be multi-year with an expectation there will be flexibility in how this is utilised for maximum output/impact. Nationally • £5 million of this is to expand access to residential rehabilitation • £5 million to support the priorities of the National Mission • £3.5 million to implement the Whole Family Approach framework. North Lanarkshire Actual Budget Spend YTD Key Initiatives Residential Rehab £317,148 £4,934 Rehab team allocate this spend based on treatment choice & new pathway National Missions £317,148 £119,004 Acute Navigators/Advocacy/Positive support/IPS SAMH/Harm Reduction Whole Family approach £222,004 £40,000 Family plus/Creative faces/housing support Outreach £190,289 £59,278 VAW partnership/ABI/Arrest Referral MAT Standards £380, 578 0 MAT oversight Group will allocate this spend Lived & Living Experience £31,715 0 Post Approved
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CORE Funded Adult support Phoenix £294,204 £108,336 Children Barnardos £270,000 £99,455 Integrated Addiction Team £260,858 £86,953 Youth Bridges £66,246 £21,544 Prison Through care £39,000 £13,000 This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT As part of the updated oversight arrangements of the ADP, a new Risk Register will be formed which will feed through into the operational registers of the partnership and the strategic register of the IJB. 7.5 PEOPLE Regular stakeholder engagement will take place through the ADP subgroup structures with people with lived experience (including families) involved in shaping the decision around tackling alcohol and drug related harms. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 NLADP Strategy Appendix 2 NLADP Position paper on progress toward priorities Appendix 3 NLADP Rapid Review Appendix 4 Self-Assessment tool template CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact John Holleran on 01698 753651
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Appendix 1 NLADP Strategy North Lanarkshire ADP Strategy 2021 – 2024
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About this Strategy This strategy has been co-developed through ongoing engagement with a broad range of stakeholders including people with lived experience across North Lanarkshire. It was vitally important to the success of any improvements we are trying to influence that individual voices and experiences were included in this process. Our approach, coupled with the existing and emerging evidence base for tackling harms from problematic substance use offer a robust and ambitious way forward that will see us confidently lead the way in keeping people safe, well and thriving in North Lanarkshire. This document sets out some of the challenges we face and how we intend to move forward. We have set out the appropriate Alcohol and Drug Partnership structures that will be tasked with implementing change and supporting more people to find their own type of recovery. A detail delivery plan will follow to support specific actions and outputs for the ADP sub-groups. This strategy does not exist in isolation and is intended to link with other strategic plans focussed on identifying and protecting those at risk of harm from substance use. This includes but is not limited to: North Lanarkshire Children’s services plan Mental Health and Wellbeing Strategy Community Justice Improvement Plan Strategic Commissioning Plan VANL strategic plan North Lanarkshire Town Visions NL Housing Strategy & Rapid Rehousing Plan About North Lanarkshire ADP North Lanarkshire Alcohol and Drug Partnership (NLADP) was established in 2019 as a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). Much of our work involves bringing people together to plan and improve services whilst setting out what needs to be put in place to support change and keep people safe and well. We do this by reviewing, monitoring and evaluating the impact of investments targeted towards reducing substance-related
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harm and improving health and wellbeing. Our Approach North Lanarkshire Alcohol and Drug Partnership has drawn on the successes, challenges and learning from previously funded initiatives to form this strategy. In addition, we commissioned targeted scoping work through Scottish Drugs Forum and Scottish Families Affected by Alcohol and Drugs to give us direct insight from individual and family experiences. These offered first-hand accounts of the needs, challenges and innovative ideas for change from those living in North Lanarkshire, including many who have been in contact with services for support with substance-related issues. We’ve also drawn from the invaluable wealth of experience, skills and local knowledge within our workforce and volunteers working across our communities. Policy Perspective In 2018, Rights Respect and Recovery 1and the Alcohol Framework2 were published setting out the Scottish Government’s commitment to reducing deaths from alcohol and drugs and tackling harms to individuals and those around them. For the first time there was direct recognition of the right to health for people who use alcohol and drugs and a focus on a wider approach moving beyond clinical services. This included a commitment to increasing harm reduction measures, tackling stigma, removing barriers to support, increasing community-based recovery opportunities, understanding the links to justice, tackling inequalities and offering direct support for the whole family. At the same time, in Scotland’s Public Health Priorities, the focus on reducing the use and harms from alcohol, tobacco and other drugs and a focus on good mental wellbeing were reinforced taking a public health approach to improve the nation’s health3. Since the publication of Rights, Respect and Recovery and Scotland’s public health priorities, further commitments have been made nationally, as part of the Drugs Deaths Task Force, to refine the response in keeping the most up-to-date evidence-base for what works to support change. This includes the new priorities set out in the Partnership Delivery Framework4, the National Mission Priorities5, Tackling Stigma6 and implementation of the Medication Assisted Treatment (MAT)7 Standards. This document recognises the cross-cutting commitments, outcomes and priorities in each publication and sets out the role of the ADP in realising the whole systems approach required to achieve these. 1 Rights, Re spect an d Reco very : Scotland’s strategy to impro v e health by preventing and reducing alcohol and drug use, harm and related deaths
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(www.gov.scot) 2 Alcohol Framework 2018 - gov.scot (www.gov.scot) 3 Scotland's public health priorities - gov.scot (www.gov.scot) 4 Alcohol and Drug Partnerships: delivery framework - gov.scot (www.gov.scot) 5 Drugs policy - update: statement by the First Minister - 20 January 2021 - gov.scot (www.gov.scot) 6 https://drugdeathstaskforce.scot/media/1111/stigma-strategy-for-ddtf-final-290720.pdf 7 medication-assisted-treatment-mat-standards-scotland-access-choice-support.pdf (www.gov.s
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Alcohol and Drug Use in North Lanarkshire Drugs North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 94 people dying from drug-related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire. There were 2,812 drug related crimes in North Lanarkshire in 2019/20 [latest figure available]. This is a rate of 82.4 per 10,000 population share, this is contrasted to a rate of 64.6 across Scotland.
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Alcohol In 2020, 101 people died from alcohol-related causes in North Lanarkshire. Alcohol related hospital admissions were 3270 in 2019/20 [latest available figures]. There were 36,135 Alcohol related hospital admissions across Scotland. Age-sex standardised rate per 100,000 for North Lanarkshire in 2019/20 was 982.36 and 673.27 for Scotland. The age-standardised death rates for alcohol-specific deaths in the most deprived 20% of areas in Scotland has been consistently higher than the rest. The death rate in the most deprived areas is 4.3 times the rate in the least deprived areas in 2020 (41 deaths per 100,000 compared to 10). Since 2001 the death rate in the most deprived areas has remained the highest of all five SIMD quintiles although the gap has narrowed slightly. *1 Not from the full sample of 94 deaths as at the time of analysis we did not have the toxicology reports for all 94 deaths therefore this percentage is from the available data set (61 of 94 deaths) SIMD and DRD Across Scotland in 2020, 1339 drug-related deaths occurred. Seven hundred and seven (53%) were in SIMD quintile 1 and three hundred and sixteen were in quintile 2 (24%) therefore 77% in quintiles 1 and 2. This is most significant if we consider the population of North Lanarkshire where 59% (32% SIMD 1; 27% SIMD 2) of the population is in SIMD quintile 1 or 2*. The strong links between drug and alcohol related harms and poverty8, inequality and trauma are widely acknowledged. Deprivation has been linked as a significant factor9 in drug and alcohol problems developing. 8 Hard Edges Scotland | The Robertson Trust 9 Staying-Alive-in-Scotland-Digital.pdf (sdf.org.uk)
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What we see in North Lanarkshire is not unique and reflects a national picture where data trends are synonymous with the wider evidence base on substance- related harms10 . It is vital we have the most relevant data and evidence available to us to target the response needed to tackle the root causes of problematic substance in a holistic way. This includes using tried and tested approaches and targeting specialist responses across key localities. This will help to improve links to universal services and support the right investment in initiatives that can influence change and prevent deaths at the earliest opportunity. Support for Families In the Scottish Families report ‘Hidden in Plain Sight’ commissioned by NLADP in 2020, the vast majority of community survey respondents (9 in 10 people) felt their community had an issue with alcohol or drug use, with just 7% believing this not to be the case. Levels of support across communities were significantly below the level of prevalence, with just over 13% feeling their community was supportive of those living with drug or alcohol addiction, rising to 19% who felt their community was supportive of families affected. For both of these statements, just over a third did not express a view (remaining neutral) but even taking this into account this indicates: Very high levels of substance-related issues for communities (89%) Very low community support for people living with addiction (13%), or for their families (19%). A strong message from the study was families in North Lanarkshire were hidden in plain sight. ‘There are thousands of families affected by substance use in the area but a tiny number reaching support’. Yet there was a significant number of community ‘touchpoints’ where families were engaging providing key routes for awareness-raising and links to early support. These include schools, churches/ faith communities, financial/ advice services and workplaces. There was widespread recognition of the impact of stigma, shame and secrecy on families. This often prevents families coming forward for support. Tackling stigma is not just about the media and communities, but also about those closest to families (wider family, friends, workplaces). * See appendix 1 for fuller data10 Problem drug use in Scotland (parliament.uk)
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North Lanarkshire Alcohol & Drug Partnership Board ADP Chair NLADP Strategic Lead NLADP Administrator Clerical Officer Development Officer Development officer Information Research COVID19 Covid19 has had a significant impact on the lives of many people living in North Lanarkshire and the services that provide for them. In some cases, this may have led to an increase in drug and alcohol consumption and increased risk and harm within the home11 Drug services and prescribing arrangements were adapted with some innovative practice offering realistic solutions for fast access to treatment and support including; electronic prescribing, distanced check- ins with people who use services, wider Naloxone distribution and wider choices in OST (including Buvidal). These were options not previously possible or permitted due to legislation but now offer learning that should be considered in our plans moving forward. What currently exists in North Lanarkshire NLADP Support staff team is made up of a Strategic Lead, Development Officer x 2, Information and Research Officer, Administrator and Clerical Support. The ADP directly funds over 30 programmes and initiatives across North Lanarkshire aimed at reducing harms, providing recovery-focussed activities and improving lives. We still have much work to do to get it right and reach those in need of support who are still not known to our services. Moving forward we will place more focus on getting what people need, where they need it most whilst making it as easy as possible to access. Our vision A North Lanarkshire where individuals and families experience less harm from the effects of problematic alcohol and drug use. People are safer, healthier and treated with dignity to make informed choices around their own care and empowered to find their own type of recovery. 11 Changes in alcohol consumption in Scotland during the early stages of the COVID-19 pandemic: Descriptive analysis of repeat cross-sectional survey data (publichealthscotland.scot)
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The way forward Actions will be centred on improving quality, offering choice and creating more of the connections to keep people safe, well and thriving. Realising a North Lanarkshire where: 1. Fewer people develop problem drug and alcohol use 2. People access and benefit from effective, integrated person-centred support to achieve their own type of recovery 3. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. 4. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. 5. Less harm is caused by alcohol. NLADP Structure ADP Board Finance Sub Group Prevention Treatment ROSC Whole Family App/FIP Justice & Health Alcohol Harms
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10 | P a g e Final Draft 2021 JHolleran ADP Strategic Framework National Outcomes Prevention and Early Intervention Developing Recovery Oriented Systems of Care Getting it Right for Children, Young People and Families Public Health Approach & Justice An Alcohol Framework for North Lanarkshire Priority Area Fewer people develop problem alcohol & drug use. People access and benefit from effective, integrated person-centred support to achieve their recovery. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. A Scotland where less harm is caused by alcohol. Sub-Group Prevention, Early Intervention, & Education Treatment, Care & Recovery Development Whole Family Approach /Family Inclusive Practice Justice, Health and Care public health to improve links to community Reducing alcohol harm and improving treatment pathways Cross-cutting Objectives Embedding a Whole Systems Approach via Workforce development, collaboration & learning Partnership Work & Collaboration Lived experience, co- production & active participation. Ongoing evaluation, quality assurance and performance monitoring Communication, transparency & good governance are key Focus on the right to health, choice, fairness & equitable opportunities free from stigma
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Final Draft 2021 JHolleran Key Priorities & Actions 2021 – 2024 NLADP Strategic Lead and the support team will develop the structures and process required to deliver the programme of work set out including establishing the appropriate sub-groups tasked with leading the work. It is expected these groups will take a lead in informing the finance arrangements and facilitating wider stakeholder engagement. A delivery plan and commissioning strategy will be developed in the first six months with progress linked to the following priorities: 1. People have early access to support for problem substance use –early intervention strategies will be put in place to prevent problem use with support offered through a range of community-based responses. 2. NLADP will facilitate efforts to embed a Whole Systems Approach – including families and a broader range of stakeholders to reach those not already known to services. 3. Strengthen the links between physical/mental health & substance use taking a ‘No w ro ng doo r appro ach’ focussed around the needs of the individual and not solely focussed on the substance use or disorder/s. 4. Young people and families receive evidence based, effective education on substances, harm reduction and how to access help when problems develop. Through the provision of effective, evidence-based education both within and beyond school. 5. Workforce capability is increased through learning via a strategic workforce development plan including needs analysis to identifying gaps and opportunities to strengthen the workforce knowledge, skills and confidence to respond. Drawing on local experience, knowledge and assets to support quality Improvement and best value. 6. People are supported to make informed decisions about their own care through a range of treatment options including residential rehab for all those who will benefit. Including all those who want, and for whom it is deemed clinically appropriate, to access residential and/or community rehabilitation. 7. People are supported to remain in treatment for as long as requested – MAT standard 5, individuals are supported to remain in the treatment that is right for them, for as long as they want or need. 8. Improved early identification, assertive outreach & increased engagement (MAT standards – opiate/benzo with rapid access) so people at high risk are proactively identified and offered support – MAT standard 3 targeting at-risk groups. 9. Overdoses are prevented from becoming fatal – increasing provision of naloxone, strengthening proactive outreach for at-risk groups improving near fatal overdose pathways. 10. All people are offered evidence based harm reduction – MAT standard 4. Provision of harm reduction materials such as injecting equipment, BBV and wound care for those who need it. 11. People who use drugs have access to information about risks and harm reduction – in person, digital and via phone information on drugs and harm reduction including WAND, EIP and DBST.
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Final Draft 2021 JHolleran 12. More families are involved in the care and treatment of their loved ones with access to support in their own right – even where their loved one is not engaged with treatment. This includes choice and wider access to opportunities locally for adult family members, young adults as well as children and young people. 13. Effective pathways between justice and community services are established including prison through-care and diversion pathways. This will take account of housing, advocacy and connections to the community. 14. Less harm is caused by stigma for people who use alcohol and drugs and their families in North Lanarkshire. NLADP will lead on a local stigma plan recognising individuals, families and communities should have access to a range of opportunities to support improved well-being, resilience and reduced feelings of isolation caused by stigma. 15. NLADP will develop an alcohol specific framework recognising the impact alcohol has on individuals, families and communities implementing targeted interventions to reduce harm, change attitudes to alcohol consumption and improve health & wellbeing. 16. NLADP Drug-Deaths Prevention Action Plan is refined and linked with key outcome areas from DDTF priorities using evidence of based practice whilst targeting those most at risk.
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13
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1 Appendix 2 NLADP Position Paper – June 2022 This paper sets out the key commitments and responsibilities of North Lanarkshire ADP and relevant integrated authorities in working towards the national mission objectives, MAT standards implementation and residential rehab progress as set out in Rights, Respect and Recovery and the partnership delivery framework. In addition, proposals and recommendations have been made to progress each of these areas in keeping with North Lanarkshire ADPs strategy. A national benchmarking report was issued on 23rd June showing progress made across Scotland on a RAG status basis. North Lanarkshire is in a good position to implement the MAT standards however, there is still a lot of work to do to fully embed the standards across all six localities. A supplementary overview, setting out further details and actions required to achieve all standards, will follow on 2nd August. This was submitted to PHS on 27th June. All services involved were asked by the ADP to review and submit comments ahead of the deadline. MAT Standards - current status in North Lanarkshire 1. Same day access - All people accessing services have the option to start MAT from the same day of presentation. RED Choice - All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose AMBER Assertive outreach - All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. AMBER Harm Reduction - All people are offered evidence-based harm reduction at the point of MAT delivery. AMBER Retention All people will receive support to remain in treatment for as long as requested. RED Funding position North Lanarkshire received £380,578 for 2021/22 towards implementing MAT standards 1-5. A further £570,866 will be made available in 2022/23 to fully embed the MAT standards over the coming year. Chief Officers and Chief Executives have been asked to sign timed, specific and published Improvement Plans for implementing the standards – to include the delivery recommendations being made locally with MIST which are to be published by PHS on 2 August. Progress so far The proposed model for MAT standards is a Pan-Lanarkshire model based on an assertive outreach delivered via an ‘Urgent Care Response Team’ to be established. Progress on this is expected from August 2022 and will include the use of telehealth and mobile outreach facilities to increase same day access to treatment. The approach will need to ensure transparency, full oversight and accountability in the delivery and evaluation of the MAT standards. There is an expectation that ADPs will monitor and report on progress via a full evidence review, numerical data and experiential
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2 qualitative feedback. There will be ongoing support from the MIST team nationally though Public Health Scotland. MATIGTerms of ReferenceDraftJH072 The ADP has already approached all services involved to report back on progress towards implementing and embedding the standards by 8th July. A full report and evidence review of clinical governance arrangements will follow. This will be handed over to the Project Lead to take forward with the Service Manager when in post.
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3 NLADP is required to submit the following to the Scottish Government: MAT standard benchmarking supplementary appendix 27th June – complete Residential rehab pathways processes publish – end of June 2022 – complete ADP Annual review 5th August – complete Treatment Target projections – 17th August – complete MAT standards Self-Assessment - 19th September 2022 - in progress Drug and Alcohol Treatment Services- MAT standards 1-5 The recent ‘Rapid Review’ research commissioned by North Lanarkshire ADP acknowledges statutory services continue to work hard in supporting people who need drug and alcohol services. The unwavering commitment of staff across the sector has been well documented and widely acknowledged by individuals and those working in services at a consensus event on the 26th May. There is agreement that the current demand on services, coupled with challenges around premises, staff recruitment and retention have all lead to limited workforce capacity which remains significant. This has limited the ability of services to meet people’s needs consistently across all six localities in North Lanarkshire. Concerns exist around the current quality and consistency of care as well as ongoing support and development opportunities for the workforce. Recruitment is likely to become more of a challenge as investment increases across Scotland. It is understood it may become more difficult to find suitably qualified practitioners with the right skills, knowledge, capability and values required to deliver the MAT standards. Next steps Immediate approval and sign-off on recruitment for a MAT standards Project Lead and Service Manager who will work closely with the ADP support team and key stakeholders to co-ordinate the operational requirements for MAT standards to be implemented and fully embedded. A decision to be reached on where these posts will be hosted in the current system including; who will assume line management responsibilities and ongoing support and supervision arrangements for these post to minimise disruption and maximise progress. Is this quality and performance/service delivery or other? Agreement that a MAT standards monitoring group will be established to oversee implementation, review progress and respond appropriately to ensure all operational elements are achieved in North Lanarkshire. Agree how the monitoring group, ADP and other stakeholders will report on progress into existing structures moving forward? Facilitate improved collaboration, input and support from Community Addiction Pharmacy and Quality Improvement colleagues sharing data and improving intelligence around all test of change initiatives linked to the MAT standards.
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4 Next steps Investment and support is urgently required to stabilise existing services and ensure equitable access to treatment, care and support across all localities. Approval work to commence to identify clinically viable premises to deliver treatment and care services. The output from this work should set out what investment/approaches are needed to offer accessible and approachable treatment services that are fit for purpose. Approval and sign-off for a full review of treatment, care and support services should be initiated (alcohol, drugs and mental health. This is vital to understand current delivery capacity and any additional investment/reconfiguration of services required to meet local need in line with current demand. Staff recruitment and retention remains a significant challenge. Further consideration should now be given to how addiction services can incentivise those staying or coming to work in North Lanarkshire. This will help not only to build capacity but to build the capability needed to ensure we have the right skill set, values and commitment within our workforce. This is significant as we move closer to same day access via the Medication Assisted Treatment (MAT) standards. Workforce development needs should be fully reviewed via a training needs analysis to upskill and inform ongoing practice in keeping with national priorities, clinical guidelines and a rights-based approach including; • more frequent care and treatment reviews, • better access and choice in treatment and care services, • increasing family inclusive practice, • routine harm reduction screening at each point of contact. Consideration should be given to workforce wellbeing through protected time and wellbeing networks for staff working across localities to come together. Assertive Outreach & Crisis Support MAT Standards 1,3 & 4 The Lanarkshire Overdose Response Team (LORT) was established in September (2021) with 4 outreach staff and 1 coordinator. This is service is funded through the Drugs Death Task Force (DTTF) until February 2023. Following the model set up on Glasgow in 2019, a proposal to complement current provision and directly address key gaps and vulnerabilities were identified as: The absence of ‘out of hours’ provision; The absence of persistent and assertive ‘wrap-around’ care at point of crisis; The inconsistency of intervention and follow-up care after near fatal overdose. The Turning Point Scotland service provides a rapid response to near-fatal overdose (NFO) providing a short, focused period of support to each person and assertively engaging them with mainstream alcohol and other drug services. The team received and responded to a total of 113 referrals during the initial reporting period. These referrals came from a variety of different sources that the team had built pathways with
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5 in order for them to refer into the response with as much ease as possible, including a 24hr free phone number and a simple referral form which can be emailed direct to the team. The 113 referrals represent 92 individuals, with 76 of these having a single referral and 16 having 2 or more referrals. NLADP has recently approved funding for a dedicated worker to monitor and co-ordinate the overdose response approach. This post will be linked with the harm-reduction team and is a shared post with SL ADP. MAV Navigators – Assertive Outreach MAT standards 1,3 & 4 North Lanarkshire APD has approved continued funding for year 2022/23; to support the development of an assertive outreach model (navigator programme) to improve engagement of service users within the acute setting and onward referral to community based drug and alcohol support services. The service was extended in 2021 via the ADP board based on local needs and demand. Increased funding was required to cover both the major trauma centre at UHW and Monklands Hospital in North Lanarkshire. Navigators are uniquely placed within the ED to provide the earliest intervention, to be there at the time of crisis and also to be there at the time of reflection (the reachable moment) when that window of opportunity to plant the seeds of change is open. In 2021/22, the service within Wishaw ED has engaged with 127 individuals from North Lanarkshire (50F:76M) since July 2021(as well as a further 38 (24M:14F) seen between April to June 2021 who were seen under the previous joint funding arrangement). Of the 127 North Lanarkshire patients 74 (58%) patients actively and immediately engaged with the service and 20 (16%) were unable to engage immediately (usually due to intoxication or serious injury). 33 (26%) refused the offer of support. Treatment Targets Next steps Drawing on learning from the Turning Point interim report and Rapid Review further consideration should now be given to extending the operational hours of the ART services to meet the needs of individuals and families who need support in crisis. The sustainability of the overdose response team beyond February 2023 needs consideration. Will this be part of our core funded response and MAT standards or should this be commissioned separately by the NLADP moving forward? Will the MAV Navigators and additional capacity provided by Substance Misuse Liaison Nurse roles be extended and funded via core or continue to be funded via the ADP beyond 2023?
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6 In North Lanarkshire, a 9% (113 people) increase is expected by April 2023 across statutory drug treatment services. This approach is linked to the evidence-base that acknowledges those engaged in treatment are less likely to experience a fatal overdose. The update from the Scottish Government, March 2022, shows the current picture across Scotland based on CHI capture. At present, the CHI capture rate of those accessing Opiate Substitution Therapy (OST – Methadone/Buvidal or other) in North Lanarkshire sits at 55%. NLADP Strategic Lead has initiated discussions with Community Pharmacy colleagues to understand more with a view to improving CHI capture – more work is required to develop a strategy to meet this target. Alcohol treatment targets will follow in 2024. Harm Reduction – MAT standards 1-5 There is significant harm related to drug injecting related to blood borne viruses, bacterial infections, injection site wounds and overdose risk. Within existing NHS Addiction services these issues are often not picked up - as appropriate questions are not asked and assessments of injecting risk are not undertaken. The Medication Assisted Treatment Standard 4 highlights this and aims to integrate harm reduction with the delivery of OST. Next steps Support from SLT to communicate treatment target requirements and identify who is best placed to support NLADP to take this forward. Approval for a SLWG to be established to fully consider the targets and to develop a strategy with the ADP to meet the targets. To establish a closer relationship across the ADP with the Community Addiction Pharmacy service to support the wider workforce capability and what the current offer is of those accessing OST in the community including Buvidal.
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7 The WAND assessment consists of: • Wound care • Assessment of injecting risk • Naloxone • Dry Blood Spot Tests Residential Rehab – MAT standards 2 & 5 Improving access to residential rehabilitation as a treatment option is a key part of the National Mission to save and improve lives. The Government is clear that residential rehabilitation should be part of the full range of drug prevention and treatment services available to people in all local authority areas. The approach and commitment is set out here Work has been undertaken through the Lanarkshire residential rehab operational and oversight working groups. The group has set out clear pathways and processes for individuals seeking to explore residential rehab as part of their care and treatment planning. • North Lanarkshire residential rehab funding 2021/22 - £317,148 • North Lanarkshire residential rehab funding 2022/23 - £ 317,148 Next steps Support from SLT to communicate the requirements and identify who is best placed to take this work forward. Agreement to increase capacity for WAND consistently across all services and at each point of contact across North Lanarkshire Wider Naloxone provision should be explored with effective monitoring so that Naloxone is offered at each point of contact across North Lanarkshire including acute sites and CPS. Agreement that all practitioners and community members likely to come into contact with people who use drugs are encouraged (possibly via a local campaign) to undertake Naloxone training and have access to a kit. All health board and local authority premises should have a nominated Naloxone contact with a supply kit available to respond in the event of an emergency situation as with first aid, AED or other heath need that is routinely expected to be met.
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8 Independent advocacy Commissioned by the ADP, the independent advocacy service (Equal Say) continues to link with individuals via referral from statutory and voluntary sector colleagues. Work is underway to strengthen pathways and referral links across all alcohol and drug services (ART). This is particularly significant given the additional investment in Residential Rehab across Scotland, MAT standards and the right for individual and their families to be involved in the co- production, delivery and evaluation of substance use services. Whole Family Approach (WFA) and Family Support There is a commitment to meeting the needs of children and young people Lanarkshire-wide through stronger links and collaboration with community planning partners to achieve our shared objectives in preventing children and young people from developing drug, alcohol and mental health problems. Work should be carried out to scope and identify opportunities to link and share financial investments for prevention and early intervention (including diversionary activities). Currently, through Rights, Respect and Recovery and the national holistic whole family approach framework there is an expectation and right for families to be involved in the care and treatment of their loved ones (where appropriate) and a right for families to have support in their own right, even if their loved one is not in treatment. There is currently support available to families via Phoenix Futures, Barnardos and carers services but this is in no way comparable to the capacity and availability of support available via statutory and voluntary sector services for those needing treatment and care for drug and alcohol issues. Next steps A more consistent approach and understanding of the residential rehab process is now required. Training for all staff in treatment and community services will commence across Lanarkshire, led by the Scottish Recovery Consortium, to ensure staff working in services (statutory and voluntary sector) understand the approach, referral pathways and assessment criteria. NLADP will lead the work focussing on how residential rehab options and access are communicated to individuals and their families as part of a wider package of treatment and care options. All data and costs associated with Residential Rehab assessment and access will be shared with NLADP on a quarterly basis. This is needed to strengthen transparency, accountability and understanding of the true picture for those being referred, assessed and placed in residential rehab.
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9 Next Steps Lived and Living Experience Rights, Respect and Recovery sets out the right to health, choice and quality in care and treatment services. This includes participation from those with lived experience in the design delivery and evaluation of services. North Lanarkshire continues to make great progress in involving the views and experiences of those who have used or need access to drug and alcohol services in shaping the way forward. NLADP commission North Lanarkshire Recovery Community, Phoenix futures and Barnardo’s who all have lived and living experience representatives involved in shaping the design, delivery and evaluation of services. In addition, the ADP commissioned Scottish Drugs Forum to lead a third phase of peer research and the addiction worker training project. The rapid review also takes account on individual and families views. Work is ongoing via the ADP support team to establish lived experience panels to connect to Voluntary Action North Lanarkshire (VANL) and Community Solutions to strengthen participation and engagement of people with lived and living experience across all services. As part of the MAT standards readiness to implement, all lived experience reports have been reviewed and NLADP is well on track to deliver on our commitment here. More parity is required to rectify this and ensure the offer of family support via treatment and care services is increased significantly. The evidence tells us that family support can be a protective factor for those not engaged in services. We have limited data and intelligence to understand the levels of family involvement in care and treatment including; care planning and family support offered via statutory services. This needs to be reviewed and a plan put in place to increase family inclusive practice, this is a right and a need that remains largely unmet. Agreement for the WFA allocation from the Scottish Government to be used to increase capacity and engagement with families based on recommendations and actions from the WFA sub-group. Next steps Agree that lived and living experience voices are heard, valued and acknowledged by all stakeholders and practitioners delivering care and support services in North Lanarkshire. To seek recognition that it will take time with the right financial investment to make an impact and see progress being made here. The ADP has funding set aside/approval for a lived experience support worker to work with all commissioned services and partners to take this work forward.
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1 0 Governance, future decision making and reporting Approval for the work set out in this paper to be the focus of the ADP Treatment, Care and Recovery Sub-group delivery plan for the next 18 months. A suitable lead and Co-lead will be identified to take the group forward. Discuss and agree the most appropriate way forward to monitor progress and ensure oversight in relation to drug related deaths, MAT standards, National mission priorities. Where/how will the ADP report on these priorities and progress moving forward? Support a review of NLADP board/finance group membership to ensure appropriate influence, oversight and information sharing to the relevant accountable groups and forums. Set out who is best placed within North Lanarkshire to support decision making moving forward in line with the Public Protection Agenda. Consider how best to strengthen collaboration across/between Integrated Authorities, voluntary sector and Community Planning Partners in tackling the root causes of problematic substance use and shared interests in reducing substance-related deaths. Background & further information: Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on the progress toward the MAT standards. on 23rd June, 2022. https://www.parliament.scot/chamber-and-committees/official-report/what-was-said-in- parliament/meeting-of-parliament-23-06- 2022?meeting=13840&iob=125537#orscontributions_M1735E440P776C2417362 Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on Accountability for Delivering the National Mission to Reduce Drug Deaths and Improve Lives. 26th May, 2022. The speech is approximately 10 minutes long with 20 minutes for questions. The full statement is available to watch back: https://www.scottishparliament.tv/meeting/ministerial- statement-accountability-for-delivering-the-national-mission-to-reduce-drug-deaths-and- improve-lives-may-26-2022 Date Name and comment 27/06/22 John Holleran - NLADP 28/06/22 LK reviewed
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1 1 Appendix 3 RAPID REVIEW OF SUBSTANCE USE SERVICES IN NORTH LANARKSHIRE May 2022 Abstract This report presents findings from interviews with sixteen stakeholders and fourteen individuals, working in or have experience of substance use or substance use services in the area. This review set out to understand current provision, what is working well and what is not, and also what people want it to be. Briege Nugent and Ian Clark briegenugentresearch@gmail.com and ian@iconic-consulting.co.uk
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1 2 Contents Executive Summary .................................................................................................... i Background and Methods ......................................................................................... 1 The Current Situation ................................................................................................ 3 What is working well? ............................................................................................................ 3 What is not working well? .................................................................................................... 5 What drives partnership working? ................................................................................... 13 Groups not accessing support ......................................................................................... 14 Future Service Provision ......................................................................................... 15 What support do people want and need? ...................................................................... 15 ‘The ideal’ ................................................................................................................................ 16 Opportunities ......................................................................................................................... 18 Wider evidence of good practice ...................................................................................... 19 Conclusion and recommendations ........................................................................ 21 Case Studies ............................................................................................................ 25 Acknowledgement We would like to take this opportunity to thank the North Lanarkshire ADP – Treatment, Care and Recovery sub-group for commissioning this research, and especially thank all the stakeholders and individuals who were open, honest, gave their time and trusted that this process would help to lead to positive change.
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i Executive Summary North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub-group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. The review involved interviews with 16 professionals from across North Lanarkshire working in this field, and 14 individuals who have issues with alcohol and drug use and, their families. Interviews were undertaken in April and May 2022. The study also involved a workshop with over 30 stakeholders in late May to share and discuss emerging findings. What is working well? Stakeholders and individuals identified the following as issues that are working well in North Lanarkshire: The recovery community Services that are accessible via out of hours support and assertive outreach Phoenix Futures Advocacy Improvements in partnership working and communication across the ADP Some of the connections and digital support developed during the pandemic What is not working well? Consultees highlighted the following as issues that were not working well in North Lanarkshire: Access to addiction, and mental health, services can be challenging Statutory addiction services under-pressure Inadequate and unequal provision across areas Incompatible cultures and short-term funding inhibiting partnership working GP treatment choices and an information gap Lack of follow-up support The negative impact of the pandemic Stigma Barriers to engagement The following barriers to engagement were identified: Stigma and perceptions Lack of resources and inappropriate responses Professional attitudes: Lack of empathy and understanding Lack of information sharing between services Lack of exit plan for methadone use What drives partnership working? The key drivers of partnership working in North Lanarkshire were identified as: Good communication Taking a holistic approach Co-location of services
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ii Groups not accessing support Stakeholders identified the following as groups that were not accessing support: Those isolated and living on their own Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) Young people aged 8-11 (as services are not available for this age group) LGBTQ+ Victims of domestic abuse Mothers People from ethnic minority backgrounds Elderly people What support do people want and need? Services need to be person-centred and holistic Services need to be responsive Services should be available out of hours and be able to provide assertive outreach Services should have a single shared assessment Prioritise prevention Elements of the ‘ideal’ future service Stakeholders and individuals proposed ‘ideal’ future service provision in North Lanarkshire should consist of the following: A one stop shop with wraparound care Responsive services with no waiting times Holistic services that take a whole family approach and address the root causes of addiction Providing out of hours and outreach support Accessible residential rehabilitation Follow-up service Connecting people into ‘something meaningful’ Individual recovery plans Opportunities Stakeholders suggested the following opportunities existed to enhance service provision in North Lanarkshire: Relating to provision: • Improve provision for those in crisis and families • Expansion of the recovery community • Digital connections Relating to cultural shifts: • Support for staff • Partnership working • Services to promote flexibility • Including the voices of people with living and lived experience in service design and delivery
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iii Recommendations The following recommendations are made by the report authors, based on the findings of their research with stakeholders and individuals in North Lanarkshire: Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. The development of a crisis service which is a hybrid between an addiction service and an emergency response. Services to move towards more provision that offers out of hours support and outreach. Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. Development of accessible rehabilitation and detox beds. Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. To commit to having no unplanned discharges. More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. Drawing on lived and living experience, working with third and statutory services, create a day programme for people. Substance use services in local areas to make connections with GPs, schools, local voluntary sector to open up avenues of communication and referral pathways. For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ Services to be trauma informed. NLADP remain committed to the development of the Stigma plan. A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers.
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1 Background and Methods North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub-group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. This research is part of a wider body of work and research being undertaken in North Lanarkshire to inform future planning of service provision. As this report will highlight, North Lanarkshire’s Strategy for 2021-2014 aligns with many of the key priorities and actions that will be recommended, but also adds new insights too. This research set out to bring together expertise from professionals, and from individuals with lived and living experience of substance misuse. The two main areas of enquiry were, firstly, to understand and hear directly from people ‘on the ground’ what current provision in North Lanarkshire is like, and secondly, what improvements or developments people would like to see to better meet the needs of people with substance misuse issues in North Lanarkshire. Methods and limitations This review involved interviews with 16 professionals from across North Lanarkshire working in this field, and through them, contact was made and discussions carried out with 14 individuals who have issues with alcohol and drug use, and their families. Eight were males and six were females. All were North Lanarkshire residents except two individuals who lived in South Lanarkshire but were engaging with support services in North Lanarkshire. Interviews ranged in length from 30 minutes to one hour 45 minutes. Two interviews were face-to-face and the rest were by telephone or video conferencing. The findings from both stakeholder and individuals’ interviews were brought together to establish key messages. These key messages were shared during an online workshop with 27 stakeholders who were invited to reflect on the findings and feedback further; their contributions are included in this report. This report is structured in three sections. Firstly presenting what participants described as the current situation in North Lanarkshire, secondly, what they said they would like future provision to look like and finally, the conclusions and recommendations formulated as a result. The main limitation for this piece of work has been time, and ideally even more stakeholders, individuals and families would have been interviewed. As it stands, there was only one family member interviewed and no young people directly although professionals who work with both these groups did contribute to the research. North Lanarkshire has already published the ‘Hidden in Plain Sight’ research which showed there are thousands of families affected by substance use but only a ‘tiny number’ reaching support. That research also drew attention to the stigma and shame felt, not just generally from the wider public, but even from within family circles. A particular strand of research is now being taken forward in North Lanarkshire to hear from families further and this report should be read as being complementary to those findings. The limited voice of young people was highlighted at the stakeholder workshop. There was a view that further research was required into the experiences and needs of young people from North Lanarkshire who have experience of substance misuse in their lives.
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2 As with any qualitative research, this work was reliant on people to open up and to be able to tell it like it is. Interviewees were not pushed for answers, but it would be fair to say that those who participated seemed to trust in the process and hoped that their testimonies would go some way to promoting positive change. They welcomed the opportunity to be heard and were encouraged by the idea that there was a sense of bravery about what provision could become. It was also clear from the interviews that across North Lanarkshire, those working across services are passionate, committed and driven to make positive change. All interviewees have been made anonymous.
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3 The Current Situation What is working well? * The recovery community Stakeholders and individuals reported that the recovery communities are doing exceptional work, helping people to connect to one another, creating genuine support networks, combatting isolation, and creating spaces where people feel understood and achieve a sense of belonging. The involvement of people with lived experience was seen as crucial as they were able to empathise and support people going through similar situations as their own. The availability of recovery cafes at different venues and times throughout the week was also important as it provided people with options and somewhere to go when they needed it. Two individuals described how when they had taken more of a lead role in these initiatives, that is when they felt most purposeful and had been at their most stable. “Last year and a half and I have got involved in community recovery. That is done more for me than all the other things the past 30 years. Firstly, it is addicts together. Speaking to someone who is not an addict, they never understand…You know everyone there is like you, under the same dark cloud as you. We are all trying to get a bit of sun...I found them on Zoom in the first year of the pandemic. There were meetings every day. There was different support out there for different folk.” (Sarah) “The recovery cafes are a godsend because they are all going through the same things… The people who work in them are brilliant because they are all recovering addicts so they know what you are going through”. (Shona) * Services that are accessible via out of hours support and assertive outreach Individuals and stakeholders felt that the best services, and which there are still so few, such as the Overdose Response Team and High Resource User Project, are able to be responsive to need, are ‘not 9-5’, proactive, and go to people, offering assertive outreach, rather than functioning on an appointment basis. One of the priorities in North Lanarkshire’s Strategy, reflecting the MAT standard 3 is the targeting of at-risk groups. One individual praised the support they were receiving from the Addiction Recovery Team (ART) highlighting how flexible and supportive they had been. This individual explained that their addiction worker picked him up once a month to go to a neighbouring town for a buvidal injection. The individual commented “They are great, couldnae ask any more of them” and they had no suggestions on additional services or how existing services could be improved.
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4 * Phoenix Futures Many stakeholders, individuals and the family member said that Phoenix Futures was a good service because of the holistic support they offer, and that they provide support to families in their own right. Consultees also highlighted the person-centred approach and compassionate way that workers supported service users. “Phoenix – they were good. If you could go and meet your worker – get acupuncture for an hour, do that, there is a wee art group.” (Alan) “They had said they offered family counselling… We met with the counsellor…it gave myself and sister a chance to say what we were feeling, be validated and get techniques to deal with it. We were thrust into this world… My role in the family is the fixer, because I know, I do and I fix… The counsellor is great with me, I am on edge that the relapse has happened. She said there is nothing I can do.” (Lorraine, family member) “I was with Phoenix Futures, that was amazing. Loved it there…My mentor… could understand me as she was a recovering addict, she knew what you were going through, she wasn’t a textbook worker. She had living experience and that makes a difference. I like them because they didn’t judge you. I was there a few times a week. They had SMART recovery group meetings when you’d go round the table and everybody tells you a little about their week. And an art class on a Friday was good cos it got you away from talking about addiction all the time. The place had a nice feel about it. And if you didn’t go for a week they’d phone you to see if you were alright. A lot of people don’t have family support so at least they’ve got that”. (Shona) * Advocacy The North Lanarkshire addiction advocacy service delivered by Equal Say was not known by all individuals, but those who had used it, reported that it had been invaluable. The opportunity to talk to someone impartial who was able to provide information, signpost, and tell people about their rights was very much welcomed by those who had used the service. “He’s (worker from Equal Say) really good. He did everything he could to get me back into the homeless unit because they were going to kick me out as I’d broken the drugs rules. He pointed me in the right direction for a few different things. He phones every wee while to make sure I’m alright.” (Shona) In addition, several people with lived experience who were unaware of the service, felt it could be helpful to people with substance misuse issues. Some suggested addiction services should do more to advocacy. * Improvements in partnership working and communication across the ADP It was felt by stakeholders that over the past year in particular, there had been an improvement in services working together and North Lanarkshire ADP had played an important part in facilitating this. The meetings now being held which give
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5 organisations a chance to share practice were especially welcomed. There were some specific examples given by stakeholders of good partnership working, for example, such as the Occupational Therapy doing joint assessments with the Addiction Recovery Team (ART), and the Individual Placement and Support Service (IPS). The Department of Work and Pensions (DWP) have also been working more closely with the recovery community and this brought to light people were missing appointments with their workcoach to make meetings, risking being sanctioned. The DWP can support people in their journey by providing ‘easements’, and this means they will not be sanctionned. At present the service are developing ‘single points of contact’ within each area, so they have a specific role for engaging with the recovery community and for example, can run outreach clinics at a recovery café to help individuals with issues relating to their benefits. * Some of the connections and digital support developed during the pandemic As well as being challenging the pandemic also led to some positive developments. Stakeholders and some individuals felt that physical delivery of methadone to those unable to get to chemists highlighted the extent of needs and legal barriers to the provision of naloxone had been lifted. Digital communication had also created new avenues for communication and opportunities. For example, the recovery community now offer digital sessions and reported that this widened participation from people in more rural areas. Moreover, innovative practice by the Harm Reduction Team, to link up professionals to provide digital consultations has reduced waiting times. What is not working well? 17. Access to addiction, and mental health, services can be challenging Individuals, a family member and stakeholders reported that access to addictions and mental health services was, sometimes, challenging. This can lead to people not accessing a service in the first place, voluntarily withdrawing, or choosing not to engage with a service at a later date. A number of specific challenges were raised which are summarised below. Individuals repeatedly said that services, particularly statutory services, could respond quicker and with greater understanding when people first ask for help. They explained that when they had asked for help, when they were at their worst, the processes put in place acted as serious barriers. The length of time it took to be able to see a worker was a particular concern, with some individuals reporting that they had been given appointments a number of weeks in the future, They felt that when they asked for help it should be immediate. The testimonies also further highlighted the lack of understanding individuals felt existed in services about the realities of addiction (stigma is discussed later in this section as a specific issue). “See when I was at my worst and I decided I needed help and phoning up the services, Integrated Addiction Services and your first appointment is a fortnight down the line. It’s not like the next day. When you need to speak to somebody, you get
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6 turned away. I went to the hospital with my mother and I was in my third day withdrawal and I was in a bad way, that doctor at Monklands Hospital told my mother to take me out on to the street and buy me heroin because there was nothing they could do. I wanted help. I wanted to go into hospital and I got turned away. We get judged, I did get judged. He asked what was the matter and the minute I told him it was a heroin addiction his whole attitude changed. My Mum was with me and she said to him if I wasn’t here I wouldn’t have believed it. In the early stages there’s just not much help there, there isn’t. I know they say you’ve got to make sure they need it but a lot of people are dying through it… in that fortnight (waiting for an appointment) you are going to use, you are going to do it to make yourself feel better. If they could give you an appointment the next day, people who could speak to you, you’d have more hope but you come out with no hope. I didn’t think I could get better because I didn’t have any hope because nobody actually sat and spoke to me and told me what could be done”. (Shona) A family member described trying to call addictions services but none of the advertised numbers on the internet were correct. They eventually relied on a friend working in a different area to get them the right contact information. Another individual recalled her own challenges accessing support after she had engaged and her experience resulted in her saying she ‘hated’ the local addiction team. She explained: “They wanted me to travel to X, with no money, in the snow all the way to pick up a prescription… and they know I’ve got a heavy, major fear of the outside because of what I’ve been through… I thought nah, fuck you… it wasnae happening. So I thought I’ll get through it… my partner, he supported me”. (Leanne) Access to mental health services was also a challenge for some people with both mental health and addiction issues. One stakeholder said that they have never had so many people request to be sectioned as they recognised this was the only way they would get the support they needed and wanted. This finding was echoed by individuals and a family member who said that when they called NHS24 for help, they were informed that they would only get someone to come out to them if they were suicidal. Several consultees referred to the need for people with addiction issues to be clean/sober for a period of time before they could access mental health services. They added that this could be very challenging for some people who used drugs/alcohol as a means of self-medication for mental health issues. A particular area of concern and which is likely to affect the majority of people using substances, is when they also have mental health issues. In these cases, and a finding which is not new, is that people are passed from mental health services to substance use services and round again, because it is argued they have to be stable to get access to mental health services, and this ‘hamster wheel’ as one stakeholder called it, means people are essentially without support. “The links into mental health – that stopping someone if they are using drugs and vice versa, they don’t get a service. I happened to get someone who I was able to
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7 get into treatment within three days, but that was me being stubborn and his sister also being stubborn and persistent.” (Stakeholder 6) 18. Statutory addiction services are under-pressure Individuals and some stakeholders suggested that statutory addiction services do not generally have time to engage meaningfully with individuals. As a result, consultees felt, these services are symptom led rather than dealing with underlying causes of substance use. Staff have substantial caseloads and were viewed as ‘firefighting’. For example, several individuals stated that they only saw their addiction worker for a short period of time once a month; they also reported that workers regularly moved on making it difficult to build trust and continuity. Although there were exceptions reported in one area, with a stakeholder and a couple of individuals stating they had fortnightly, sometimes weekly hour-long appointment with their community addiction worker, this was not the experience of any of the other individuals interviewed from across North Lanarkshire. The ART team highlighted that problems with staff recruitment and retention resulted in high caseloads, and accommodation issues added to the pressured environment. It should be noted that statutory addiction service have met the targets set by the Scottish Government throughout covid and this is despite with depleted staffing levels. Generally, other stakeholders understood the pressures the team was operating under. Individuals felt that it was when they were really able to speak to someone, to understand the underlying reasons why they took substances that real change was able to happen, highlighting that meaningful engagement is imperative. In North Lanarkshire’s Strategy, what is referred to as the ‘No wrong door approach’, this promotes the need to focus not only on the substance use or disorder but all the needs people may have. A third sector representative observed that statutory services “don't have time to dig deep into the myriad of peoples’ problems” and this was instead felt to be left to the third sector to do the ‘heavy lifting’, leading to staff burnout. The rise in cost of living and the support people needed to deal with poverty was also highlighted as something statutory services do not have the time to deal with. Individuals also said that statutory workers did not let them know of the different options available to them in the community, and instead there was an emphasis only on prescribing methadone, medicalising what was recognised to be a psychosocial problem. “I think the problem is that no one is really speaking to you about why you are drinking or taking drugs. You don't have that time. I was going to get my script and there are 12 people in there at a time and they are all waiting to be seen by 3 or 4 workers, and so you feel like you are taking up peoples’ time. You can also hear what people are saying, so you don’t have privacy. You are also seeing different people all the time, so you don’t build that relationship with the worker… I have had lots of different addictions workers and it has got to the point where I don’t know who I am going to see when I go in there.” (Kate)
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8 “I think is my 10th or 11th addiction worker. It’s hard because you only see them for about 10 minutes about once a month or something. A lot of the time they just want to keep you on a script. I went to them in April to ask about the rehab and was told there was no funding and they asked if I wanted to up my methadone rather than come off it…The addiction workers don’t know what you are going through and they don’t have the time to sit and get to know you…Addiction services don’t offer you things. So unless you know about it. It is only when you go to the recovery cafes that you hear about these things and you think why didn’t my addiction worker mention it. They’re happy to up your methadone though, it’s crazy.. Also use other things other than medication. They want to medicate everything. It’s only now I know that’s not the answer because I was addicted to painkillers for years. It’s not the answer. You need to sort out the problem before you can medicate it. ” (Shona) “I have a drugs worker but you see her once a month and I don’t really get any help. They ask how things are going – I can see that the worker I have is stressed out of her mind and so I am thinking – right get out the door. So I think that needs to change, there should be more of her. You can feel the stress that they are going through, you don't want to take up any of their time.” (Peter) As a result of the lack of meaningful engagement, fewer connections are occurring to mental health provision or access to counselling - which can help people to open up and begin to understand and address underlying causes. “I have a sickly feeling he will be on buvidal for the rest of his life. We are not addressing any of the issues.” (Lorraine, family member) “They need to sit down one-on-one with people and get into their story why, and exactly what help they need. Listen to the patient, not what they have read in a book. They can’t relate to how I have lived. They don’t come from our areas. They come from nice affluent areas, mortgages and they come down here and it is different. I don't think I have ever had a meaningful conversation with my drugs counsellor. I probably could speak to them, but they don't have that experience. The biggest thing for me is that they can’t relate to how I have lived.” (Mark) 19. Inadequate and unequal provision across areas Consultees highlighted a number of issues regarding service provision which they felt was either inadequate or unequal across North Lanarkshire. There was a strong agreement that crisis support in North Lanarkshire was inadequate. In situations where services can only offer appointments a number of weeks in the future, as reported above, stakeholders and individuals felt there was no service where people in crisis could be seen at short notice. Some individuals and stakeholders mentioned the Crisis Centre in Glasgow as being good practice. Stakeholders and individuals also highlighted the lack of residential rehabilitation options and hospital detox beds. Most of the individuals with lived experience had not been offered residential rehab and had no expectation of it being a treatment option; they were aware that finances was the reason.
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9 “False economy at the moment. Guy in his early 40s continually relapsing in hospital for 10 days, back out with no support to a sparsely furnished flat in the middle of a scheme, relapse, re-admitted to hospital, until eventually he died – at no point was he offered residential rehab.” (Stakeholder 7) “No. The addiction services gave me a stable prescription. They never helped. They never suggested a detox, rehab, nothing.” (Sarah) A number of individuals and stakeholders reported that the recovery pathways were unclear and this was regarded as a significant issue. Several individuals stated they did not know what support and treatment was planned and, significantly, what the milestones would be that triggered the next step in their journey for example, progressing from a methadone prescription in the community to residential rehab. They stated they would welcome an individual recovery plan that clearly set out the support and treatment they would be following. Similarly, several stakeholders felt there was no clear treatment and support pathway which set out how services in North Lanarkshire would support people in different situations. This meant they were unable to provide clarity to individuals they were working with. “When people turn up at statutory services they need to be given a plan, knowing what is expected of them, so they know the steps they need to take to get there”. (Stakeholder 7) One particular area of concern was the limited support for people when they leave prison. In North Lanarkshire’s Strategy this is a particular group highlighted as requiring support and needing a partnership approach, taking account of housing, advocacy and connections to the community. Interviewees observed the importance of family support and felt that at present this is an area which needs to be addressed in North Lanarkshire. One stakeholder suggested that having a recovery café specifically for family members and having a local Scottish Families Affected by Drugs and Alcohol, to offer face to face support would be beneficial. One of the key priorities in North Lanarkshire’s Strategy is the development of support for families in their own right. It transpired that in different areas there are particular issues relating to the poor infrastructure inhibiting engagement. In Bellshill in it was reported by both stakeholders and individuals that the current buildings for addictions support are inadequate, with no waiting area and people having to ‘hang around’ outside feeling especially stigmatised as a result. At the stakeholder workshop it was raised that the Wishaw ART team had to temporarily operate out of Motherwell because of accommodation issues, which meant service users could be faced with three different modes of public transport to make appointments. In rural areas, in particular, stakeholders felt more should be done to provide people access to support. Individuals and stakeholders also reported that in some areas there is a lack of access to buvidal.
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10 It was also reported that generally across services there is a problem with recruitment and retention of ‘good’ staff. It was felt that this can add affect the support available to people with substance misuse problems across North Lanarkshire. 20. Incompatible cultures and short-term funding inhibiting partnership working Stakeholders reported that as yet, there is a lack of integration and information sharing between statutory services and the third sector. It was also reported that some staff from statutory services had displayed a level of ‘professional snobbery’ in their interactions with staff from the third sector. There was a view that short term funding and competition could inhibit partnership working between third sector organisations. It was also reflected that short term funding restricts the extent to which services can recruit high quality staff. 21. GP treatment choices and an information gap Three individuals reported that GP prescription of opiate-based painkillers had led to a heroin addiction either when the prescription ended or when they self-medicated by taking heroin as well as their painkillers. These individuals felt the ten-minute time limited appointment was not long enough and their addiction may not have developed if the GPs had taken a different approach. For example, one of these individuals who had experienced childhood trauma was prescribed co-codamol as a teenager when she enquired about counselling, and was prescribed dihydrocodeine in her 20s, when she had another traumatic experience. Some individuals and stakeholders suggested that some GPs did not know what support people could access for addiction and mental health problems. Individuals reported they had found this information through engagement with the recovery community or when they had hit crisis point. “I didn't know where to ask for help. My cheese had slid off my cracker. I had gone into fits outside and taken into hospital. I think if there had been one person I could have spoken to, if I had been able to say, I wouldn't have got so extreme… I think even a leaflet through the door so people know what support is there. Rather than Domino’s pizza leaflet.” (Peter) 22. Lack of follow-up support Individuals described points in their life when they had relapsed soon after getting stable through support such as rehab or a Drug Treatment Testing Order (DTTO). They explained that the lack of follow-up support once these interventions had ended had been a key factor in their relapse. As highlighted earlier, people leaving prison also reported a lack of follow-up support.
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11 23. The negative impact of the pandemic Partnership working between statutory and third sector services that had begun to take place in one area stopped as a result of the pandemic and was said to have not started again. Over this time, contact was lost by statutory services with people. By May 2022, face-to-face contact by statutory services was reported to still not be happening to the extent it had, prior to the pandemic. Individuals reflected on the staff shortages and subsequent lack of continuity of service, and stakeholders noted the rise in referrals, with the impact on staff stress levels. 24. Stigma Individuals and stakeholders reported that people working in some services, especially statutory services, could make people feel stigmatised, and there was much work to be done to challenge stigma. “When I was in hospital having caused this injury through using drugs, half the nurses looked at me as a drug user, and half as a patient. Most of the young nurses treated me like a drug user, it was the older ones that were better, they didn’t have the experience.” (Alan) A few individuals opened up about the realities of living in poverty and that the areas they lived in were rife with drugs and people felt stigmatised more generally. “There are three big high rise flats down the road and everyone calls them ‘Heroin Heights’, they put everyone who is in the same situation in the same places.” (Kate) In North Lanarkshire’s Strategy there is a commitment for the NLADP to lead on a local stigma plan. Barriers to engagement 1. Stigma and perceptions Stigma felt from the wider public and professionals is a significant barrier to people engaging with help. Individuals reported even feeling stigmatised by the chemist they went to, when picking up their prescription. “You can’t talk to anyone who looks down on you. The Chemist look down on you. They make you wait. Some of them are awkward. They don’t need to look down on you. Why are they working with people they don’t like?” (Neil) Stakeholders reflected that many people with an addiction have experienced systematic failures over their lifetime and distrust services, and overcoming this is a significant barrier. “Some people think what’s the point. You have an addictions issue and an addiction workers and they ask you to keep a diary, what’s that all about. It seems quite passive – here’s a leaflet, here’s a website. There’s a feeling of self-loathing scum. People need to be grabbed by a community like the recovery community who can
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12 say you’re not scum, I was like you and look at me, and I’ll come on the journey with you.” (Stakeholder 7) 2. Lack of resources and inappropriate responses Many participants, both stakeholders and individuals reported that at present people ask for help and the response is not timely, with waiting times a particular barrier, preventing people from engaging. The lack of provision for mental health support was also identified. “When people make that decision they need help that day. They don’t need a referral for a fortnight’s time. We need walk-in clinics that are staffed by prescribers. Somebody who can say to them that day this is what the plan is, they leave with an NHS prescription, and they are asked to come back again tomorrow to maintain support. Something to get through the night. To be grabbed at that point.” (Stakeholder 6) “The initial referral, you need to wait three weeks before you see a drugs counsellor. Within those three weeks, they insist on you giving a dirty sample. If I said to them, I have gone through cold turkey, but they can’t start you on treatment unless you are giving in a dirty sample…Access to psychiatrist. I have been waiting a year.” (Mark) As already mentioned, mental health services and addiction services not being integrated meant that some people were in a situation without any support. Stakeholders reflected that where a medical intervention for substance use was not clear, gaps arose, and this was also echoed by individuals. “All the services seem to be focussed on opiates. People don’t want to go there if they’ve got a problem with cocaine, alcohol, diazepam – don’t want to go in as its seen as the junkies place.” (Leanne) In addition, stakeholders and individuals felt services operating on a mainly 9-5 Monday to Friday, appointment-only basis were inhibiting levels of engagement. 3. Professional attitudes: Lack of empathy and understanding Stakeholder and individuals observed that the current model of working of discharging people who miss a number of appointments, fails to recognise the realities of the challenges people face and the practical barriers that are likely to also exist. A number of barriers were highlighted including public transport links, distance, finance, family/relationship issues, ongoing substance misuse, mental health, and the support that was likely to be provided during the appointment. Consultees suggested a more flexible approach with assertive outreach was required. One stakeholder suggested that people who were missing appointments should be the focus of intensive proactive support – the opposite of the current situation when they are likely to be discharged from services.
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13 4. Lack of information sharing between services Third sector services felt that at present statutory services generally do not share information in a way that would enable wider access to support for individuals and this needs to change. 5. Lack of exit plan for methadone use Individuals reflected on being put on methadone on a long-term basis without an exit plan and viewed this as replacing one addiction for another. What drives partnership working? 1. Good communication Stakeholders welcome the partnership meetings now being convened by the ADP. Stakeholders also spoke about the success of different partnerships developed, between the third sector, and also some examples of the statutory and third sector working together too. “Same goals and working together and the opposite of that is services getting precious.” (Stakeholder 3) 2. Taking a holistic approach Stakeholders reported that the best partnership working was when services worked with whole person and family, understood the complexity of the issues, the extent of the support needed and prioritised building relationships with the person around this, ‘being human’. An example of good practice was discussed whereby the Simon Community Housing First Team are working closely with addiction services, doing outreach and helping people sustain their tenancies and connect to relevant services. “In the statutory services there needs to be more of a shake up, what they see as their role, the old school speak about how they approach their job and there is a lot of burn out. There isn’t role validation, is what I am doing right? There is also a fear of change too. Are statutory services welcoming to people? MAT standards, same day access to treatment, we don’t even have that for assessment! If someone wants help, they want help, you want to help them then. We send people away and then they have to come back, and then back again.” (Stakeholder 6) “I had been in rehab for six months, years ago and it was good, but I was back drinking more or less as soon as I got out as I was back in the same area and same problems, nothing had changed…I do think if I had got the help that I am getting now, to be able to talk about the things that happened to me, the abuse when I was younger I might not have handled things the way I did… I remember last time getting the taxi (after the detox) to take me straight to the shops and I bought drink. No one
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14 is looking at the reasons why you are drinking. You are left to the same things that you left, the only difference is now you can get drunk faster. The area I was living in, everyone was taking drugs… I have numbed my feelings all these years and now when I stopped they are all coming back. There is always a reason why people drink the way they drink. I feel like I have been born again as I am having to learn all about my feelings again. ” (Kate) 3. Co-location of services Although rare, a few stakeholder said that when services are co-located together it makes partnership working easier and promotes ongoing communication. The example of statutory sector addiction and housing staff sharing office space in Motherwell was highlighted as an example. Groups not accessing support The following are the key groups that stakeholders felt were not accessing support: ● Those isolated and living on their own ● Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) ● Young people aged 8-11 (as services are not available for this age group) ● LGBTQ+ ● Victims of domestic abuse ● Mothers ● People from ethnic minority backgrounds ● Elderly people Raising awareness of what is available to people who are not in supported accommodation and not connected with services was felt to be key, and some noted that the GP could be a ‘way in’ for this group. It was felt that for people who are LGBT+, mothers and people from ethnic minority backgrounds, they face additional layers of stigma which makes seeking help especially challenging. It was felt by most that it is important therefore for substance use services to try to reach these groups building links in the community. “I think women with young kids are definitely more unlikely to be able to engage, so the fear of losing their kids, and that has been an ongoing issue. It is about letting people know that it is ok to ask for help. We need to raise awareness of that.” (Stakeholder 5) One stakeholder however also raised that at present, services are not giving those who are coming to services, good support, and therefore trying to engage with those ‘missing’ would not be a good use of time, as resources are already stretched.
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15 Future Service Provision What support do people want and need? 1. Services need to be person-centred and holistic Individuals and stakeholders emphasised the importance of people having a choice and being informed about the options available to them, and services designed around needs and wants, for example to be age and gender specific. Good practice was identified when it was felt that services took a holistic approach, to link in with partners, supporting people to make links to help that was meaningful to their whole lives, working towards positive mental, physical and social health. 2. Services need to be responsive A key message across groups was that people need to get support quickly, and they described the need for a crisis service which was a hybrid between an addiction service and an emergency response. Interviewees felt this service should be an accessible walk-in service that provided immediate support for people seeking assistance with a substance misuse issue, including overnight accommodation if required. They also felt the service should fully support people to access the most appropriate substance misuse service in the days following their initial presentation. 3. Services should be available out of hours and be able to provide assertive outreach At present it was felt that generally services are designed for service providers and not for the people the service is for. Taking account of the needs identified, good practice was felt to be when services provided both assertive outreach and out of hours support. The interim report of the Overdose Response Team (Evans et al. 2022), which operates in the area of North Lanarkshire, highlights the benefits of this type of provision. “The worker gave me a list of numbers but I prefer one to one and have not phoned anyone… I think having people come to you, so I had the workers come to me when I was out of hospital and it really helped.” (Kate) 4. Services should have a single shared assessment Statutory service providers reported that the referral systems and bureaucracy involved mean that staff are having to spend a lot of time between different systems to gather information and link people in appropriately, and a single shared assessment across services would work better. 5. Prioritise prevention One stakeholder observed that addiction is inextricably linked to poverty and inequalities and one of the best ways of addressing this is to offer universal services to young people by way of breakfast clubs, free meals and afterschool care that are
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16 preventative in nature. They recognised this was a ‘brave’ move in terms of future commissioning, but also felt that the current system including a focus on people who are using opiates is not working. ‘The ideal’ Stakeholders and individuals were asked what the ideal provision would look like. Some felt that service provision should be completely overhauled and to get ‘the ideal’ it is a case of starting again. “What we need to do is not tinker and look at workforce planning and job roles. We need to start again to fundamentally change how things are done”.(Stakeholder 7) 1. A one stop shop with wraparound care The majority of consultees wanted North Lanarkshire to have a ‘one stop shop’. A physical building with staff who are trauma informed, that individuals could self-refer into at any time, that offered a range of support options. Staff from a variety of services would have time to meaningfully engage, and practical help could be provided to help people make links to the support they needed and wanted, and they would be provided with aftercare. “I think people need a personal worker, so they can phone people day to day, appointments, things like that, take them out for something to eat.” (Leanne) Essentially the vision is that people could get crisis management support and a forward plan would be developed, taking account of people’s needs, wants and capabilities. 2. Services are responsive and there are no waiting times Echoing earlier findings, stakeholders and individuals wanted services to be responsive and, ideally, there would be no waiting times. “Services need to be set-up so they can rapidly respond when folk make that decision.. Timing is so important – striking while the iron’s hot. Someone might be ready to do it one week but the next week they are back using again. If you had the service set-up with a rapid response with a multi-disciplinary team that they should be able to help someone enough within that week when they are open to help for them to think it’s not worth going back to their old life. Someone leaving detox may only have a small window of clarity but if they are going straight back to a homeless unit with an appointment in three weeks’ time to speak to an addictions worker, they are likely to slip and the moment has passed. Find it difficult when people are at that stage. Temptation there when they are being offered street valium for a fiver.” (Stakeholder 7) “I think it takes too long to the time people ask for help to when they get it. When people are chapping the door for help, they want it now, they don’t want it in a
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17 month. When they go to an addictions worker, they want that help. You can’t go to A and E even. It is time people have not got…I have went for help before, I chapped the door, and then they are away. I am on the bender. I went to the addictions team in X to ask for help, they took all my details, by the time I went for urine tests and they finally got back to me, I was on a binge. I think I really wanted the help and I don’t think I would have had those other years if they had given it to me then.” (Neil) 3. Services are holistic, taking a whole family approach and addressing the root causes of addiction As already discussed, consultees felt that the best approaches took a holistic view, listened, learned and responded to what people and their families wanted and needed, providing or connecting people to appropriate practical and emotional support, and taking time to help address the root causes of addiction. 4. Providing out of hours and outreach support A common theme was the need for out of hours and outreach support. “Going to people, out of hours. There are people who can’t get out as much. I feel that they would respond more towards their recovery, if they had that ability to sit in their own house, make the person a tea and coffee, instead of hard chairs and made to rush. You are in your own home. There needs to be a thing of time.” (Alan) The Overdose Response Team and Harm Reduction Team were identified as providing excellent support and ‘bending over backwards’ to help people get the support they want and need. 5. Accessible residential rehabilitation Stakeholders and individuals felt that in North Lanarkshire there was much need for accessible residential rehabilitation, actively promoted and not limited by funding. “I asked for rehab three years ago and still waiting. I ask every fortnight about getting into rehab…we don’t have a rehab in North Lanarkshire. For the last 18 months, every other person on Zoom from Glasgow has been in and out of rehab. We have been told there are 3 beds available in North Lanarkshire, you would need to be really lucky to be one of the three. Where does our worth start?” (Sarah) 6. Follow-up service Individuals and stakeholders also felt follow-up provision was required. This would ensure people are supported by a ‘checking in’ service when they are at home . 7. Connecting people into ‘something meaningful’ One of the key findings in this report is the importance of the recovery community to supporting people to make connections with others, engage in meaningful programmes, support and groupwork. Two individuals spoke about when they were
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18 at their most stable they had taken more of a leading role in the recovery community and it was felt by all, that supporting people to have a sense of purpose and linking into their communities was the ideal. Many individuals spoke about the benefits of the recovery community and of being able to access groups in the community. “These groupwork sessions, art or computer course, little things, acupuncture, meditation, open up something like that…you have no friends when you stop using. Most people who are in recovery, they don’t have a place to go and meet people who are focused on the same thing as them. Get to know more people. Play games, be social. We were experienced in recovery ourselves, see other people. There are not these places about. It is expensive to travel to these other places.. Part of my problem was the isolation and then I had this recovery café, you made friends. ” (Alan) “So the café that I go to, it has opened an allotment. So different days they do different things. There are five different cafes on from Motherwell, sometimes you can get lifts.” (Sarah) One stakeholder described a Community Day Programme that had existed in North Lanarkshire years ago, that provided health information, groupwork and provided people with structure. There was support for something similar to be re-introduced. 8. Individual recovery plan Individuals and stakeholders reported that every person should have their own individual recovery plan. The plan would set out a tailored treatment and support plan including clear milestones that triggered progression to the next stage of the plan. Opportunities Stakeholders were asked where they felt the opportunities were in North Lanarkshire and what change they would like to see happen. The key messages: Relating to provision: 1. Improve provision for those in crisis and families The need to address the lack of crisis services and support for families currently available was a particular focus. 2. Expansion of the recovery community The value of the recovery cafes was clear and it was hoped that they would exist in all areas throughout North Lanarkshire, and there would be specific provision for families too. 3. Digital connections One stakeholder discussed the opportunities that digital connections open up and are yet to be fully utilised.
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19 Relating to cultural shifts: 4. Support for staff At present it was felt that staff, particularly in statutory services are overworked and had become reductive in their practice, so having adequate support and development for staff is needed. Another stakeholder said the one thing they would like to change is that staff are ‘nice’ and have compassion for people. In North Lanarkshire’s Strategy one of the key priorities focuses on the need to develop the workforce. 5. Partnership working Across sectors the benefits of working in partnership are clear and there was a commitment for this to happen more. It was suggested that services offer opportunities to staff across sectors to shadow one another, and in doing so understand their working practices, challenges faced and ideally arrive at solutions together to address them. Stakeholders and individuals alike noted the important role GPs could play in helping people to link into service provision and the need for more information raising. Individuals felt that the responsibility for service provision design and delivery needed to involve statutory, third sector and people with lived experience, and that it was only by working together that real change is possible. 6. Services to promote flexibility It was felt that closing down the cases of people who have not made appointments needs to change and instead barriers to engagement needed to be decreased as much as possible. 7. Including the voices of people with living and lived experience in service design and delivery It was raised by one stakeholder that there is much value in having people who are still using substances included in decision making, and this should be treated as one form of evidence, so that decisions are informed by as many stakeholders and evidence as possible. Wider evidence of good practice The following were ideas given by stakeholders of initiatives that could be tried, drawing from the wider evidence base: ● Rehabilitation services run by people who are in recovery and offering a day programme. ● In Forth Valley there is a paid member of staff from the recovery community who works with the Housing First team there, to support people with any practical and/or emotional needs they may have, as well as actively linking them in with the recovery community, reducing isolation. ● To have people with lived experience paid as experts to inform every aspect of provision. ● Better pathways for rehabilitation, taking the holistic approach to involve the recovery community and family, to understand the best time for this person and the support they require.
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20 ● Injecting rooms and being able to test drugs. ● Therapeutic communities. ● Have no unplanned discharges like Norway. ● Legalise and regulate the supply of drugs.
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Conclusion and recommendations This conclusion draws together the key messages from across the different questions. There was a lot of synergy between what stakeholders and individuals with substance misuse problems said in terms of what the current provision is and what people want for the future. Significantly, there was also a collective commitment and desire to make this happen. There was a sense that this could be a key moment in time when real change for the better began. What is working well? Interviews recognised the backdrop of poverty, backgrounds of trauma, abuse and long-standing issues people faced as being the underlying reasons why individuals had issues with substance use. The services felt to be working well therefore viewed people holistically, often doing outreach, offering out of hours support, taking time to really listen to and understand people, promoting their rights, and worked hard to link people into support they wanted and needed, particularly mental health provision. They also provided or linked people in so they could avail of whole family support, understanding the ripple effect substance use has. The importance of human connection and meaningful engagement, relationships built over time and trust was further emphasised by interviewees’ recognition of the good work carried out by services such as Phoenix Futures, the Overdose Response Team, Equal Say and the recovery communities. Many wanted this outstanding work by these organisations to be expanded further. What is not working well? Lack of resources The responses to what is not working well could be divided into resource and cultural issues. In terms of resources and provision, it was felt that crisis support, accessible rehabilitation options, detox beds, the length of waiting times for treatment and support for families was inadequate. Stakeholders and individuals were concerned about the rise in the cost of living and reflected that deprived areas are already badly affected by drugs. It was reported that the extent to which people with mental health issues are requesting to be sectioned so they can get support has never been seen to this level before. The lack of support for people leaving prison was also noted. Cultural barriers Issues relating to cultural barriers were that addiction and mental health services are sometimes not easy to access, not responsive and people who have a dual diagnosis can fall between mental health and addiction services. Although, there were exceptions reported, stakeholders and all individuals felt that at present, statutory addiction services are overwhelmed and do not have time to meaningfully engage with individuals. All felt that this model meant culturally the focus was on the symptoms rather than addressing the underlying causes of addiction, and essentially medicalising what is a psychosocial problem. There was a perceived cultural divide between statutory services and the third sector, while short-term funding could inhibit partnership working between third sector organisations. A few individuals felt their addiction could have been avoided if they had received better support from their GP and it was also suggested that GPs could play a more proactive role in linking people in to treatment or community support options. Individuals praised the support they
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had received from completing a DTTO and within rehab, but the lack of follow-up support meant that this was not able to be sustained. At the time of writing, statutory services are still not seeing people face-to-face to the extent they had prior to the pandemic. Culturally, the stigma around substance use is a significant barrier and as well as the general public, both individuals and stakeholders, felt this also came from professionals who worked in the field. Barriers to engagement Stigma about addiction was felt to be the main barrier to people asking for help and that when they do, services are not always responsive, with lengthy waiting times for a first appointment. Interviewees reflected on the inflexibility of the current model of working, which tends to be 9-5 Monday to Friday and appointment based. Further, if people do not attend a number of appointments they tend to be discharged by services which underlines the lack of empathy and understanding within the current system. Limited information sharing between services was also noted as a barrier to people connecting to appropriate support. Finally, individuals revealed that a barrier to engagement is the concern of going on methadone long-term without an exit plan, and this is essentially linked again to people not having meaningful engagement with workers. Partnership working Good partnership working was felt to be when services are working together towards the same goals, have good communication and when services worked with the whole person and their family, echoing the move towards this being viewed as the ideal way to support people. Co-location of services was also observed as promoting links, for example in Motherwell between housing and health services. Groups not accessing support There were particular groups identified and felt to currently not be accessing support, namely, those living on their own, those not taking opiates, young people, LGBT+, victims of domestic abuse, mothers, people from ethnic minority backgrounds and those who are elderly. GPs were mentioned as a potential ‘way in’ for these groups but also the need to widen partnerships even further. Future service provision Most interviewees emphasised the importance of person-centred and holistic support, giving individuals and their families options and choice, finding out what support they want and need, creating a single shared assessment and connecting them to services and clear treatment plans as quickly as possible. Services would also ideally be designed around persons’ needs, offering out of hours provision, assertive outreach and accessible residential rehabilitation. Effectively what people want is to have a ‘one stop shop’ with wrap-around care provided, connecting people also into ‘something meaningful’ in their communities, with the recovery community viewed as playing a vital supporting role, for example by running a day programme. Stakeholders were asked about what they felt the opportunities were in terms of change. As well as those already discussed relating to the need for more provision, expansion of the recovery community and digital connections, the need for cultural shifts were discussed. It was said that staff need to be supported and would benefit
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from shadowing and sharing practice across organisations, to understand more and support one another to overcome current challenges. Services needed to be more flexible, taking account of the people they are supporting, and including the voices of those with lived and living experience going forward. It was also felt that digital connections which worked well during the pandemic could continue to support people into the future. Wider evidence Drawing on wider evidence, interviewees also suggested better links between housing, addiction and recovery; involving the family and recovery community in treatment plans; having a commitment to have no unplanned discharges; creating injecting rooms; developing therapeutic communities and, finally, legalising and regulating the supply of drugs. Recommendations 1. Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. 2. The development of a crisis service which is a hybrid between an addiction service and an emergency response. 3. Services to move towards more provision that offers out of hours support and outreach. 4. Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. 5. Development of accessible rehabilitation and detox beds. 6. Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. 7. To commit to having no unplanned discharges. 8. More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. 9. Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). 10. More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. 11. Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. 12. Drawing on lived and living experience, working with third and statutory services, create a day programme for people. 13. Substance use services in local areas to make connections with GPs, schools, the local voluntary sector to open up avenues of communication and referral pathways.
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14. For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ 15. Services to be trauma informed. 16. NLADP remains committed to the development of the Stigma plan. 17. A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers.
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Case Studies Rab: Alcohol addiction, lack of aftercare in the past but in recovery with vital support from Phoenix Futures and AA Rab drank heavily all his life from a young age and this was the culture he had grown up in, to the point that he drank, not for enjoyment but to get through the day. He had ‘always’ been a ‘secret drinker’, and would go to the pub, but described that it was when he got home that is when he really started to drink, and yet always made his work the next day. He described losing friends because they had helped him too many times over the years, with debts or just even getting himself ready, when he would go on spells of not washing or looking after himself. He had been to hospital many times before for a detox, but was ‘straight out’ and back drinking. Just before lockdown he had was suicidal and called Phoenix Futures who sent the police around to his house and he was taken into a psychiatric ward. He realised if he didn’t stop drinking he would die. Over the past two years he has been engaging with Phoenix and the worker, who has lived experience and feels this has been a real turning point for him. He does not remember being offered support like this before and said that aftercare in the past had been ‘non-existent’. He tried AA in the past and had rejected it, but now attends local meetings. He explained ‘you go there with your bag of shit, put it down and leave it there.’ He says attending the meetings helps him to keep his head clear and he said, ‘I get a wee cuddle off people’. Other services he feels have been excellent were the housing officer that helped him with his debt. He was given support also by a mental health charity but felt that their time frame of working with him for 12 weeks only was not realistic. Rab has stayed sober and feels that one of the reasons is that he is the main carer for an elderly aunt, which is ‘all consuming’ and has given him ‘a real sense of purpose’. Rab felt the main thing missing from services at the moment is communication, with people not having read your file and feeling like you have to explain yourself all the time. His GP also refused to give him medication to deal with withdrawals from alcohol. Rab has found support from the psychologist to be really useful and felt for the first time he was learning about his emotions. The doctor at the hospital also said he could call anytime and he has found this person really helpful too. Rab felt that he had to be suicidal to really get help and felt this should not be the case.
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Shona: Prescription drug addiction led to longstanding illicit drug use, in recovery with support from the recovery community and various services When she was 16, Shona was prescribed co-codamol and diazepam by her GP after enquiring about counselling to help address childhood abuse. For a number of years, Shona continued to take the drugs to “block things”; she was also self- harming. In her 20s Shona was raped. By then she was also taking dihydrocodeine. On an occasion when she could not get the tablets an acquaintance told her dihydrocodeine was heroin in a tablet so she started using heroin. She became addicted to heroin and also started using street valium and crack cocaine. Her addiction continued with sporadic attempts to get clean. On one occasion she had “a major relapse and ended up in hospital” when a doctor told her Mum there was nothing they could do and her best option was to buy Shona heroin. After her relapse, Shona ended up back in hospital with an abscess. At that point she said, “I was done, I was exhausted and I got put on to methadone”. She has not used illegal drugs for two months and said she was “feeling brilliant, feeling really good”. Shona regularly attends recovery cafes throughout North Lanarkshire as well as CA meetings. She described the recovery cafes as a “godsend” adding that “it keeps you busy and gives you something to look forward to; there’s a lot of boredom otherwise”. She has previously been supported by Phoenix Futures and described them as “amazing” but “fell away from it and relapsed again” during lockdown. Shona also has experience of the Addiction Recovery Team. She described having 10 or 11 addiction workers and felt that none of them had the time to support her and focus on the traumatic events which had led to her substance misuse. In the past she had asked about rehab but was told there was no funding and, she reported, her worker asked if she wanted to up her methadone dose. Shona felt her GP had missed numerous opportunities to recognise her dependency on prescription drugs and subsequent use of illegal drugs. Shona was identified by the High Resource User Project as a frequent A&E attender. She has been supported by this project and by the Homes First service. She was very complimentary about both services. Shona has also been supported by Equal Say’s addictions advocacy service which helped greatly when she was at risk of being homeless after leaving hospital. Equal Say’s involvement stemmed from Shona’s mum who was told about the service by SFAD. Shona described her mum’s help as invaluable, “she’s been great, she’s my rock, so she is”. Shona’s mum has continued to engage with SFAD including Zoom calls and added “they’ve been really good for her; they’ve given her an understanding of what it’s like to be an addict”. Shona suggested that, to improve, services needed to “make a point of seeing people more often, and for longer, offer the services that are available other than medication (like counselling) as they want to medicate everything”. Shona also suggested it would be ideal if there was more funding for rehab places.
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Appendix 4 ANNEX A IMPROVING GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS WITHIN ALCOHOL AND DRUG PARTNERSHIPS: SELF ASSESSMENT TOOL Alcohol and Drug Partnerships Partnership Delivery Framework Self Assessment Tool
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June 2022 Introduction to the Self Assessment Tool This Self Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. The Scottish Government and COSLA coproduced the Partnership Delivery Framework for Alcohol and Drug Partnerships which was published in 2019. It sets out the expectations for the role of Alcohol and Drug Partnerships (ADPs The purpose of the self-assessment The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes ADPs are strategic planning partnerships that set out plans to delivery national and local priorities. To effectively deliver these priorities ADPs undertake strategic planning, formulate delivery plans and report outcomes. They do this on a partnership basis
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that aims to be inclusive and transparent with representation from stakeholders affected by alcohol and drug harms. Increasingly alcohol and drug harms are seen as a “whole system” issue and not just the realm of specialist drug and alcohol services. ADPs are not Statutory Public Bodies, i.e. they are not “organisations” and therefore rely on the Integration Authority for financial governance and ratification of investment as well as performance oversight. Community Planning Partnerships hold the overall responsibility for population level outcomes set out in the National Outcomes Framework for Scotland and therefore provide ADPs with an overarching forum for reporting achievement of outcomes. Local areas will also have other strategic partnerships which are required in statute such as Children Service Boards, Community Justice Partnerships etc and it is important to ensure that there are strong links between ADPs and these partnerships. The self-assessment is designed to help local stakeholders ensure that these key relationships are in place and that the local system is supporting the work of the ADP and vice versa. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders. The Scottish Government use of the Self Assessment reports As stated, the self-assessment tool is for local stakeholders to ensure that they are creating the right conditions and operating environments for ADPs to function effectively. The Scottish Government will have oversight of the self-assessment reports and the information will be used to help develop programmes of support for local areas when required and will help facilitate peer discussions with ADPs about best practice and achievements. Where an ADP signals it would like further discussion or support in responding to local barriers, this will initially be provided through discussion with the ADP Liaison leads within the ADP Support Team in the Scottish Government. External Validation ADPs are asked to assess their own ability to deliver against the Quality Standards and highlight any issues. At a future point the Scottish Government will seek to validate the self-assessment through a third-party organisation such as the Care Inspectorate or Health Improvement Scotland. On that basis, ADPs should complete the self-assessment from the perspective of “if an external person reviewed our approach would they find the same evidence we are presenting?” How to complete the Self Assessment Tool
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The self-assessment should tell a story about where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: Strategic planning Financial arrangements Quality improvement and Outcomes Governance and Oversight The relationship between the ADP and the Integration Authority A representative national working group agreed the following five standards in relation to the Partnership Delivery Framework. The five quality standards are: Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Structure of the Self Assessment Tool The Self Assessment Tool should be completed in conjunction with the Self Assessment Criteria (Appendix 1 page 25-34). The criteria outline the minimum supporting evidence required to demonstrate the ADP is delivering and working in line with the Partnership Delivery Framework.
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The first part of the Self Assessment asks ADPs to assess themselves against the Self Assessment Criteria and to map themselves again the Criteria using the definitions Maintain, Explore, Develop outlined in the table below. Definition Maintain We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. To meet this definition the ADP needs to be confident that it has policies and practice in place. ADP member’s and senior stakeholders support this statement. The ADP has feedback processes in place and is confident that an external process could independently gather similar feedback locally. The ADP is confident in maintaining this standard as core practice. Explore We currently partly demonstrate this standard and may need further development The ADP feels it has some evidence to support the standard but isn’t confident it is consistently maintained. The ADP and stakeholders feel there is room for improvement on some elements of the standard. Develop We do not fully demonstrate this standard currently and need to develop / discuss this further. The ADP is not confident it is achieving the standard. Further work is required to generate support for improvement or progress The self-assessment then asks the ADP to demonstrate their assessment with narrative in line with the headings of: * How effective is the ADP in respect of this area? * How do you know this? * How will you do it and by when?
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For each of the elements described above, please outline in no more than 250 each what you need to maintain, improve or do differently and provide a timeframe for these to be implemented. Please be open and honest in your response and consider the self-assessment in collaboration with relevant stakeholders, including local communities, children, young people and families. This will provide opportunities to: 25. review what progress has been made and what development and learning has happened 26. provide assurance about the quality of delivery 27. highlight areas of good practice for sharing 28. highlight areas for improvement and levels of priority Those completing the self-assessment are encouraged to use information from different sources to triangulate evidence of the quality of service delivery. The completed Self Assessment should focus on outcomes rather than activities. This could include a description of the impact of changes or improvement activities on the delivery or information on how potential impact is being monitored.
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The Self Assessment Tool ADP area: Please use the box below to highlight relevant contextual and background information about the ADP including: -Population data for context -Outlining Governance and accountability arrangements (particularly in relation to ADP, Community Planning Partnership, Integration Joint Boards and Chief Officer Groups) -Links to other local statutory plans/partnerships (and how they link to local delivery) e.g. what links / role does the ADP have in relation to delivery of outcomes against their Local Outcome Improvement Plan / Children’s Services Plan
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Section 1: Strategic Planning Maintain Explore Develop We are confident that we are demonstrating this standard; we have evidence to support this, including stakeholder confirmation and need to maintain this focus overtime. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 1.1 Transparency and Effectiveness 1.2 Inclusion 1.3 Planning Cycle 1.4 Needs Assessment 1.5 Whole System Approach 1.6 Resources and Delivery 1.7 Outcomes Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes
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Q. How effective is your approach to Quality Standard 1? 1.1 Transparency and Effectiveness 1.2 Inclusion 1.3 Planning Cycle 1.4 Needs Assessment
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1.5 Whole System Approach 1.6 Resources and Delivery 1.7 Outcomes Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when?
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Any further comments?
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Section 2: Financial Governance Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 2.1 Investment 2.2 Governance 2.3 Accountability 2.4 Reporting 2.5 Financial Planning Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of its Strategic Plan
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Q. How effective is your approach to Quality Standard 2? 2.1 Investment 2.2 Governance 2.4 Accountability 2.5 Reporting
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2.6 Financial Planning Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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Section 3: Quality Improvement Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 3.1 Methodology 3.2 Reporting 3.3 Sustainability Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes
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Q. How effective is your approach to Quality Standard 3? 3.1 Methodology 3.2 Reporting 3.3 Sustainability Q. How do you know this? Q. What do you want to maintain, improve or change?
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Any further comments?
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Section 4: Governance and Oversight Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 4.1 Oversight 4.2 Governance 4.3 Risk Management 4.4 Accountability Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan
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Q. How effective is your approach to Quality Standard 4? 4.1 Oversight 4.2 Governance 4.3 Risk Management 4.4 Accountability
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Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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Section 5: The relationship between the ADP and the Integration Authority Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 5.1 Alignment and Governance Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan
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Q. How effective is your approach to Quality Standard 5? 5.1 Alignment and Governance Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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This Self-Assessment of Partnership Delivery Framework is agreed and ratified by: Senior System Stakeholders ADP Lived Experience Stakeholder/s / Representative Chair of the Alcohol and Drug Partnership Chair of the Community Planning Partnership The Chief Executive of the Local Authority The Chief Executive of the NHS Board Director of Public Health The Chair of the Integration Joint Board The Chair of the Chief Officers Group Divisional Commander for Police Scotland Chief Executive of Third Sector Interface The Chief Officer of the Health and Social Care Partnership
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APPENDIX 1 Self Assessment Criteria
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1 Quality Standard 1 : The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans 1.1 Transparency and Effectiveness The strategic plan is agreed by the ADP The strategic plan is published and publically available The ADP can demonstrate effective strategic linkage with other local partnership groups and local communities The ADP can demonstrate examples of improvement activities and positive outcomes for the local population The ADP can demonstrate evidence that Strategic Planning is safe, effective, compassionate and person-centred 1.2 Inclusion The ADP can describe how they engage with local communities The ADP can demonstrate how any potential barriers to involvement or engagement are removed The ADP strategic planning is inclusive of people affected by drug and alcohol harms and their family members, those who use services, those who deliver services, and the local population The ADP embeds equality impact assessment processes to understand the diverse needs of local populations and uses this information to inform pathways and provision in its strategic planning and ensure human rights are met
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The ADP Strategy effectively aligns to other statutory plans / priorities on delivery in support to families in crisis or at risk of being in crisis as a result of drug / alcohol use (e.g. Child Protection, Adult Protection) 1.3 Planning Cycle The ADP can demonstrate that it delivers in line with a strategic cycle for planning which includes: needs assessment, delivery, commissioning, review and reporting of outcomes / progress ADP Strategic Planning is based on population health approaches and includes primary, secondary and tertiary prevention 1.4 Needs Assessment The ADP has a local assessment of the needs of people who use alcohol / drugs led by NHS Public Health and involving partners 1.5 Whole System Approach The ADP can demonstrate that their strategic planning is based on national and local priorities, is evidence based and aligns with delivery of local supports and services The ADP has representatives of: Health and Social Care Partnership: mental health, primary care, adult services Specialist drug / alcohol services Health (e.g. emergency department, relevant acute wards, health improvement / public health)
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Children’s services Police Justice services Housing / accommodation / homelessness services Employment services Community Lived experience Education Third Sector Interface The ADP can demonstrate that other local planning partnerships and services incorporate and complement ADP activity to reduce alcohol and drug harms 1.6 Resources and Delivery The ADP has an annual delivery plan agreed by member organisations that details resources aligned in support of delivery, including the following: direct resource, local financial investments and “in kind” resources. It details cross-system prioritisation and responsibilities within, for example, Health and Social Care Partnerships, Children’s Services Planning Partnerships, Community Justice Partnerships and Community Planning Partnerships to be deployed to implement the Annual Delivery Plan and the outcomes to be achieved
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1.7 Outcomes The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework The ADP outcomes are measureable and reportable The ADP routinely reports on progress against strategic outcomes 2 Quality Standard 2 : The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans 2.1 Investment The ADP is able to demonstrate that investment in the delivery of outcomes comes from a range of sources, including the Local Authority, Health Board and the Integration Authority, as well as outside of the public sector The ADP can demonstrate investment is in line with Scottish Government priorities The ADP can demonstrate that investment is based on evidence of effectiveness and outcomes The ADP can demonstrate ability to disinvest based on evidence of effectiveness and outcomes and in line with changing priorities articulated though formal needs assessment
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2.2 Governance The ADP has clear policies and procedures for aligning resources for investment with strategic planning The ADP seeks authorisation for investment from the Integration Authority and local scheme of delegation The ADP has a clear policy agreed with members and the Integration Authority on the treatment of underspends / overspends The ADP can demonstrate effective and transparent governance arrangements are in place The ADP can relate investments in third sector and public sector to performance and outcomes 2.3 Accountability The ADP and the Integration Authority can demonstrate all funding allocated to NHS Boards for onward delegation to ADPs is available to the ADP The ADP has full accountability for the totality of funding allocated for drugs / alcohol from its NHS Board and Local Authority 2.4 Reporting The Health and Social Care Partnership Chief Finance Officer is a member (or formally represented) on the ADP There is regular routine financial reporting to the ADP on the total spend on alcohol and drug services The ADP and Integration Authority provide an quarterly and annual financial report to the Scottish Government The ADP reports to local governance structures on investments
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2.5 Financial Planning The ADP strategy includes investment to increase activity over time in relation to prevention and early intervention aligned with other such preventative spend across local partners / partnerships 3 Quality Standard 3 : The ADP can demonstrate quality improvement in delivery of outcomes 3.1 Methodology The ADP has or uses an underpinning quality improvement methodology ADP staff and members are supported to use improvement methodologies through training and other workforce development activities 3.2 Reporting The ADP can demonstrate examples of where improvement methods have had a positive impact The ADP can demonstrate links with outcome reporting, needs assessment and financial investment / disinvestment
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3.3 Sustainability The ADP can demonstrate how achieved improvements are embedded and sustained The ADP benchmarks performance with other areas (e.g. other ADPs, other partnership groups) 4 Quality Standard 4 : The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan 4.1 Oversight ADP Members can demonstrate effective oversight arrangements are in place to deliver the local strategy The ADP can demonstrate processes to ensure oversight, coordination and alignment of ADP activity with other relevant local partnerships and strategies 4.2 Governance The ADP has published the roles and remit for members setting out how decisions are made, issues and disputes are resolved, conflicts of interest are managed There is a organogram that sets out the relationship of the ADP with the Integration Authority, with other planning boards (e.g. Children’s Partnership and the Community Justice partnership), and with areas of statutory responsibility (e.g. Child Protection and Adult Protection)
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The ADP can demonstrate how they know governance structures provide appropriate assurance of safe, effective, compassionate and person-centred delivery There are process in place for the ADP Chair to escalate and progress discussions with local partners / responsible officers when a priority is not being delivered and a process in place to ensure ADP contribution to aligned plans is being progressed The ADP strategic plan forms part of the overall Community Planning Partnership (CPP) offer, is ratified via CPPs, and aligns with the priorities of other key statutory plans 4.3 Risk Management There is a clear process for identifying and managing risk in relation to delivery of national and local priorities There are clear controls in place to reduce impact of identified risks The ADP can demonstrate how failure is reported, analysed and learning facilitated 4.4 Accountability The ADP can describe clear accountability to appropriate Chief Officer(s) responsible for the delivery of relevant policy, system or targets The ADP can demonstrate clear articulation of the relationship with senior accountable officers, and specifically, the relationship between the ADP and Public Protection that sit with the local Chief Officers Group and can demonstrates that
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processes are in place to ensure learning from drug deaths and responsibility for reducing substance use mortality and harm 5 Quality Standard 5 : The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan The ADP has a clear policy on taking investment plans and business cases to the Integration Authority Joint Board for ratification The ADP provides performance and financial reporting to enable support the development of the Integration Authority’s Annual Performance Report The ADP regularly reports to the Integration Authority on performance The work of the ADP is reflected in the objectives of the Integration Authority Strategic Plan Governance and oversight arrangements for ADP business are supported by the Integration Authority Adult treatment services are delivered in line with ADP strategy The ADP and the Integration Authority have a clear policy on how decisions and directions are managed for services out- with the scope of the Integration Authority (e.g. children’s services, police, housing will be issued)
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The Integration Authority ensures governance arrangements support the deployment of resources at pace to support the Mission
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1 REPORT Item No: 11 1. PURPOSE OF REPORT This paper is coming to the IJB; The purpose of this report is to provide a summary to the Integration Joint Board (IJB) on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team 3. RECOMMENDATIONS 3.1 The IJB Committee is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. SUBJECT: Risk Management: IJB Risk Register TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 21st September 2022 For approval For endorsement To note Yes No N/A
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2 5.2 The PF&A Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PF&A committee considered the risk register at its last meeting on 31st August 2022. No changes to the risk rating were recommended at that meeting however the actions associated with each risk have been updated. 5.3 Four new risks were added to the IJB Risk Register following the last meeting of the IJB: IJB 15/22 – Cost of Living impacts IJB 16/22 – National Care Service IJB 17/22 – Unscheduled Care and patient flows IJB 18/22 – Community Alarms 5.4 There are currently three 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 IJB 17/22 – Unscheduled care and patient flows 5.5 These risks were reviewed in September 2022 and will be subject to further review with the new Chief Finance Officer as part of the financial planning exercise for 2022/23. 5.6 One risk has been downgraded since the last meeting of the Committee, in line with the NHS Board’s decision to move from very high to high due to ongoing developments. IJB 14/22 (CAMHS) moved from very high to high following completion of the waiting list initiative which reduced the total number of waits by 16% and also due to ongoing progress in relation to recruitment with 59/102wte new posts now recruited from the Recovery and Renewal Funded posts. 5.5 There are seven high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing IJB 14/22 - CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service 5.6 There are a number of high/very high rated operational risks recorded on NHSL and NLC risk systems that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services. No/Ref Risk Risk Rating Lead Organisation/Area 2115 CAMHS Service - There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non-clinical posts and challenges recruiting to new posts identified High NHSL Corporate
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3 through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of NHSL 1710 Public Protection: There is a risk that NHSL could fail to identify harm to any vulnerable person, child or adult, or prevent harm to others resulting from the complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. High NHSL Corporate 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. Very High NHSL Corporate 2126 Sustaining Out of Hours Primary Care Service Very High NHSL Corporate 2086 Sustaining GP Services Very High NHSL Corporate 2129 Sustaining Whole System Patient Flow Very High NHSL – Corporate NLC RIA0000446 Unable to deliver services due to funding issues Very High NLC - Social Care/Social Work NLC RIA0000448 Availability of workforce to deliver services within legislative and regulatory compliance requirements. High NLC – Social Care/Social Work NLC RIA0000449 Information & Data Protection – non-compliance with information governance legislation, standards and processes and data security and inability to retrieve relevant data with deadlines High NLC – Social Care/Social Work NLC RIA0000450 Health & Safety of staff in SW & partnership companies – failure to ensure the health safety and welfare at work of the service, employees, partners and provider agencies High NLC – Social Care/Social Work NLC RIA0000453 Supplier failure or services not provided to required standard. Insufficient number of providers. High NLC – Social Care/Social Work NLC RIA0000457 Inadequate supervision, governance and monitoring across professional workforce High NLC – Social Work/Social care
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4 NLC RIA0000458 IT system not fit for purpose High NLC – Social Work/Social care NLC RIA0000459 Integration – there is a risk that services and not integrated effectively thus impacting on improving the outcomes for individuals receiving care and support High NLC – Social Work/Social care NLC RIA0000460 Performance & planning – increasing expectations and changing performance demands will result in a failure to provide performance information internal, external and including S Govt, High NLC – Social Work/Social care NLC RIS0000414 Community alarm and assistive technology – unable to continue to support people with a community alarm system and develop use of assistive technology Very High NLC – Social Work/Social care NLC RIS0000415 Mental Health Officers – Failure to comply with legal obligations High NLC – Social Work/Social care NLC RIS0000417 Communications strategies and engagement plans – Inadequate strategies not aligned with strategic objectives High NLC – Social Work/Social care NLC RIS000419 Non- compliance with Information Governance & Data Protection High NLC – Social Work/Social care NLC RIS000426 Analogue to digital transition & ability to provide a working community alarm service High NLC – Social Work/Social care 6. CONCLUSIONS 6.1 The IJB currently has 18 risks identified on its IJB risk register with ten risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
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5 Financial risks are identified in the risk register. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE N/A 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and fully contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPER None 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752591.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB02. 21 Financial Reputational 01/04/2021 Ineffective Governance Arrangements There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Planned Procurement and Standing Financial Instructions presentations at Extended SLT by 31 March 2022. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.09.22 Previously IJB6. Reviewed and updated on 15 May 21. 30.09.22 IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programmes which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. 16. Additional Scottish Government funding to address Covid‐19 costs and to progress the Remobilisation and Recovery Plan in 2021/2022 is not sufficient. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2021/2022 has been agreed and is being reviewed regularly. The IJB Financial plan 2022/23 is being developed. 7. Capacity plans in place to maximise efficiency. 8. IJB Integration Scheme setting out the budget recovery processes. 9. IJB Financial Regulations and financial procedures. 10. Consultation and involvement with key stakeholders including service users and carers. 11. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 12. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. Financial sustainability payment arrangements in place to 30 June 2022 to support external social care providers. 16. A Change Fund of £6.076m has been agreed with the Scottish Government. 17. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. The Scottish Government announced on 9 December 2021 the indicative Scottish Budget 2022/2023. Work is ongoing to confirm recurring and non‐recurring funding allocations. 19. Lanarkshire Mobilisation Plan 2021/2022 Funding has been confirmed which meets the additional costs of the Covid‐19 pandemic, including the underachievement of savings. The cost of the recovery and remobilisation of health and social care services in 2022/2023 continues to be monitored. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2022/2023 is being progressed. 3. The review and update of the IJB Medium to Long Term Financial Plan is ongoing. 4. The Business Case to take forward the remobilisation and recovery of services and also transformational changes is being developed. 5. The Lanarkshire Mobilisation Plan 2021/2022 costs for quarter 3 were submitted to the Scottish Government on 31 January 2022. 6. Confirmation was received on 25 February 2022 of the additional funding for 2021/2022 to address the costs incurred in 2021/2022 in respect of the Covid‐19 pandemic and also the remobilisation and recovery of services. On conclusion of the financial year 2021/2022, any uncommitted funding will be ring‐fenced as an IJB reserve to meet Covid costs in 2022/2023. The financial implications of this are being monitored. 7. Ongoing consultation with the Scottish Government in respect of the IJB Reserves Strategy 2022/2023 and the anticipated additional costs in 2022/2023 will be progressed by the IJB Chief Financial Officer. 8. The implementation of the approved Business Case to invest the Change Fund and the 2022/2023 recurring Scottish Government funding to maximum effect over the following 2 to 3 year period. HIGH Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB Report Prepared by Christine Jack on behalf of the Chief Officer Page 1 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2021/2022. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.09.22 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. ACTIONS 1. North and South IJBs will undertake a review the financial principles in respect of the hosted services to further develop the current arrangements in line with emerging good practice and guidance. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs Prescribing costs may escalate due to increases in prescribing activity and increasing price volatility, new drugs becoming available, the response to the Covid‐19 pandemic and the impact of EU withdrawal. M edium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. ACTIONS 1.. Locality Prescribing Action Groups. 2. Continuation of Scriptswitch. M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 Previously IJB11. CONTROLS 1. Silver command' group formed for HSCP. 2. On 24 December 2020 a new EU‐UK trade and co‐operation deal was agreed. 3. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 4. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 5. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 6. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 7. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 3 stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. 9. Reciprocal health care is subject to the Withdrawal Agreement, the collection of guidance outlining the rules in each state, the completion of relevant visa applications and the payment of the Immigration Health Surcharge in order to access NHS services (where applicable). The rights of access for EU citizens who need work or study in the UK for less than six months was still being decided. Global Health Insurance Cards have been implemented to cover both urgent and routine medical treatment. 10. In respect of reciprocal health care, the rights of access to health care for UK citizens who move to the EEA after the transition period is being decided independently by each member state and will differ substantially between them. ACTIONS 1.HSCP fully participates in the NLC and NHSL resilience arrangements. 2.HSCP workshops undertaken. 3. Business Continuity Plans revisited and updated for all services and sites. IJB03. 21 Financial Strategic 01/04/2021 Impact of European Union Withdrawal There is a risk that the IJB is unable to implement the Strategic Plan because of the operational and financial challenges posed by European Union (EU) withdrawal leading to a failure to achieve the desired strategic aims and an adverse impact on both operational service delivery and the achievement of financial balance. The impact on health and social care services of leaving the EU continues to be difficult to forecast. The following significant risks continue to be monitored at a national level. (1) The UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology. (2) In respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. (3) There is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. (4) The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. (5) There continues to be a risk of disruption to the supply chains, part of the risk in respect of which was minimised with mitigating actions such as stockpiling. (6) The future of Scottish patients' healthcare in other European countries and the impact of reciprocal healthcare and the free movement of healthcare including the impact of the changes to the European Health Insurance Card (EHIC). M edium Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 Report Prepared by Christine Jack on behalf of the Chief Officer Page 2 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 Previously IJB16. IJB08. 21 Financial Strategic 01/04/2021 Financial Implications of Responding to and Recovering from the Covid‐19 Pandemic There are a range of IJB risks associated with the response to and recovery from the Covid‐19 pandemic. Additional funding was received from the Scottish Government in 2020/2021 to meet the additional costs of the Covid‐19 pandemic. Further funding for 2021/2022 has been confirmed by the Scottish Government to meet the additional costs of responding to and recovering from the Covid‐19 pandemic. The IJB projected out turn 2021/2022 is not available to meet the 2021/2022 Covid‐19 costs. The projected underspend requires to be retained to implement the Business Case and to recover and redesign health and social care services. Insufficient reimbursement of funding from the Scottish Government would impact on the implementation of the Response, Recovery and Redesign Plans in 2022/23. The 2022/2023 Savings Plans may also not be achieved in part or in full due to key resources continuing to be diverted to respond to the Covid‐19 pandemic. This risk could lead to significant operational, financial, legal and/or reputational harm to the HSCP and also adversely impact on the Strategic Plan outcomes. VERY HIGH CONTROLS 1.Governance arrangements are in place in respect of the approval and monitoring of additional Covid‐19 costs and the recovery and redesign plans. 2 Delivery of savings will continue to be tracked and monitored. 3.The financial position is being monitored on an ongoing basis by SLT, IJB PFA and IJB. 4. The IJB Chief Officer and the Chief Financial Officer are actively engaging with the Scottish Government and other Networks and providing regular updates on the mobilisation and remobilisation plans and the associated costs. ACTIONS 1. All costs associated with responding to the Covid‐19 pandemic are being tracked and reported to the Scottish Government through the completion of the Remobilisation Plan Financial Returns. 2. A financial tracker on Covid‐19 related expenditure (as part of the Local Remobilisation Plan) is updated on a 4 weekly basis. Quarterly updates are submitted to the Scottish Government. 3. The IJB Reserves Strategy 2021/2022 has been discussed with the Scottish Government Officers. 4. The IJB Reserves Strategy 2021/2022 is being implemented. The IJB Reserves Strategy 2022/2023 is being developed. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.09.22 IJB09. 21 Financial Strategic 01/04/2021 Impact on the Strategic Plan Due to the Covid‐19 Pandemic 1. Social Care providers continue to be significantly impacted by the Covid‐19 pandemic. There are risks associated with the ongoing financial stability of providers during the Covid‐19 pandemic and some external providers may be unable to continue operating without ongoing financial and operational support. If providers are unable to safely staff services, there could be a risk of harm to service users and failure of the provider. 2. Providers are operating under unique and significantly detrimental conditions including continuity of service being disrupted due to the requirement to focus on priority services only, increased infection control measures and associated costs, increased staff absence and associated costs, reduced availability of back‐up staff and social distancing requirements. Premises may not be suitable to deliver services in these circumstances. 3. Increased reporting requirements to provide data to regulatory bodies are stretching limited resources. 4. Sufficient emergency/additional services to continue to respond to the Covid‐19 pandemic may not be available. Hospital admissions may not be avoided and discharges from hospital may be delayed. General Medical Services may not be sustainable. There are whole system capacity constraints across primary care services impacting on Acute Services. 5. Discharges from hospital may impact on care at home, residential care, nursing care and respite provision. 6. There is an increase in demand for a range of health and social care services as a result of the Covid‐19 pandemic. There is insufficient workforce capacity and there is a risk the Working Time Directive may be breached. There is insufficient equipment for key areas e.g. ventilators, pumps, etc. Personal Protective Equipment and supplies may be limited. The required service specification and standard may not be procured. There may be insufficient mobile IT devices. 7. There may be constraints in respect of the supply of vaccinations. 8. There are significant risks associated with the mutation of the Covid‐19 virus and the new variants. 9. There is an adverse impact on the progress of transformation service redesign opportunities including implementing agreed efficiency savings. 10. Prioritising the impact of the response to the Covid‐19 pandemic may divert limited resources away from key essential services which may lead to additional resource requirements and costs over the medium to longer term. 11. There may be a lack of HSCP management capacity and resilience to co‐ordinate the response to the pandemic. This may lead to an adverse impact on service delivery and financial overspends. 12. The risk status across NHS Lanarkshire has been moved to 'Black', the highest risk level. VERY HIGH CONTROLS 1. Scottish Government and COSLA guidance is being complied with. 2. NHS National Services Scotland are supporting primary care and social care services. PPE is available in line with Health Protection Scotland guidance. 3. Chief Medical Officer guidance as adopted by the four nations has been published, put into effect and endorsed by the Scottish Government/COSLA. Updates are also adopted. 4. Scottish Government are focusing on the care home sector to support continuity of service delivery. A national protocol to support discharge of Covid‐19 patients is in place. Care home liaison nurses are in place. 5. Remote working and flexible working arrangements are also in place. There is an increase in the number of agile workers and an increase in the number of laptops/tablets provided. A blended approach to home/work‐based working is being developed going forward. 6. Arrangements are in place across the partnership to review service user and carer prioritisation in terms of accessing service and support. Resources are targeted to those with critical or substantial needs. 7. Arrangements are in place to support carers in their caring role, working in partnership with voluntary organisations to provide early intervention and preventative supports. 8. Reliance is being placed on the Social Care Sustainability Payments by External Social Care Providers up to 30 June 2022. The HSCP continues to liaise and support providers to ensure there is early identification of problems and early intervention if necessary. 9. The Response, Recovery and Redesign Remobilisation Plan has been developed and is regularly updated. Response, Recovery and Redesign Plans are in place across the IJB and both partners. 10. Safe systems of working have been adopted. Regular cleaning regime is in place across all premises. All workplace appropriate social distance signage is in place. 11. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 12. The Scottish Government is taking appropriate action to mitigate the impact of the variants of the Covid‐19 virus as far as possible. ACTIONS 1. Emergency Command and Control structures have been established by each partner. Infection Prevention Control and Social Distancing requirements are being complied with. 2.Up‐to‐date information is disseminated to all staff across the HSCP as the situation develops and a consistent communication strategy is in place with employees across IJB, NHSL and NLC websites 3.IJB and partner business continuity plans are being regularly reviewed. 4.The HSCP is actively engaging with the third and independent sector in relation to service opportunities to meet the low/moderate needs of service users/patients and their associated costs. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.09.22 Report Prepared by Christine Jack on behalf of the Chief Officer Page 3 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements Due To the Covid‐19 Pandemic 1. There is a risk that the intensity of the required response to Covid‐19 could result in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended Covid‐19 legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. ACTIONS 1. Staff health and well being is a key priority for both partners and all key stakeholders. The commitment to staff health and well being is being actively promoted through all available forums. M EDIUM LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 31.12.22 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g. Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff well‐ being programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation. 4. Staff being encouraged to submit proposals for use of targeted funding & some programmes already in place. HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 30.09.22 IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. The financial support for social care providers during the Covid‐19 pandemic is being reviewed. Payments in respect of under‐occupancy in care homes were extended to 30th June 2022. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. Staff and visitor testing in place. 4. All care homes advised to use PPE in line with national addendum. High medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 30.09.22 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid‐19 funding was confirmed on 25 February 2022. 6. The vaccination programme is continuing to be rolled out. 7. Having regard to the assessment of risk across NHS Lanarkshire as 'Black', action is being taken to mitigate the impact of the Covid‐19 pandemic over the winter period and COP26 in consultation with the Scottish Government. The position is being closely monitored. Report Prepared by Christine Jack on behalf of the Chief Officer Page 4 of 4
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1 REPORT Item No: 12 SUBJECT: Delivering for Communities - Engagement & Participation TO: Integration Joint Board - Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Manager, Quality Assurance Graeme Cowan, Manager, Performance & Planning DATE: 21st September 2022 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 Reviewed Endorsed Prepared By: Manager, Quality Assurance Reviewed By: Head of Planning, Performance & Quality Assurance Endorsed By: Ross McGuffie Chief Officer 3. RECOMMENDATIONS 3.1 The Committee is asked to endorse our approach and the contents of the report 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This is a follow up to the report submitted to Committee on 16 February 22 and is intended as a progress update on the development of our approach to supporting Engagement & Participation through the Delivering for Communities agenda. 5.2 As previously reported, there is a long and established track record of engagement and participation within health and social care in North Lanarkshire. Our approach facilitates the involvement and engagement of people, carers and families, community and voluntary sector organisations and the independent sector in the development of services and support for people across our communities. 5.3 It has been recognised that while our structure(s) offer opportunity for multiple levels of engagement that is more than purely attendance at meetings, this presents a complex picture across the partnership that can be inflexible and perceived as tokenistic. Our ambition is to create a more robust process that promotes active participation and meaningful engagement that helps shape, inform and develop the whole system into the future. 5.4 A review our engagement and participation structure(s) (HSCNL Review of engagement and participation structures - April 22) resulted in recommendations to support our overarching intentions to facilitate active participation, that demonstrates shared accountability, is place based and addresses inequality. 5.5 To implement the recommendations from the review, a programme of work to create a true co-produced approach, building on the successful partnerships already established across our networks and with third sector providers already delivering services across our communities, is underway. It is intended to: be community led help embed our Engagement & Participation Strategy into practice align with the revised operational structure of the H&SCP establish robust links with Community Boards consider the lasting impact of COVID-19 and recovery of services 5.6 A review of the funding currently provided directly to several providers supporting our engagement activity is also underway, as we recognise that organisations important to our structures require financial commitment to ensure stability and security to support meaningful engagement and participation. 5.7 A review of the investment needed to support our strategic direction and offer some certainty to organisations to allow work to develop and positive practice to be fully incorporated across all our engagement and participation networks, will strengthen our approach. 5.8 Work continues to establish robust links with Community Boards and support improved engagement and participation across all care groups by:
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3 strengthening the voices of supported people and their families including unpaid carers embedding participation that goes beyond listening/sharing information further developing sector and area wide engagement and participation forums incorporating learning from Covid regarding engagement and participation identifying strengths and opportunities in terms of local resources/ communities 5.9 Community boards are the foundation of the community planning process in North Lanarkshire as agreed by all partners of the North Lanarkshire Partnership including HSCNL. Multi-agency Local Partnership teams have been launched recently to support the development of the community planning agenda within community partnership areas. Managers from each of the localities within the Health & Social Care Partnership are key members of these forums, and this developing piece of work offers opportunities to co-ordinate our locality improvement activities across the wider Community Planning Partnership. 5.10 There are several forums operational in North Lanarkshire that present a good opportunity for working together with staff from statutory services, community/ voluntary and independent sector. A place-based focus is important in the delivery, development and improvement of effective services that support local people. However, these structures add complexity to the engagement and participation landscape, which is cluttered resulting in forums being used mainly as a vehicle to share information. 5.11 The chairs of Locality Planning Groups have been considering the future remit and responsibilities of their groups within the context of the wider sector in which they exist and in light of the findings of the recent review. The current engagement activities for the Strategic Commissioning Plan has presented a further opportunity to progress this agenda. 6. CONCLUSIONS 6.1 Following recommendations made in the report, work remains underway to establish a clear and robust engagement and participation structure. Feedback and the outcome of the review has confirmed that our structures had lost focus, exacerbated by the pandemic, as many meetings and forums were stood down. As we begin to re-establish these, we will seek to clarify remits and functions with a planned timeline for completion by early 2023. 6.2 Reviewing our investment to support engagement activity will ensure we maintain a broad reach across our communities and establish a proactive approach to promoting participation. By formalising our approach, we will ensure robust contract management arrangements are wrapped around provision.
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4 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES We live in communities that are inclusive, empowered, resilient and safe The Plan for North Lanarkshire Priority: Enhance participation, capacity, and empowerment across our communities Ambition Statement(s): (19): Improve engagement with communities and develop their capacity to help themselves. (20) Improve the involvement of communities in the decisions, and development of services and supports, that affect them. 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks will be identified as the planned programme of work progress and reported on via the relevant risk register. 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire, wider stakeholders with a link to North Lanarkshire. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities by creating opportunities to engage and participate in the development HSCNL key priorities and strategic direction. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS
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5 8.1 Engagement & Participation report to Integration Joint Board Performance, Finance & Audit Committee 16th February 2022. https://mars.northlanarkshire.gov.uk/egenda/images/att97899.pdf 9. APPENDICES 9.1 HSCNL Review of engagement and participation structures, April 22. 9.2 HSCNL Engagement &B Participation Survey Highlight Report CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Maria Williamson: Manager, Quality Assurance WilliamsonM@northlan.gov.uk
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6 Appendix 1 HSCNL Review of engagement and participation structures Gina Alexander April 2022
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7 Contents 1. Introduction ...................................................................................................................... 8 2. Review process ............................................................................................................... 9 3. Engagement and participation in North Lanarkshire ...................................................... 11 4. Scope and limitations ..................................................................................................... 14 5. Findings and recommendations ..................................................................................... 15 6. Summary of findings, conclusions and recommendations ............................................. 37 Appendix 1 Links to relevant guidance and legislation ........................................................ 43 Appendix 2 Semi structured interview questions and information......................................... 44 Appendix 3 Current engagement and participation landscape ............................................. 45 Appendix 4 Survey results .................................................................................................... 46 Appendix 5 Positive examples of engagement and participation .......................................... 47
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8 1. Introduction 1.1 Context and purpose of review Health and Social Care North Lanarkshire (HSCNL) has a long and established record of engagement and participation facilitating the involvement and engagement of people, carers and families, community and voluntary sector organisations and the independent sector in the development of services and supports. Addressing need, reducing inequality and supporting communities to reach their potential is not something which can be done in isolation and HSCNL formalised their commitment to working collaboratively with all agencies to achieve this through the Engagement and Participation Strategy, Framework and Principles published in early 2021. 1.2 In January 2022, HSCNL commissioned a review of the engagement and participation structure within the Delivering for Communities workstream to support implementation of the strategy, framework and principles. The review was to consider:- Role and remit of Locality Planning Groups, their links with Partnership Boards and any sector-wide structures and forums; Partnership Boards – focus/role/remit – links both strategically and with locality planning structures; Connection to Community Boards and local outcome improvement plans (LOIPs); Links with Community Solutions locality host/anchor organisations; Strengthening the voices of supported people and their families including unpaid carers; Embedding participation that goes beyond listening/sharing information; Sector and area wide engagement and participation forums; Incorporating learning from Covid regarding engagement and participation; Strengths and opportunities in terms of local resources/ communities. 1.3 This document outlines the review process, the findings, conclusions and recommendations.
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9 2. Review process The review process was developed by the independent worker and HSCNL staff commissioning the review. The review involved a number of stages:- 2.1 Desk based research and review of relevant guidance and legislation. See Appendix 1 for further details. 2.2 Semi-structured interviews were conducted with 60 people. HSCNL Core Management Team HSCNL Staff North Lanarkshire Council (NLC) staff IJB participants Community Solutions Locality Hosts Voluntary Action North Lanarkshire senior team and staff Community and voluntary sector organisations Engagement and participation group members Members of the public in contact with community and voluntary sector services Figure 1 shows a breakdown of interviewees eg the largest number of interviewees, 30%, were HSCNL staff Figure 1 The interviews were conducted by the independent worker leading the review, online via Teams or Zoom on an individual basis or in small groups.
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10 Some interviewees are involved in multiple activities in the current engagement and participation structure. Appendix 2 outlines the type of questions covering during interviews. 2.3 Development and distribution of a survey for completion by anyone living or working in North Lanarkshire. The survey was developed by the independent worker in consultation with staff from HSCNL, including those with experience in research and evaluation, and community and voluntary sector staff. It was distributed online and was also available in Word or pdf format for people who preferred to complete it off line. One survey was completed and returned by email. The survey was open from 14 February 2022 to 4 March 2022 and was circulated via:- HSCNL Chief Officer across HSCNL VANL – via direct contact with community and voluntary sector organisations and via Facebook Community Solutions Locality Hosts People interviewed as part of the review Various corporate and personal Twitter accounts 447 people (respondents) completed the survey. Appendix 4 contains the survey analysis (see separate document) 2.4 Preparation of a draft report for submission to the HSCNL project team for review. 2.5 Presentation of final report to the HSCNL Strategic Leadership Team.
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11 3. Engagement and participation in North Lanarkshire “Plans to transform our services will not succeed without the full engagement, participation and support of our stakeholders: people who use health and social care services, carers, and the community and voluntary and independent sectors.” HSCNL Engagement and Participation Strategy, Framework and Principles 2021 3.1 In early 2021, HSCNL published an Engagement and Participation Strategy, Framework and Principles (EPS) which demonstrated a firm commitment to ensuring ongoing meaningful engagement with the people and communities it serves. This document outlined a shared set of principles to guide all engagement and participation activities:- Services are planned and developed in a way which actively and systematically engages with the community and local professionals; All stakeholders are treated fairly, equally and with respect; Engagement opportunities should be accessible and engagement materials offered in accessible formats; All health and social staff have a role to play in supporting engagement and participation; A commitment to learning and continuous improvement. 3.2 The EPS framework includes the following elements:- 3.2.1 Key Stakeholder Network Meetings The EPS lists a range of engagement and participation activities (page 13 of the EPS) which cover a wide range of stakeholders; 3.2.2 Locality Engagement Fund Details a fund to support engagement and participation activity in localities; 3.2.3 Engagement Tracker A template to record any engagement activities and the outcomes; 3.2.4 Volunteer Induction Guidelines Outlining good practice relating to induction, education and support for people and carers involved in participation and engagement meetings and activities; 3.2.5 Volunteers Expenses Guidelines Details of the process for reimbursing expenses for people involved in participation and engagement activities to ensure consistency of
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12 approach; that no one is out of pocket as a result of their contribution; and to ensure that finance is not a barrier to participation. 3.3 The Stakeholder Engagement and Participation Working Group (SEPWG) brings together several stakeholder representatives who worked on the development of the engagement and participation strategy and developing the tools and resources within the framework. The group have an annual action plan. The actions agreed for 2021-22 had a focus on promoting the strategy and framework across the partnership and actively supporting engagement and participation including collating information about activities using the engagement tracker. 3.4 There is commitment to include engagement and participation in the planning process. For example:- each programme of work within HSCNL Strategic Commissioning Plan should now include an engagement and participation activity plan; locality development plans produced by Community Solutions locality hosts/anchors and consortia should include information about how people and communities have been involved in the creation of plans. 3.5 The strategy defines engagement and participation as a collective term across a wide range of stakeholders as follows:- Public; People who use health and social care services; Carers; Health and social care colleagues; Housing colleagues; Other NHS and local authority staff; Community and Voluntary sector; Equality groups; Independent sector; Elected members. 3.6 Involvement, engagement and participation has been reviewed and reported on previously as follows:- April 2018 – discussion and feedback session on locality planning groups at Partnership for Change Assimilation meeting May 2018 – stakeholder focus groups involving 20 representatives from across the IJB governance and related structures, ie locality planning groups and partnership boards.
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13 A report, “service user and carer involvement in North Lanarkshire Integrated Joint Board governance structures.”, was written and published in July 2018 following these activities. This report is a rich and comprehensive source of information and insight about involvement, engagement and participation. There are many similarities in the findings, themes identified and recommendations between that report and this review.
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14 4. Scope and limitations 4.1 This review recognises that all stakeholders are important and, to achieve collective ambitions, must all be involved across health and care planning, delivery, monitoring and improvement activities. 4.2 The review will focus on services which are publicly funded by and via HSCNL involve, engage and encourage participation of supported people, their families, unpaid carers and the wider communities of North Lanarkshire. 4.3 The interviews conducted and the survey issued during this review give a snapshot of the current situation. Inevitably there will be some people or groups who have not had the opportunity to participate in this review and consideration should be given to further opportunities for them to contribute during the planning and implementation phase.
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15 5. Findings and recommendations 5.1 Locality planning groups (LPGs) The terms of reference of LPGs states their purpose as:- “The Locality Improvement Group promotes health and wellbeing and leads the implementation of relevant areas of the Strategic Commissioning Plan of Health & Social Care North Lanarkshire (H&SCNL), and the locality’s own priorities.” Two LPGs operate in each locality and have been aligned to one of two partnership boards: Frailty and Long Term Conditions or Addictions, Learning Disability and Mental Health. LPGs have been chaired by Locality Social Work managers and Service Managers, Health and set out to involve the following membership:- Frailty and Long Term Conditions LPG Addictions, Learning Disability and Mental Health LPG Locality Social Work Manager or Health Service Manager (Chair/Vice Chair) Locality Social Work Manager or Health Service Manager (Chair/Vice Chair) LTC Team Leader CMHT Lead Nursing Senior Social Worker (Older Adults ) Senior Social Worker (Mental Health and Younger Adults) Lead Psychiatrist for locality Lead Psychiatrist for locality Manager Locality Support Services Manager Locality Support Services Lead General Practitioner Lead General Practitioner Housing Services – Representative Housing Services – Representative User Representative User Representative Psychological Services – Representative Psychological Services – Representative Health Improvement Officer Health Improvement Officer Centralised MH Services Representative Centralised MH Services Representative Carer Representative Carer Representative VANL Representative VANL Representative Community Justice Representative Community Justice Representative CLD Representative CLD Representative The review found that LPGs:- have been a good forum for information sharing with other agencies (other statutory services and community and voluntary sector organisations); Maintain a focus on locality issues; Enable development of working relationships and networks ;
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16 have provided an opportunity to hear from supported people and unpaid carers and organisations who support them; Support good communication between agencies; Work well when there is consistent attendance and a good mix of people round the table; Aim to focus on improvement and making things better; In some localities, LPGs have integrated so only one LPG exists instead of two. Challenges faced by LPGs Meetings take place four weekly which feels too frequent; Insufficient time to progress actions agreed alongside other responsibilities (LPG chairs); Meeting schedule has been affected by COVID resulting in a loss of impetus; Personnel changes have had an impact on attendance of agencies; Some colleagues (from statutory services and community and voluntary sector organisations) are asked to participate in several or all LPGs; Representation of supported people and carers is not consistent; Lack of clarity in terms of expectations of LPGs from partnership boards and HSCNL management team; Not all LPGs operate in the same way; Understanding of the role and function of Community Boards. Conclusions LPGs do present a good opportunity for joint working between staff from statutory services, community and voluntary and independent sector. They continue a local, place based focus, important in the delivery, development and improvement of effective services which support local people. Understandably during COVID LPGs have not operated as was intended. LPGs also exist within a busy existing and developing landscape of structures and forums eg introduction of Community Boards (CB), similarly, working to improve the wellbeing of people and communities. To add to this, the landscape has changed and developed throughout COVID when there have been added pressures across health and social care in all sectors with reduced time and capacity to get involved in developments and improvement activity. See Appendix 3.
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17 The position and function of LPGs lacks clarity and create multiple, unachievable demands on the time of colleagues across statutory services, community and voluntary and independent sectors. Supported people and unpaid carers have not been consistently involved in LPGs. The 2018 review of participation in LPGs highlighted positive and negative aspects of involvement. In summary, some people felt that locality planning groups were a good opportunity for supported people and unpaid carers to get involved, receive information and put forward their views. Some examples of the difficulties experienced were: not receiving agendas and minutes in time to review, long agendas, service focused and driven, large number of people in meetings, little input to the agenda, limited opportunity to share views, lack of clarity about purpose, barriers in terms of location, timing, environment and language. Recommendations in relation to LPGs Refresh scope, purpose and aims of LPGs with reference to and in collaboration with other key structures eg Community Solutions Locality Consortium and Community Boards, to avoid duplication of effort and achieve synergy of action focussing on local communities. Reduce LPGs one per locality to ensure an integrated approach and a focus on priorities highlighted locally. The single LPG should align with Community Boards and the work highlighted through Community Solutions Locality Consortium development plans and locality outcome improvement plans which should have been informed by people and communities. Review membership of LPGs and define roles and responsibilities of staff from all responsibility for involvement of people and communities. As outlined in the EPS action plan, implement support and resource to the LPGs to plan and deliver an effective range of engagement and participation activities with people and communities which are not limited to representation at LPG meetings utilising the locality engagement fund if required. Clarify LPGs accountability within the management structure of HSCNL. 5.2 Partnership Boards The HSNCL strategic plan published in 2016 committed to creating two partnership boards (previously there were four) designed to bring health and social care staff and stakeholders together to focus on the needs of major care groups:-. Frailty and Long Term Conditions;
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18 Addictions, Learning Disability and Mental Health. The partnership boards were to be supported by LPGs at locality level to ensure that the needs of individuals within each locality were considered and supported. Partnership boards have met quarterly and are chaired by senior staff from HSCNL with a large membership drawn from health and social care (HSCNL, NHS Lanarkshire), representatives of other statutory agencies (NLC, Police Scotland), community and voluntary sector, independent sector and representatives of supported people and unpaid carers. LPGs have been invited to report to the Frailty and Long Term Conditions partnership board via LPG chairs on a six monthly basis. LPG chairs are members of the Addictions, Learning Disability and Mental Health partnership board. The review found that partnership boards:- have provided a mechanism to bring agencies together in relation to major care groups across North Lanarkshire; were designed to focus on service improvement and development. Challenges faced by partnership boards:- Developed at the start of the integration journey and now run alongside with other care groups activities eg ADP, Mental Health Strategy Board; Both have extremely broad remits in terms of the care groups covered; Partnership boards expectations of LPGs are not clear; Governance links have become blurred – lack of clarity about “who does the partnership board report to?”; Expectations of and goals for partnership boards are not clear; Have developed into update or information giving meetings; Meeting schedule has been interrupted by pandemic pressures and rescheduled or cancelled; Consistent representation of supported people and unpaid carers; Opportunities to hear from a wider and more representative group of supported people. Conclusions
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19 The partnership boards played a key role in the initial stages of health and social care integration ensuring a focus on major care groups and service improvement and development. Some of the care groups covered by partnership boards now have other structures and mechanisms focusing on the delivery, development and improvement of health and care services eg ADP, Mental Health Strategy Board and the need to involve and engage people and communities. The potential exists for the remits of these care group and partnership boards to overlap in terms of development work, the need to involve a range of agencies and the requirement to involve and engage with people and communities. These structures alongside care groups add further complexity to the engagement and participation landscape as referred to in 5.1 above. Partnership boards are described as covering major care groups. It is not clear how other care groups across health and social care including primary care fit into the structure. Therefore the mechanisms for engagement, participation and involvement are not clear. Consider:- Are we connecting with all key stakeholders? Do people and communities have the opportunity to engage and participate across all and any health and care services? Are we supporting the whole system to engage and involve? What governance is in place to ensure that engagement and participation happens and is of good quality? Recommendations in relation to partnership boards:- Review the role of partnership boards alongside the role and remit of care groups in relation to engagement and participation; identify overlaps and synergies; Review the contribution of partnership boards within the governance structure, clarifying their role, if any, within the proposed structure; Consider a simplified structure across HSCNL where roles and responsibilities in relation to engagement and participation are clearly agreed and communicated; collaborate and coordinate with LPGs, relevant Community Board sub groups, Community Solutions Consortia and organisations supporting involvement and representation (Partnership for Change, Voice of Experience Forum, NLDF, Lanarkshire Links, NLCT) in relation to engagement and participation activities.
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20 Establish engagement and participation mechanisms across all care groups 5.3 Community Boards and local outcome improvement plans (LOIPs) In August 2020, the North Lanarkshire Partnership (NLP) in it’s role as the Community Planning Partnership established nine community boards in a new approach to enhancing and supporting community involvement as required by the Community Empowerment (Scotland) Act 2015. The precursor to community boards was Community Matters. NLP members 9 community boards Police Scotland NHS Lanarkshire Scottish Fire and Rescue Service New College Lanarkshire Skills Development Scotland Scottish Enterprise Voluntary Action North Lanarkshire Community and Voluntary Sector Partnership Group Job Centre plus Community boards meet quarterly and aim to involve local people, community representatives and representatives from NLP members. The purpose of community boards is to make sure local people are involved in issues that affect the community, are listened to and to ensure their ideas on improving the community are heard. Community champions, directors of NLC, are aligned to support each community board. The aspiration is for all community boards to be chaired by community representatives. Local outcome improvement plans (LOIP) have been developed which outline key priorities for each community board area identified through engagement with people and communities and NLP members. These plans have been developed by LOIP sub groups of the community boards. A summary of the key priorities by community board area is shown in Figure 2. Figure 2
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21 Community Solutions locality consortia are represented at community boards by locality hosts/anchor organisations. Some LPGs are represented at community boards. NLP are evaluating the effectiveness of community boards in consultation with all participants. In relation to community boards and local outcome improvement plans, the review found that:- Awareness of the purpose and remit of community boards and local outcome improvement plans is still not well understood; Community boards feel more about giving updates, agendas tight and not open to contribution. Comparisons were made in relation to the precursor of community boards – Community Matters; No effective connections between LPGs and community boards; Community boards still feel “council driven” and quite formal. Conclusions Community boards are the foundation of the community planning process in North Lanarkshire as agreed by all partners of the North Lanarkshire Partnership including HSCNL. Community boards and the priorities identified through LOIPs provide insight for locality planning groups and
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22 cross over with Community Solutions locality consortia development plans. It is important for these three structures to work cohesively and collaboratively to maximise resources required to achieve priorities and collectively plan opportunities to hear from local people and communities on a continuous basis about issues which have an impact health and wellbeing. Recommendations in relation to Community Boards:- Develop and strengthen the links between LPGs, Community Solutions locality consortia, community boards and LOIP sub groups and clarify respective roles and responsibilities 5.4 Community Solutions locality host/anchor organisations Locality host organisations (also known as an anchor organisation) are community and voluntary sector organisations appointed to encourage the development and strengths of local community groups and voluntary organisations to improve health and wellbeing The locality host organisation supports a network or consortium made up of local organisations, groups, partners and people to explore community needs in relation to health and wellbeing. They work collectively to create a dynamic development plan, commission projects, co-produce proposals and oversee the administration of a locality activity fund of £30,000 per year to support community capacity building. Community Solutions locality hosts:- Are well established organisations which are physically located in communities; Have established and informal relationships across communities and are able to hear what matters to people; Have a track record in collaborating to create development plans focused on improving health and wellbeing. Challenges:- Capacity to get involved across all relevant LPGs, community boards and subgroups; Some locality hosts have more than one community board in their area; Multiple demands for local engagement at short notice from statutory partners; Capacity to support broader range of engagement and participation
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23 activities. Conclusions Locality hosts are well placed to support engagement and participation of local community and voluntary sector groups and facilitate “natural consultation” with people and communities. Since the creation of community boards, locality anchor organisations have been expected to participate in both community boards and subgroups and have done so willingly viewing it in the best interests of the consortium they support and their communities. Two locality anchors are required to serve multiple community boards (Cumbernauld and the North locality anchor cover Cumbernauld, Kilsyth and the Northern Corridor community boards, Wishaw & Shotts locality anchor cover Wishaw and Shotts community boards). Being part of a structure which involves people and communities consistently and in a meaningful way requires investment. With appropriate investment locality anchors can further contribute to embedding a culture of involvement and their role in community engagement and participation should be explored with them. The capacity of locality hosts to provide this support and facilitation is limited by resources. Recommendations in relation to Community Solutions locality hosts:- As per recommendation for community boards above; Collaborate with Community Solutions locality hosts and programme management to formalise the role of locality hosts in local involvement, engagement and participation; Improve the capacity and resource of Community Solutions locality hosts to support local involvement, engagement and participation. 5.5 Strengthening the voices of supported people, their families and unpaid carers The HSCNL Engagement and Participation Strategy, Framework and Principles covers all groups of stakeholders. Engagement and participation or collaborative working involving all stakeholders is essential to “getting the job done” across health and social care. The involvement, engagement and participation of supported people including their families or support networks and unpaid carers (supported people and unpaid carers) as experts in their own experience brings a unique perspective to the development, delivery and improvement of health and social care. The survey issued as part of this review gave some insight into how people feel about current involvement in health and social care services.
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24 Survey findings:- 95% of respondents believed it is very important or quite important to involve people in the development or improvement of health and social care services 35% of respondents identified as someone who uses health and social care services regularly or occasionally or an unpaid carer o 81% said they felt they had no involvement o 53% of respondents said they would not feel confident or unsure about how to share their views, opinions and ideas o Respondents were asked “what would encourage them to get involved?” Comments included:- Awareness that our opinion is wanted in the first place Clear routes for being able to do so. Simply being asked Knowing that the views I have to put forward will be taken into account and acted on. Evidence that the voice and opinions of carers had been respected, listen to and acted upon in the past Examples of where public opinion/feedback has resulted in real improvement to services. Making it easy to be involved like online participation An accessible and genuine platform A rolling co-design process (not one-off) which allows service-users to speak freely and safely about their experiences. o Respondents were asked how they would like to be involved in the development or improvement of health and social care services. They were given the following option:- a) Going along to an event run by local community groups b) Taking part in regular meetings with people who run health and social care services c) Social media/online d) Filling in a survey/questionnaire e) Getting together with a small group of others to
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25 speak about a specific subject Option d) was the most popular but all other options were equally appealing, signifying people are open to getting involved in a range of ways. There are opportunities for supported people and unpaid carers to get involved, engage and participate in relation to health and social care services in North Lanarkshire including:- Representatives on locality planning groups Representatives on partnership boards Representatives on Integrated Joint Board and committees Representatives on Strategic Commissioning Planning Group As individuals (supported by community and voluntary sector staff) through the Annual Adult Protection Group involvement event As individuals through the Carers Forum convened and supported by North Lanarkshire Carers Together As individuals through members meetings and local issues group convened and supported by Lanarkshire Links Community Council representatives on Public Partnership Forum (PPF) As individuals on Public Reference Forum (PRF) As individuals through the Self Directed Support Forum convened and supported by North Lanarkshire Disability Forum As representatives or individuals (supported by community and voluntary sector staff) through the Partnership for Change Assimilation Meetings Collectively through existing community and voluntary sector organisations ie North Lanarkshire Carers Together, North Lanarkshire Disability Forum, Lanarkshire Links, Voice of Experience Forum, Partnership for Change As individuals through Care Opinion As individuals through engagement activities, surveys, questionnaires issued by commissioned providers. Evidence of engagement and participation required through regular contract
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26 monitoring reports. HSCNL provide funding to community and voluntary sector organisations to Facilitate the involvement of supported people and unpaid carers as representatives in various meetings (see above) Present the collective voice of their community of interest eg older people, unpaid carers at various meetings Interviewees shared “good practice” examples in relation to involvement, engagement and participation. (see example in Figure 3 and Appendix x) Figure 3 Challenges in relation to strengthening the voice of supported people and unpaid carers:- Encouraging involvement of new people in representative roles;. Lack of wider representation; o Existing representatives have been strongly committed to their roles over a number of years. However, they do not and cannot represent all supported people and unpaid carers; o Ensuring a focus on collective issues as opposed to personal issues; o Representatives do not have time or means to collect views of other supported people or unpaid carers; o Ensuring involvement of smaller or specific communities of Involving unpaid carers in developing availability of support. North Lanarkshire Carers Together gathered the views, suggestions and ideas of unpaid carers (adults and parent carers) via various mechanisms (online groups, forum meetings, feedback from locality anchors, online survey) to inform a funding proposal submitted to HSCNL to expand regular breaks for unpaid carers in North Lanarkshire. Following approval unpaid carers were involved in the decision making process to allocate funding to community and voluntary sector groups to develop regular breaks and pilot sitter services. There are plans for unpaid carers to be involved in the monitoring process.
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27 interest eg people with learning disabilities, ethnic communities; Some existing activities have not supported effective involvement: lack of clarity over the role and expectations within the meeting, people have to “fit in” within the existing agenda, difficult to contribute to the agenda, papers are late, meetings cancelled at short notice; Time commitment and resource required from support organisations and staff to support effective representation eg training and support for representatives, pre meeting preparation, interpreting and summarising reports, keeping up to date with developments, initiatives and best practice, supporting access (in person or digitally) and travel arrangements, post meeting and ongoing support; Involvement, engagement and participation in health and social care seems to rely heavily on representation at meetings either by a small number of supported people and unpaid carers or by organisations who have representation as part of their role; The use of Care Opinion as a way to give feedback on individual experiences of health and care services delivered or commissioned by HSCNL is still relatively low although plans are underway to improve this (13 stories). Conclusions There are a range of current opportunities which exist to hear the voices of supported people, their families and unpaid carers. However, the take up of these opportunities are low and limited with the majority of people reporting, via survey, that they don’t feel involved or know how to contribute their views, opinions and ideas about the development or improvement of services. The opportunities which do exist are heavily focussed on inviting people into the existing system to contribute. Effective opportunities for involvement shared by interviewees are characterised by going out to where people are ie their communities, groups they participate in, their homes. Enabling effective bottom up or “outside in” involvement driven by supported people and their families and unpaid carers and the wider community requires investment in time and resource.
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28 People and communities can be encouraged to get involved if they have evidence that their contribution has a positive impact. There appear to be limited opportunities for individuals to share their experiences opinions, views and ideas, eg through regular evaluation of services. Recommendations in relation to strengthening the voice of supported people and unpaid carers Develop a wider range of involvement opportunities at different levels ie representation, collective, individual levels Figure 4 Level Considerations Individual Involvement takes place in relation to individual’s own experiences Opportunities should be constant and consistent taking place at the point of care and using methods which individuals can access at various times eg - Care Opinion, user satisfaction surveys eg online or paper surveys, Smiley face surveys Individuals should be asked how they would like to share their views, opinions and ideas Improving engagement and participation at this level is the highest priority in the journey to embed a culture of involving people The aim should be for all supported people and their families and unpaid carers to have the opportunity to participate at individual level People may choose to participate at this level only or decide to get involved at other levels. Effective engagement and participation at the level provides legitimacy to collective voice and representation levels Collective voice Gathering and presenting views, opinions and ideas from people
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29 Level Considerations with similar backgrounds eg unpaid carers, mothers to be, people with autism Regular opportunities are created and supported by community and voluntary sector organisations. Views, opinions and ideas are based on the collective experience of individuals People should understand their role at this level and can access training and support People may choose to participate at this level only or decide to get involved at other levels Representation The legitimacy of engagement and participation at this level is strengthened effective involvement exists at other levels. A smaller number of people involved Representing a specific group Focus should be on ensuring effective engagement and participation is taking place at local and service level People should have a clear understanding of their role and can access training and support Expand the methods used to hear voices and experiences of supported people, unpaid carers and the wider community on a constant and consistent basis Survey respondents indicated they would be willing to get involved via a range of different methods, plans for engagement and participation need to demonstrate greater flexibility, creativity and openness instead of relying on representation at meetings. Build the capacity of existing community and voluntary sector organisations to support wider involvement, develop clear and mutually agreed outcomes focused on increasing the numbers, confidence and capability of people in representational roles and group working. Improve information and awareness for people and communities about the range of ways they can get involved and participate. Share examples of the impact of engagement and participation to encourage involvement. An engagement tracker is being implemented as part of the EPS action plan which should provide these examples. 5.6 Embedding participation that goes beyond listening/sharing information
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30 Empowering supported people and unpaid carers feel involved and engaged at an individual level in relation to their own situation was a theme emerging from interviews and the survey. The Three Conversations model is currently being piloted in North Lanarkshire as an approach which focusses on improving conversations: a) with people who need support and b) between colleagues and partners with the ultimate aim of delivering the help and support people need and want. The survey gave some useful insights into what staff feel about involvement in the development or improvement of services:- 49% of staff in health and social care said they didn’t feel involved at all in the development and improvement of health and care services 49% of staff in health and social care said they were unsure or not confident about how to contribute their views, opinions or ideas to the development or improvement of health and care services Another example of positive practice in relation to engagement and participation is highlighted in Figure 5. Figure 5 Commissioned providers of health and care services in North Lanarkshire are required to provide evidence of engagement and participation activities as part of their contract monitoring reports. Engagement and participation is used as an all-encompassing term within the EPS, eg working as part of a team with colleagues from other HSCNL Suicide Prevention Lived Experience Panel Currently in development, the creation of this panel to include people and families affected by suicide has been commissioned by HSCNL and is being facilitated by Voluntary Action North Lanarkshire (VANL). The vision is an open forum where participants can share their views, opinions and ideas. Participants will decided how and with whom their information will be shared. The objective is that the panel will help shape the design of suicide prevention services in North Lanarkshire.
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31 departments; involving staff representatives in meetings; collaborative working with colleagues from stakeholders (North Lanarkshire Council (NLC), NHS Lanarkshire acute services, North Lanarkshire community and voluntary sector, Police Scotland, Scottish Fire and Rescue Service, NLC Education department and education providers); working with and networking community and voluntary sector representatives, groups and organisations. These activities are essential to the effective delivery of services which support citizen health and wellbeing across North Lanarkshire. However, the definition of engagement and participation in relation to supported people and their families, unpaid carers and the public needs particular focus and should be uniform and understood across all stakeholder groups. The existing structure of activity and meetings is complex and there appears to be varying degrees of understanding about what opportunities for involvement, engagement and participation are in place at any given time. There appears to be some lack of clarity around remit, roles and responsibilities of some activities in relation to the here and now. Interviewees report frustrations at the same information being shared at different meetings attended by the same people. Conclusion The relationship and the quality of conversations which take place between staff or volunteers who deliver health and care services (across statutory, independent and community and voluntary sectors) and the people they support, their families and unpaid carers is vital in embedding a culture of involvement. It is crucial that staff fully understand their own role they have in the development and improvement of health and care services and that listening to and hearing the voice of supported people and their families, unpaid carers and the public is an integral part of that role. This “Involvement is everyone’s business” idea features in HSCNL’s Engagement and Participation Strategy, Framework and Principles. The Suicide Prevention Lived Experience Panel is an example of new way of integrating engagement and participation and using the voices of people and communities to inform service improvement and development. Recommendations in relation to embedding participation Reinforce a culture of involvement through staff recruitment, induction,
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32 training and development and CPD. Staff should be clear about what is expected of them in relation to their own role and how they can encourage engagement and participation of the people they support. Implement learning from the Three Conversations pilot across health and social care. Review and refresh remits and responsibilities in relation to engagement and participation for each activity. Each participant whether they are a staff member, supported person, unpaid carer or other member of the public must have a clear understanding of their own role and responsibilities in relation to engagement and participation. Improve resources and support for staff across health and social care (HSCNL,primary care, community and voluntary sector and independent sector) in relation to how to “do” engagement and participation. (Linked with recommendation re Care Groups) Agree a clear and common definition of engagement and participation focused on supported people and their families, unpaid carers and the public shared across North Lanarkshire Embed the requirement for engagement and participation plans covering all levels (see above) across all existing services including commissioned services and new initiatives. 5.7 Sector and area wide engagement and participation forums; Within HSCNL plans are currently being developed to group localities into East and West sectors for governance purposes. These groups will ultimately feed into the HSCNL Support Care and Clinical Governance group. Responsibility for engagement, participation, involvement and awareness of all system wide feedback is integral to the governance system. Within NLC, there are plans to organise support for community boards into North and South areas. The North Lanarkshire Public Partnership Forum (PPF) is supported by NHS Lanarkshire colleagues and involves representatives from community forums and councils operating in North Lanarkshire. Not all community forums and councils are represented. An interviewee with
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33 experience of PPF said that it was a good opportunity to gather information which was then fed back into the community forum. Conclusions Further clarity about the responsibility for engagement, participation and involvement within the HSCNL governance structure is helpful. The terminology used by HSCNL (east/west) and NLC (north/south) in relation grouping localities and community boards has the potential to create confusion. The North PPF is not representative of all areas of North Lanarkshire. Although there was not an opportunity to understand the work carried out by the PPF, it seems that this is another mechanism within existing busy landscape of engagement and participation in North Lanarkshire. Recommendations in relation to sector and area wide engagement and participation forums:- Finalise the governance hierarchy, ensuring responsibilities and expectations at each level are clear to all involved Work with NLC colleagues to ensure that terminology and activity does not have unintended negative consequences on engagement, participation and involvement. Further review the work of the North PPF to establish if membership and activity can be incorporated into other existing mechanisms. 5.8 Incorporating learning from Covid regarding engagement and participation Prior to the pandemic, it would appear that most involvement, engagement and participation opportunities took place face to face across a range of venues eg Dalzeil Building, Council chambers, town halls across North Lanarkshire. During COVID, all non-essential face to face contact stopped and over time all meetings and activities moved online. The positive impact of COVID:- Enabled involvement of people who would not otherwise have been able to travel to venues due to various issues eg health, transport, timing, confidence, lack of other support; Encouraged people to improve or develop digital skills; Given people who have digital skills a new opportunity to access involvement opportunities. The negative impact of COVID:-
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34 People with limited or digital skills or technology have been excluded throughout the pandemic; Lack of in person meetings and the impact on communication, relationships, the ability for full involvement; Reduced opportunity for social interaction and network eg chat over breaks or before and after meetings; Pressures on health and care services have resulted in non- essential meetings and activities being stood down at various times so engagement and participation opportunities have been interrupted. The survey indicated that people would be willing to consider getting involved in a range of ways which included online but there was also a similar level of interest in participating in meetings or small groups. Conclusions The pandemic has encouraged us all to find digital solutions to keeping connected. Digital solutions can provide opportunities to increase involvement and to expand the ways people can get involved. However, digital solutions also have the potential to exclude some people from being able to participate. Future involvement opportunities should cover a range of methods (as above) and enable face to face and online participation in meetings or groups Recommendations in relation to learning from COVID Investment in technical solutions which facilitate hybrid (online and in person) engagement and participation activities 5.9 Strengths and opportunities in terms of local resources/ communities Section 7.4 outlines the strengths and opportunities of the Community Solutions infrastructure in relation to locality hosts/anchor organisations and consortia. Section 7.5 contains recommendations for building the capacity of existing community and voluntary sector organisations to increase support for engagement and participation. The community and voluntary sector (CVS) in North Lanarkshire has a range of mechanisms to support networking and collaboration across organisations and groups including:- CVS partnership group Volunteering partnership group
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35 Mental health and wellbeing network Children, young people and families network Home visiting and befriending network Climate emergency network With the support of the third sector interface, Voluntary Action North Lanarkshire, these groups and networks are developing and aiming to achieve wider representation of the CVS. Members of these groups and networks are operating in the heart of communities. They are ideally placed to support engagement, participation and involvement of local people. Recommendation in relation to strengths and opportunities of local resources/communities:- Work with the CVS groups, networks and organisations to establish an agreed role in encouraging engagement, participation and involvement of local people. 5.10 Investment Throughout the research and discussions there has been reference to investment and recognition that this goes beyond direct financial investment and extends to investment in systems, staff, opportunities and resources. Where there is direct financial investment, a proportion of this is historical. The level of investment and the outcomes from this is based on decisions made in a political and strategic landscape that has since evolved and approaches and priorities that have since been developed and refreshed. Organisations have changed and adapted whilst financial arrangements and outcomes have drifted. Limited capacity and restricted opportunities are a feature amongst some of the stakeholder organisations. The commitment to engagement and participation, the evidence that stakeholders consider this to be important and the drive to increase and improve involvement, to be realised will come with a cost. Recommendations in relation to investment Acknowledging that the Strategic Commissioning Plan and Engagement and Participation Strategy will be refreshed in the coming 12 months, it is recommended that HSCNL:- Review investment and outcomes in the context of the strategic commissioning plan and future ambitions; Consider the need for increased investment to realise the objectives of the Engagement and Participation Strategy.
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36
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37 6. Summary of findings, conclusions and recommendations There is strong commitment to for the need to improve involvement, engagement and participation. The current engagement and participation landscape is busy and complex. (Appendix 3) Structures and systems to encourage involvement have developed over time and in different ways which has created multiple and competing demands on the time of health and social care across all sectors, supported people, their families and unpaid carers. Investing in and building the capacity of key community and voluntary sector organisations is key to strengthening the voice of people and communities at local level and across communities of interest. There must be a renewed effort to driving a culture of involvement where all staff have a clear understanding of their role in engagement and participation which is seen as the “golden thread” through all aspects of service development, delivery, evaluation and improvement. This means investing in staff and developing their skills and experience to involve and encourage participation of the people they support. Commitment to and opportunities for involvement, engagement and participation require a constant and consistent approach across all health and care services. Investment in information and communication infrastructure which raises awareness of, supports, encourages and demonstrates the impact of engagement and participation activity is essential. Implementing these recommendations will require HSCNL staff, and community and voluntary sector and stakeholder groups to engage in further planning and genuine collaborative working. Figure 6 summarises the foundations of engagement and participation in North Lanarkshire, the areas for development and the enablers required to support development.
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38 Figure 6 Recommendations in relation to LPGs 1 Refresh scope, purpose and aims of LPGs with reference to and in collaboration with other key structures eg Community Solutions Locality Consortium and Community Boards, to avoid duplication of effort and achieve synergy of action focussing on local communities 2 Reduce LPGs one per locality to ensure an integrated approach and a focus on priorities highlighted locally. The single LPG should align with Community Boards and the work highlighted through Community Solutions Locality Consortium development plans and locality outcome improvement plans which should have been informed by people and communities 3 Review membership of LPGs and define roles and responsibilities of staff from all responsibility for involvement of people and communities 4 As outlined in the EPS action plan, implement support and resource to the LPGs to plan and deliver an effective range of engagement and participation activities with people and communities which are not limited to representation at LPG meetings utilising the locality engagement fund if required 5 Clarify LPGs accountability within the management structure of HSCNL Recommendations in relation to partnership boards:- 6 Review the role of partnership boards alongside the role and remit of care groups in relation to engagement and participation; identify overlaps and
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39 synergies 7 Review the contribution of partnership boards within the governance structure, clarifying their role, if any, within the proposed structure 8 Consider a simplified structure across HSCNL where roles and responsibilities in relation to engagement and participation are clearly agreed and communicated; collaborate and coordinate with LPGs, relevant Community Board sub groups, Community Solutions Consortia and organisations supporting involvement and representation (Partnership for Change, Voice of Experience Forum, NLDF, Lanarkshire Links, NLCT) in relation to engagement and participation activities 9 Establish engagement and participation mechanisms across all care groups Recommendations in relation to Community Boards:- 10 Develop, strengthen and formalise the links between LPGs, Community Solutions locality consortia, community boards and LOIP sub groups and clarify respective roles and responsibilities Recommendations in relation to Community Solutions locality hosts 11 Collaborate with Community Solutions locality hosts and programme management to formalise the role of locality hosts in local community involvement, engagement and participation 12 Improve the capacity and resource of Community Solutions locality hosts to facilitate local community involvement, engagement and participation Recommendations in relation to strengthening the voice of supported people and unpaid carers 13 Develop a wider range of involvement opportunities at different levels ie representation, collective, individual levels 14 Expand the methods used to hear voices and experiences of supported
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40 people, unpaid carers and the wider community on a constant and consistent basis 15 Build the capacity of existing community and voluntary sector organisations to support wider involvement, develop clear and mutually agreed outcomes focused on increasing the numbers, confidence and capability of people in representational roles and group working. 16 Improve information and awareness for people and communities about the range of ways they can get involved and participate 17 Share examples of the impact of engagement and participation to encourage involvement. An engagement tracker is being implemented as part of the EPS action plan which should provide these examples Recommendations in relation to embedding participation 18 Reinforce a culture of involvement through staff recruitment, induction, training and development and CPD. Staff should be clear about what is expected of them in relation to their own role and how they can encourage engagement and participation of the people they support 19 Implement learning from the Three Conversations pilot across health and social care 20 Review and refresh remits and responsibilities in relation to engagement and participation for each activity. Each participant whether they are a staff member, supported person, unpaid carer or other member of the public must have a clear understanding of their own role and responsibilities in relation to engagement and participation 21 Improve resources and support for staff across health and social care (HSCNL, primary care, community and voluntary sector and independent sector) in relation to how to “do” engagement and participation (Linked with recommendation re Care Groups above) 22 Agree a clear and common definition of engagement and participation focused on supported people and their families, unpaid carers and the public shared across North Lanarkshire 23 Embed the requirement for engagement and participation plans covering all levels (see above) across all existing services and new initiatives Recommendations in relation to learning from COVID
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41 24 Invest in technical solutions which facilitate hybrid (online and in person) engagement and participation activities Recommendations in relation to partnership boards:- 25 Review the role of partnership boards alongside the role and remit of care groups in relation to engagement and participation; identify overlaps and synergies 26 Review the contribution of partnership boards within the governance structure, clarifying their role, if any, within the proposed structure 27 Consider a simplified structure across HSCNL where roles and responsibilities in relation to engagement and participation are clearly agreed and communicated; collaborate and coordinate with LPGs, relevant Community Board sub groups, Community Solutions Consortia and organisations supporting involvement and representation (Partnership for Change, Voice of Experience Forum, NLDF, Lanarkshire Links, NLCT) in relation to engagement and participation activities 28 Establish engagement and participation mechanisms across all care groups Recommendations in relation to sector and area wide engagement and participation forums:- 29 Finalise the governance hierarchy, ensuring responsibilities and expectations at each level are clear to all involved 30 Work with NLC colleagues to ensure that terminology and activity does not have unintended negative consequences on engagement, participation and involvement 31 Further review the work of the North PPF to establish if membership and activity can be incorporated into other existing mechanisms Recommendation in relation to strengths and opportunities of local resources/communities:- 32 Work with the CVS groups, networks and organisations to establish an agreed role in encouraging engagement, participation and involvement of local people Recommendations in relation to investment Acknowledging that the Strategic Commissioning Plan and Engagement and Participation Strategy will be refreshed in the coming 12 months, it is recommended that HSCNL:-
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42 33 Review investment and outcomes in the context of the strategic commissioning plan and future ambitions 34 Consider the need for increased investment to realise the objectives of the Engagement and Participation Strategy.
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43 Appendix 1 Links to relevant guidance and legislation Alongside the HSCNL engagement and participation strategy the following legislation and guidance has informed the review:- Public Bodies (Joint Working) (Scotland) Act 2014: statutory guidance Statutory guidance and advice around health and social care integration covering: planning for improvement; measuring performance; finance; governance and working with partners, produced to support the Act Community Empowerment (Scotland) Act 2015 The Community Empowerment (Scotland) Act 2015 will help to empower community bodies through the ownership or control of land and buildings, and by strengthening their voices in decisions about public services. National Standards for Community Engagement (reviewed 2015/16) The National Standards for Community Engagement are clear principles that describe the main elements of effective community engagement. They provide detailed performance statements that everyone involved can use to achieve the highest quality results and the greatest impact. Patients’ Rights (Scotland) Act 2011 and the Charter of Patient Rights and Responsibilities The Act gives everyone the right to receive healthcare that: considers their needs; considers what would most benefit their health and wellbeing; and encourages them to take part in decisions about their health and wellbeing and gives them the information and support to do so. The Act also gives patients a right to give feedback and make comments and raise concerns or complaints about the care they have received. Care Services - planning with people guidance – Scottish Government & COSLA Planning with People promotes consistency, culture change and true collaboration and encourages creativity and innovation, based on best practice. This guidance applies to all care services – for children, young people and adults. It should be followed not only by health and care providers but also by local, regional and national planners, Special Boards and all independent contractors and suppliers such as care homes, pharmacies and general practices. Draft Quality Framework for Community Engagement and Participation Aligned to the planning with people guidance, this quality framework is being designed to support NHS boards, local authorities and Integration Joint Boards to carry out effective community engagement and demonstrate how they are meeting their statutory duties for public involvement.
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44 Appendix 2 Semi structured interview questions and information General questions what do you understand by the term engagement and participation? For owners/initiators/chairs Engagement activity initiated by you: [insert activity or meeting/s] What do you think is the purpose/aim/vision of this activity? What are the opportunities for participation and engagement of people and organisations who support people to share their views? What works well? What could be improved? How does being involved in leading this activity make you feel? What support do you and participants need to help improve participation, engagement and achieve the aims of this activity? For participants What activities are you involved in? (see checklist of current structures below) How clear do you feel about your role in this activity? And the role of others? What works well? What could be improved? How does being involved in this activity make you feel? What support/help do you think you or others might need to strengthen your participation and engagement even further? What other ways can we involve people planning and sharing their views and ideas about health and social care? For stakeholder organisations What activities do you support people to get involved in? How clear do you feel about your role in this activity? How do the people you support feel about their role? What works well? What could be improved? What support/help do you require to support people to get involved?
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45 Appendix 3 Current engagement and participation landscape
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46 Appendix 4 Survey results See attached document
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47 Appendix 5 Positive examples of engagement and participation Interviewees shared examples of “good practice” in relation to involvement, engagement and participation. These examples are characterised by the diversity of activities which engage and involve from:- representation within the community planning process “town hall” events; small local conversations about needs; end to end involvement in new initiatives. Examples of engagement and participation activities in North Lanarkshire Area Death and dying A series of events (large event and small community gatherings) where people were asked their thoughts on this topic. One of the key messages was that people wanted to be at home. This message has strongly influenced developments and decisions around care. NL Slipper Amnesty A large scale event put on by a range of community and voluntary sector and statutory services working together to combat a common issue – falls. Members of the public participated in these events where information about other services was provided. NL Bump to baby Staff at Getting Better Together (GBT) in conversation with mums to be picked up there was a service gap due to COVID restrictions. In response, GBT started Bump to Baby classes in Shotts to support women and families in the pre/post birth phase during COVID. Shotts Carer Breather Involving unpaid carers in developing availability of support. North Lanarkshire Carers Together gathered the views, suggestions and ideas of unpaid carers (adults and parent carers) via various mechanisms (online groups, forum meetings, feedback from locality anchors, online survey) to inform a funding proposal submitted to HSCNL to expand regular breaks for unpaid carers in North Lanarkshire. Following approval unpaid carers were involved in the decision making process to allocate funding to community and voluntary sector groups to develop regular breaks and pilot sitter services. There are plans for unpaid carers to be involved in the monitoring process. NL
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48 Examples of engagement and participation activities in North Lanarkshire Area Improving uptake in cancer screening in Asian women The objective to increase uptake was successful because the staff member developed strong relationships and trust with women in the community. Hearing the voices of these women through this work led to connections being made with other service which were needed. Shopmobility position statement People using the Shopmobility services were encouraged to share their views of existing and potential services. Views have been shared with the Development Group and included in a short term funding request to support development activity. Motherwell Suicide Prevention Lived Experience Panel Currently in development, the creation of this panel to include people and families affected by suicide has been commissioned by HSCNL and is being facilitated by Voluntary Action North Lanarkshire (VANL). The vision is an open forum where participants can share their views, opinions and ideas. Participants will decided how and with whom their information will be shared. The objective is that the panel will help shape the design of suicide prevention services in North Lanarkshire. NL Development of Lanarkshire mental health strategy A range of methods were used to encourage views, opinions and ideas to inform the development of Lanarkshire’s mental health strategy. This included the ongoing involvement of members of Lanarkshire Links. Lanarkshire Young Peoples’ engagement and participation structure in NL Work has been ongoing since November 21 to develop the Future NL Board. The ultimate aim is for the Board to comprise of - • Representatives from 9 Youth forums linked with Community Boards • 9 members of SYP • 12 elected members The Board will be working on key themes highlighted during a young people’s event held in November 21. They are also tasking with acting on the NL results of the national Strengths and Difficulties questionnaire completed by teachers (on behalf of primary students) and secondary student. NL Playpeace Volunteers run this local organisation. They are currently (Facebook March 22)circulating a questionnaire to all families to check in with them and to inform service planning. Bellshill Coatbridge Covid Community Champions Network Initiated by Health Improvement colleagues, the network comprised of representatives from community and voluntary sector groups and health and care colleagues. The aim was to ensure that public health messages were filtering through to all parts of the community. NL
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49 Examples of engagement and participation activities in North Lanarkshire Area In practice, there was a two way flow of information. Reps were able to highlight community concerns and ask questions. Health and care colleagues received guidance on how to communicate key messages and had the opportunity to quickly respond to concerns.
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50 Appendix 2 Your local health and social care services survey What you told us. June 2022 This survey was developed to inform the review of engagement and participation structures in Health and Social Care North Lanarkshire (HSCNL). It was live in February and March 2022. Responses There were 447 responses representing all areas in North Lanarkshire. 35% (158 people) were from members of the public including unpaid carers. 54% (238 people) worked in health and social care services. 9% (39 people) worked or volunteered in the community and voluntary sector.
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51 Is involvement important? 95% of respondents thought that it was very important or quite important that people were involved in the development or improvement of health and social care services in North Lanarkshire. Who responded to the survey? A member of the public who uses services occasionally 1% 17 7 Someone who works in health and social care services 11 No 54
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52 How involved to you feel in the development or improvement of health and social care services locally? Although it is clear that this is important, not such a high number of respondents felt involved. 58% (258) did not feel invovled at all 31% (137) felt quite involved 6 % (28) felt very involved 5% (24) prefered not to be involved Looking closer at those who did not feel involved 81% of members of the public and unpaid carers 49% of health and care staff 28% of staff and volunteers in the community and voluntary sector. How involved do public and unpaid carer 1 1 4 13 Very involved Quite involved 81
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53 How involved staff in health and social care 1 1 7 Very involved Quite involved Not involved at all 49 42 How involved community and voluntary sector 3 18 Very 28 Quite involved Not involved at all 51
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54 How confident do people feel about sharing their views, opinions or ideas? There were 435 responses to this question. Of these 220 respondents felt very confident or quite confident and 215 were unsure or not confident. Looking closer at who felt very confident or quite confident about how to share their views, opinions or ideas 47% of members of the public and carers 50% of staff who work in health and social care 79% of staff and volunteers in community and voluntary sector organisations What would encourage you to get involved in the development or improvement of health and social care services locally? Respondents had a text box to note their suggestions and observations. The word cloud shows the most common words respondents used. The comments made in response to this question had common themes.
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55 1. Personal impact and evidence of impact Respondents suggested that personal impact or experience of services and supports, positive or negative, motivates people to get involved in the development or improvement of health and social care services. Also, people would be encouraged if there was evidence that involvement would have positive impact on the development or improvement of health and social care services.
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56 “If I or a member of my family needed help and it wasn't available.” “Experience as service user and child as requiring additional support due to disability Hurdles, challenges encountered system and processes challenging and frustrating over years” “Knowing that the views I have to put forward will be taken into account and acted on.” “Examples of where public opinion/feedback has resulted in real improvement to services.” 2. Clear information, invitation and welcomed- Respondents said it is encouraging when their involvement in the development or improvement of health and social care services was welcomed and they were actively invited. They also mentioned a need clearer information on why, how and when to get involved. “Awareness that our opinion is wanted in the first place...” “Clear routes for being able to do so.” “Simply being asked” “What is the service people are actually receiving in comparison to what H&SC think is being given? “ 3. Accessibility -Respondents suggested that a more flexible and inclusive approach to involvement would encourage people to get involved in the development or improvement of health and social care services. In a way and at a time that suits them, e.g. online, in person, in writing, at small meetings, one to one, out of working hours, immediately following service, on an ongoing basis, cultural considerations With support or assistance i.e. physical help to get online or to a meeting, or building confidence to contribute views, suggestions and ideas If all written and verbal information was shared in a way which is understandable, jargon free and as brief as possible.
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57 “Filling in a questionnaire with a space for my opinions.” “Need post treatment feedback mechanism after interaction with a health and social care service. Best feedback needs to happen whilst interaction is fresh in the memory.” “A rolling co-design process (not one-off) which allows service-users to speak freely and safely about their experiences. Ensuring participation feels valuable, empowering and inclusive, not tokenistic.”
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58 What ways of getting involved in developing or improving health and social care services would appeal to you? The responses have been ranked below. Respondents could select more than one answer. Number of responses Ways of getting involved 267 Filling in a survey/questionnaire 220 Taking part in regular meetings with people who run H&SC services 204 Getting together with a small group of others to speak about a specific subject 202 Social media/online 192 Going along to an event run by local community groups 20 Prefer not to get involved 7 Other “Other ideas” included: Meet with professionals face to face A process where people are actually heard and decisions are taken after taking account of real social and clinical needs not based on money saving ways Offer ideas via management Meeting within the service, 1 person to liaise with superiors What next? The survey was part of a review of engagement and participation structures in health and social care. It took place alongside interviews with volunteers and staff who are involved in health and social care services and supports. Together these informed a report that concluded with a number of recommendations. These recommendations will be considered and actions identified to take forward over the next 6-12 months. If you would like more information, please email engage@northlan.gov.uk
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1 REPORT Item No: 13 SUBJECT: Strategic Commissioning Plan 2023 - 26 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief officer North HSCP Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 1. Seeking endorsement of our approach from IJB 2. Seeking promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, 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. 5.2 Along with Safer, Healthier, Independent Lives 2016–2026, the SCP is informed and shaped by The Plan for North Lanarkshire and Achieving Excellence. Achieving Excellence, a plan for person-centred, innovative healthcare for people in Lanarkshire, is currently being refreshed. 5.3 The SCP is further underpinned by key strategies and plans including but not limited to: a) Community Solutions Strategy and investment Plan b) Mental Health and Wellbeing Strategy for Lanarkshire c) North Lanarkshire Children’s Services Plan d) Alcohol and Drug Partnership Strategic Plan e) Tackling Poverty Strategy f) Engagement and Participation Strategy g) Market Facilitation Plan h) North Lanarkshire Strategy for Adult Carers and Young Carers i) Lanarkshire Advocacy Plan j) Lanarkshire Healthy Weight Strategy k) Digital and IT Strategy 5.4 The 9 Local Outcome Improvement Plans developed through each of the Community Boards capture local priorities and actions (noted below) which both inform and are informed by the work of the Health and Social Care Partnership and shape the Strategic Planning process. Mental Health and Wellbeing Public and community transport Tackling poverty and inequalities Community Safety Health inequalities Community Engagement Food inequality Digital Inclusion Covid 19 recovery Youth engagement and consultation Town centre and hub development Social interaction and inclusion
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3 Greenspace maintenance and environmental quality Summary of Key Issues 5.5 The development of the Strategic Commissioning Plan 2023–26 is underway with discussions already commenced across a range of important forum, including Strategic Leadership Team, Strategic Planning Group, Chairs and Co- chairs of Locality Planning Groups and Partnership Boards, as well as discussion with key partner organisations and engagement forums. These discussions have helped on shaping the next steps of engagement and participation in the Strategic Commissioning Planning process as well as draw a range of related activities together to refresh how they are undertaken and aligned to use resources smartly. Further embedding a Whole System Approach 5.6 The Health and Social Care Partnership has long been committed to a whole system approach, recognising the co-dependencies. Ensuring engagement and participation in the development of the SCP across the whole system then clearly building performance frameworks which reflect the whole system will change meeting structures, governance arrangements and strengthen partner involvement. A whole system approach needs understand activity across: Community supports and activities Proactive and preventative activity First or initial responses Change services such as rehabilitation, recovery, treatment and reablement Ongoing interventions Complex and statutory interventions Acute or in-patient responses Strengthening engagement and participation 5.7 The Engagement and Participation Strategy, Framework and Principles 2021- 24 clearly outlines the importance of, and the approach to, ensuring strong voices inform and shape the work undertaken through the Health and Social Care Partnership. 5.8 Whilst significant progress has been made in engagement and participation, in aspiring a more co-productive approach, there is more to be done. The voice of communities is embedded through Community Solutions supporting local consortia who have a broad and wide reach. The voice of carers is well represented through North Lanarkshire Carers Together. Good progress has been made in representing the voice of people with lived experience, discussions are being undertaken to invest in future approaches which robustly enhance this to increase the focus on underrepresented groups. 5.9 Frontline staff and wider stakeholders are also important in wider engagement and participation. Quarterly staff roadshows are an important vehicle to
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4 augment local arrangements and facilitate easier information sharing and participation. Delivering on major change as well as business as usual 5.10 The 6 key ambitions of the SCP 2020-23 is achieved through 41 programmes of work, previously noted through the IJB relating to the DELIVERY of services and supports, ENABLING, SUPPORTING and GOVERNING factors. It is also worthy of note however that there are several transformational change programmes being supported simultaneously, in particular: a) Child and Adolescent Mental Health Service change b) Community Nursing Review c) Development of Mental Health in Primary Care Services d) Development of Home First approach incorporating Home Assessment Teams, Integrated Rehabilitation Teams and modernisation of Home Support Services e) Development of Alcohol, Drugs and Mental Health Services The learning and development achieved through these programmes of change need to feed into the SCP 2023-26. Active governance and refresh of performance 5.11 Developing the Whole System Approach described at 5.6 above, includes revision to performance reviews to promote active governance. Increasingly data will be used to assure, anticipate, and prioritise, within the Health and Social Care Partnership, with key partners and through the role governance committees play in scrutinising data in detail. 5.12 The construction of performance reviews will develop the revised structures within the Health and Social Care Partnership, using the two Sector and 3 main Area Wide constructs to promote integrated approaches, cross cutting learning and shared ambition. The review groupings in the first instance will become: North West Sector (including Airdrie, Coatbridge and North Localities); North East Sector (including Bellshill, Motherwell and Wishaw localities); Children’s health services including CAMHs Addiction, Learning Disability and Mental Health Services across health and social care Area wide health and social work services which will include home support services 5.13 Proposals to also introduce a whole system performance review are being developed to more actively include the voice of communities, the voice of carers, the voice of people with lived experience, representation of the independent sector, colleagues from acute services. Representing South H&SCP hosted services and the North Core Team.
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5 5.14 Bringing the key considerations together, dates are being identified to facilitate 5 key engagement sessions to analyse and discuss the Strategic Needs Assessments and Local Outcome Improvement Plans for each locality and area wide services. These sessions will be held in August and will inform both the development of the SCP 2023-26 and establish the revised performance review groups. Invitation will be made to IJB members to participate in events. 6. CONCLUSIONS 6.1 The Strategic Commissioning Plan (SCP) is crucial to achieving the strategic ambitions for people in North Lanarkshire. Wide engagement which brings together Strategic Needs Assessments, Locality Outcome Improvement Plans, national and local strategies, and plans, as well as learning and lessons from the transformational change agendas is being planned and developed for late August 2022. The engagement sessions, and others to be agreed with stakeholders will be designed to genuinely share, listen, and act in the complex whole system approach. 6.2 A draft SCP will be presented to the IJB in late 2022. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S) The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the SCP 2023-26 This paper has been reviewed by Finance: Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the SCP 2023-26. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Wide range of engagement activity planned and will be further enhanced following feedback from the engagement and participation stakeholder group
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6 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development of First Point of Contact. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# This content in this paper links directly to the following: • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic-Comm- Plan-20-23-FINAL.pd 9. APPENDICES Appendix 1 – Programme of Engagement Activity Appendix 2 – Timeline for SCP Development ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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7 Appendix 1 Programme of Engagement Activity August 2022 4 August 9.30am- 11am Staff Roadshow MS Teams 31 August 9-12pm NE Sector In person 22 August 12-3pm NW Sector In person September 2022 6 September Adult Social Work, Care & Wellbeing Committee In person, Council Chambers 13 September, 2pm Strategic Planning Group Online via MS Teams 15 September, 6.30pm – 8.00pm Community Board Strategic Engagement Session 1 Online via Cisco WeBex 29 September, 6.30pm – 8.00pm Community Board Strategic Engagement Session 2 Online via Cisco WeBex TBC Area Wide Health & SW In person TBC Children’s Services In person TBC Mental Health Event In person TBC Staff Roadshow Online via MS Teams November 2022 2 November IJB Liaison In person 22 November, 6.30pm – 8.30pm Shotts Community Board Online via Cisco WeBex 23 November, 6.30pm – 8.30pm Northern Corridor Community Board Online via Cisco WeBex 24 November, 1.30pm Addictions, LD & MH Partnership Board In person, venue TBC 24 November, 6.30pm – 8.30pm Cumbernauld Community Board Online via Cisco WeBex 29 November, 6.30pm – 8.30pm Coatbridge Community Board Online via Cisco WeBex 20 November, 6.30pm – 8.30pm Wishaw Community Board Online via Cisco WeBex December 2022 1 December, 6.30pm – 8.30pm Kilsyth Community Board Online via Cisco WeBex 6 December, 2pm Strategic Planning Group Online via MS Teams 6 December, 6.30pm – 8.30pm Motherwell Community Board Online via Cisco WeBex 7 December Integration Joint Board (approval of draft SCP) 7 December, 6.30pm – 8.30pm Airdrie Community Board Online via Cisco WeBex 8 December, 6.30pm – 8.30pm Bellshill Community Board Online via Cisco WeBex
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Appendix 2 8
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1 REPORT Item No: 14 SUBJECT: National Care Service Bill – Call for Views and Future Planning TO: Integration Joint Board Committee (IJB) Lead Officer for Report: Ross McGuffie, Chief Officer, North HSCP Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the Integration Joint Board; For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB Committee is asked to note the response to the Bill. 3.2 The IJB is asked to note the next steps in the NCS consultation. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 On the 9th August 2021 the Scottish Government launched a consultation on a ‘National Care Service for Scotland’ as its principle response to the Yes No N/A
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2 Independent Review of Adult Social Care (IRASC) which it has commissioned the previous year and which reported in February 2021. 5.2 The National Care Service (Scotland) Bill was introduced to parliament on 20th June, and its accompanying documents on the 21st June, 2022. The Bill seeks to provide a framework for the establishment of a National Care Service within the lifetime of the current parliament. 5.3 The Bill sets out provisions which would enable Ministers to transfer responsibility for social work and social care from local authorities to local care boards reporting to Scottish Ministers. The Bill establishes a National Care service; sets out provision for the processing of health and social care information and sets out provision for the regulation and delivery of social care. It specifically proposes a charter of rights and responsibilities for social care, as well as rights for unpaid breaks for carers, along with visiting rights to adult care homes, both of which may be introduced in advance of other Bill provisions. 5.4 Reflecting the significance of the Bill as the vehicle to facilitate the most significant public sector reform in decades, four Scottish Parliament Committees issued a ‘Call for Views’ on the Bill on the 8th July 2022 with a tight timeline for submission before 2nd September 2022. The Health, Social Care and Sport Committee is leading on the scrutiny of the Bill, with the Finance and Administration; Education, Children and Young People and Local Government, Planning and Housing Committees also considering evidence. 5.5 It is proposed that much of the detail of the National Care Service will be worked through within a process of ‘co-design’ and effectively shaped by secondary legislation/regulation. 5.6 A submission was developed from the North Lanarkshire IJB/HSCP which reiterates the feedback already provided by the IJB through the NCS consultation, with many of the areas previously raised still no clearer. 5.7 The response to the Call for Views is included in appendix 1. 6. CONCLUSIONS 6.1 Views will now be collated by the Parliamentary Committees and the whole Parliament will vote on whether to continue with the Bill in its current form in early 2023, concluding Stage 1 of the process. 6.2 If agreed, MSPs will have the chance to propose amendments to the Bill at Stage 2. 6.3 Finally, the whole Parliament will again vote on whether to pass the final Bill in summer 2023, concluding stage 3 of the process. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES N/A
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3 8.2 ASSOCIATED MEASURE(S) N/A 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB.16 sets out the potential risks around the NCS process destabilising the current system at a time of significant ongoing challenge. 8.5 PEOPLE The paper highlights the response to NCS Bill which was open to all members of the public and the National Care Service will have an impact on all Scottish residents. 8.6 STAKEHOLDER ENGAGEMENT The IJB included all stakeholder members in developing the submission of the IJB response to the consultation. 8.7 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A 9. BACKGROUND PAPER Links to Consultation document are included within the report and were previously circulated. 10. APPENDICES Appendix 1 - National Care Service Bill: Call for Views response CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact; Morag Dendy, Head of Planning, Performance and Quality Assurance.
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3 Appendix 1 A National Care Service for Scotland - Consultation RESPONDENT INFORMATION FORM Please Note this form must be completed and returned with your response. To find out how we handle your personal data, please see our privacy policy: https://www.gov.scot/privacy/ Are you responding as an individual or an organisation? Individual Organisation Full name or organisation’s name Phone number Address Postcode Email The Scottish Government would like your permission to publish your consultation response. Please indicate your publishing preference: Publish response with name Publish response only (without name) Do not publish response North Lanarkshire IJB Kirklands Hospital Fallside Rd Bothwell 01698 752594 G71 8BB DendyM@northlan.gov.uk Information for organisations: The option 'Publish response only (without name)’ is available for individual respondents only. If this option is selected, the organisation name will still be published. If you choose the option 'Do not publish response', your organisation name may still be listed as having responded to the consultation in, for example, the analysis report.
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1 We will share your response internally with other Scottish Government policy teams who may be addressing the issues you discuss. They may wish to contact you again in the future, but we require your permission to do so. Are you content for Scottish Government to contact you again in relation to this consultation exercise? Yes No Organisations – your role Please indicate what role your organisation plays in social care Providing care or support services, private sector Providing care or support services, third sector Independent healthcare contractor Representing or supporting people who access care and support and their families Representing or supporting carers Representing or supporting members of the workforce Local authority Health Board Integration authority Other public sector body Other Would you like to be involved in future engagement work? Yes, I would like to be involved in future engagement work and agreed to be contacted by the Committee in the future.
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3 The Policy Memorandum accompanying the Bill describes its purpose as being “to improve the quality and consistency of social work and social care services in Scotland”. Will the Bill, as introduced, be successful in achieving this purpose? If not, why not? As previously noted, the overarching principles set out are welcomed by the North Lanarkshire IJB. Given the high level nature of the Bill, it is difficult to truly understand its impact. The North Lanarkshire IJB is keen to be involved in future co-design activity and would welcome further information around the opportunities that will be afforded. Given the significant progress made in North Lanarkshire around integration within the current system, there is concern that a significant change programme will inevitably cause the partner bodies to look inwards for a period to address organisational concerns which can impede progress towards a national agenda, and as such improvements will be impacted. This in turn may jeopardise the national strategy to implement The Promise, particularly impacted by the ongoing decisions around whether children and family / justice services are included in the NCS or not. Because the focus of the Bill is around social work and social care, with only functions of community health (NHS staff will not be transferred into the NCS), it is difficult to see where the benefits of integration will be progressed or further realised. One of the main concerns is around the risk of destabilising or even disaggregation of integrated services should only one group of staff transfer to the NCS. In North Lanarkshire, an outcome focussed approach has been a priority with services being delivered through a whole system approach to Self-Directed Support. The number of people supported at home is one of the highest in Scotland, as choice and control is promoted widely alongside innovative approaches in working with communities, and it is currently unclear if this level of choice and control will be protected in the Bill. There are also some risks in considering a rights based, almost consumerist approach to access to support and care without a clearer acknowledgement that not all people are equally able to articulate their needs or aspirations or that these can at times conflict with best interests or the rights of others. Equally the consultation is relatively silent on the impact of poverty, its links with other needs and the role of social work and social care in addressing this. It is important to reflect on the learning from the Public Bodies Act in that commissioning and contracting are not the means to create lasting, consistent change. The successes derived through integration have been driven by local relationships and collaborative whole-system working. Is the Bill the best way to improve the quality and consistency of social work and social care services? If not, what alternative approach should be taken? The Bill at present potentially moves an already challenging governance landscape into something even more complicated, with professions potentially split across different governance and delivery structures (e.g. adult social work and social care in the NCS, children’s and justice SW in local government and NHS staff remaining managed within the NHS). Given the significant progress made within our local system over a number of years, a viable and attractive alternative is to retain a focus on local accountability governed through a single plan such at The Plan for North Lanarkshire, bringing together all local partners with a unified goal. Learning
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3 from the pandemic has already shown the strength and impact that partners coming together working on an agreed collective priority can make. While we are all committed to a strong improvement journey, it is worth noting that complex change programmes take significant time to achieve. The North Lanarkshire SDS journey has taken over 10 years, but has transformed service provision in the area. It is important to recognise the inter-connectedness of the range of services wider than health and social care that impact on health and wellbeing, i.e., housing, employability support, education etc. and the importance of maintaining and improving these connections so services work in tandem to support the best outcomes for people and communities. It is important therefore, that further consideration is given to how these connections can be maintained and strengthened in this new approach to prevent any potential eroding of broader, effective, collective partnership working which improves health and wellbeing. Are there any specific aspects of the Bill which you disagree with or that you would like to see amended? Based on learning from within our local system, it would be good to see a place-based approach more firmly embedded within the Bill. Local people need to be placed firmly at the centre of their own care and support. This also creates an added benefit of providing a far clearer focus on the social and economic determinants of health that drive demand. An uplift in funding through existing arrangements for the local partnership to enable a renewed focus on improved outcomes, which is the expressed aspiration of the Plan for North Lanarkshire, and which enables the improvement model which has been described in this overall response, would be a viable alternative that removes the significant risks of structural change. Social work and social care services are currently in crisis nationally, with waiting times for assessment and support growing, low morale, and long-term structural challenges now manifesting. The Bill risks placing further tension and uncertainty into an already unstable system. The lack of detail on the human resource impact for staff is concerning. Work at a National level to review levels of pay, role standardisation and improved support for building future workforce resilience through funded training and practice would be welcomed as part of a wider solution to the longstanding problem of workforce pressures. The role of Social Work has not been fully represented within these proposals and the analysis of current practice does not reflect the complex interventions that take place with individuals, their families and carers within challenging environments. There is no recognition that the role of Social Work is not merely transactional or that of a gatekeeper to services but is based on developing strong working relationships. The statutory role of Social Work to balance rights, sometimes conflicting rights, and risks is not sufficiently acknowledged. The focus of the Bill is the interface between social work and social care, however, there is no reference to the positive existing work that goes beyond case management with a greater focus on outcomes. The work that Social Workers undertake with those people who are hard to reach, is very much defined by local knowledge and local relationships and not always the provision of a support package. The role social workers play in empowering individuals and their families, working towards
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4 self-actualisation, independence and life without ongoing paid support is hard to define but has the most significant impact on people’s lives. The risk in the consultation is that the criticism of gatekeeping and bureaucracy overlooks and oversimplifies the need for conversations which encourage and raise expectation and ambition. The need to continue to focus on recovery, rehabilitation and reablement are not currently prominent enough in the Bill. The public protection structures, a clearly critical role, are also not fully clear in the Bill. The need for local arrangements is critical in this area, to ensure that this work remains a priority. The work undertaken in North Lanarkshire across the public protection agenda to improve practice and outcomes for people should be recognised and valued. It will be essential that local arrangements such as Chief Officer Groups continue to provide the necessary leadership. There is no reference to the excellent practice and learning that is produced through COGS any reflection on how the impacts on governance nor on how the checks and balances essential to rights based practice within the current system could be addressed within a structure of direct accountability to Scottish Ministers. There is a significant focus placed on structural reform. There is some concern that this poses significant associated risk that, to achieve this, will delay the necessary work to improve and deliver high quality services and outcomes for people. Is there anything additional you would like to see included in the Bill and is anything missing? Given the high level nature of the Bill, there is a lot of additional information required to fully understand the direction of travel. The North Lanarkshire IJB would like to see further information around the expectations of the National Social Work Agency and how this will interface with local arrangements. There is insufficient reference to the importance of recovery, rehabilitation and reablement which needs to remain a focus. There is an over focus on services rather than wider community resources and assets based approaches. Promoting easier access to service based on wants runs the significant risk that more people will end up with service where change responses would promote greater independence and improved quality of life. The current support arrangements from local statutory partners, such as legal support and Chief Social Work Officer duties in local government, are a vital element of current service provision and loss of such support would have a significant impact on the outcomes of vulnerable individuals in our community. The costs of re-provisioning this support in a new entity should not be underestimated. Further clarity on the process to be undertaken around children and justice social work services, including the evidence base against which decisions will be made, would be welcome. The introduction of a single record is a welcome aspiration, but further clarity around how this will be taken forward, timelines and associated costs would be welcome. Given the multiple databases currently used both within the NHS as a single organisation and across local authorities and the complexity of change in this area, it appears highly unlikely that a single record would be achievable within the proposed timeframe for the establishment of the NCS. There is a risk of loss of local intelligence and relationships which are key to supporting providers and investing in organisations that will target local population needs. Work is needed to ensure that smaller, more local provision and providers are not inadvertently disadvantaged in a standardised
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5 approach. Whilst a select range of “once for Scotland” resources for particularly complex and unusual circumstances is supported, significant work is needed to ensure national consistency on thresholds is maintained. The Bill does not cover the emergent Homelessness Prevention Duties for public bodies which seeks to ensure the appropriate care, support and collaborative working required to ensure whole system change. The Scottish Government proposes that the details of many aspects of the proposed National Care Service will be outlined in future secondary legislation rather than being included in the Bill itself. Do you have any comments on this approach? Are there any aspects of the Bill where you would like to have seen more detail in the Bill itself? The approach taken of focusing on a framework primary legislation followed by more detailed secondary legislation leaves a significant level of detail to be worked up through the co-design process and could cause significant uncertainty within local partnerships at a time of high challenge. It is vital that the co-design approach enables genuine engagement with those involved in leading, managing and delivering integrated services. The North Lanarkshire IJB would have liked to have seen more information on the functions to be transferred to the NCS, and the rationale for the different approaches taken. There is significant concern that the approach could risk the disaggregation of integrated services through some local government functions transferring to the NCS, others remaining with local government and health services remaining managed within the NHS. There is no mention of GP contracts transferring to the NCS, which had been a recommendation of the original review. We support the ambition to improve quality and consistency in standards of care however, there is little evidence in the Policy Memorandum regarding how proposals to transfer accountability and centralise powers with Scottish Ministers will lead to an outcome of improved quality and consistency across Scotland. Other centrally directed services under direct control of Ministers such as acute hospitals continue to display significant local variation and inconsistencies. The Bill proposes to give Scottish Ministers powers to transfer a broad range of social care, social work and community health functions to the National Care Service using future secondary legislation. Do you have any views about the services that may or may not be included in the National Care Service, either now or in the future? There needs to be much greater clarity on the delivery and employment arrangements for any NHS functions included in the NCS given the statement that NHS staff will not transfer with associated functions. This includes delivery of community health services providing front line patient care and also leadership, management and strategic planning functions as well as support functions such as premises, IT, administration and commissioning/procurement. The rationale for the different positions taken for social work and NHS functions is not clear and raises significant concerns around the potential impact on existing integrated services and the future for integrated working. We feel that all functions being delegated to a National Care Service should be identified from the outset, as a staggered approach leaves some functions transferring over after the structures and governance arrangements have already been developed. This creates a significant risk for those services transferring as a second tranche from both local and national perspectives (i.e. local Care
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6 Board arrangements being developed that are predominantly focused on adults and the national co- design being equally focused that way). A key principle of any co-design activity has to be around ensuring no negative impacts on public protection arrangements, which is one of the greatest risks faced by the Bill. As noted previously, we need to maintain a degree of flexibility for place based approaches, so communities have an ability to influence the direction of travel to maximise the outcomes for people, while still striving for a degree of consistency across the country. Do you have any general comments on financial implications of the Bill and the proposed creation of a National Care Service for the long-term funding of social care, social work and community healthcare? It is recognised that historic underfunding has impacted on service delivery and development in both social work and social care and there are concerns that the cost of restructuring and set up will both be disruptive to current improvement work and divert investment from those areas where investment is required to meet the desired outcomes of the legislation. There is a huge margin of error within the estimated set up costs as expressed within the financial memorandum and no estimate of, or commitment to the investment required to meet the aspirations of Feeley. It feels inevitable that the creation of another employing body locally, will come with greater backroom costs (e.g. finance, payroll, HR, legal etc) diverting much needed funding from frontline activity. As it stands, there is not enough detailed information to form a view around the affordability of what is being proposed in the Bill and the Financial Memorandum doesn’t include many aspects of future secondary legislation. The legal status, structure and governance arrangements of a National Care Service will lead to a determination around the appropriate VAT status of the organisation. While a VAT neutral position will be sought, the financial risk around this not being secured is vast.
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1 REPORT Item No: 15 SUBJECT: Tacking Poverty TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Alison Gordon, Head of Children. Families and Justice/CSWO DATE: 21st September 2022 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 Reviewed Endorsed Endorsed and remitted to the IJB by the People and Communities Committee in NLC. 3. RECOMMENDATIONS 3.1 The Integration Joint Boards is asked to: Note the contents of the report 4. VARIATIONS TO DIRECTIONS?
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In line with the Plan for North Lanarkshire and the Council’s Programme of Work, the report attached in appendix 1 sets out the progress on implementation of the Fuel Poverty Hardship Payment Scheme, which was approved by the Community Empowerment Committee in November 2021. 5.2 The report covers the period of January to June 2022, where over 8000 applications were received, with payments totalling over £913k being made to households who met the eligibility criteria to date. 5.3 Crucially, all applicants to the scheme were offered the opportunity of receiving a benefit check, money advice and fuel advice. 5.4 Proposals for the new scheme to be actioned from October 2022 are currently moving towards approval within North Lanarkshire Council. 6. CONCLUSIONS 6.1 The fuel poverty hardship payment plays an important role in supporting North Lanarkshire residents through the winter period, which will only be exacerbated by the current cost of living crisis ahead of winter 2022/23. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The attached report touches on all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) Progress against the scheme is monitored through the People and Communities Committee 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB.09 notes the impact of the pandemic on inequalities and the ability to achieve the outcomes of the SCP and risk IJB.15 highlights the impact of the current cost of living crisis. 7.5 PEOPLE Yes No N/A
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3 The Towards a Fairer North Lanarkshire – Tackling Poverty Strategy ensures all agencies are aware of their role in tackling poverty and inequalities in the North Lanarkshire population. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS N/A 9. APPENDICES Appendix 1: remitted paper from People and Communities Committee CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy, Head of Planning, Performance and Quality Assurance
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4 Appendix 1 North Lanarkshire Council Report Yes ☐ No From Alison Gordon, Head of Children. Families and Justice/CSWO E-mail gordonal@northlan.gov.uk Telephone 01698 332001 Executive Summary This report updates on the implementation of Fuel Poverty Hardship Payment Scheme. The Council’s approach was approved by Community Empowerment Committee on 1st November 2021. This payment initially proposed for targeted groups of £75 per household was subsequently enhanced to £150 per household due to the increase in budget provided by the Scottish Government through the Tackling Insecurity Fund and Winter Support Fund. The report provides detail on payments made though the fund during the period January- June 2022 supporting reflection on the successes and challenges in reaching its target population. Information is also provided on funding available for Winter 2022/23. It is planned that the Tackling Poverty Officers Action Group lead on reviewing the Scheme and report back to the Corporate Management Team with a view to implementation from October 2022. Recommendations (i) Note the outcome of the Fuel Poverty Hardship Payment Scheme (ii) Agree that the Tackling Poverty Officers Action Group review the Scheme and bring proposals to Corporate Management Team for a revised scheme for Winter 22/23 (iii) Remit to this report to the People and Communities Committee The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities People and Communities Committee P005.2 Tackling Poverty – (2) Update report on implementation of the Tackling Poverty Strategy and improved outcomes achieved - Fuel Poverty Hardship Payment It is recommended that the People & Communities Committee: Does this report require to be approved? Ref AG/JC Date 19/07/22
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5 Ambition statement (11) Increase economic opportunities for adults by understanding, identifying, and addressing the causes of poverty and deprivation and barriers to financial inclusion
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6 1. Background 1.1 The Corporate Management Team meeting on 28th September 2021, approved the approach to the Fuel Poverty Hardship Payment which targets groups identified as priority through the Council’s third Local Child Poverty Action Report and the updated Towards a Fairer North Lanarkshire Tackling Poverty Action Plan. The Action Plan identified that around 31,000 people were experiencing fuel poverty in North Lanarkshire, with 8,000 of these people being families with children who are householders. The Projected Household Report (2018) indicated that 5375 of young people aged between 18 & 24 years old would be householders by 2020 and that due to the levels of benefit entitlements/living wage level for this age group, it was also highly likely that they will also experiencing fuel poverty. These two groups were therefore targeted as groups likely to be in fuel poverty and without access to other schemes such as winter fuel payment. 1.2 The Community Empowerment Committee approved the approach for the Council’s Fuel Hardship Payment on 1st November 2021. At that time, based on the level of budget available and factoring in the number of potential claimants from the targeted groups, the payment was set at £75 per household. 1.3 The payment per household was subsequently raised to £150 per household, facilitated by the increase in the budget provided by the Scottish Government via the Tackling Insecurity Fund and the Winter Support Fund. 1.4 The eligibility criteria for the Fuel Hardship Payment were agreed as noted below: Applicants must be a householder in North Lanarkshire Be aged between 16 and 24 years of age /or Householders who are responsible for a child Be in receipt of income-based benefits including Universal Credit and Council Tax reduction Scheme/or Low income (ie: household income of £26,600 or less per annum) Have savings of less than £700, and Meet the definition of being in fuel poverty. This was based on the Fuel Poverty (Targets, Definition and Strategy) (Scotland) Act 2019, which defines a household is in fuel poverty if the household is spending more than 10% on fuel, of their net income after paying their rent/mortgage. An amendment was subsequently made to extend the age based criteria to up to 26 for those young people who have experienced care, in line with entitlement to after care.
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7 2. Report 2.1 The Fuel Hardship Payment opened for applications from 10th January 2022 with payments to successful applicants being made from 20th February 2022. 2.2 Corporate Communications and the Financial Inclusion Team ran a campaign advising residents and targeted groups, using a series of social media messages (Facebook and Twitter), as well as promoting the payment via Council Services, VANL and the North Lanarkshire Advice Network. Applications 2.3 In total, 8,101 applications were received, 556 applications from householders from the age group 16 to 24, and 7,545 applications from households with children. The was below overall target was for 14,000 households to benefit from the Fuel Hardship Payment with the reach of the scheme to households with children falling only slightly short of those in this category estimated to be in fuel poverty but the number of households without children reached within the age related category, significantly less than anticipated. 2.4 315 applications for the age group were successful and received a payment, with 199 rejected, as they failed to meet the eligibility criteria. As of the end of May 2022, 42 applications were still outstanding, awaiting further information. 2.5 5,774 applications for Households with Children were successful and received a payment, with 1,113 rejected, as the failed to meet the eligibility criteria. At the end of May 658 applications were still outstanding awaiting further information 2.6 The Revenues and Benefit Team in conjunction with the Financial Inclusion Team are progressing the outstanding applications, applicants have been sent 2 emails and given 14 days to reply with the requested information. If no response is received, then the cases are closed. 2.7 Any new evidence was requested by the 30th June 2022 when the 2021/22 Scheme was formally closed. Payments 2.8 The total budget allocated to the Fuel Hardship Payment was £2.1M. To date £913,350 has been paid to Households who met the edibility criteria, with a potential further maximum of £105,000 payments due for the outstanding applications. Advice (Income Maximisation, Money/Debt Advice and Fuel Poverty) 2.9 All applicants to the fund were offered the opportunity of receiving a benefit check, money advice and fuel advice. Of the 8,101 applicants, 2336 household took up this offer. 1,117 were dealt with the Financial Inclusion Team. 588 failed to engage and 529 were provided with advice and support on benefits/money advice and fuel advice. 2.10 1,219 applicants were referred to CABx who also offered advice on benefits/money advice and fuel advice, 545 failed to engage and 674 were provided with advice and support on benefits/money advice and fuel advice.
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8 2.11 It is too early at this stage to advise any additional income generated for these applicants, as we are still wating on decisions on claims for social security benefits and other benefits. Next Steps 2.12 The final underspend in the Financial Insecurity Fund and Fuel Hardship Payments will be added to the Local Authority Recovery Fund £960,000 for Fuel Poverty which was approved by the Corporate Management Team on 26th April 2022. This brings the total available for Winter 2022/23 Fuel Hardship Payment to £2.161M (excluding any of the 105,000 held not required for outstanding claims) 2.13 The Tackling Poverty Officers Action Group will develop a new Fuel Hardship Payment Scheme to be actioned in October 2022, in line with the next increase on the energy cap. Clearly there has over the past year been a significant change in context with acute rise in energy prices meaning that a much higher percentage of the population are at risk of fuel poverty, only partially mitigated by support already announced by the UK government. Proposals for the new Scheme will be informed both by the evolving context and learning from the targeting and implementation of the 2021/22 Scheme locally. 2.14 Proposals for the new Scheme will be brought to the Corporate Management Team for approval by the end of August 2022. 3. Measures of success 3.1 Number of Families and individual residents who have benefited from the Fuel Poverty Payments. 4. Supporting documentation N/A Alison Gordon Head of Children, Families and Justice/Chief Social Work Officer
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9 5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? No groups will be disadvantaged or excluded through the implementation of the measures and interventions outlined in the report which present an opportunity to promote equality and ensure greater access to public services and support. The Fuel Hardship Payment supports the Council to meet the requirements of the Fairer Scotland Duty by reducing inequalities in line with Towards a Fairer North Lanarkshire North Lanarkshire Tackling Poverty Strategy. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Budget was provided via the Scottish Government Covid -19 funding for Financial Insecurity and Winter Support Fund. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☒ No ☐
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10 If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☒ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? IT developed an online application form for residents. Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☒ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The Corporate Communications Teams worked with the Fuel Poverty Sub Group to develop and implement a communications plans for residents who may be eligible for the payments and to keep applicants up to date with the progress of their applications. 5.9 Risk impact Is there a risk impact? Yes ☐ No ☒ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed?
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REPORT Item No: 16 SUBJECT: Financial Inclusion Team Activity Report 21/22 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Alison Gordon, Head of Children. Families and Justice/CSWO DATE: 21st September 2022 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 Reviewed Endorsed Endorsed and remitted to the IJB by the People and Communities Committee in NLC. 3. RECOMMENDATIONS 3.1 The Integration Joint Boards is asked to: Note the contents of the report 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In line with the Plan for North Lanarkshire and the Council’s Programme of Work, the report attached in appendix 1 sets out activity within the Council’s Financial Inclusion Team during 2021/22. 5.2 Over the financial year, the team generated over £35m of additional benefit income for the residents of North Lanarkshire, with externally commissioned services generating over £5m, bringing the overall total to over £40m. 5.3 The report notes some of the challenges brought about by the pandemic response as well as the continued Welfare Reform agenda and its impact on the local system. 6. CONCLUSIONS 6.1 The Financial Inclusion Team continues to play a vital role in providing service users and members of the public with advice and assistance on a variety of benefits related issues. 6.2 Income maximisation is an ever more crucial role given the current cost of living crisis and work continues to develop the ‘routine enquiry’ across all health and social care services to maximise the number of individuals who can be supported through the service. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The attached report touches on all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB.09 notes the impact of the pandemic on inequalities and the ability to achieve the outcomes of the SCP and risk IJB.15 highlights the impact of the current cost of living crisis. 7.5 PEOPLE The Towards a Fairer North Lanarkshire – Tackling Poverty Strategy ensures all agencies are aware of their role in tackling poverty and inequalities in the North Lanarkshire population. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed:
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Yes No N/A 8. BACKGROUND PAPERS N/A 9. APPENDICES Appendix 1: remitted paper from People and Communities Committee CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy, Head of Planning, Performance and Quality Assurance
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Appendix 1 North Lanarkshire Council Report Yes ☐ No From Alison Gordon, Head of Children, Families and Justice/CSWO E-mail gordonal@northlan.gov.uk Telephone 01698 332001 Executive Summary This report provides details of the income maximisation work carried out by the Financial Inclusion Team and Council Services during 2021/22 which generated £35,006,809 in additional benefit income for the residents of North Lanarkshire. It also highlights the activity of the External Services commissioned by the Council under the new commissioning model which started in April 2018 which generated £5,423,784M in additional benefit income for the residents of North Lanarkshire. Over this period the Coronavirus pandemic has brought inequality and therefore the importance of income maximisation and wider work to tackle poverty into sharp focus, highlighting the impact of low paid and insecure work in particular. Local approaches to tackling poverty and reducing inequality in North Lanarkshire, continue to be driven by the ‘Towards a Fairer ‘North Lanarkshire Tackling Poverty Strategy with activity focused on the key drivers of poverty The report also updates on the continued programme of Welfare Reform and its impact, including on the introduction of benefits devolved to, and now provided through, Social Security Scotland as well as the challenges which the Council, partners and our communities will face over the next three to four years. Recommendations (i) Approve the content of the report and specifically the approach to reviewing the scheme (ii) Agree that a further report updating on the outcome of that review is provided to the next People and Communities Committee (iii) Remit this report to the Integration Joint Board for Information The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities People and Communities Committee POO5.2 Financial Inclusion Team Activity Report 2021/2022 It is recommended that People & Communities Committee: Does this report require to be approved? Ref AG/JC Date 19/07/22
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Ambition statement 1. Background (11) Increase economic opportunities for adults by understanding, identifying, and addressing the causes of poverty and deprivation and barriers to financial inclusion 1.1 Due to the complexity of the benefits system, general and specialist welfare rights services are crucial to individuals and families who are dependent on benefits. The Financial Inclusion Service provide support and assistance to staff on the range of state benefits and assist service users to claim all benefits to which they are entitled. The main thrust of all welfare rights work is the maximisation of income for individuals, for the Council and for the community as a whole. Given the poverty levels within North Lanarkshire, it is important that the Council mobilises its resources to tackle poverty amongst service users and in the wider community. 1.2 The Financial Inclusion Team (First Point of Contact) and all Social Work Services provide service users and members of the public with advice and assistance on a wide variety of benefit-related issues. A full benefits check is offered to all new service users. Income maximisation also plays a vital role in longer term Social Work services such as Community Care, Children and Families, Justice Services, Mental Health and Addictions. 1.3 A key role of the Financial Inclusion Team is to support the income maximisation service through consultation and guidance for fieldwork staff, representing clients at tribunals and hearings, and supporting specialist Social Work Services. Successful welfare rights intervention, where individuals are awarded extra benefit, frequently means that, as a result of increased income, they are better able to manage their own affairs and may not require further social work services. 1.4 Income Maximisation work is also undertaken by key staff within the Council’s Housing Services and supported by the Financial Inclusion Team through training or where wider/more specialist support is required. 1.5 Since 2011, the Council has succeeded in securing financial contributions from a number of partner organisations to help fund programmes aimed at reducing the impact of welfare reform. These additional resources, which to date amount to approximately £2.7m, have been used to; enhance capacity to deal with the significant increase in demand for representation, training, advice, information and support. 1.6 The Coronavirus pandemic has brought inequality into sharp focus, highlighting the impact of low paid and insecure work in particular. The impact of the measures to combat the pandemic have had an unequal impact across Scotland and North Lanarkshire, with a greater impact on people living in socio-economic disadvantage and with a number of specific impacts on children who were already living in poverty, or whose families have now been pushed into poverty. 1.7 Over the past number of years, progress in developing local approaches to tackling poverty and reducing inequality in North Lanarkshire, have been strengthening with activity focused on the key drivers of poverty, via the ‘Towards a Fairer ‘North Lanarkshire Tackling Poverty Strategy. The FIT team have a key role in leading and co-ordinating this work across services and with key partners although this report focuses on the activity directly delivered by, or commissioned through, the team.
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1.8 The challenges that the Council and partners will face in delivering our ambitions with respect to Tackling Poverty over the next three to four years are significant. These include the ongoing recovery from Covid-19, the Cost-of-Living Crisis, rising energy costs, fuel increases, the highest inflation in 40 years and the impact of the conflict in Ukraine. This is within a context of the continuing programme of Welfare Reform led by the UK Government but also the roll out of changes to areas of benefit support now devolved to the Social Security Scotland 2. Report 2.1 Income Maximisation North Lanarkshire Council is the largest local authority landlord in Scotland with circa 36, 315 houses. In addition, the local Registered Social Landlord sector owns and manages approximately 9,000 properties. It is estimated that around 58.5% of social tenants are in receipt of Housing Benefit (57.3% in the council housing sector). Early intervention with income maximisation assists in the prevention of rent arrears and the sustainability of tenancies. Housing advisors provide basic information and advice to vulnerable tenants and homeless people, concentrating on housing benefit to ensure people can pay their rent. They receive welfare rights training and are supported by Welfare Rights Officers from the Financial Inclusion Team (FIT). From 1 April 2021 to 31 March 2022, Housing Services generated £13,023,541 in benefits for 5,076 new and existing tenants, making 6,288 claims for benefits of which 3,680 were claims for Housing Benefit (including Supported Accommodation), Discretionary Housing Benefit and Council Tax Reduction Scheme (which is a direct income for the Council and in the longer term contributes to the sustainability of tenancies). Similarly, FIT, together with Social Work Services completed 16,409 Benefit Checks in 2021/22 generating an income to local residents of £19,052,784m, with additional financial gains of £383,839, (benefits, charities, and energy suppliers etc.) generated via Debt Advisors within the FIT. The MacMillan Lanarkshire Advice Service is provided by North Lanarkshire Council and provides home visits, telephone interviews, office visits and surgeries in local hospitals. The FIT manages this service. Between 1 April 2021 and 31 March 2022, there were 668 referrals to the service, of which 403 were for DS1500 cases (terminally ill) It should be noted that this is a reduction from previous years, due to cancer services pausing due to COVID-19 nonetheless £2,546,644m of income was generated for those residents referred affected by cancer. The table below summarises the income maximisation work undertaken throughout the year: Social Work / FIT £19,052,785 Housing Services £13,023,541 Macmillan Lanarkshire Service £2,546,644
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Charities, and energy suppliers £383,839 Total £35,006,809 The FIT and Social Work Service generated 59.40% of the Council total, with Housing Services making up the remaining 40.60%. In cost/benefit terms, it is worth noting that every £1 invested by the Council in income maximisation during 2021/22 generated £27.52 for residents and the local economy. The Financial Inclusion Team also received 9,321, referrals from Elected Members, MSP’s/MP’s, NHSL and other agencies, for welfare rights advice and information. Appeals Representation is a core element of a Welfare Rights Officer’s work. During 2021/22, Welfare Rights Officers represented at 217 appeals (a significant decrease on the previous year due to decrease in DWP activity and the impact of Covid-19)). The overall success rate for Social Security Appeal Tribunals by the Financial Inclusion Team was 67%, which is an improvement on last year and slightly above the national average of 66%. Service Users Questionnaires/Surveys to monitor customer satisfaction did not take place during 2021/22 due to Covid-19 however the Business Intelligence Team have are currently developing an online consultation tool called SNAP, where surveys can be emailed to a client’s email address / put onto the Council website. It is anticipated that this will support this activity going forward. Debt Advice The FIT received 1194 referrals for Money Advice/Debt Advice during 2021/22 from residents, elected members, CABx, Health and Social Care Services, Housing Services, NHS Lanarkshire and other Advice and Information agencies. The FIT dealt with 7 Debt Payment Programmes (DPP) and 26 Bankruptcies were awarded. Whilst the number of Debt Payment Programmes dropped (which was inevitable due to Covid-19 and people’s circumstances being unstable), there was a vast increase in the number of payment/crisis breaks, variations and revocations being dealt with by the team for current Debt Payment Programme’s. The total debt dealt with was £5,084,771. Although there has been a drop in DPP’s and bankruptcies, the amount of debt dealt with only dropped by £854,762 from the previous year. This was largely due to increase in variations, revocations and payment/crisis breaks Due to Covid-19, The Money Advice, Consumer Advice Project (MACA project) for first and second level primary school pupils did not take place during 2021/2022. In common with the situation with Appeals representation Customer Satisfaction Survey’s for Money Advice did not take place in 2021/22 however will be reintroduced in collaboration with The Business Intelligence Team going forward with the intention to use the SNAP tool.
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Training Throughout 2021/22, the FIT has provided training to Council and External Partners, via online video tools, covering updates on benefits, welfare reforms and legislation, financial assessments, employment and support allowance, Migrant Workers and other welfare benefits-related subjects. The FIT also maintains and updates online e-learning training packages for the Scottish Welfare Fund, Personal Independence Payments and Universal Credit, which are available to all council services, elected members and partners via their online platforms. External Services The Financial Inclusion Team commissions and monitors the external services and has carried out monitoring visits of each Citizen Advice Bureaux as outlined in the funding agreement and can provide assurances that each provider are meeting the outcomes agreed in the funding agreement and are providing a quality advice and information service in line with the Scottish National Standards for Advice and Information Providers, their locality profiles and the Council’s 5 Strategic priorities. The External Services have had 5,953 welfare rights enquiries, 3,034 Housing Advice enquiries with 1,185 referred to other agencies, 7,392 Money Advice enquiries with 4,131 referred to other agencies and completed 4,893 Benefit Checks in 2021/2022, generating benefit income to local residents of £5,423,784m. In cost/benefit terms, every £1 invested by the Council in External Services during 2021/22 generated £11.63 for residents and the local economy. It is important to reaffirm that the Council commissions the External Services to provide specific advice and information services (not CAB Services) and that they receive other funding from funders, the above information relates only to the funding that these External Services receives from the Council 2.2 Legislative/Policy Changes (Welfare Reforms) 2.2.1 The UK Government welfare reform agenda was paused during 2021/22, due to Covid-19. A number of financial measures and supports were put in place to support people during the pandemic, however some which came via the benefit system eg. the £20 week increase in Universal Credit have now ended, along with other financial measures and supports. The UK Government/DWP have now resumed the welfare reform programme, as has the Scottish Government. As previously reported, the full impact of the UK Government welfare reform agenda is not yet known as the reforms are still being embedded into the system whilst the number of claimants being migrated from legacy benefits on to Universal Credit increases on an ongoing basis. Full service Universal Credit went live in North Lanarkshire in April 2018, but it will not be completed until 2024 or indeed later. DWP data shows that by November 2020 24,312 households within North Lanarkshire were in receipt of Universal Credit, this rose to 25,894 in March 2021 and in November this had dropped to 24,128. The UK Government Spring Statement for 2022 introduced some further reforms as set out below:
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Reducing the Universal Credit taper rate from 63% to 55% and increasing Universal Credit work allowances by £500 a year with the intention to make work pay. increasing the National Living Wage (NLW) for workers aged 23 and over by 6.6% to £9.50 an hour from April 2022. increasing benefits and pensions by 3.1% (well below the current level of inflation due to the link to previous year’s rate) an additional £500 million for the Household Support Fund from April to help the most vulnerable households with the cost of essentials such as food, clothing and utilities, bringing total funding to £1 billion. Further reforms as set out below were announced by the UK Government on 26th May 2022, principally to address the impact of fuel price rises. Windfall Tax on Oil and Gas Companies (Levy) of 25% on profits. Low Income Families to receive £650 in two payments July and Autumn administered by DWP. Pensioners to receive an additional payment of £300, on top of the Winter Fuel Payment Disabled people to receive a one off £150 payment in Autumn. The Family Support Fund is to be topped up by a further £250 in the Autumn. The £200 Universal support to household which was to be repaid back over 5 years, has been changed to a grant (not to be repaid) and increased to £400 per household. 2.2.2 Scottish Social Security Agency and devolved benefits: A number of benefits have now been devolved to Scotland and the Scottish Social Security Agency are in the process of gradually rolling these out, as detailed below: Job Start Payment Implemented 2020 Scottish Child Payment for under 6’s Implemented February 2021. Disability Assistance for Children & Young People Implemented Summer 2020 Children who receive the highest care component of Disability Assistance become entitled to Winter Heating Assistance Implemented January 2021 Disability Assistance for Working Age People In NL as part of Pilot in June 2022. Roll out Nationally will be August 2022 Additional payments to carers who look after more than one disabled child Implemented early 2021 Pension Age Disability for Older People Implemented 2021 Winter Heating Assistance (to be called Low Income Winter Heating Assistance) Due to be implemented Winter 2022/23
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Cold Spell – Heating Assistance Implemented Winter 2021 Scottish Carer’s Allowance Due to be implemented August 2022 Employment Injury Assistance Due to be implemented Autumn 2022 Scottish Child Payment for under 16s Due to be implemented by the end of 2022 Many of these benefits are replacing existing DWP benefits, but with eligibility criteria being broadened and payments amounts increased, in addition to a number of brand- new benefits being created. This is an import raft of reforms which will have the potential to provide a positive impact on the income of the residents of North Lanarkshire. The FIT will continue to maximise the income of residents, ensuring to check eligibility for these new benefits and support applications where appropriate. 2.2.3 Future Context and Challenges The impact of the pandemic on the national and local labour market has created new challenges for employers and those out of work. The North Lanarkshire claimant count, which acts as a measure of unemployment, was 14,415 (6.6%) people in March 2021 compared with 8,225 (3.8%) in March 2020, a 75% increase on the pre pandemic level. However, in May 2022 it has decreased to 8,050 (3.7%). On the face of it this is good news but behind the unemployment figures real challenges are apparent. As 2021/22 progressed it became clear that a significant number of people, mainly older workers and the majority women, had left the labour market either through early retirement, health concerns or to take up caring responsibilities. These factors, combined with the rapid re- opening of the economy through the year led to staffing shortages across a range of sectors with jobs available, especially at entry level, for those who were job ready or even nearly job ready. The number reported as ‘long term sick’ in North Lanarkshire has increased from 14,900 in December 2019 to 29,400 in December 2021 and the number reported as ‘looking after family/home’ in the Council area increased from 8,500 to 13,000 in the same period. While unemployment is lower than pre pandemic levels the number of people in the workforce in North Lanarkshire has reduced from 174,000 (78.1%) in December 2019 to 159,300 (71.1%) in December 2021, this clearly impacts on income levels. The other concerning national trend is that despite falling unemployment, long-term unemployment remains above pre pandemic levels; with the long-term unemployed now accounting for 35% of all those unemployed (compared with 28% two years ago). Short-term unemployment is at its lowest ever level. For those in work there are also concerns as pay growth remains well below inflation in many of the sectors predominant in North Lanarkshire with the rising costs of living affecting the financial benefits of employment and labour shortages, rising costs and supply chain challenges affecting employers plans for recruitment and business development. So, despite a fall in unemployment in the area there is higher worklessness, negative pay growth and continued labour shortages for businesses and these factors will
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have a continued and sustained impact on the demand for financial inclusion services. Residents will be migrated to Universal Credits full service over the next three years and are expected to fully comply with the UC rules as someone not in employment. This means that they could be sanctioned and lose their UC payments if they fail to follow their Claimant Commitment. Whilst it is problematic to be absolutely accurate based on DWP information and data with regards to Working Tax Credit from HMRC, it is likely that the minimum number of residents who be migrate from their current benefits to UC across the period July 2020 to 2024, will be 49,200, meaning that nearly 77,000 residents will be impacted by Universal Credit and/or other welfare reform changes over the next 5 years with the majority being Council tenants in receipt of Housing benefit/Council Tax Reduction Scheme and/or users of IJB Services. Despite the potentially positive impact of some of the new benefits listed at 2.2.2 above the biggest emerging issues from April 2022, is the end of the financial measures and supports for Covid-19, along with elements of the Coronavirus Legislation ending, the cost of living crisis, soaring energy and fuel prices, highest inflation in over 40 years (expected to peak at 10%), real term cuts in wages, benefits and pensions and the National Insurance increase for workers. These have the potential to result in major issues for our community and council services with respect to increased issues with rent/council tax arrears, debt, food poverty, fuel poverty, homelessness and impact on capacity of services. 3. Measures of success 3.1 Ensuring and improving the standardised service to all residents and providing a sustainable, responsive and effective means of quality advice and support to our communities across North Lanarkshire. 4. Supporting documentation N/A Alison Gordon Head of Children, Families and Justice/CSWO
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? No groups will be disadvantaged or excluded through the implementation of the recommendations of the report. Indeed noting, the recommendations presents an opportunity to promote equality and ensure greater access to public services. The current activity of the FIT, Housing Services and North Lanarkshire Health and Social Care Services mitigates where there are negative impacts of welfare reform changes within North Lanarkshire and meets the requirements of the Fairer Scotland Duty by reducing inequalities. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☒ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐
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5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? There context described above has the potential to impact negatively on the Council’s Corporate Tackling Poverty Risk (which is already a high risk), particularly with respect to in work poverty and despite the significant investment in in this work related demand may challenge the Council’s capacity to respond.