Item 12 - Participation and Engagement
North Lanarkshire Council · 21 September 2022
Back to Health and Social Care Integration Joint Board — 21 September 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 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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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