Combined Meeting Papers Pack
North Lanarkshire Council · 30 November 2022
Back to Health and Social Care Integration Joint Board — 30 November 2022 and its agenda
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A meeting of the IJB will be held on Wednesday 30th November 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 1. Welcome and Apologies 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 21.9.22 For Approval Attachment Chair 4. IJB Action Log For Approval Attachment Ross McGuffie 5. External Auditor Annual Audit Report For Approval Attachment Amanda Kilburn 6. Auditied IJB Annual Accounts For Approval Attachment Amanda Kilburn 7. Financial Monitoring For Noting Attachment Amanda Kilburn 8. Covid Update For Noting Attachment Ross McGuffie 9. Quality Assurance For Endorsement Attachment Morag Dendy 10. Risk Register For Approval Attachment Ross McGuffie 11. Whistleblowing Annual Report For Noting Attachment Lesley McDoanld 12. Strategic Commissioning Plan For Approval Attachment Morag Dendy 13. Mental Health Hospital Based Complex Care Contracted Beds For Approval Attachment Ross McGuffie 14. Supporting Unpaid Carers For Noting Attachment Morag Dendy 15. Net Zero Attachment Ross McGuffie 16. Cost of Living Helpline Report For Approval Attachment Ross McGuffie
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2 17. Winter Plan For Approval Attachment Ross McGuffie 18. 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 19. Date of Next Meeting TBC For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st September 2022 at 2pm-4.30pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Tracy Carragher (Chair) North Lanarkshire Nominated Councillor Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Kirsten Larson North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Amanda Kilburn Chief Finance Officer North HSCP 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 John Watson Employee Representative NLC Unison Officer in Attendance: Ken Adamson (Item 6) Stacey Connor Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddie Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director NLHSCP Marie McFadden Audit Scotland Lucy Munro Medical Director NL Des Murray Chief Executive NLC Soumen Sengupta (Item 8) Chief Officer South Lanarkshire HSCP Dr Tyra Smyth General Practitioner (GP) Lesley Thomson (Item 8) Nurse Director South HSCP APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Neil Findlay NHS Lanarkshire Nominated Non Exec Director Alison Gordon Head of Children & Families & Justice Services
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2 CSWO of NLC Councillor Ayesha Khan North Lanarkshire Council Nominated Councillor Heather Knox Chief Executive NHS Lanarkshire James Muir NHS Lanarkshire Nominated Non Exec Director ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. Special welcome was made to Amanda Kilburn who has taken up position of Chief Finance Officer for North Lanarkshire HSCP. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB 22.6.22 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ IJB Action Log There were no matters arising. Ross McGuffie 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: Action 1 Reserve Strategy – Has been delayed until December to allow the new CFO to review information. Action 2 Internal Audit Report- This was shared at today’s committee. Action 5 Category One Responders- Have submitted ourselves for evaluation, West of Scotland RRP is meeting in October and will review all responses; it is planned to report back to the IJB in December. Action 8 MH Continuing Care Contracted Beds - Been delayed due to advice from HIS being required, an options appraisal will be completed soon and a business case presented to the IJB in December.
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3 Action 17 Audited Accounts- Report delayed due to delay in Audit Scotland process, special IJB to be called end of October to sign of the accounts. 5. Finance Report 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). 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. Section 7.7 provides reasons for variances mostly down to employee costs with number of vacancies and issues with recruitment. There is a £5.5m funding gap for 22/23 looking at budget realignments and savings plans. In 31st March there was £119m in reserves as at July £16m has been drawn down leaving a balance of £103m. Currently in the process of reviewing all reserves if funding is not required will rerouted to other priorities. Brian Moore asked for breakdown of reserves that have already been drawn down. For the covid money it looks like Scottish government will claim some of the money back do we have any details around this. Amanda Kilburn confirmed they are looking at clawing back funds but there are no timescales or details around the amounts. A report detailing the reserves will be tabled at the December IJB committee. Cllr Larson queried with recruitment is Lanarkshire in a similar position to the rest of Scotland. Amanda Kilburn confirmed this is the case across the whole of NHS Scotland. Ross McGuffie noted had a number of new funds allocated in the winter business case but due to recruitment challenges difficult to spend the funding. Cllr Kelly asked if can seek assurance from Scottish Government around funding gaps. Amanda Kilburn noted this is already highlighted at the CFO network regularly. Heather Knox also noted the board have similar concerns that funding would be clawed back then required to be allocated back would cause issues across services. Maddy Halliday queried what the scope of the funding clawed back would be. Amanda Kilburn advised at the minute the discussions are around covid
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4 funding only but this could change. For ring fenced reserves they are related the project already so would be challenging to reallocate them. Trudi Marshall advised for nursing staff having to look at different staffing models as not got nursing workforce volumes need. So will consider career pathways which take time but still require to protect the money to be utilised at the later date. This also support employability and anchor work. The IJB agreed 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. 6. Internal Audit Review- Due Diligence Review 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. 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. 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. 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 work plan, 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. Internal Audit staff appreciated the help and co-operation extended to them by the officers of the IJB and the staff within the partnership. Ken Adamson advised working on a draft audit plan with Ross McGuffie and Amanda Kilburn to be shared at a later date. Ross McGuffie requested that
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5 this be reported through IJB PFA for a quicker timescale; this was agreed by the committee. The IJB is agreed 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. 7. Covid Update 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. 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. On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. As of today there are 89 covid positive inpatients across 3 acute sites and12 in community. There are 9 care homes in outbreak situations. The rate of infections is 1 in 45 across Scotland which is higher than the rest of the UK. Delayed discharge sitting mid to high 70s generally. Today there are 91 delays but have got good flow through the system, with 50 planned discharges by the weekend. In Wishaw and Cumbernauld areas running home assessment teams; areas should be at full capacity next week. Also had some success for AHP recruitment into the service too. Administered 1.6million doses of the vaccine. Due to changes in travel criteria’s may see a reduction of uptake this will be monitored. Cllr Larson queried how has the relaxation of mask wearing been received and will this link to outbreaks. Ross McGuffie advised never been a static position throughout the pandemic but has moved when required. Trudi Marshall noted for residents in care homes staff wearing face masks has been challenging for communication particularly with dementia patients but there is still the choice to wear masks if the individual wishes. Public Health still have regular outbreak surveillance meetings so they may recommend face masks wearing if required. John Watson noted number of concerns around home care workers having expectation to wear masks and when they don’t can be subject to disciplinary process, how do we ensure those with exemptions are protected from this.
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6 Trudi Marshall advised have in the past worked with specialists to help manage fears for particular situations and will continue to do so. Maddy Halliday noted transmission rates are much lower. Previously VANL tried to put some protection measures in place from a public health point of view and health and safety, as there is no mandatory guidance in place. It was around trying to maintain distance and ensure ventilation for events through risk assessments but this was not well received. Ross McGuffie noted with different national position it is challenging to ask individual to do this in a work environment. Des Murray added would be dependent on individuals and different circumstances. The IJB: (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. Primary Care Out of Hours GP Service 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. 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
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7 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. Soumen Sengupta advised this paper has been taken through the population health committee for endorsement and it has also been taken to the South IJB on 20th September for approval. The service is hosted in South so requires to be approved here but with endorsement of North. There was also a briefing session held for both South & North IJB members in August. Attention was drawn to challenges outlined in the paper under section 5.21. Cllr Kelly queried around multi-disciplinary teams what would be the expectation for social work staff who are already under pressure. Soumen Sengupta advised would consult with relevant services when required. Brian Moore noted looking at the usage of the service to ensure get it right, this key through public engagement. For NHS 24 usage it would need to be a whole system change across all health boards around their approach to risk management and how they use OOH. Brian Moore also queried are there any issues for the service in regard to children’s access to the service Lesley Thomson advised training nurse practitioners for paediatrics to manage the demand profile for children. Maddy Halliday noted reference to public awareness and communication would welcome more information. Soumen Sengupta advised it’s an ongoing area of work and for patients to understand what the service is there for and the pressure the service is under. Maddy Halliday offered to support work in communities if required. She also asked if there are any accessibility issues for both sites as will note suit everyone geographically. Soumen Sengupta advised there are also home visits available and the work stream will review access issues. They are also considering cost of living pressures. Challenges with GP recruitment would welcome more information. Lanarkshire is different in terms of national picture have roughly 11% single handed practices. Need an attractive package to offer GPs and ANPs going forward; can send Maddy additional information if required. The committed acknowledge the work that has gone into this piece of work. 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.
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8 Endorse the development of an updated whole system Urgent Care Model. 9. Child & Adolescent Mental Health Services 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 received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 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. 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. Lucy Munro outlined the different work streams as part of the plan. The waiting list initiative started in the last month have put on extra staff in evenings and weekends to reduce waiting lists; currently done over 100 extra appointments. Harry Robertson noted his thanks for the programme of work presented; this was echoed by other committee members. Maddy Halliday advised the CAMHS engagement officer has come to some meetings to discuss the programme. It is an opportunity to invest in community and voluntary sector would welcome some discussion; this was noted. It is recommended that Integration Joint Board: Note the progress of the programme and note further development steps
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9 10. Alcohol & Addiction Services 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. 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 There are 5 work stream supporting to work they are working to national mission priorities to save lives overall. Group involve those with lived experience, front line staff and stakeholders. Action plan will be submitted to Scottish Government at the end of this month. Financial governance arrangements are well in place to manage expectations of funding. Will be bring further detail to the IJB PFA meeting. Brian Moore queried on behalf of Neil Findlay limited expenditures on residential rehab can we anticipate greater use in future. Morag Dendy noted do expect the numbers to increase the reason we had low number in the past is due to other options available. Resources across Scotland are
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10 stretched but reality of getting the right responses. The operational oversight group will seek to understand the decision making processes. Brian Moore asked is there a plan to address those areas identified in the deep dive that are not working. Morag Dendy noted currently reviewing these as part of the working groups. The IJB noted: (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. 11. Risk Register 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. 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 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 These risks were reviewed in September 2022 and will be subject to further
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11 review with the new Chief Finance Officer as part of the financial planning exercise for 2022/23. 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. There are seven high rated risks on the IJB risk register. 1. IJB 01/21 - Financial Challenges 2. IJB 04/21 - Notional Set Aside Budget 3. IJB 13/21 - Impact on discharge performance linked to care home 4. IJB 12/21- Staff Health & wellbeing 5. IJB 14/22 - CAMHS 6. IJB 15/22 – Cost of Living 7. IJB 16/22 – National Care Service 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. It was noted the report shared had cut off the 4 new risks. The committee approved the report subject to updated risk report being shared with the committee for any comments. 12. Participation & Engagement 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. 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. 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.
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12 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. 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 Ally Boyle queried development of our health together work with engagement and participation. Morag Dendy confirmed have monthly meetings with relevant colleagues to consultant on issues. The Committee is asked to endorse our approach and the contents of the report; this was noted. 13. 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. 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. Expecting a draft version to come back to IJB in December with a final period of consultation before final sign off in March 2023. The IJB agreed the following recommendations: Seeking endorsement of our approach from IJB Seeking promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26
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13 14. National Care Service –Progress Update On the 9th August 2021 the Scottish Government launched a consultation on a ‘National Care Service for Scotland’ as its principle response to the Independent Review of Adult Social Care (IRASC) which it has commissioned the previous year and which reported in February 2021. 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. 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. If agreed, MSPs will have the chance to propose amendments to the Bill at Stage 2. Finally, the whole Parliament will again vote on whether to pass the final Bill in summer 2023, concluding stage 3 of the process. There are significant risks to the organisation within the NCS bill so need to work out how to best maximise opportunities and be part of the co-production process. Des Murray noted there has been written evidence submitted by a number of agencies. Social work Scotland noted that all services including children should be part of the bill as if not it will be a great risk. They submitted an open letter last week requested that the process is held as the bill does not meet requirements there is no detailed funding and what scale of service this would cover. COSLA took the decision to not engagement in co design process. Heather Knox added from a health point of view it does fracture acute and community services relationships. It is a costly process at time of a tightening fiscal position so not clear how will be offered. John Watson noted from trade union point of view concerned for member’s pensions and will continue to input into the process. Cathy McGinty asked was any of the consultation input taken into consider, it was confirmed this was not. The IJB Committee noted: The response to the Bill and the next steps in the NCS consultation. 15. Tackling Poverty 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
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14 implementation of the Fuel Poverty Hardship Payment Scheme, which was approved by the Community Empowerment Committee in November 2021. 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. Crucially, all applicants to the scheme were offered the opportunity of receiving a benefit check, money advice and fuel advice. Proposals for the new scheme to be actioned from October 2022 are currently moving towards approval within North Lanarkshire Council. 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. Considering funding a cost of living helpline for a period. Ross McGuffie plans to bring a business case to consider supporting this to a future committee. Cllr Larson queried what would the cost be for the help line. Ross McGuffie advised have previous experience of phone lines for other services so can use this to build into this but not sure of exact costs yet. Cllr Larson also asked how would we measure success of helpline not duplicating the work of the 3rd sector- Ross can share previous data to support quality measures. Ken Adamson advised team are looking to reduce eligibility criteria to get the money moving quicker. The committee noted the report. 16. Financial Inclusion Team Activity 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. 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. 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. 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.
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15 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. Brian Moore queried if working with Scotland social security. Des Murray advised meeting with them around joint working arrangements regularly. 17. Risk There was no new risks identified by the committee. 18. Date of Next Meeting 7th December 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 A Kilburn 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 Reserve strategy presented to IJB PFA on 16th Nov. Final version to March IJB alongside updated SCP
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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 A Kilburn 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. Complete – presented to IJB PFA on 16th Nov
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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 Complete Ongoing updates on progress scheduled into forward plan for PFA
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4 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives 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 Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23 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 March 2022 – draft guidance shared with NLC and awaiting comment December 2021 December 2022 Ongoing On agenda 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.
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5 On agenda 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. March 2023 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 On agenda 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 Complete Update provided at 16th Nov PFA 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 On agenda
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6 ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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7 CLOSED ACTIONS 1. NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 2. 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 3. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove Complete 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 Complete 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 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. March 2022 June 2022 Complete
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8 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 Complete
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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:- (1) Outlines the outcome of the audit by the North Lanarkshire Integration Joint Board’s External Auditor, Audit Scotland: (2) Advises that the External Auditor has submitted an Annual Audit Report setting out their key findings for the consideration of the members of the Integration Joint Board (IJB); and (3) Provides details of the proposed management response to the action points detailed in the External Auditor’s Annual Audit Report. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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) Consider the External Auditor’s Annual Audit Report, attached at appendix 2, in advance of the approval of the IJB Annual Accounts 2021/2022; (2) Note that an unqualified audit certificate has been received in respect of the North Lanarkshire IJB Annual Accounts 2021/2022; and (3) Approve the management response to the action points which is highlighted at pages 20 to 21 of the External Auditor’s Annual Audit Report, attached at appendix 2. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB must meet to consider whether to approve the unsigned audited North Lanarkshire IJB Annual Accounts 2021/2022 for signature. The members therefore require to have regard to any report made or advice provided by the External Auditor. SUBJECT: External Auditor’s Annual Audit Report 2021/2022 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer North HSCP DATE: 30th November 2022 Yes No N/A 1
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5.2 The IJB’s appointed External Auditor, Audit Scotland, is required to supply an audit certificate outlining the findings of the audit process undertaken in relation to the IJB Annual Accounts 2021/2022. A letter setting out their responsibilities is attached at appendix 1 together with a letter of representation from the Chief Finance Officer (appendix 2). The findings are detailed in the External Auditor’s Annual Audit Report for the financial year 2021/2022 which is attached at appendix 2. 6. CONCLUSIONS 6.1 The External Auditor’s Annual Audit Report on the IJB Annual Accounts extends across several subjects, as follows: IJB Annual Accounts 2021/2022; Financial management and sustainability; and Governance, transparency, and best value. 6.2 The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2021/2022 give a true and fair view of the net expenditure for the year and have therefore issued an unqualified independent report. 6.3 This report, attached at appendix 2 includes the key messages at page 3 and an action plan on pages 20 to 21 which have been agreed by both the Chief Officer and the Chief Finance Officer. 6.4 The External Auditor highlighted that there are no significant findings to report on the North Lanarkshire IJB Annual Accounts 2021/2022 and no misstatements were identified. 6.5 The IJB Chief Finance Officer would like to acknowledge the support of the NLC and NHSL finance teams throughout the year and particularly in respect of the preparation of the IJB Annual Accounts. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all national outcomes. 7.2 ASSOCIATED MEASURE(S) The IJB, the Performance, Finance and Audit Committee and both partners are required to ensure effective governance arrangements are in place. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The main risk associated with the IJB Annual Accounts is a qualified audit report. The risk has been assessed as low due to the detailed preparation in relation to the year-end process and technical training undertaken by key finance staff. The finance staff across the partners supported the achievement of key deadlines. 7.5 PEOPLE None 2
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7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS IJB 22nd June 2022 Unaudited IJB Annual Accounts 2021/2022 9. APPENDICES External Auditor’s Letter to the IJB 2021/2022 Appendix 1 External Auditor’s Annual Audit Report 2021/2022 Appendix 2 ........................................... Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362. 3
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102 West Port Edinburgh EH3 9DN T: 0131 625 1500 E: info@audit-scotland.gov.uk www.audit-scotland.gov.uk North Lanarkshire Integration Joint Board Audit of 2021/22 annual report and accounts 30 November 2022 Independent auditor’s report 1. Our audit work on the 2021/22 annual accounts is now substantially complete. Subject to receipt of a revised set of accounts for final review, we anticipate being able to issue unqualified audit opinions in the independent auditor’s report on 30 November 2022 (the proposed report is attached at Appendix A). Annual audit report 2. Under International Standards on Auditing in the UK, we report specific matters arising from the audit of the financial statements to those charged with governance of a body in sufficient time to enable appropriate action. We present for the Integration Joint Board’s consideration our draft annual report on the 2021/22 audit. The section headed “Significant findings from the audit in accordance with ISA 260” sets out the issues identified in respect of the annual report and accounts. 3. The report also sets out conclusions from our consideration of the four audit dimensions that frame the wider scope of public audit as set out in the Code of Audit Practice. 4. This report will be issued in final form after the annual accounts have been certified. Unadjusted misstatements 5. We also report to those charged with governance all unadjusted misstatements which we have identified during our audit, other than those of a trivial nature and request that these misstatements be corrected. 6. We have no unadjusted misstatements to be corrected. Fraud, subsequent events and compliance with laws and regulations 7. In presenting this report to the Integration Joint Board we seek confirmation from those charged with governance of any instances of any actual, suspected or alleged fraud; any subsequent events that have occurred since the date of the financial statements; or material non-compliance with laws and regulations affecting the entity that should be brought to our attention. 4
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Representations from the Section 95 Officer 8. As part of the completion of our audit, we are seeking written representations from the Section 95 Officer on aspects of the annual accounts, including the judgements and estimates made. 9. A draft letter of representation is attached at Appendix B. This should be signed and returned to us by the Section 95 Officer with the signed annual accounts prior to the independent auditor’s report being certified. 5
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APPENDIX A: Proposed Independent Auditor’s Report Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2022 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2021/22 (the 2021/22 Code). In my opinion the accompanying financial statements: • give a true and fair view in accordance with applicable law and the 2021/22 Code of the state of affairs of the body as at 31 March 2022 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2021/22 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 10 April 2017. The period of total uninterrupted appointment is 6 years. I am independent of the body in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. 6
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Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, I report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Financial Officer and the Integrated Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Integrated Joint Board determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The Integrated Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • obtaining an understanding of the applicable legal and regulatory framework and how the body is complying with that framework; • identifying which laws and regulations are significant in the context of the body; 7
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• assessing the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited part of the Remuneration Report I have audited the part of the Remuneration Report described as audited. In my opinion, the audited part of the Remuneration Report has been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Financial Officer is responsible for other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent 8
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explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit; • there has been a failure to achieve a prescribed financial objective. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 120 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Brian Howarth ACMA CGMA Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT 9
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APPENDIX B Letter of Representation (ISA 580) Brian Howarth Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT Dear Mr Howarth North Lanarkshire IJB Annual report and accounts 2021/22 1. This representation letter is provided about your audit of the annual accounts of North Lanarkshire IJB for the year ended 31 March 2022 for the purpose of expressing an opinion as to whether the financial statements give a true and fair view in accordance with the financial reporting framework, and for expressing other opinions on the remuneration report, management commentary and annual governance statement. 2. I confirm to the best of my knowledge and belief and having made appropriate enquiries the following representations given to you in connection with your audit of North Lanarkshire IJB’s annual accounts for the year ended 31 March 2022. General 3. North Lanarkshire IJB and I have fulfilled our statutory responsibilities for the preparation of the 2021/22 annual accounts. All the accounting records, documentation and other matters which I am aware are relevant to the preparation of the annual accounts have been made available to you for the purposes of your audit. All transactions undertaken by North Lanarkshire IJB have been recorded in the accounting records and are properly reflected in the financial statements. 4. I confirm that I am not aware of any uncorrected misstatements. Financial Reporting Framework 5. The annual accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2021/22 (2021/22 accounting code), and in accordance with the requirements of the Local Government (Scotland) Act 1973, the Local Government in Scotland Act 2003 and The Local Authority Accounts (Scotland) Regulations 2014. 6. In accordance with the 2014 regulations, I have ensured that the financial statements give a true and fair view of the financial position of the North Lanarkshire IJB at 31 March 2022 and the transactions for 2021/22. Accounting Policies & Estimates 7. All significant accounting policies applied are as shown in the notes to the financial statements. The accounting policies are determined by the 2021/22 accounting code where applicable. Where the code does not specifically apply, I have used judgement in developing and applying an accounting policy that results in information that is relevant and reliable. All 10
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accounting policies applied are appropriate to North Lanarkshire IJB’s circumstances and have been consistently applied. 8. The significant assumptions used in making accounting estimates are reasonable and properly reflected in the financial statements. Judgements used in making estimates have been based on the latest available, reliable information. Estimates have been revised where there are changes in the circumstances on which the original estimate was based or as a result of new information or experience. Going Concern Basis of Accounting 9. I have assessed North Lanarkshire IJB’s ability to continue to use the going concern basis of accounting and have concluded that it is appropriate. I am not aware of any material uncertainties that may cast significant doubt on North Lanarkshire IJB’s ability to continue as a going concern. Fraud 10. I have provided you with all information in relation to: • my assessment of the risk that the financial statements may be materially misstated as a result of fraud • any allegations of fraud or suspected fraud affecting the financial statements • fraud or suspected fraud that I am aware of involving management, employees who have a significant role in internal control, or others that could have a material effect on the financial statements. Laws and Regulations 11. I have disclosed to you all known instances of non-compliance or suspected non- compliance with laws and regulations whose effects should be considered when preparing financial statements. Related Party Transactions 12. All material transactions with related parties have been appropriately accounted for and disclosed in the financial statements in accordance with the 2021/22 accounting code. I have made available to you the identity of all the North Lanarkshire IJB’s related parties and all the related party relationships and transactions of which I am aware. Remuneration Report 13. The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Amendment Regulations 2014, and all required information of which I am aware has been provided to you. Management commentary 14. I confirm that the Management Commentary has been prepared in accordance with the statutory guidance and the information is consistent with the financial statements. Corporate Governance 15. I confirm that the North Lanarkshire IJB has undertaken a review of the system of internal control during 2021/22 to establish the extent to which it complies with proper practices set out in the Delivering Good Governance in Local Government: Framework 2016. I have 11
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disclosed to you all deficiencies in internal control identified from this review or of which I am otherwise aware. 16. I confirm that the Annual Governance Statement has been prepared in accordance with the Delivering Good Governance in Local Government: Framework 2016 and the information is consistent with the financial statements. There have been no changes in the corporate governance arrangements or issues identified, since 31 March 2022, which require to be reflected. Events Subsequent to the Date of the Balance Sheet 17. All events subsequent to 31 March 2022 for which the 2021/22 accounting code requires adjustment or disclosure have been adjusted or disclosed. Yours sincerely, Amanda Kilburn Chief Financial Officer 12
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Prepared for North Lanarkshire Integration Joint Board and the Controller of Audit November 2022 North Lanarkshire Integration Joint Board 2021/22 Annual Audit Report DRAFT Appendix 2 13
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North Lanarkshire Integration Joint Board 2021/22 Annual Audit Report DRAFT | 2 Contents Key messages 3 Introduction 4 1. Audit of 2021/22 annual accounts 6 2. Financial management and sustainability 10 3. Governance, transparency and Best Value 17 Appendix 1. Action plan 2021/22 20 Appendix 2. National performance reports and briefings 23 14
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Key messages | 3 Key messages 2021/22 annual accounts 1 Our audit opinions on the annual accounts of the North Lanarkshire Integration Joint Board are unmodified and there were no significant issues. Financial management and sustainability 2 The IJB returned an underspend of £66 million in 2021/22. There were significant underspends in health and social care services due to staff vacancies. 3 £32 million of Covid-19 funding in 2021/22 remains unspent and total reserves are £119 million. 4 The medium to long term financial plan has not been updated to reflect the expected impact of Covid-19. Governance, Transparency and Best Value 5 Finance capacity is being increased with the appointment of a new Chief Financial Officer for the IJB. 6 Performance has been affected by Covid-19, but the IJB has identified the steps required to address this. 15
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Introduction | 4 Introduction 1. This report summarises the findings arising from the 2021/22 audit of North Lanarkshire Integration Joint Board (the IJB). 2. The scope of the audit was set out in our 2021/22 Annual Audit Plan which was presented to the Board on 22 June 2022. 3. This report comprises the findings from the audit of the North Lanarkshire IJB’s annual accounts; consideration of the four audit dimensions that frame the wider scope of public audit set out in the Code of Audit Practice 2016; and a review of the arrangements put in place by the IJB to secure Best Value. 4. The global coronavirus pandemic has had a continued impact on the IJB during 2021/22. We did not identify any significant audit risks for 2021/22. Adding value through the audit 5. We add value to the IJB, through the audit by: • identifying and providing insight on significant risks, and making clear and relevant recommendations • sharing intelligence and good practice through our national reports (Appendix 2) and good practice guides • providing clear and focused conclusions on the appropriateness, effectiveness and impact of corporate governance, performance management arrangements and financial sustainability. Responsibilities and reporting 6. The IJB has primary responsibility for ensuring the proper financial stewardship of public funds. This includes preparing annual accounts that are in accordance with proper accounting practices. The IJB is also responsible for compliance with legislation and for putting arrangements in place for governance and propriety that enable it to successfully deliver its objectives. 7. Our responsibilities as independent auditor appointed by the Accounts Commission are established by the Local Government in Scotland Act 1973, the Code of Audit Practice 2016 and supplementary guidance, and International Standards on Auditing in the UK. 8. As public sector auditors we give independent opinions on the annual accounts. Additionally, we conclude on: • the effectiveness of the IJB’s performance management arrangements, 16
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Introduction | 5 • the suitability and effectiveness of corporate governance arrangements, • the financial position and arrangements for securing financial sustainability, and • Best Value arrangements. 9. Further details of the respective responsibilities of management and the auditor can be found in the Code of Audit Practice 2016. and supplementary guidance. 10. This report raises matters from our audit. Weaknesses or risks identified are only those which have come to our attention during our normal audit work and may not be all that exist. Communicating these does not absolve management from its responsibility to address the issues we raise and to maintain adequate systems of control. 11. Our annual audit report contains an agreed action plan at Appendix 1 setting out specific recommendations, responsible officers and dates for implementation. It also includes outstanding actions from last year and progress against these. Auditor Independence 12. Auditors appointed by the Accounts Commission or Auditor General must comply with the Code of Audit Practice and relevant supporting guidance. When auditing the financial statements auditors must comply with professional standards issued by the Financial Reporting Council and those of the professional accountancy bodies. 13. We can confirm that we comply with the Financial Reporting Council’s Ethical Standard. We can also confirm that we have not undertaken any non- audit related services and therefore the 2021/22 audit fee of £27,960 as set out in our 2021/22 Annual Audit Plan remains unchanged. We are not aware of any relationships that could compromise our objectivity and independence. 14. This report is addressed to both the IJB and the Controller of Audit and will be published on Audit Scotland's website www.audit-scotland.gov.uk. Audit appointment from 2022/23 15. The Accounts Commission is responsible for the appointment of external auditors to local government bodies. External auditors are usually appointed for a five-year term either from Audit Scotland’s Audit Services Group or a private firm of accountants. The current appointment round was due to end in 2020/21 but this was extended for a year. The procurement process for the new round of audit appointments was completed in May 2022. From financial year 2022/23, Audit Scotland will continue to be the appointed auditor for North Lanarkshire Integration Joint Board, although the team undertaking the audit will change. 16. We would like to thank members and staff, particularly those in finance for their co-operation and assistance over the last six years. 17
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1. Audit of 2021/22 annual accounts | 6 1. Audit of 2021/22 annual accounts The principal means of accounting for the stewardship of resources and performance Main judgements Our audit opinions on the annual accounts of the North Lanarkshire Integration Joint Board are unmodified and there were no significant issues. Our audit opinions on the annual accounts are unmodified 17. The IJB’s annual accounts for the year ended 31 March 2022 were approved by the Performance, Finance and Audit Committee on 30 November 2022. As reported in the independent auditor’s report: • the financial statements give a true and fair view and were properly prepared in accordance with the financial reporting framework • the audited part of the Remuneration Report, Management Commentary and the Annual Governance Statement were all consistent with the financial statements and properly prepared in accordance with the relevant regulations and guidance. The annual accounts were submitted for audit by the statutory date 18. The unaudited annual accounts were received in line with our agreed audit timetable on 30 June 2022. 19. The working papers provided with the unaudited accounts were of a good standard and finance staff provided support to the audit team during the audit. There were no objections raised to the annual accounts 20. The Local Authority Accounts (Scotland) Regulations 2014 require local government bodies to publish a public notice on its website that includes details of the period for inspecting and objecting to the accounts. This must remain on the website throughout the inspection period. There were no objections to the 2021/22 annual accounts. 18
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1. Audit of 2021/22 annual accounts | 7 21. The notice of inspection did not state the objection end date (which is one working day after the inspection period). The notice was posted on the North Lanarkshire Council’s website and not the IJB website. Recommendation 1 The notice of inspection should state the objection end date and the advert should be posted on the IJB website as well as the North Lanarkshire Council website. Overall materiality is £6.5 million 22. We apply the concept of materiality in both planning and performing the audit and in evaluating the effect of identified misstatements on the audit and of uncorrected misstatements, if any, on the financial statements and in forming the opinion in the auditor’s report. We identify a benchmark on which to base overall materiality, such as gross expenditure, and apply what we judge to be the most appropriate percentage level for calculating materiality values. We also determine a lower performance materiality threshold. 23. The determination of materiality is based on professional judgement and is informed by our understanding of the entity and what users are likely to be most concerned about in the annual accounts. In assessing performance materiality, we have considered factors such as our findings from previous audits, any changes in business processes and the entity’s control environment including fraud risks. 24. Our initial assessment of materiality for the annual accounts was carried out during the planning phase of the audit. This was reviewed on receipt of the unaudited annual accounts and remains unchanged. This is summarised in Exhibit 1. Exhibit 1 Materiality values Materiality level Amount Overall materiality £6.5 million Performance materiality £4.8 million Reporting threshold £200 thousand Source: Audit Scotland 19
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1. Audit of 2021/22 annual accounts | 8 We have no significant findings to report on the audited annual accounts 25. International Standard on Auditing (UK) 260 requires us to communicate significant findings from the audit to those charged with governance, including our view about the qualitative aspects of the body’s accounting practices. We have no issues to report from the audit. We have obtained assurance over the significant risks identified in our Annual Audit Plan 26. Exhibit 2 sets out the significant risks of material misstatement to the financial statements we identified in our 2021/22 Annual Audit Plan. It summarises the further audit procedures we performed during the year to obtain assurances over these risks and the conclusions from the work completed. Exhibit 2 Significant risks of material misstatement in the financial statements Audit risk Assurance procedure Results and conclusions 1. Risk of management override of controls International Auditing Standards require that audits are planned to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes the risk of fraud due to the management override of controls. • Agreement of balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports / ledger / correspondence. • Assurances will be obtained from the auditors of NHS Lanarkshire and North Lanarkshire Council over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year-end. • Review of financial monitoring reports during the year. Results & Significant Judgements: We obtained relevant assurances from the auditors of North Lanarkshire Council and NHS Lanarkshire. We identified the process for preparing the accounts based on financial reports from the partner organisations We undertook detailed testing of year-end adjustments. We reviewed financial reports prepared during 2021/22 Conclusion: We did not identify any incidents of management override of controls. There were no identified misstatements in the audited annual accounts 27. It is our responsibility to request that all misstatements, other than those below the reporting threshold, are corrected. However, the final decision on making the correction lies with those charged with governance considering 20
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1. Audit of 2021/22 annual accounts | 9 advice from senior officers and materiality. There were no misstatements identified that exceeded our reporting threshold. Limited progress was made on prior year recommendations 28. The IJB has made limited progress in implementing our prior year audit recommendations. Only two of the four prior year recommendations have been complete. For actions not yet implemented, revised responses and timescales have been agreed with management, and are set out in Appendix 1. 21
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2. Financial management and sustainability | 10 2. Financial management and sustainability Financial management is about financial capacity, sound budgetary processes and whether the control environment and internal controls are operating effectively. Financial sustainability looks forward to the medium and long term to consider whether the council is planning effectively to continue to deliver its services or the way in which they should be delivered. Main judgements The IJB returned an underspend of £66 million in 2021/22. There were significant underspends in health and social care services due to staff vacancies. £32 million of Covid-19 funding in 2021/22 remains unspent and total reserves are £119 million. The medium to long term financial plan has not been updated to reflect the expected impact of Covid-19. The 2021/22 budgeted gap of £2.5 million was to be met by planned savings and from reserves 29. The IJB approved its 2021/22 budget on 23 March 2021. The budget had a funding gap of £2.5 million. Plans to address the gap included savings of £1.7 million and a transfer of £0.8 million from reserves. 30. All funding and expenditure for the IJB is incurred by partner bodies (North Lanarkshire Council and NHS Lanarkshire) and processed in their accounting records. North Lanarkshire Council progressed the previously agreed savings plans for year 2 of the 3-year Efficiency Programme, approved in March 2020, which aimed to meet £1.5 million out of the total £1.7 million planned savings. In NHS Lanarkshire, part of the funding gap was due to the net increase in prescribing costs of £0.3 million. This was addressed by a Prescribing Quality and Efficiency Programme target totalling £1.6 million. The IJB underspent by £66 million in 2021/22 31. The Covid-19 pandemic had a significant impact on the IJB’s 2021/22 budget. Costs remained uncertain throughout the year, and it was not clear 22
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2. Financial management and sustainability | 11 whether Covid-19 costs and undelivered savings would be fully funded going forward. 32. The IJB returned a total underspend of £74 million which reflects an underspend on services of £66 million and an £8 million draw down on the IJB reserves (Exhibit 3). The outturn was a result of significant year-end additional allocations from the Scottish Government, including Covid-19 funding and because of underspends, caused by ongoing vacancies across many services. Exhibit 3 Performance against budget IJB budget summary Budget £m Actual £m Variance £m Gross Core Expenditure 751.7 685.2 66.5 Total Income (751.7) (759.9) 8.2 In-year expenditure met from Reserves 0 8.3 8.3 Surplus of Income over Expenditure 0.0 (66.4) 66.4 Source: North Lanarkshire IJB Annual Accounts 2021/22 There were significant underspends in health services due to vacancies 33. The most significant variances within the NHS Lanarkshire underspend are within Hosted Services of £16.6 million which includes underspends of £10.3 million in Mental Health & Learning Disability Services and £5.3 million in Children and Adolescents Mental Health Services. Both underspends were mainly due to vacancies in nursing, psychology and administration posts. 34. There was also an underspend in Locality and Other services of £4.5 million. This is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities totalling 66.06 WTE. There were incremental pay increases and unfunded enhancements across many services however these cost pressures were offset in-year by the vacancies. 35. There were also underspends in Addiction Services of £2.3 million, Prescribing of £1.5 million and Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund of £9.8 million. There were significant underspends in social care services due to additional funding and vacancies 36. From the North Lanarkshire Council underspend, £6.4 million is in relation to the Scottish Government Funding for winter planning and £0.8 million from 23
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2. Financial management and sustainability | 12 carers budgets. These will both be carried forward to ring-fenced reserves to be incurred in 2022/23. There was also an £8 million underspend within the care at home sector predominantly relating to staff shortages. £32 million of Covid-19 funding in 2021/22 remains unspent 37. Covid-19 funding totalling £45 million was received from the Scottish Government in 2021/22 of which £13.4 million was incurred in 2021/2022 and £31.7 million will be transferred to a ring-fenced reserve to meet ongoing Covid- 19 costs in 2022/2023. 38. The Scottish Government provided the following additional allocations which were unspent at the year-end and have been added to IJB reserves for use in future years: • Adult & Drug Partnership (ADP): £1.931 million • Child and Adolescent Mental Health Services (CAMHS): £9.109 million • Multi-Disciplinary teams: £1.160 million • Additional healthcare support workers: £0.634 million • Mental Health Action 15: £3.016 million • Distress brief Interventions: £1.444 million • Mental Health Recovery – Facilities: £1.840 million The budget monitoring arrangements are appropriate and clear information was provided to IJB Board members 39. Detailed budget monitoring reports were submitted to the IJB Board and the Performance, Finance and Audit Committee. The outturn to date and projected year-end outturn position were clearly stated in these reports while the actual year-end outturn position was in line with expectations. 40. The content of the budget monitoring reports was updated to reflect the financial impact of Covid-19 and an additional section was included that highlighted additional income received and expenditure incurred because of Covid-19. This ensured the IJB were aware of how Covid-19 impacted on the overall financial position and outturn. 41. We observed that senior management and members receive accurate financial information on the IJB’s financial position. However, the first quarterly financial monitoring report was not presented to the Performance, Finance & Audit Committee until 5 months into the 2021/22 financial year on 24 August 2021. A prior-year audit recommendation regarding the timeliness of budgetary information being presented to members is included in Appendix 1. 24
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2. Financial management and sustainability | 13 The medium to long term financial plan has not been updated to reflect the expected impact of Covid-19 42. Financial sustainability looks forward to the medium and longer term to consider whether the body is planning effectively to continue to deliver its services or the way in which they should be delivered. 43. The IJB has a medium to long term financial plan in place spanning the period 2020/21 to 2029/30 which is aligned to the Strategic Commissioning Plan. However, the financial plan has not been updated since it was initially presented to the Board on 24 March 2020, and specifically has not been updated to reflect the impact of Covid-19. Financial planning has focussed primarily on the annual budget setting exercise. 44. Reports are presented to the Board as national funding allocations are announced. The medium to long term financial plan is to be updated to reflect these financial assumptions. 45. This was a recommendation that was included in our 2020/21 Annual Audit Report and has been carried-forward in Appendix 1. Total reserves are £119 million, with the majority of this either earmarked or ring-fenced for specific purposes 46. With the £66 million surplus achieved in 2021/22, the balance on the General Fund was £119 million at 31 March 2022. The IJB’s reserves position for 2021/22 is summarised at Exhibit 4. Exhibit 4 Composition of IJB reserves as at 31 March 2022 38% 59% 3% Ring Fenced Reserves (£45.718m) Earmarked Reserves (£70.050m) Contingency Reserves (£3.684m) 25
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2. Financial management and sustainability | 14 Source: 2021/22 North Lanarkshire IJB Annual Accounts 47. Ring-fenced reserves are those where funding has been provided by the Scottish Government for specific purposes, such as funding to address Covid- 19 costs. Earmarked reserves are those where the IJB has approved the use of reserve balances for specific purposes. 48. The substantial increase in 2021/22 is primarily due to an underspend with Covid-19 funding received at the year-end by the Scottish Government, to be spent in future years. The non-recurring nature of these funds, and the reserves, presents a significant challenge to IJBs. Exhibit 5 below sets out the reserve balances of the IJB between 2016/17 to 2021/22. Exhibit 5 Reserves 2016/17 to 2021/22 2016/17 £m 2017/18 £m 2018/19 £m 2019/20 £m 2020/21 £m 2021/22 £m Ring-Fenced Reserves 0.000 0.000 2.4 2.3 20.7 45.7 Earmarked Reserves 3.2 13.8 13.5 10.4 28.7 70 Contingency Reserves 4.3 4.4 0.1 3.7 3.7 3.7 Total Reserves 7.5 18.2 16 16.4 53.1 119.4 Source: North Lanarkshire Integration Joint Board 2016/17 to 2021/22 Annual Accounts 49. The IJB Reserves Strategy for 2022/23 is still to be finalised and presented to Committee. Recommendation 2 The IJB should develop a reserves strategy for 2022/23 which sets out how and when reserves will be spent. 95 per cent of planned savings were achieved, however savings targets in 2022/23 have increased 50. The IJB is required to make efficiency savings to maintain financial balance. The total savings target in 2021/22 was £2.7 million. The IJB achieved £2.6 million (95%) of planned savings. It is important to note that some of the funding 26
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2. Financial management and sustainability | 15 solutions in 2021/22 were non-recurring and therefore some cost pressures are expected to recur in 2022/23. 51. The 2022/23 Financial Plan was approved on 23 March 2022. Including the cost of the approved North Lanarkshire Winter Planning and Enhanced Supports Business Case, costs are projected to increase by a total of £56.9 million in 2022/23 and funding is projected to increase by £51.4 million. The 2022/23 funding gap of £5.5 million is to be addressed by budget realignments (£3.3 million), a projected recurring prescribing budget underspend (£1.5 million), prescribing efficiency savings (£0.4 million) and reliance on reserves (£0.4 million). There remain significant workforce pressures within both partner organisations 52. There are significant workforce pressures in the NHS and social care systems. In its February 2022 NHS in Scotland 2021 report, Audit Scotland noted the risk of workforce issues in the NHS. This included concerns about staff wellbeing, sustainability because of retirals, recruitment challenges, and the need to ensure the appropriate skills mix. In social care, Audit Scotland’s 2022 Social Care briefing highlighted that the social care workforce has high vacancy rates, with many services facing recruitment problems. Together with the increasing demand for social care, this presents a risk to the capacity and quality of social care services. The national workforce issues are replicated within both partner organisations of the North Lanarkshire IJB. These issues have the potential to impact on the IJB’s performance. 53. The IJB’s management team are already planning to undertake a review of workforce planning, as this has been a recurring theme in the risk register, particularly the availability of the workforce in certain areas. Challenges faced by the IJB need to be addressed regardless of medium-term proposals for a new National Care Service 54. Following the publication of the Independent Review of Adult Social Care in February 2021, work is currently under way nationally to develop and implement a new National Care Service (NCS). The Scottish Government expects the new NCS to be operational by 2026. 55. In its January 2022 Social Care briefing, Audit Scotland noted stakeholders concerns about the extent of the proposals for reform and the time it will take to implement them. Many of the current issues experienced by the social care sector, for example the workforce pressures, cannot wait for the Scottish Government to implement a new NCS. In its formal response to the national consultation on the new NCS proposals, the IJB highlighted similar points to those identified in the Audit Scotland national report. Whilst supportive of the opportunity to discuss improvements to users experience of social care services, the IJB emphasised the importance of ongoing discussions on the short, medium, and long-term challenges relating to funding, staffing, and service redesign. 27
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2. Financial management and sustainability | 16 Financial systems of internal control operated effectively 56. The IJB does not have its own financial systems and instead relies on partner bodies’ financial systems. All financial transactions are therefore processed under the partner bodies’ internal controls. 57. As part of our audit approach, we sought assurances from the external auditor of NHS Lanarkshire and North Lanarkshire Council and confirmed there were no significant weaknesses in the systems of internal controls for either the health board or the council. 58. As auditors, we need to consider whether audited bodies have established adequate financial management arrangements. While the Joint Board has comprehensive financial regulations in place, these have not been reviewed since approval on 8 March 2016. They require to be updated to reflect the budget disaggregation of Children, Families and Justice Services and to also note the arrangements for the management of financial resources for hosted services. The IJB should ensure all governance documents are reviewed periodically to ensure they remain up-to-date and fit for purpose. Recommendation 3 The financial regulations were approved on 8 March 2016. These should be updated to reflect the budget disaggregation of Children, Families and Justice Services and to note the arrangements for the management of financial resources for hosted services. Standards of conduct and arrangements for the prevention and detection of fraud and error were appropriate 59. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. We reviewed the arrangements in place at North Lanarkshire Council and NHS Lanarkshire and found them to be adequate. The IJB has a Code of Conduct in place and members are required to complete a Register of Interest on an annual basis. We are not aware of any specific issues we require to bring to your attention. 28
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3. Governance, transparency and Best Value | 17 3. Governance, transparency and Best Value The effectiveness of scrutiny and oversight and transparent reporting of information Main Judgements Finance capacity is being increased with the appointment of a new Chief Financial Officer for the IJB. Performance has been affected by Covid-19, but the IJB has identified the steps required to address this. Governance arrangements are appropriate and operate effectively 60. Our observations at committee meetings throughout the year has found that these are conducted in a professional manner and there is a good degree of scrutiny and challenge by members. We consider that governance arrangements are appropriate and support effective scrutiny, challenge and decision making. 61. Our audit work in 2020/21 identified areas of the IJB website which are out of date and have not been revisited following changes to the partnership’s structure and operations. Children, families and justice social work services were transferred to the council in 2020/21 but are still identified as a devolved service to the IJB on the website. The website was not updated and therefore this remains as a recommendation brought forward form last year in Appendix 1. Finance capacity is being increased with the appointment of a new Chief Financial Officer for the IJB 62. At its meeting in December 2021, the IJB approved a new management structure to accommodate additional capacity in the finance function. The previous Chief Financial Officer (CFO) had responsibility for North and South Lanarkshire IJBs. 63. Following an options appraisal exercise, it was decided to create a full-time CFO position for each of the North and South Lanarkshire IJBs. A full-time CFO has been appointed to the North Lanarkshire IJB and the new structure is now established. 29
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3. Governance, transparency and Best Value | 18 Appropriate arrangements are in place to secure Best Value 64. Integration Joint Boards have a statutory duty to have arrangements to secure Best Value. To achieve this, IJBs should have effective processes for scrutinising performance, monitoring progress towards their strategic objectives and holding partners to account. 65. The IJB undertook a self-evaluation exercise in 2021, with the results reported to the Board on 31 August 2022. This self-evaluation exercise took the form of a checklist developed by the Improvement Service to allow IJBs to assess their own performance at board level against the expectations of the Public Bodies (Joint Working) (Scotland) Act 2014. It focuses primarily upon the effectiveness of current arrangements and how well the Board meets its intended outcomes. 66. Three areas were considered good practice, as 100% of the assessment team strongly agreed or agreed with each of the statements. This included: • The IJB can evidence examples of how it worked well together in response to Covid-19 • The IJB can demonstrate effective partnership working through local NHS mobilisation plans and local authority recovery and renewal planning • The IJB should look to permanently retain new ways of working developed during the response to Covid-19. 67. The IJB identified three areas for improvement which are set out below: • Evidencing how health and social care spending contributes to prevention and early intervention • Embedding learning and new ways of working in the IJB from the response to the pandemic to ensure plans and governance are fit for purpose • Review how performance information is used by the IJB to ensure it is timely, relevant, and provides a good measure of progress. 68. An improvement plan was developed for each of these three areas for improvement. There will be ongoing monitoring of progress against this improvement plan, and consideration of the need for a future follow up self- evaluation exercise. Performance has been affected by Covid-19, but the IJB has identified the steps required to address this 69. The pandemic is expected to have had a substantial impact on performance measures, particularly for services which have been temporarily suspended, are operating at a reduced level or have had to adapt to new ways of working. 30
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3. Governance, transparency and Best Value | 19 70. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to produce an annual performance report covering areas such as assessing performance in relation to national health and wellbeing outcomes, financial performance and best value, reporting on localities, and the inspection of services. 71. The Board has continued to monitor key performance targets throughout the year. The IJB has a corporate performance dashboard which is monitored and reported on a quarterly basis. However, the 2021/22 Annual Performance Report has not yet been finalised. It is due to be presented to the IJB Board meeting on 7 December 2022. 72. The 2020/21 annual performance report was presented to the IJB in December 2021. The report acknowledges that there is a data gap nationally for a number of performance indicators and calendar year data for 2020 has been used in some instances. Performance levels are measured against a suite of 23 key performance indicators covering areas such as emergency admissions rates and patient satisfaction with GP services. 73. Delayed discharges, A&E attendances and unscheduled bed days remain key focusses for the IJB. 74. The annual performance report sets out the next steps for the IJB in improving performance across the statutory indicators. This is supported by the Strategic Commissioning Plan 2020-2023 and Programme of Work 2021-2022 which outline the approach to transformational change required to meet the IJB’s commissioning objectives. National performance audit reports 75. Audit Scotland carries out a national performance audit programme on behalf of the Accounts Commission and the Auditor General for Scotland. During 2021/22 we published some reports which may be of direct interest to the IJB as outlined in Appendix 2. 76. We noted that reference to relevant national reports were made by IJB Board members throughout the year. 31
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Appendix 1. Action plan 2021/22 | 20 Appendix 1. Action plan 2021/22 2021/22 recommendations Issue/risk Recommendation Agreed management action/timing 1. Accounts inspection advert The notice of inspection should state the objection end date and the advert should be posted on the IJB website in addition to the North Lanarkshire Council website. The IJB should ensure it has procedures in place to ensure the accounts inspection advert is published in line with criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. Paragraph 21. The IJB will ensure future adverts are posted on the IJB website in addition to the North Lanarkshire Council website. Responsible officer: IJB Chief Financial Officer Agreed date: June 2023 2. 2022/23 Reserves Strategy There are significant reserves held at 31 March 2022. A reserves strategy for 2022/23 which sets out how and when monies will be spent, has not yet been developed. The IJB should develop a reserves strategy for 2022/23 which sets out how and when monies will be spent. Paragraph 47. The IJB 2022/23 Reserves Strategy will be presented to the PFA Committee on 16th November and to the IJB on 30th November 2022. The reserves strategy will continue to be updated in line with the new Strategic Commissioning Plan 2023- 2026 and the new Medium Term Financial Plan 2023- 2026. Responsible officer: IJB Chief Financial Officer Agreed date: November 2022 3. Review of Financial Regulations The financial regulations were approved on 8 March 2016. They require to be updated to reflect the budget disaggregation of Children, The financial regulations should be reviewed to ensure they remain up-to-date and fit for purpose. Paragraph 58. Agreed. The services currently delegated by each partner to the IJB will be specified in the IJB Financial Regulations. The principal method of accounting for 32
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Appendix 1. Action plan 2021/22 | 21 Issue/risk Recommendation Agreed management action/timing Families and Justice Services and to also note the arrangements for the management of financial resources for hosted services. Hosted Services will also be included. Responsible officer: IJB Chief Financial Officer Agreed date: 31 March 2023 Follow-up of prior year recommendations Issue/risk Recommendation Agreed management action/timing b/f 4. Website refresh It should be clear who has ownership of the IJB website and responsibility for maintaining it. The website should be refreshed to reflect the IJB’s current operating model. Ongoing HSCP working group is currently completing the development of the website. Responsible officer: IJB Chief Officer Revised date: 31 March 2023 b/f 5. Financial Management The CFO should continue to work with partners to improve the timing of financial reports being presented to Committee. The first quarterly financial monitoring report was not presented until 5 months into the financial year on 24 August 2021. Complete The current reporting arrangements are in line with the North Lanarkshire IJB Financial Regulations which state that a quarterly financial management report will be presented to the IJB by 31 August, or the nearest meeting of the Board or nearest complete accounting period. This is to enable the implementation of the financial strategy to be monitored. The IJB requires to wait until the first financial reports for the financial year from each partner are available. Presenting the first financial report is also dependent on when the first meeting of the IJB or PFA is scheduled for. 33
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Appendix 1. Action plan 2021/22 | 22 Issue/risk Recommendation Agreed management action/timing Opportunities will continue to be identified to develop financial monitoring arrangements. b/f 6. Hosted Services The IJB should set out the arrangements that exist in practice for the management of financial risk for hosted services on a permanent basis. Complete The 2022/23 Financial Plan for North Lanarkshire IJB has been prepared on the basis of the “principal” method of accounting for hosted services and on the understanding that the lead partner for the hosted services will continue to retain underspends and will manage overspends. b/f 7. Medium to long term financial plan The IJB’s medium to long term financial plan should be reviewed due to the impact of Covid-19 and EU withdrawal. Ongoing The new Medium Term Financial Plan 2023-2026 reflects the impact of recovering from Covid-19 and other challenging factors facing the IJB. It has been condensed to a three-year plan rather than the original ten-year plan due to the pending formation of the National Care Service (NCS) and the continuing uncertainty around future funding. The MTFP will align to the Strategic Commissioning Plan 2023- 2026 and the current IJB Reserves Strategy Responsible officer: IJB Chief Financial Officer Revised date: 31 March 2023 34
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Appendix 2. National performance reports and briefings | 23 Appendix 2. National performance reports and briefings May Local government in Scotland Overview 2021 June Covid 19: Personal protective equipment July Community justice: Sustainable alternatives to custody September Covid 19: Vaccination programme January Planning for skills Social care briefing February NHS in Scotland 2021 March Local government in Scotland: Financial Overview 20/21 Drug and alcohol: An update Scotland’s economy: Supporting businesses through the Covid 19 pandemic 35
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Appendix 2. National performance reports and briefings | 24 North Lanarkshire Integration Joint Board Draft 2021/22 Annual Audit Report Audit Scotland’s published material is available for download on the website in a number of formats. For information on our accessibility principles, please visit: www.audit-scotland.gov.uk/accessibility For the latest news follow us on social media or subscribe to our email alerts. Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit-scotland.gov.uk www.audit-scotland.gov.uk AS.4.0 36
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1 REPORT Item No: 6 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 details of the unsigned audited IJB Annual Accounts 2021/2022 for consideration and approval by the IJB. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 that the External Auditor’s audit opinions are all unqualified in respect of the IJB Annual Accounts 2021/2022; (2) Approve the IJB Annual Accounts 2021/2022 for signature; and (3) Note that the signed audited IJB Annual Accounts 2021/2022 will be available to view electronically at the following website: https://www.hscnorthlan.scot/key-documents/ 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB have to meet to consider whether to approve the audited IJB Annual Accounts 2021/2022 for signature. SUBJECT: Audited IJB Annual Accounts 2021/2022 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer North HSCP DATE: 30 November 2022 Yes No N/A
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 6. CONCLUSIONS 6.1 This report provides an overview of the unsigned audited IJB Annual Accounts for the financial year 2021/2022 in line with legislative requirements. 7. IJB ANNUAL ACCOUNTS 2021/2022 7.1 The IJB Annual Accounts 2021/2022 were prepared in accordance with the requirements of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable, and prudent judgement were made, and proper accounting records were maintained. The preparation of the unaudited annual accounts also met the statutory deadline of 30 June 2022. 7.2 The unsigned audited IJB Annual Accounts 2021/2022 are attached as an appendix. 7.3 The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2021/2022 give a true and fair of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report. The findings of the audit process have also been reported to the IJB and an action plan approved as set out in the External Auditor’s Annual Audit Report. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES This relates to all national outcomes. 8.2 ASSOCIATED MEASURE(S) The IJB, the Performance, Finance and Audit Committee and both partners are required to ensure effective governance arrangements are in place. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT The main risk associated with the IJB Annual Accounts is a qualified audit report. The risk has been assessed as low due to the detailed preparation in relation to the year-end process and technical training undertaken by key finance staff. The finance staff across the partners supported the achievement of key deadlines. 8.5 PEOPLE None 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed:
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Yes No N/A 8.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 9. BACKGROUND PAPERS IJB 22 June 2022 Unaudited IJB Annual Accounts 2021/2022. 10. APPENDICES Unsigned Audited IJB Annual Accounts 2021/2022 Appendix 1 ........................................... Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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Appendix 1 NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS AUDITED 2021/2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 2 CONTENTS Management Commentary Page 3 Statement of Responsibilities 14 Remuneration Report 15 Annual Governance Statement 18 Comprehensive Income and Expenditure Statement 29 Movement in Reserves Statement 30 Balance Sheet 31 Notes to the Financial Statements 32 Independent Auditor’s Report 44
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 3 MANAGEMENT COMMENTARY Introduction The North Lanarkshire Integration Joint Board (IJB), which was established as a body corporate by order of Scottish Ministers under the Public Bodies (Joint Working) (Scotland) Act 2014, became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. The functions delegated by North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) to the IJB are detailed in the Integration Scheme. The North Lanarkshire Health and Social Care Partnership (HSCP) refers to the joint working arrangements between the partners NLC and NHSL. The IJB is a separate legal entity which is responsible for the strategic planning and commissioning of the wide range of health and social care services across North Lanarkshire. The partnership is responsible for the operational delivery of the IJB’s strategic directions. The purpose of the IJB is to improve the wellbeing of people who use health and social care services and their carers’ and to deliver on the nine national health and wellbeing outcomes. There are multi faceted factors which impact on the demand for health and social care services across North Lanarkshire which is the fourth largest and fifth most densely populated area in Scotland with a population of 341,140. The increase in the age group of people 65 years and over is projected to be 20.2% by 2028 and 39.6% by 2043. 110,563 residents live in the worst 20% datazones and it is estimated that 36% of North Lanarkshire residents have a limiting long-term illness. This management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year ended 31st March 2022 and provides an indication of the issues and risks which may impact upon our finances in the future. The Role and Remit of the IJB The IJB has responsibility for the strategic planning and commissioning of the following services: accident and emergency services provided in a hospital; inpatient services related to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine and palliative care services in a hospital; community health services including Lanarkshire-wide (hosted) services; and social care services. The IJB is made up of eight voting members: four Elected Members appointed by NLC and four Non- Executive Directors appointed by NHSL. Non-voting members of the Board include the Chief Officer, the Chief Social Work Officer, the Nurse Advisor, the Medical Advisor, the Chief Financial Officer, the Registered Medical Practitioner and representatives for staff, the third sector, service users and carers. In March 2019, the IJB approved the Strategic Commissioning Framework1 for the period 2019 to 2022 and issued in March 2021 IJB Directions2 for 2021/2022 to each of the partners to achieve safer, healthier, independent lives for the residents of North Lanarkshire. The IJB’s Business Model and Strategy The business model for the IJB is managed through key leadership groups which are aligned to both partners’ objectives. Front-line service delivery continues to be carried out by NLC and NHSL across six localities in line with the directions from the IJB. The directions from the IJB to NHSL and NLC outline what the IJB requires both bodies to do, the funding allocated to these functions, and the mechanisms through which the performance in delivering the directions will be monitored. The limited resources of the IJB and both partners are targeted to achieve our outcomes. This includes: strong financial planning and management the achievement of best value and supporting sustainable models of service delivery from a whole system perspective. 1 https://mars.northlanarkshire.gov.uk/egenda/images/att90476.pdf 2 https://mars.northlanarkshire.gov.uk/egenda/images/att95940.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 4 The IJB’s Outcomes for the Year The 2021/2022 financial year was dominated by the response to the pandemic, though performance across all key HSCP areas continued to be reported to the IJB throughout the year as set out in pages 8 and 9. The final year-end underspend at 31 March 2022 is £74.670m. Expenditure incurred against reserves in 2021/2022 is £8.336m. The surplus on the provision of services and total comprehensive income and expenditure in 2021/2022 is therefore £66.334m. A further explanation of this surplus, including the main reasons for this level of underspend in 2021/2022, is detailed on pages 8 to 10. Some of the key outcomes for individuals in North Lanarkshire are summarised below: Following the World Health Organisation’s declaration of a Covid-19 pandemic on 12 March 2020, command structures were initiated in North Lanarkshire Council and NHS Lanarkshire, alongside those through the Lanarkshire Resilience Partnership. The IJB exercised agile governance principles and the Chief Officer participated as a full and active member of North Lanarkshire Council and NHS Lanarkshire’s Gold Command structures and the Lanarkshire Resilience Partnership. The IJB is now included as a Category 1 Responder. The delivery of the Covid-19 vaccination programme progressed at pace throughout 2021/2022, reaching over 548,000 individuals in Lanarkshire and delivering over 1.5 million doses in total by the end of the financial year. As part of the pandemic response, the partnership hosted a pan-Lanarkshire Care Home Assurance Group, bringing together key HSCP partners, NHSL/NLC/South Lanarkshire Council service leads and the Care Inspectorate to provide additional support and assurance around the safe delivery of care within the Care Home sector. Similarly, a joint group was formed for Care at Home services. This led to a wide range of quality and assurance activities across both sectors, whilst enabling the sharing of best practice and implementation of consistent approaches across Lanarkshire as a whole. A whole system approach has been adopted to increase the resilience of community health and social care services including statutory services, independent providers and the third and voluntary sector through the redeployment of staff, increasing existing staff capacity and the reliance on volunteers. Partners and staff have embraced different ways of working and new technologies including remote service delivery and the use of telephone and Near Me (video) consultations to minimise footfall and enable face-to-face consultations for patients and service users who need it the most. In the latter months of the 2021/2022 year, restrictions have continued to ease, creating opportunities to increase footfall on sites and subsequently face to face consultation, though the focus has been on ensuring that the positive gains made during the pandemic around hybrid working are maintained. This will ensure we maintain flexible and adaptable models of service delivery for staff and our service users alike. Significant work has been undertaken to continue to align the Remobilisation Plan with the Strategic Commissioning Plan 2020-2023 ambitions and the Programme of Work. 53 service reviews have been undertaken to refresh the key priorities for 2021/2022 and to build on the recovery plans. Many aspects of the Programme of Work had moved forward more quickly due to the emergency response to the Covid-19 pandemic. Engagement continued with stakeholders to develop the detail of the plan. Response, Redesign and Recovery groups have been established to remobilise services.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 5 Remobilisation plans continued to be developed and updated throughout 2021/2022, with some services significantly impacted by the ongoing pandemic response. Through clinical prioritisation, some community services were paused to free staff to support service delivery within the acute sector due to the overwhelming pressures being experienced. Waiting times have continued to prove challenging across a range of services and while we have seen strong recovery in services such as Psychological Therapies and Podiatry, others like Child and Adolescent Mental Health Services (CAMHS) and Children and Young People’s Speech and Language Therapy continue to be areas of high risk. Remobilisation plans have been updated accordingly. In February 2022, the IJB approved the winter plan and enhanced support business case, which focused on prevention and early intervention, empowering individuals and communities and improving efficiency by working as a whole system. Key developments contained within included: o Creation of new Home Assessment teams in each Locality to support both earlier discharge and rapid community response to prevent admission o Expanded Integrated Rehabilitation Team and Reablement capacity to enable a greater local focus on maximising independence o Expanded capacity within the Equipment and Adaptation service to support rapid deployment of equipment to enable the safe roll out of the model described above o Expanded Home Support capacity to meet growing demand o Creation of new roles within Community Nursing teams to focus additional supports on the Care Managed Caseload (those at highest risk of hospital admission within the community) o Roll out of digital community alarms and the creation of a Technology Enabled Care team to support Localities to maximise the innovative use of technology enabled care o Extended hours and service model to include both admission prevention and discharge support within Hospital at Home o Support for the Independent Sector Self Directed Support suppliers, including support at home. In line with North Lanarkshire Council’s Delivering for Communities report, the HSCP finalised its structural changes, ensuring strong and proactive systems and processes to maximise the use of the Community Boards as a key vehicle for participation and engagement. A wider review of participation and engagement was commissioned in 2021/2022, led independently via Voluntary Action North Lanarkshire, with the outputs and recommendations due to be reported to the IJB for implementation in 2022/2023. The mixed market of provision supports genuine choice and control for people. This has seen a significant investment in the relationship with the 19 independent sector providers on the Self- Directed Support Framework. This relationship offers greater flexibility to achieving outcomes, promotes inclusion and connection and incorporates digital responses. This requires trust, co- operation and a partnership approach between all stakeholders. The operating model supporting individual budgets has also developed to ensure financial stability for providers whilst ensuring best value for people considering the use of their indicative budget. Choice and control are further promoted through the option of people receiving their individual budget as a direct payment. The Carers (Scotland) Act 2016 came into force on 1st April 2018. North Lanarkshire Carers Together is the overarching carer information service in North Lanarkshire, overseeing a range of information and advice services relevant to carers’ needs. They work in partnership with health and social care, community and voluntary sector colleagues to identify and to support hard to reach carers. North Lanarkshire Young Carers Project also supports young carers aged 8-18 (or age 18 and still at school). They raise awareness, identify and provide direct support to children and young people who look after or help to look after someone in their family who is unwell or disabled, including children caring for parents who have mental health or substance misuse problems.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 6 Mental Health and Learning Disability Services are a hosted service which is managed and strategically led within North Lanarkshire on behalf of both HSCPs. The Lanarkshire Mental Health and Wellbeing Strategy set in progress a range of service improvements for all age groups. Access to mental health services expanded in Accident and Emergency Departments, police custody suites and prisons as a result of the availability of Action 15 funding. Through the Mental Health Recovery and Renewal Funding, a range of service developments are underway, including: o Psychological Therapies: roll out of Assessment Plus (a guided self-help intervention delivered by a range of Psychologists); roll out of ACCEPT programme (delivered by Applied Psychologists to support those living with long term conditions in the community); Psychological supports for Adults living with Learning Disabilities; expended digital interventions; expanded Neuropsychology offering; expanded Eating Disorders provision; and expanded Psychological Therapies provision. o CAMHS: roll out of the Choices and Partnership Approach (rapid triage and collaborative consulting model); full implementation of the national service specification including expanded age range; creation of a new CAHMS facility in Udston Hospital, co-designed with those with lived experience; creation of the Neurodevelopmental Service. o Perinatal and Infant Mental Health: development of perinatal and infant mental health teams including recruitment of Multi-Disciplinary Teams (MDT), training etc, with services now open to referrals; development of Maternity and Neonatal Service embedded within Maternity services with MDT recruited and open for referrals. A wide range of stakeholder engagement was undertaken to support the Alcohol and Drug Partnership (ADP) to develop its Strategic Plan and associated Investment Plan in line with national evidence, regional scoping work and learning from commissioned services. Following an in-depth review of the governance structures, the IJB approved in September 2021 the new arrangements, including five subgroups that will support delivery on the Partnership Delivery Framework; National Mission - Rights Respect and Recovery; National Alcohol Framework; and the Ministerial priorities. The development of urgent care pathways continued in 2021/2022, with a new single point of access through NHS24 and the Flow Navigation Centre. Mental Health hubs were developed, greatly reducing the waiting times spent within Emergency Departments. Through opening up direct access to Mental Health services via police triage, the percentage of individuals maintained in the community has increased substantially from 28% in 2019 to 62.5% in 2021. The IJB participated fully in the consultations on the National Care Service, working collaboratively with North Lanarkshire Council and NHS Lanarkshire as part of the process. As part of the process, the HSCP undertook a self-assessment against all aspects of the report to support identification of any potential strengths and gaps for the future. This led to some more detailed areas of work, such as a review of ethical commissioning in North Lanarkshire, which was presented to the IJB in March 2022. The IJB undertook a Best Value Audit in conjunction with the Improvement Service. This was undertaken in order to prepare for the formal IJB audits on Best Value originally scheduled for between 2022/2023 and 2026/2027. The IJB Best Value Review Audit Programme however has been put on hold pending the outcome of the National Review of Care Services. Notwithstanding this, an improvement plan has been developed following the self-assessment exercise already undertaken in order to ensure Best Value opportunities continue to be identified and implemented across health and social care services delivered in North Lanarkshire.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 7 New whistleblowing standards were approved by the IJB, which bring a consistent approach to how the IJB alongside its NHSL and NLC partners will manage whistleblowing cases in future. The whole system approach undertaken included joint presentation to the IJB by the NHSL and NLC leads to ensure a once for North Lanarkshire approach. In June 2021, the IJB approved the roll out of the McMillan Cancer Support Improving Cancer Journey programme, bringing £2m of non-recurring funding into the two Lanarkshire partnerships to develop support over a five-year period for those affected by and recovering from a cancer diagnosis. Through the Community Solutions programme, a strategic funding programme for the community and voluntary sector managed by Voluntary Action North Lanarkshire, the third sector interface in North Lanarkshire, the partnership has invested in a number of condition specific, locality-based services which offer information, activities and support to carers. The Community Solutions Programme has made a significant contribution to supporting vulnerable groups and communities during the Covid-19 pandemic. The Community Solutions Programme utilises eleven project hosts to guide best practice (e.g. in physical activity; healthy eating; anticipatory planning; transport etc) and six locality host organisations to ensure a truly community led approach. Crucially, the IJB has confirmed recurring funding of £1.141m to the Community Solutions Programme to ensure stability and continued development with Voluntary Action North Lanarkshire as a key strategic partner. In collaboration with North Lanarkshire Council and NHS Lanarkshire, a new community campus in Chryston is now under construction, that will see primary education, community and health and social care facilities created in Chryston. This will support the repatriation of a number of community health services for the Northern Corridor area that are currently provided via a service level agreement by NHS Greater Glasgow and Clyde, creating equitable service provision across the North Lanarkshire area.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 8 The IJB’s Financial Position at 31 March 2022 The delegated funds for the IJB come from NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. The IJB Financial Plan 2021/2022 was approved by the IJB on 23 March 2021. Demographic growth, inflationary cost pressures and national priorities were originally projected to increase costs by £55.060m in 2021/2022. Additional funding invested in the HSCP totalled £52.575m. The funding gap was therefore £2.485m. In order to address this, savings totalling £1.453m within NLC were approved and the remaining £1.032m was proposed to be addressed by part of the achievement of the Prescribing Quality and Efficiency Programme target in 2021/2022 (£0.251m) and reliance on IJB reserves (£0.781m). Taking into account budget movements, including the removal of non-recurring funding from 2020/2021, the movement in each partner’s funding contribution is summarised as follows: Partner Funding Contributions NLC £m NHSL £m Total £m Original Partner Funding Contributions at 1 April 2021 148.431 518.560 666.991 Partner Funding Contribution Changes - Net Increases 16.357 19.285 35.642 Final Partner Funding Contributions at 31 March 2022 164.788 537.845 702.633 The actual expenditure incurred in 2021/2022 is detailed at note 4 on page 36 and is compared to the actual expenditure incurred in 2020/2021 and 2019/2020 in the graph below. 0 25 50 75 100 125 150 175 200 225 250 Social Care Services (£203m) Prescribing Costs (£69m) Hospital Acute Services (£65m) Housing Services (£1.7m) Corporate Services (£0.2m) Comparison of Expenditure 2019/2020, 2020/2021 and 2021/2022 2019/2020 2020/2021 2021/2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 9 As highlighted on page 4, the final year-end underspend at 31 March 2022 is £74.670m (NHSL - £58.697m; NLC - £15.973m). Expenditure incurred against reserves in 2021/2022 is £8.336m (NHSL - £7.564m; NLC - £0.772m). The surplus on the provision of services and total comprehensive income and expenditure in 2021/2022 is therefore £66.334m (NHSL - £51.133m; NLC - £15.201m). Information on the significant variances across health and social care services are highlighted as follows: % of Total Underspend of £74.670m Main Factors 42% Funding received from the Scottish Government during 2021/2022 to address the cost of the response to the Covid-19 pandemic totalled £45.098m. The actual costs incurred in respect of the Covid-19 pandemic totalled £13.412m. The uncommitted funding of £31.686m was therefore transferred to a ring-fenced IJB Covid-19 reserve at 31 March 2022. The use of this reserve in 2022/2023 to address the significant changes to the Public Health policies in relation to Covid-19 pandemic is being discussed and agreed with the Scottish Government. It is expected that part of this IJB Covid-19 reserve may be returned to the Scottish Government to be redistributed across the health and social care sector to meet current Covid priorities. 20% The underspend across the Hosted Services led by the North Lanarkshire IJB totalled £15.276m. This includes an underspend across Mental Health and Learning Disability Services of £8.885m and an underspend of £5.285m across Children and Adolescents Mental Health Services. 20% There is an underspend totalling £7.987m across the Care At Home Service. This is predominantly due to staff shortages. A balance of the funding received in 2021/2022 to support winter planning remained uncommitted at 31 March 2022 and totalled £6.400m. Funding totalling £0.843m to support Carers also remained uncommitted at the year-end. These underspends total £15.230m. 8% The underspend across Locality and Other services totalled £5.869m. This includes an underspend of £2.528m across the six localities, all of which is due to vacancies. It also includes an underspend of £1.443m across the Distress Brief Intervention funding. 10% The balance of the underspend totalling £6.609m relates to Addiction Services (£2.336m), Area-wide Services (£1.676m), Prescribing (£1.500m) and the Medical and Nursing Directorate (£0.758m). The total underspend of £74.670m represents approximately 10% of the total financial envelope available. As highlighted at note 11 on page 41, the underspend of £74.670m has been transferred to the IJB reserves. The IJB Reserves Strategy 2022/2023 is being further developed in consultation with both partners. The total savings target was £2.485m. The value of the savings target achieved was £2.399m (97%). The underachievement of savings totalling £0.086m (3%) was addressed by Scottish Government funding for proposals delayed as a consequence of the Covid-19 pandemic.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 10 Annual Accounts 2021/2022 The financial outturn for the year ended 31 March 2022 is therefore a surplus of £66.334m. This is highlighted on the Comprehensive Income and Expenditure Statement on page 29 and is also included in the Movement in Reserves Statement on page 30. The total movement on reserves at 31 March 2022 is a net increase of £66.334m. The final year-end underspend of £74.670m and the movement in reserves of £66.334m are reconciled in the table below. Financial Outturn 2021/2022 Movement In Reserves Reduction / (Increase) Returned to Partner £m £m £m NLC - General Underspend 15.973 (15.973) NLC -Housing Revenue Account Underspend 0.302 (0.302) NLC - Net Underspend 16.275 (15.973) (0.302) NHSL Underspend 58.697 (58.697) Total As At the 31 March 2022 74.972 (74.670) (0.302) Expenditure incurred against reserves in 2021/2022 8.336 Deficit or (surplus) on provision of services and total comprehensive (income) and expenditure (Page 29 and Page 41 Note 11) (66.334) The services which are hosted by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB and the hosted services which are led by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB are detailed in note 10 on pages 39 to 40. 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. The North Lanarkshire IJB and the South Lanarkshire IJB endorsed this principle in respect of 2021/2022. During the year, £8.336m was drawn from the IJB reserves. Of the total underspend of £74.670m reported at 31 March 2022, £31.686m (42%) was transferred to ring-fenced reserves, with the remainder of £42.984m (58%) being added to the earmarked reserve. The net transfer to reserves was therefore an increase of £66.334m and is summarised as follows: Financial Outturn 2021/2022 £m Underspend As At 31 March 2022 66.334 Analysis Of Net Transfer To IJB Reserves Ring-fenced Reserves 25.016
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 11 Earmarked Reserves 41.318 Contingency Reserve 0.000 Total 66.334 The balance on the IJB reserves at 31 March 2022 is therefore £119.452m. The ring-fenced (£45.718m), earmarked (£70.050m) and contingency reserves (£3.684m) are detailed at note 11 on page 41. It is good financial management to maintain a contingency reserve. The contingency reserve represents 0.5% of the total IJB financial envelope. Due to the Covid-19 pandemic and the uncertainty in respect of the projected outturn for 2021/2022, a planned underspend was not agreed at the start of the financial year 2021/2022. The cost of responding to the Covid-19 pandemic was unknown particularly due to the emergence of Covid variants and the vaccination programme. There continues to be a significant element of financial risk associated with the ongoing response to and consequences of the Covid-19 pandemic. The Chief Finance Officer and both partners will continue to confirm the Covid-19 pandemic costs which will require to be set against the remobilisation and recovery plan. In order to ensure financial sustainability during the pandemic and post-pandemic, the IJB Medium to Long Term Financial Plan will be updated. The North Lanarkshire IJB was established under the Public Bodies (Joint Working) (Scotland) Act 2014 and falls within section 106 of the Local Government (Scotland) Act 1973. The annual accounts are therefore prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014. Matters of Strategic Importance The IJB Financial Plan 2022/2023 was approved on 23 March 2022. Including the cost of the previously approved North Lanarkshire Winter Planning and Enhanced Supports Business Case, costs are projected to increase by a total of £56.901m and funding is projected to increase by £51.396m. The funding gap of £5.505m will be addressed by budget realignments (£3.264m), a projected recurring prescribing budget underspend (£1.493m), prescribing efficiency savings (£0.387m) and reliance on reserves (£0.361m). In respect of demographic growth and demand for services, research indicates that expenditure on healthcare would require to increase in real terms by an average of 3.3% per annum over the next 15 years to 2033 in order to maintain NHS provision at current levels. Social care funding would also require to increase by 3.9% per annum to meet the needs of the population living longer and an increasing number of younger adults living with disabilities. These projections do not take into account the impact of the Covid-19 pandemic including long-Covid, the financial cost of which continues to be uncertain but is expected to be significant. The impact of Covid-19 on health and social care services and the economy as a whole is unprecedented in recent times and has increased the risk of an overspend. Governance arrangements continue to be in place for the approval and monitoring of costs and regular updates are provided to the Scottish Government. Resilience is required within our health and social care system for the foreseeable future in response to Covid-19. The NLC and NHSL governance arrangements were reviewed and adapted as appropriate to support the response, recovery and redesign of services following the pandemic. The response, redesign and recovery of services is continuing. The aim of this next stage is to provide good corporate governance and oversight; seek out innovative solutions aligned to redesign for effectiveness and efficiencies; provide a safe working environment for essential services; and engage openly and constructively with all key stakeholders throughout the recovery planning. The IJB considers the innovative approaches and service alterations put in place out of necessity may present opportunities as we seek to re-start services within the new context in which health and social
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 12 care services now need to be delivered. In doing so the IJB will continue to follow appropriate governance structures and consider equalities and human rights requirements to ensure that from the current crisis emerges a more efficient and effective health and social care system that delivers on the priorities set out in the strategic commissioning plan. The NLHSCP will actively seek to understand the impact of the measures implemented during the emergency response to the Covid-19 pandemic and also the remobilisation and recovery activity in order to agree which changes can be retained or adapted to improve services whilst still continuing to be person-centred and meet individual outcomes. A review will also be undertaken to identify key learning points and to share good practice. Key Strategic Risks and Uncertainties The IJB Risk Management Strategy complements the existing risk management processes within each partner. All three risk registers are reviewed regularly by the management team. It is important to note that some of the funding solutions in 2021/2022 were non-recurring and some cost pressures are expected to recur again in 2022/2023. The impact of the savings not achieved in full in 2021/2022 (£0.134m) will be taken into consideration during the review of the 2022/2023 Financial Plan. The notional set-aside budget aims to provide a mechanism for tracking the consumption of an element of hospital resources by North Lanarkshire residents. The budget for 2021/2022 was agreed at £65.164m (2020/21 - £63.066m). The agreement currently in place with the NHSL partner is that where a service change is agreed that alters the balance between hospital and community provision the impact of the specific change will be re-costed and the set aside budget adjusted accordingly. There were no such changes in 2021/2022. In the absence of changes, the agreement is that the services covered within the set aside arrangements will be provided for the agreed notional sum and that the risk of the cost of the directed services exceeding the agreed notional sum is borne by NHSL during the year. On that basis the expenditure recorded in the 2021/2022 annual accounts equals the notional budget of £65.164m. This amount will be included in both the NHSL Health Board and IJB annual accounts. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB in 2021/2022 however it has been endorsed as an acceptable approach pending further updates from Public Health Scotland’s information services division. It is consistent with advice issued by the Scottish Government on how the sum set-aside should be recorded in the annual accounts. The complexities of this mechanism and actual information so far is explained in more detail at note 2.2 on pages 34 and 35. A whole system approach will continue to be adopted by the partners to support the use of set-aside resources. Conclusion Covid-19 has affected each and every member of our society and a robust response was implemented. Staff, partners and communities continue to work in partnership to ensure we respond effectively to this ongoing public health crisis, protect lives and keep people safe. In the face of this unprecedented challenge, partnership working continues to be critical to respond effectively to this national health and social care crisis. Available resources have, to date, been refocussed on the critical areas affected by the Covid-19 pandemic. However, our focus is increasingly moving towards recovery and remobilisation, but with the realisation that a ‘more of the same’ approach will not be sufficient. Services will require to create new and innovative solutions to support recovery, based on the new levels of demand created by the pandemic. A financial surplus totalling £66.334m was reported at 31 March 2022. This is mainly due to the additional funding received from the Scottish Government to address Covid-19 expenditure and to
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 13 take forward national and local priorities and also the essential and necessary changes across HSCP service delivery which released core funding. It is important to note that we do not expect to receive any further Covid-19 expenditure, so the resource carried forward will require to support any future Covid-19 spend in 2022/2023 and beyond. Although the current operational and financial challenges will inevitably drive the pace of change, improving outcomes for individuals will continue to underpin the IJB’s strategic commissioning intentions and the ongoing re-design and integration of health and social care services. We will do this by ensuring that we continue to adhere to sound governance arrangements and by exploring alternative pathways to divert people into more appropriate forms of support. Much of this will require a coordinated and consistent communications message to the public, together with concerted action planning with colleagues in acute services and also the third sector, independent providers and carers across the partnership. Support for all health and social care professionals, particularly those working in community settings, will be fundamental to managing service delivery while Covid-19 remains a risk. Maintaining the positive developments which have been rapidly stepped up in response to the crisis will be a priority during the recovery process. Ensuring health and social care resources are directed to best effect and achieving financial sustainability will be key to achieving this. Approved By Cllr Ayeshah Khan Ross McGuffie Amanda Kilburn Chair Chief Officer Chief Financial Officer Date 30 November 2022 Date 30 November 2022 Date 30 November 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 14 STATEMENT OF RESPONSIBILITIES Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire Integration Joint Board (IJB) is required to: make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the IJB has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973; Coronavirus (Scotland) Act 2020). In this IJB, that officer is the Chief Financial Officer. manage its affairs to secure economic, efficient and effective use of resources and safeguard its assets. ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far as is compatible with that legislation, in accordance with proper accounting practices (s12 of the Local Government in Scotland Act 2003). approve the Annual Accounts for signature. I confirm that these Annual Accounts were approved for signature at a meeting of the North Lanarkshire Integration Joint Board on 30 November 2022. Signed on behalf of the North Lanarkshire Integration Joint Board Confirmed By Chair: Cllr Ayeshah Khan Date: 30 November 2022 Responsibilities of the Chief Financial Officer As Chief Financial Officer I am responsible for the preparation of the IJB’s statement of accounts which, in terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2021/2022 (the “Code of Practice”), as supported by the International Financial Reporting Standard (IFRS), is required to give a true and fair view of the financial position of the IJB at the financial year end and its income and expenditure for the year then ended. In preparing the Annual Accounts, I am responsible for: Selecting suitable accounting policies and applying them consistently; Making judgements and estimates that are reasonable and prudent; and Complying with the Local Authority Code (in so far as it is compatible with legislation). I am also required to: Keep proper accounting records which are up to date; and Take reasonable steps for the prevention and detection of fraud and other irregularities. I certify that these Annual Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2022 and the transactions for the year then ended. Certified By Chief Financial Officer: Amanda Kilburn Date: 30 November 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 15 REMUNERATION REPORT 1 Introduction The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014 which requires, at least, disclosure about remuneration and pension benefits of any persons whose remuneration is £150,000 or more. The Regulations also require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant person’ in relation to the Remuneration Report for a financial year includes a senior officer holding office with associated authority, whether on a permanent or temporary basis, in the financial year to which that Remuneration Report relates. All information disclosed in the tables at sections 6 and 7 in this Remuneration Report is subject to audit by Audit Scotland. The other sections of the Remuneration Report will be reviewed by Audit Scotland to ensure that they are consistent with the financial statements. 2 Integration Joint Board The Standing Orders of the IJB, as prescribed by the Public Bodies (Joint Working) (Integration Joint Board) Order 2014, set out the detail regarding IJB membership, voting, calling of meetings and the quorum for meetings. The IJB comprises eight voting members, four of whom are Elected Members appointed by North Lanarkshire Council (NLC) and four of whom are Non-Executive Directors appointed by the NHS Lanarkshire (NHSL). The term of office of members is for a period of three years. There are also non- voting representatives on the IJB drawn from health and social care professionals, employees, the third sector, service users and carers. 3 Remuneration: IJB Chair and Vice Chair The Board Members do not currently receive remuneration or expenses directly from the IJB. Any remuneration or reimbursement of expenses for voting board members is governed by the relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs borne by the partner. During 2021/2022, the Chair of the IJB was Dr Avril Osborne and the Vice Chair was Councillor Paul Kelly. The details of the Chair and Vice Chair appointments held during 2021/2022 are shown below. No taxable expenses were paid by the IJB in 2021/2022. Name Post Held Nominated by Dr. A.Osborne Chair (1 April 2021 to 31 March 2022) NHS Lanarkshire Cllr Paul Kelly Vice Chair (1 April 2021 to 31 March 2022) North Lanarkshire Council The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or the Vice Chair.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 16 REMUNERATION REPORT (Cont.) 4 Senior officers The Chief Officer is appointed by the North Lanarkshire IJB and is employed by North Lanarkshire Council. The Chief Officer is seconded to the IJB in line with the local arrangements. The Chief Financial Officer is appointed by the North Lanarkshire IJB and is employed by South Lanarkshire Council. The Chief Financial Officer is seconded to the IJB in line with the local arrangements. 5 Remuneration policy The remuneration of the Chief Officer is set with reference to national arrangements as well as local decisions on management structures and their associated remuneration levels. The Scottish Joint Negotiating Committee for Local Authority Services sets out the spinal column salary points for Chief Officers which can be utilised in setting salary levels for such posts. 6 Remuneration: Officers of the IJB The senior officers received the following remuneration in the period: Name Salary, Fees, Allowances 2021/2022 Total Remuneration 2020/2021 Total Remuneration Ross McGuffie, Chief Officer (1 April 2021 to 31 March 2022) £102,352 £102,352 £101,601 Marie Moy, Chief Financial Officer (1 April 2021 to 31 March 2022) £36,631 £36,631 £36,224 The Chief Financial Officer is also appointed to the South Lanarkshire IJB. The remuneration disclosed in the table above is the proportion of remuneration received in relation to the activity of the North Lanarkshire IJB during 2021/2022. The remuneration in respect of South Lanarkshire IJB is therefore shown separately in the South Lanarkshire IJB Annual Accounts 2021/2022 The IJB does not directly employ any Health or Social Care staff. They are employed by either NHSL or NLC and remuneration for staff is reported in the employing organisation. Pay band information is not separately provided as all staff pay information has been disclosed in the information above. 7 Pension benefits In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pensions liability reflected on the IJB balance sheet for the Chief Officer or any other officers. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The senior officers are members of the Strathclyde Pension Fund which is a Local Government Pension Scheme (LGPS). The LGPS is a defined benefit statutory scheme, administered in accordance with the Local Government Scheme Regulations 2014.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 17 REMUNERATION REPORT (Cont.) 7 Pension benefits (Cont.) Costs of the pension scheme contributions for the year to 31 March 2022 are shown in the table below: Name In-year pension contributions Accrued pension benefits To 31 March 2021 To 31 March 2022 As at 31 March 2021 Movement In Year As at 31 March 2022 £000 £000 £000 Ross McGuffie Chief Officer £19,519 £21,291 Pension 8 2 10 Lump Sum Nil Nil Nil Marie Moy Chief Financial Officer £6,966 £7,058 Pension 15 1 16 Lump Sum 22 0 22 The pension benefits detailed in the table above relate to the proportion attributable to the activity of the North Lanarkshire IJB. In respect of the Chief Financial Officer, a pro-rata approach has been adopted for 2021/2022. Approved By Cllr Ayeshah Khan Ross McGuffie Chair Chief Officer Date: 30 November 2022 Date: 30 November 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 18 ANNUAL GOVERNANCE STATEMENT Introduction The Annual Governance Statement explains how the North Lanarkshire Integration Joint Board (IJB) complies with the Code of Corporate Governance and meets the requirements of the Delivering Good Governance in Local Government Framework developed by CIPFA and SOLACE in 2016. This statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control. Scope of Responsibility The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) sets out the legislative responsibilities for the delivery of integrated health and social care services. The original North Lanarkshire Health and Social Care Integration Scheme was approved by the Scottish Parliament in May 2015 and the IJB became a public sector organisation in June 2015. In April 2019, the Cabinet Secretary approved an updated Integration Scheme to reflect the transfer of the discretionary delegated functions for Children, Families and Justice Services from the IJB to the newly reshaped Education and Families Service in North Lanarkshire Council (NLC). The system of internal control is proportionate to the IJB’s strategic responsibility and reliance is placed on the NHS Lanarkshire (NHSL) and NLC systems of internal control. Within a strategic context, the IJB has a statutory duty of best value. The IJB is required to ensure that risk is effectively managed and public money is safeguarded and properly accounted for. The Governance Framework The terms of reference for the IJB are formally set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 with particular reference to the Scottish Statutory Instruments 2014 No.285. This Order sets out provisions which apply in relation to the membership, proceedings and operation of all IJBs. Article 17 also confers powers on IJBs to establish committees and delegate functions to those committees. The roles and responsibilities of the IJB and the Performance, Finance and Audit Committee (PFAC) were originally set out in the Terms of Reference3. The IJB Code of Corporate Governance4 describes the IJB’s governance arrangements. The internal control system can only provide reasonable and not absolute assurance of effectiveness. The effective operation of each partner’s financial and corporate systems, processes and internal controls are key to achieving IJB outcomes. Review of Adequacy and Effectiveness The ongoing effectiveness of the IJB’s governance arrangements in 2021/2022 was reviewed in line with the Local Authority Accounts (Scotland) Regulations 2014. The review took into consideration the changes necessary to address the Covid-19 pandemic. Improvement actions continue to be implemented to further develop controls and to achieve integration outcomes. The review is also informed by cross-assurances from each of the partners, NHSL and NLC, including consideration of their relevant internal audit and external audit reports and the governance arrangements implemented in response to the Covid-19 pandemic. Ongoing service sustainability is a key priority for the IJB and both partners. 3 https://mars.northlanarkshire.gov.uk/egenda/images/att87070.pdf 4 https://mars.northlanarkshire.gov.uk/egenda/images/att86221.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 19 Assessment of Governance Arrangements The assessment of the IJB governance framework and internal control system confirmed that no significant control weaknesses or significant failures have arisen in the expected standards for good governance, risk management and internal control. Some areas for improvement have been identified and are detailed in the continuous improvement actions on page 25 and 26. The key conclusions which contributed to this overall assessment are detailed below. 1. Response to the Covid Pandemic 1.1 The IJB and both partners moved quickly and decisively in 2020/2021 to manage the pressures on health and social care services across North Lanarkshire. The IJB, the Chief Officer and the Senior Leadership Team have been key active participants and stakeholders across the range of governance structures adopted to manage the impact of the pandemic. 1.2 During 2020/2021, the NLHSCP implemented new service areas and service delivery models in response to the changing levels of need as a result of the pandemic. Examples included: the establishment of community assessment centres the delivery of the vaccination programme the creation of a hub to support the distribution of personal protective equipment to health and social care staff, the third and independent sector, personal assistants and carers the requirement for mental health assessment units and the adoption of social distancing requirements. This effective response continued to be implemented during 2021/2022. Care Home Assurance Group and Care at Home Assurance Group arrangements were also implemented in 2021/2022. 1.3 In response to the pandemic, IJB governance arrangements were amended, allowing special meetings to be convened if required, with regular meetings between the Chair, Vice Chair and Chief Officer maintained throughout. During 2021/2022, all meetings proceeded as planned, with special meetings called in September 2021 and February 2022. 1.4 The governance context within which the IJB operates will continue to be impacted by the need to implement business continuity processes to respond to the national and international public health challenge which the Covid-19 pandemic, and its variants, continues to present. The adapted IJB governance arrangements continue to effectively support the planning and delivery of health and social care services with a particular focus going forward on the remobilisation and recovery of services. 2. IJB Governance Developments 2.1 The IJB has arrangements in place to deal with any conflicts of interest that may arise. It is the responsibility of IJB and PFAC Members to declare any potential conflicts of interest and it is the responsibility of the Chair of the relevant IJB or PFAC to ensure such declarations are appropriately considered and acted upon. The IJB arrangements continue to be regarded as fit for purpose in accordance with the governance framework. 2.2 The Scottish Government are legislating for IJBs to be included as Category 1 Responders under the Civil Contingencies Act 2004. The Scottish Government believe this status will complement the work already conducted by all of the partners. In terms of resourcing, there should be limited additional activity associated with the requirement given local partners are already working with an integrated health and social care model. Some concerns were expressed locally during the consultation with regards to the strategic role of the IJB in the context of the NLHSCP’s operational role, governance, the role of the Chief Officer and that there were no additional formal resources to undertake this activity.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 20 2.3 The following IJB responsibilities are standing items on the IJB and PFAC agendas: Financial monitoring reports Performance monitoring reports Risk management update Progress report on agreed actions 3. IJB Strategic Commissioning Intentions 3.1 The three year Strategic Commissioning Plan 2020-20235 was approved by the IJB on 24 March 2020. In line with the Community Empowerment (Scotland) Act 2015, an extensive engagement process was undertaken involving a wide a range of staff, service users, carers and over 1,000 responses to an online questionnaire. This plan is underpinned by a Programme of Work to achieve the key ambitions which details the aims of each work programme, anticipated performance impact, key deliverables, approval routes and financial implications. In order to strengthen the links to addiction and mental health services, an integrated approach within justice services continues to be embedded. 3.2 The IJB is committed to ensuring stakeholders are fully engaged. A review of participation and engagement was commissioned during 2021/2022 and the outputs and recommendations will be presented to the IJB in 2022/2023. In addition, the IJB approved the developments around the Delivering for Communities strategy, which will see the use of Community Boards as a key pillar of engagement activity moving forwards. 3.3 As part of the HSCP structural review, the support arrangements around the Chief Finance Officer were reviewed in conjunction with colleagues in the South Lanarkshire HSCP, with approval granted to move to both IJBs having a 1WTE Chief Finance Officer from 2022/2023 onwards. Recruitment to the additional post is already underway. Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires that Annual Performance Reports (APRs) are prepared by IJBs. The 2014 Act obliges that the APR should cover the preceding year’s activity and be published four months after the end of that reporting year. The purpose of the APR is to ensure that performance is open and accountable, whilst at the same time providing an overall assessment of performance in relation to planning and carrying out integration functions. In line with paragraph 8 of Schedule 6 to the Coronavirus (Scotland) Act 2020, the publication of the final North Lanarkshire IJB Annual Performance Report 2020/2021, which can be accessed at https://www.hscnorthlan.scot/wp-content/uploads/2022/04/HSCNL-APR-20- 21-1-1.pdf, was rescheduled to September 2021. 3.4 A genuine integrated performance culture is embedded across the NLHSCP. The IJB and PFAC continue to receive reports on service performance, despite some of the operational performance systems being delayed due to the pandemic response. A continuous improvement programme is in place which relies on performance data to drive further improvement and support informed decision making in respect of strategic planning and commissioning. 3.5 A particular measure of IJB and Scottish Government focus continues to be the number of delayed discharge bed days. This was of particular critical importance during the pandemic to improve bed capacity across Acute Services. In comparison to the same period last year, performance for the period from April to March is summarised as follows: A&E attendances down by 5.5% against 2019/20 (pre-pandemic) Emergency admissions down by 9% against 2019/20 (pre-pandemic) Unscheduled bed days (Acute) down by 4% against 2019/20 (pre-pandemic) Delayed discharge (standard delay) bed days down by 22% against 2019/20 (pre- pandemic) 5 https://mars.northlanarkshire.gov.uk/egenda/images/att93862.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 21 3.6 The Discharge Without Delay programme commenced in 2021/2022, with the aim of taking a whole system approach to reducing delayed discharge. This has included the introduction of Planned Date of Discharge across all acute sites, developing relationships and teams, having an understanding of the roles of individuals, consistency of personnel attending daily ward multi- disciplinary team meetings and improving access to systems including Near Me. 3.7 The management of ‘set-aside’ budgets totalling £65.164m in 2021/2022 continues to be complex however NHSL continue to maintain an appropriate mechanism for its operation. The overspend across the set-aside service has been managed by the health partner since 2016 and this approach was maintained in 2021/2022. As highlighted at note 2.2 on pages 34 and 35, the operation of the set-aside budget for unscheduled care services is a key area of uncertainty which has been further exacerbated by the Covid-19 pandemic. These challenges will continue during the post-pandemic period. Both hospital and community services must continue to operate together to maximise the efficacy of unscheduled care services and a whole system approach is being adopted by the partners. 4. Financial Governance 4.1 The IJB Financial Plan 2021/2022 was approved by the IJB on 23 March 2021 and set out the parameters to achieve a balanced budget by 31 March 2022. The financial position of the IJB for 2021/2022 is set out at pages 8 to 10 of the management commentary and also at pages 29 to 31. 4.2 The financial impact of implementing the emergency response to the Covid-19 pandemic was, and continues to be, significant. The Scottish Government established a process whereby the necessary activity and the additional costs incurred across health and social care services as a result of Covid-19 are reported through Mobilisation Plans. The expenditure incurred by both partners in response to the Covid-19 pandemic was fully funded by the Scottish Government in 2021/2022. A balance of funding received for 2021/2022 is being retained by the IJB in reserves to meet additional Covid-19 expenditure in 2022/2023. 4.3 The IJB Financial Plan 2022/2023 was approved by the IJB on 23 March 2022 and set out the parameters to achieve a balanced budget by 31 March 2023. The financial strategy will require to be reviewed to reflect the ongoing impact of the Covid-19 pandemic on operational services. 5. Risk 5.1 There has been continued focus and development around the IJB Risk Register over the financial year, undertaken by the Chief Officer, IJB Section 95 officer and the Operational & Business Manager. In line with the findings of the table top review undertaken in 2020, new and emerging risks or changes in risk level are agreed at each meeting as appropriate. Each report gives due consideration to any risks associated with the subject matter. All risks identified relating to the functions delegated to the IJB are regularly reviewed and updated. 5.2 A table top review of the existing IJB Risk Management Strategy and the IJB Risk Register6 was undertaken by the Chief Officer, IJB Section 95 officer and the Operational & Business Manager in August 2020. Following this review, a number of risks were closed with the approval of the IJB on 22 September 2020. A proactive approach to risk management is being adopted. Confirmation of new emerging risks is agreed at each meeting as appropriate. Each report gives due consideration to any risks associated with the subject matter. All risks identified relating to the functions delegated to the IJB are regularly reviewed and updated. Internal Audit also recommended that mitigating controls be separated between controls and actions. This continuous improvement action will be completed in June 2021. 6 https://mars.northlanarkshire.gov.uk/egenda/images/att96291.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 22 5.3 10 risks are recorded on the IJB Risk Register as follows: 5.4 The two very high risks relate to the following: The financial implications of responding to and recovering from the Covid-19 pandemic The cost of responding to the Covid-19 pandemic continues to be monitored and reported to the Scottish Government. An IJB Covid-19 reserve totalling £31.6m was established at 31 March 2022 and is available to meet specific Covid-19 costs incurred in 2022/2023 as agreed with the Scottish Government. The total cost of continuing to respond to further waves of the Covid-19 pandemic is still uncertain. The cost of remobilising services following the Covid-19 pandemic is still being quantified. Part of the IJB Covid reserve which remains uncommitted in 2022/2023 is likely to be reclaimed by the Scottish Government to be redisributed across the sector to meet current Covid priorities. There are however expected to be recurring and non-recurring legacy costs as a result of the Covid-19 pandemic which the IJB and both partners will require to manage in 2022/2023 and beyond. The impact on the Strategic Plan due to the Covid-19 pandemic In addition to the financial implications, there are operational and strategic implications of the Covid-19 pandemic which will adversely impact on the implementation of the Strategic Plan. These include social distancing requirements, increased infection control measures, staff absence, workforce availability - including whole system capacity constraints across internal and external health and care services and Acute Services. Scottish Government guidance is being implemented. If clinically appropriate to do so, priority continues to be focussed on avoiding hospital admissions and ensuring people are discharged from hospital without delay. Prioritising the ongoing response to the Covid-19 pandemic and the requirement to continue to deliver statutory health and social care services may impact on the progress of the implementation of the transformation service redesign opportunities and the achievement of agreed efficiency savings. 5.5 The following very high risks are also recorded on the NHSL partner’s risk register: The ability to maintain the existing General Medical Services across NHSL. Sustainability of the two-site model for the Out-of-Hours Service. Acute sector bed capacity linked to availability of beds in care homes affected by the Covid- 19 pandemic. CAMHS performance and recovery Staff fatigue, resilience, wellbeing and safety following sustained pandemic response Impact of analogue to digital phone line transition on the Community Alarm Service Recovery of performance 2020/2021. 5.6 The Risk Management Update was reported to the IJB on 23 March 2022. The optimum management of risks by the IJB and both partners continues to be a priority. There is a significant element of financial risk associated with Covid-19 and service recovery. Sustainable financial strategies require to be developed to meet increased demand and to maintain the innovative and beneficial changes to service delivery which have been implemented. The IJB Reserves Strategy also requires to be reviewed in response to current circumstances. Current Risk Level No. % Very High 2 15% High 4 31% Medium 4 31% Low 3 23% Total 13 100%
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 23 6. Partner Assurances 6.1 In recognition of the Public Health emergency, in March 2020 both partners moved from normal operating arrangements into emergency response mode in order to react quickly and effectively to the evolving Covid-19 pandemic. Each partner adopted appropriate command and control structures and resilience arrangements as the mechanism for rapid decision making in line with their respective legislative responsibilities. Key meetings were held daily at the height of the pandemic to assess the situation and to take immediate decisions. Clear lines of reporting and escalation were in place to allow rapid assessment and resolution. Action logs and a separate Covid-19 risk register were maintained. Some services had to be stood down. Risks were assessed and consideration was given to the process for ensuring services were safely stood up once Covid-19 numbers reduced. 6.2 The pandemic impacted on the way health and social care services were delivered over the last year with many staff redeployed to critical service areas. In recent months, staff have returned to their substantive posts, though the recovery and remobilisation efforts will continue for the foreseeable future. 6.3 Within NLHSCP, a Wellbeing Group has been established to focus on supporting and developing the strategy for Staff Health and Wellbeing across the Partnership area. Of critical importance is the co-production and collaboration with multi-agency partners, representative of residential care, third sector colleagues, psychology, spiritual care and Locality Management Teams. 6.4 Both partners provided assurance to the IJB that satisfactory controls are in operation in respect of the delivery of the IJB delegated functions. Notwithstanding the changes necessary to respond to the Public Health emergency, both partners provided assurance that the governance arrangements remained appropriate and effective. 6.5 Both partners have well established stakeholder engagement mechanisms in place which were adjusted as appropriate during the pandemic. 6.6 During the Covid-19 pandemic elective activity was curtailed. At peak times it was suspended to allow all staffing resources to be diverted to treat the surge of Covid-19 patients but, even during periods of less demand, the need for additional physical distancing and infection control measures reduced the number of people who could be seen. Given the numbers waiting and the continued impact of working in an environment with Covid-19 present, the risk to getting back to normal waiting times performance is graded very high by the NHSL partner. To reduce harm, processes are in place for regularly reviewing the waiting lists and having a structured clinical prioritisation process to ensure the most urgent cases are seen first. This is combined with a review of very long waits over 52 weeks. Remobilisation plans continue to be developed and actioned. 6.7 Following the transfer of the discretionary Children, Families and Justice Services budgets from the IJB to NLC, a hosting arrangement was agreed in respect of the cross-cutting and support services which could not be allocated to either the IJB delegated services or to the discretionary functions transferred to NLC. This hosting arrangement is being implemented and monitored.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 24 6.8 The sustainability of GP services in its current format across NHSL since being placed on an emergency footing remains a very high risk. The South Lanarkshire IJB is the lead partner for this hosted service. Practical measures to reduce the pressure on GP practices include additional pharmacists, the transition of responsibility of vaccinations to Health Board staff, the availability of video/telephone consultations to help GP practices to continue to safely provide support to patients and the progression of a rolling programme to transfer the property responsibility to the NHS Board where GPs feel the property burden is affecting the practice’s attractiveness. Learning will also be taken from the measures put in place over the pandemic about alternative ways of accessing practice services. 6.9 The Out of Hours Service is a hosted service led by the South Lanarkshire IJB. In June 2019, the Primary Care Out of Hours service became very fragile with the inability to cover every clinical session to sustain the two-site model leading to the frequent closure of the Airdrie site. The risk level was raised to very high and this has continued at this level ever since. Active daily management has been required and business continuity plans are in place with planned redirection to A&E, improved triaging jointly with NHS 24, plans for the further recruitment of salaried GPs, increased numbers of advanced Nurse practitioners and a communication & engagement strategy. 6.10 NLC has identified that the transfer of phone lines from analogue to digital is a very high risk to the Community Alarm service. The current analogue alarms will not be able to work via a digital telephone line however the user will not be aware that this is the case. A provider advised NLC of their plans to migrate over 1,700 properties over onto a digital line. Contingency plans were therefore escalated which included the purchase of new alarms that can work on both analogue and digital infrastructures. Providers were also asked to delay implementation. 7. External and Internal Audit Arrangements 7.1 There are currently 9 external audit actions, with 2 complete, 4 ongoing and 3 delayed and overdue due to the pandemic response. However, work to progress to completion has re- started and aims to bring all outstanding to a quick conclusion. 7.2 The Internal Audit Plan 2021/2022 was presented to the PFAC for approval on 25th May 2021, at an earlier stage than in previous years, providing greater opportunity for implementation in year. 7.3 During 2020/2021, the joint internal audit arrangements were reviewed by the IJB Chief Financial Officer in consultation with both partners. The outcome of the review concluded that the current skills and expertise of each Internal Audit team are being deployed to best effect to achieve the following outcomes: provide the independent appraisal of the functions delegated to the IJB. assess the effective management of the strategic IJB risks contribute positively to the strategic commissioning intentions of the IJB and provide an opinion on the overall governance arrangements of the IJB. The joint approach is efficient, cost effective, minimises the complexities of accessing data to complete audit assignments and avoids unnecessary disruption to the auditees. The IJB Chief Financial Officer’s recommendation to the IJB that the joint Internal Audit service continue up to 2022/2023 was therefore approved and remains extant.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 25 Overview of Control and Governance Improvements during 2021/2022 Improvement areas to further strengthen the IJB’s governance arrangements during 2021/2022 were identified in the Annual Governance Statement included in the IJB Annual Accounts 2020/2021. A progress report in respect of these actions is detailed below. Ref. Improvement Area Action Undertaken 1 Completion of previous internal and external audit actions. Ongoing Some progress was made during 2021/2022, notably through completion of major actions within the Integration Review including a review of financial support arrangements and formal consultation on the updated Integration Scheme. 2 Review of Recruitment and Retention Strategies Progressed Wide range of work undertaken to support improved recruitment and retention in 2021/2022, including: Expansion of staff health and wellbeing activities including creation of local budgets for teams to access Refresh of the Care Academy approach Changes to post requirements such as removal of SVQ2 requirement in Home Support, with the service then supporting individuals to achieve the qualification at work Recruitment of additional HR supports to facilitate greater recruitment capacity with partner orgs Use of skill mix to support recruitment (e.g. new Nursing workforce within CAMHS) 3 Review of Set-Aside Concept Ongoing There have been no developments nationally on this. 4 Independent Review of Adult Social Care Services Progressed While the final form of the National Care Service remains unknown, the HSCP undertook a self-assessment exercise against the 53 recommendations of the Independent Review of Adult Social Care Services, which informed the IJB’s consultation responses.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 26 Overview of Control and Governance Improvements for 2022/2023 Following consideration of the internal review of the adequacy and effectiveness of the IJB governance arrangements, in addition to the ongoing continuous improvement actions from 2021/2022, further actions will be progressed in 2022/2023 to strengthen the good governance controls. These actions, including the timeline, are highlighted in the table below. Ref. Improvement Area Action Agreed Lead Officer Timeline 1 Completion of previous internal and external audit actions Although some progress was made during 2021/2022, all previously agreed internal and external audit actions were not completed. Progress was reported to each meeting of the PFAC throughout 21/22, with revised timescales agreed. Chief Financial Officer March 2023 2 National Care Service To develop a sound understanding of the impact for the NLHSCP of the outputs of the National Care Service legislation. Chief Officer March 2023 3 Implementation of improvement actions identified in the Best Value Self-Assessment exercise Following a self-assessment review assisted by the Improvement Service in February 2022, an action plan is being finalised to support the IJB in demonstrating Best Value, with actions to be completed throughout 2022/2023. Chief Officer March 2023 4 Review the IJBs progress in becoming a Category 1 Responder as set out within the Civil Contingencies Act In conjunction with the Local Resilience Partnership, undertake a self-assessment review against the seven duties, reporting progress to the West of Scotland Regional Resilience Partnership. Chief Officer March 2023
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 27 Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the partnership conducts its business in a manner that has due regard to the principles of good governance. This responsibility has continued throughout the Covid-19 pandemic and includes any changes to business processes that have been required throughout this period. Internal Audit monitor these changes. Overall, the results of all of the work undertaken by Internal Audit in 2021/2022, including shared system audits and the reports produced by External Audit, help to inform an opinion on whether the internal controls the NLHSCP has in place are adequate. The formal annual Internal Audit opinion on the soundness of the IJB’s internal control systems is presented jointly by the NLC Audit and Risk Manager and the NHSL Chief Internal Auditor. It was recognised that the IJB and both partners continue to function within a challenging environment. The additional challenges presented in 2021/2022 by the Covid-19 pandemic further increased the scale and complexity of issues. Internal Audit have a generally positive view of the IJB’s governance, internal control arrangements and progress to achieve previously agreed audit recommendations. 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. There are no matters that Internal Audit require to highlight in the Annual Governance Statement. Compliance with the requirements of the IJB corporate governance framework 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. The joint Internal Audit opinion is therefore 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. The Internal Audit work for 2022/2023 will continue to focus on key strategic and operational areas of risk for the IJB.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 28 Conclusion and Opinion on Assurance In response to the Public Health emergency, the governance arrangements which were adapted by the IJB and both partners in 2020/2021 to support the most effective response to the Covid-19 pandemic continued to be adopted throughout 2021/2022. This included changes to normal business operations, systems and controls. NLC and NHSL continued to respond pro-actively to the Covid-19 pandemic and emergency arrangements continued to be implemented when necessary to allow services to maintain an effective response, particularly to new Covid-19 variants and updated best practice and guidance. Risk assessments were also regularly reviewed and updated. Against this unprecedented backdrop, the IJB has adhered to the stated principles of good governance, acted in the public interest and been committed to continuous improvement. The IJB continues to comply with the CIPFA statements on the role of the Chief Financial Officer and the practical guidance for audit committees. In respect of the role of the Head of Internal Audit and the management of fraud and corruption, the IJB continues to place reliance on the arrangements in place with each partner. The scrutiny and oversight of the North Lanarkshire IJB PFAC contributes effectively to these arrangements. There were no significant control weaknesses, issues or failures in the expected standards for good governance, risk management and internal control. Assurances that adequate and effective systems of internal control are in place have been exchanged between the IJB and each partner. The IJB governance arrangements are effective and consistent with the recommendations of the CIPFA/SOLACE Framework (2016). The IJB considers that review processes are in place and are effective. Making transformational change, at the same time as managing existing services and funding pressures, particularly during the ongoing Covid-19 pandemic, continues to be challenging. Both partners will experience significant challenges in recovering from the pandemic. There will be a significant backlog of activity to be addressed. Workforce and financial resources will be stretched. Response, recovery and remobilisation plans are being refreshed to ensure available resources are prioritised and new approaches, which have proven to be effective, continue to be implemented. While recognising that continuous improvement actions will be progressed during the seventh year of operation, it is the IJB’s opinion that reasonable and objective assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements and that any significant risks impacting on the IJB’s principal objectives will be identified and actions taken to avoid or mitigate their impact. This assurance is limited, however, to the work undertaken during the year, the assurances provided by each partner and the evidence available at the time of preparing this statement. In partnership with NHSL and NLC, the IJB continues to have effective and robust structures in place to deliver the commissioning intentions. The good governance arrangements across the NLHSCP also effectively contribute to the implementation of the objectives of both partners. Approved By Cllr Ayeshah Khan Ross McGuffie Chair Chief Officer Date: 30 November 2022 Date: 30 November 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 29 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2022 This statement shows the actual cost of providing services in accordance with generally accepted accounting practices, the total funding contributions from the partners and the surplus on activities during the year. 2020/2021 2021/2022 Gross Expenditure Gross Income Net Expenditure Gross Expenditure Gross Income Net Expenditure £m £m £m £m £m £m 189.048 (1.226) 187.822 Social Care Services 202.610 (1.593) 201.017 105.773 0.000 105.773 Family Health Services 109.652 0.000 109.652 69.088 0.000 69.088 Prescribing Costs 68.739 0.000 68.739 141.034 0.000 141.034 Hosted Services (Note 10) 149.126 0.000 149.126 63.066 0.000 63.066 Hospital Acute Services (Notional Set Aside Budget) 65.164 0.000 65.164 65.557 0.000 65.557 Health Care Services 74.073 0.000 74.073 1.281 (1.281) 0.000 Housing Services 1.668 (1.668) 0.000 0.000 0.000 0.000 Transport Services 0.539 (0.539) 0.000 0.212 0.000 0.212 Corporate Services (Note 6) 0.214 0.000 0.214 21.342 0.000 21.342 Covid-19 Costs (Note 13) 13.412 0.000 13.412 656.401 (2.507) 653.894 Cost of Services 685.197 (3.800) 681.397 0.000 (666.991) (666.991) Taxation and Non- Specific Grant Income (Note 5) 0.000 (702.633) (702.633) 0.000 (23.607) (23.607) Covid-19 Funding (Note 13) 0.000 (45.098) (45.098) 656.401 (693.105) (36.704) Deficit or (surplus) on provision of services and total comprehensive (income) and expenditure (Note 4) 685.197 (751.531) (66.334) The IJB was established on 27 June 2015. Integrated delivery of health and social care services commenced on 1 April 2016. 2021/2022 is the sixth year of operation for the IJB. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 30 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. Movements in Reserves General Fund Balance £m Total Reserves £m Opening balance at 1 April 2020 16.414 16.414 Total Comprehensive Income and Expenditure (36.704) (36.704) Increase or (decrease) in 2020/2021 36.704 36.704 Opening balance at 1 April 2021 53.118 53.118 Total Comprehensive Income and Expenditure (66.334) (66.334) Increase or (decrease) in 2021/2022 66.334 66.334 Closing balance at 31 March 2022 119.452 119.452
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 31 BALANCE SHEET AS AT 31 MARCH 2022 The balance sheet shows the value as at 31 March 2022 of the IJB’s assets and liabilities at the balance sheet date. The net assets of the IJB are matched by the reserves held by the IJB. Notes 31 March 2022 £m 31 March 2021 £m Current assets Short term debtors 7 119.452 53.118 Net assets / (liabilities) 119.452 53.118 Usable reserves 11 119.452 53.118 Total reserves 119.452 53.118 The Statement of Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2022 and its income and expenditure for the year then ended. The unaudited accounts were authorised for issue on 24 June 2022. These audited accounts certified by the Chief Financial Officer on 30 November 2022 replace the unaudited accounts. Authorised by Amanda Kilburn Chief Financial Officer Date: 30 November 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 32 NOTES TO THE FINANCIAL STATEMENTS 1. Accounting policies 1.1 General principles The financial statements summarise the transactions of the IJB for the financial year 2021/2022and its position at the year end of 31 March 2022. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between North Lanarkshire Council and NHS Lanarkshire. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2021/2022, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. Each partner complies with their accounting policies as appropriate. 1.2 Going concern The annual accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. 1.3 Accounting convention The annual accounts are prepared under the historical cost convention. 1.4 Accruals of income and expenditure Activity is accounted for in the year that it relates to and not simply when financial transactions are undertaken. In particular: Expenditure is recognised when goods or services are received and their benefits are used by the IJB. Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income, and receipt of the income is probable. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. Where debts may not be received, the balance of debtors is written down. 1.5 Funding The IJB is primarily funded through funding contributions from the statutory funding partners, North Lanarkshire Council and NHS Lanarkshire, to fund its services. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Lanarkshire. 1.6 Cash and cash equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a “cash and cash equivalent” figure on the balance sheet. There is therefore no requirement for the IJB to prepare a cash flow statement. The funding balance due to or from each funding partner as at 31 March 2022 is represented as a debtor or creditor on the IJB’s balance sheet. 1.7 Employee benefits The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a pensions liability on its balance sheet.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 33 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 1. Accounting policies (Cont.) 1.8 Corporate services The IJB has a legal responsibility to appoint a Chief Officer. A Chief Financial Officer has also been appointed to the IJB. The details in respect of these arrangements are outlined in the Remuneration Report. The charges from the employing partner are treated as employee costs within Corporate Services. The absence entitlement of both the Chief Officer and the Chief Financial Officer as at 31 March 2022 is not material and has therefore not been accrued. 1.9 Contingent Liability A contingent liability is a possible liability arising from events on or before 31 March 2022 whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s balance sheet but is disclosed in a note where it is material. 1.10 Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities. NHS Lanarkshire and North Lanarkshire Council have responsibility for claims in respect of the services that they are statutory responsible for and that they provide. Unlike NHS Boards, the IJB does not have any “shared risk” exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The IJB participation in CNORIS is therefore analogous to normal insurance arrangements. 1.11 Debtors and creditors Where income and expenditure have been recognised but cash has not been received or paid, a debtor or creditor for the relevant amount is recorded in the balance sheet. Debtors have been analysed as short term debtors which is income receivable within one year on the basis that these reserves could be utilised at any time. A bad debt provision is not assessed as necessary as the debtor balances represent usable reserves held by each partner on behalf of the IJB. There are no creditor balances. 1.12 Reserves A reserve is the accumulation of surpluses, deficits and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2022, the usable reserve balance totals £119.452million. There are no unusable reserves. 1.13 Specific Service Income Income may be received from individuals as a contribution towards the cost of their social care services. The amount collected is allocated to the relevant expenditure category and the net cost is reported in the Comprehensive Income and Expenditure Statement. This is the basis upon which the 2021/2022 annual accounts have been prepared.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 34 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 2. Critical judgements and estimation uncertainty The critical judgements made in the financial statements relating to complex transactions include the following: The accounting treatment of hosted services and the hospital acute services (set-aside). Expenditure in respect of these services is included in the financial statements on the basis of estimated figures. Estimates are made taking into account the best available information, however, actual results could be materially different from the assumptions and estimates used. This is further explained at notes 2.1 and 2.2. 2.1 Hosted Services In applying the accounting policies set out above, the IJB has had to make a critical judgement relating to complex transactions in respect of values included for services hosted within North Lanarkshire IJB for South Lanarkshire IJB. Within Lanarkshire, each IJB has operational responsibility for the services which it hosts on behalf of the other IJB. In delivering these services the IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such, the IJB is considered to be acting as “principal” and the full costs are now reflected within the annual accounts for the services it hosts. This is the basis upon which the 2021/2022 annual accounts have been prepared. The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the North Lanarkshire IJB on the basis of 51% of the total expenditure. 49% of the services relating to the South Lanarkshire IJB are also included as the North Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the annual accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service. 2.2 Hospital Acute Services (Set Aside) The legislation sets out that Integration Authorities are responsible for the strategic planning of hospital services most commonly associated with the emergency care pathway along with primary and community health care and social care services. As the emergency care services in large hospitals, both within Lanarkshire and out of region, are used by the residents of multiple IJBs and are delivered using resources shared with other hospital services, estimating the resource used each year by each IJB involves a complex allocation methodology. This is enabled by a national NHS Information Services Division (ISD), now under NHS Public Health Scotland (PHS), and involves apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJBs based on postcode.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 35 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 2. Critical judgements and estimation uncertainty (Cont.) 2.2 Hospital Acute Services (Set Aside) (Cont.) The complexity of this exercise means the results are produced at a time lag of over a year. The 2019/20 data was expected to be available during 2021/2022 however difficulties were experienced by NHS PHS in completing the 2019/20 exercise so this resource review has still to take place. The latest available data therefore remains 2018/19. In respect of the data which is currently available for each of the 3 years between 2016/17 and 2018/19, as detailed in the table below, the estimated costs of providing the services exceeded the budget. The notional budget has been increased by funding uplifts and adjusted to reflect the impact of agreed service changes. The actual cost reflects the costed patient activity produced by NHS ISD. The additional cost was borne by NHSL in each year rather than recharged to the IJB. Year Notional Budget £m Actual Cost £m Underspend/(Overspend) £m 2016/2017 57.250 57.444 (0.194) 2017/2018 56.719 58.373 (1.654) 2018/2019 58.103 58.693 (0.590) There have been no developments nationally during the year which offer a more timeous complete solution. Research reported by the NHS Finance Director has revealed that some Boards use preset apportionments of their ledger costs and discussions will continue as to whether a more timely but less precise methodology like that would have merit in future. 3. Events after the reporting period The Chief Financial Officer authorised the audited annual accounts for issue on 30 November 2022. There have been no other material events since the date of the balance sheet which require revision to the figures in the annual accounts.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 36 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 4. Expenditure and Income Analysis by Nature 2020/2021 £m 2021/2022 £m 189.048 Social Care Services 202.610 105.773 Family Health Services 109.652 69.088 Prescribing Costs 68.739 110.374 Hosted Services - Led by the North IJB (Note 10) 114.573 30.660 Hosted Services - Led by the South IJB 34.553 141.034 Hosted Services – Total 149.126 63.066 Hospital Acute Services (Notional Set Aside Budget) 65.164 52.430 Health Care Services – Localities 58.073 8.648 Health Care Services - Area Wide 11.010 4.480 Health Care Services - Out-of Area 4.990 65.558 Health Care Services – Total 74.073 0.741 Housing Services - Housing Revenue Account 1.183 0.540 Housing Services - General Fund 0.485 1.281 Housing Services – Total 1.668 0.000 Transport Services 0.539 0.212 Corporate Services 0.214 21.342 Covid-19 Costs 13.412 656.401 Total Gross Expenditure 685.197 (518.560) Funding Contribution - NHS Lanarkshire (537.845) (148.431) Funding Contribution - North Lanarkshire Council (164.788) (2.507) Specific Service Income (3.800) (23.607) Covid-19 Funding (45.098) (693.105) Total (Income) (751.531) (36.704) Deficit or (surplus) on the provision of services (66.334)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 37 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 5. Taxation and Non-Specific Grant Income 2020/2021 £m 2021/2022 £m (518.560) Funding Contribution from NHS Lanarkshire (537.845) (148.431) Funding Contribution from North Lanarkshire Council (164.788) (666.991) Total (702.633) The funding contribution from the NHS Board shown above includes £65.164m in respect of the “set aside” resources relating to acute hospital and other resources. These are provided by NHS Lanarkshire which retains responsibility for managing the costs of providing these services. The IJB however, has responsibility for the consumption of, and level of demand placed on, these resources. The funding contributions from the partners shown above exclude any funding which is ring- fenced for the provision of specific services. Such ring-fenced funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement. The ring fenced contributions received by the North Lanarkshire IJB are detailed as follows: 2020/2021 £m 2021/2022 £m (0.741) Housing Revenue Account (1.183) (0.540) Garden Assistance Scheme Income (0.485) (1.281) Housing Services Total (1.668) The funding contributions from the partners shown above also exclude specific service income contributions from individuals towards the cost of their social care services. In 2021/2022 this income totalled £1.592m and is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement on page 29. There are no other non-ring fenced grants or contributions. 6. Corporate Services 31 March 2021 £m 31 March 2022 £m 0.182 Staff Costs 0.183 0.027 External Audit Fee 0.028 0.003 Administration Costs 0.003 0.212 Total 0.214
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 38 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 7. Short Term Debtors 31 March 2021 £m 31 March 2022 £m 36.400 NHS Lanarkshire 87.533 16.718 North Lanarkshire Council 31.919 53.118 Total 119.452 All balances due to the IJB from the partner bodies have been classified as short term debtors on the basis that these reserves could be utilised at any time. 8. Contingent Liabilities The IJB is unaware of any material contingent liability as at 31 March 2022. Contingent liabilities represent items that at 31 March 2022 are not recognised in the IJB’s annual accounts because there is significant uncertainty at that date as to the necessity of the partner or IJB to make payments in respect of them. 9. VAT The IJB is not VAT registered and as such the VAT is settled or recovered by the partner agencies. The VAT treatment of expenditure in the IJB’s annual accounts depends on which of the partner agencies is providing the service as these are treated differently for VAT purposes. Where North Lanarkshire Council is the provider, income and expenditure excludes any amounts related to VAT, as collected VAT is payable to HM Revenue & Customs and all VAT paid is recoverable from it. North Lanarkshire Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from HM Revenue & Customs. Where NHS Lanarkshire is the provider, expenditure incurred will include irrecoverable VAT as, generally, NHS Lanarkshire cannot recover VAT paid as input tax and will seek to recover its full cost as income from the IJB. The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 39 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 10. Hosted Services - Principal Income and Expenditure On behalf of the South Lanarkshire IJB within the NHS Lanarkshire area, the North Lanarkshire IJB acts as the lead for a number of delegated services. It therefore commissions services on behalf of the South Lanarkshire IJB and reclaims the costs involved. The payments that are made on behalf of the South Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since the North Lanarkshire IJB is acting as principal in these transactions. The net amount of expenditure and income relating to these principal arrangements is shown below: 2020/2021 Delegated Services - Services hosted by the North Lanarkshire IJB On behalf of the South Lanarkshire IJB 2021/2022 Expenditure on hosted services Income from hosted services Net Expenditure Expenditure on hosted services Income from hosted services Net Expenditure £m £m £m £m £m £m 1.360 (1.360) 0.000 Sexual Health Services 1.442 (1.442) 0.000 1.057 (1.057) 0.000 Continence Services 1.099 (1.099) 0.000 0.908 (0.908) 0.000 Immunisation Services 1.077 (1.077) 0.000 2.862 (2.862) 0.000 Speech and Language Therapy Services 2.962 (2.962) 0.000 3.930 (3.930) 0.000 Children and Adult Mental Health Services 6.097 (6.097) 0.000 5.591 (5.591) 0.000 Children’s Services 5.619 (5.619) 0.000 0.253 (0.253) 0.000 Integrated Equipment and Adaptation Service 0.278 (0.278) 0.000 1.854 (1.854) 0.000 Dietetics Services 1.864 (1.864) 0.000 2.081 (2.081) 0.000 Podiatry Services 2.118 (2.118) 0.000 0.848 (0.848) 0.000 Prisoner Healthcare Services 0.984 (0.984) 0.000 0.703 (0.703) 0.000 Blood Borne Virus Services 0.739 (0.739) 0.000 1.062 (1.062) 0.000 Hospital at Home Services 1.264 (1.264) 0.000 34.988 (34.988) 0.000 Mental Health Services 38.312 (38.312) 0.000 57.497 (57.497) 0.000 South Lanarkshire IJB Total 63.855 (63.855) 0.000 52.877 (59.843) (6.966) North Lanarkshire IJB Total 50.718 (65.994) (15.276) 110.374 (117.340) (6.966) Total services hosted by the North Lanarkshire IJB (Note 4) 114.573 (129.849) (15.276)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 40 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 10. Hosted Services - Principal Income and Expenditure (Cont.) Similarly, the South Lanarkshire IJB within the NHS Lanarkshire area acts as the lead for a number of delegated services on behalf of the North Lanarkshire IJB. The payments that are made by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since this expenditure is incurred for the residents of North Lanarkshire. The net amount of expenditure and income relating to those principal arrangements hosted by the South Lanarkshire IJB is shown below: 2020/2021 Delegated Services - Hosted Services 2021/2022 Expenditure on hosted services Income from hosted services Net Expenditure Expenditure on hosted services Income from hosted services Net Expenditure £m £m £m £m £m £m 7.373 (7.373) 0.000 Primary Care Improvement Fund 8.870 (8.870) 0.000 3.325 (3.325) 0.000 Community Dental Services 3.758 (3.758) 0.000 4.255 (4.255) 0.000 Out of Hours Services 4.509 (4.509) 0.000 2.211 (2.211) 0.000 Diabetic Services 2.929 (2.929) 0.000 4.565 (4.565) 0.000 Occupational Therapy Services 5.180 (5.180) 0.000 3.636 (3.636) 0.000 Palliative Care Services 3.770 (3.770) 0.000 0.378 (0.378) 0.000 Primary Care Services 0.389 (0.389) 0.000 4.917 (4.917) 0.000 Physiotherapy Services 5.148 (5.148) 0.000 30.660 (30.660) 0.000 Services hosted by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB (Note 4) 34.553 (34.553) 0.000
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 41 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 11. Usable Reserve: General Fund The purposes of the General Fund are detailed in the IJB Reserves Policy7. Funding received for a specific purpose and not yet spent will be allocated to a ring-fenced reserve. Funding for future expenditure needs and key financial risks will be allocated to earmarked reserves. A contingency reserve is required to cushion the impact of unexpected events or emergencies. This is a key part of the risk management strategy. The table below shows the movements on the General Fund balance, analysed between these purposes and the amount held as a general contingency. 7 https://mars.northlanarkshire.gov.uk/egenda/images/att91214.pdf Balance As At 1 April 2020 Transfers Out Transfers In Balance As At 31 March 2021 Useable Reserve Transfers Out Transfers In Balance As At 31 March 2022 £m £m £m £m Ring-Fenced Reserves £m £m £m 0.000 0.000 6.076 6.076 Integrated Authority Support 0.000 0.000 6.076 0.086 (0.086) 2.358 2.358 Mental Health and Learning Disability Services - Action 15 Funding (2.355) 0.000 0.003 0.000 0.000 2.265 2.265 Covid-19 Funding (2.265) 31.686 31.686 0.000 0.000 1.941 1.941 Winter Adult Social Care Preparedness Fund 0.000 0.000 1.941 0.000 0.000 1.298 1.298 Community Living Change Fund 0.000 0.000 1.298 0.313 0.000 0.964 1.277 Alcohol and Drug Partnership Funding (0.135) 0.000 1.142 0.000 0.000 0.900 0.900 Children and Adolescent Mental Health Services Funding 0.000 0.000 0.900 0.647 (0.127) 0.300 0.820 Mental Health and Learning Disability Services - Distress Brief Intervention (0.712) 0.000 0.108 1.290 (0.271) 2.748 3.767 Ring-fenced Reserves - Other Services (1.203) 0.000 2.564 2.336 (0.484) 18.850 20.702 Ring-Fenced Reserves Total (6.670) 31.686 45.718 Earmarked Reserves 0.000 0.000 3.988 3.988 Social Care Services (Risk Based Reserve) 0.000 0.000 3.988 3.214 (3.214) 0.000 0.000 Self Directed Support Strategy (Risk Based Reserve) 0.000 0.000 0.000 3.786 0.000 0.575 4.361 Prescribing Fund (Risk Based Reserve) 0.000 0.000 4.361 0.384 0.000 6.188 6.572 IJB Financial Plan 2022/2023 (NLC) 0.000 0.000 6.572 0.000 0.000 3.000 3.000 Long Covid Contingency (Risk Based Reserve) 0.000 0.000 3.000 0.000 0.000 1.500 1.500 Minor Capital Works (0.113) 0.000 1.387 0.000 0.000 0.807 0.807 Speech, Language and Therapy Services 0.000 0.000 0.807 0.000 0.000 0.717 0.717 Children and Adolescent Mental Health Services Funding 0.000 0.000 0.717 0.000 0.000 0.600 0.600 Digital and IT Strategy Technology Improvements Funding (0.034) 0.000 0.566 0.580 0.000 0.000 0.580 Carers Act 2018 0.000 0.000 0.580 0.000 0.000 0.000 0.000 Earmarked Reserves 2021/2022 0.000 42.984 42.984 2.430 (0.492) 4.669 6.607 Earmarked Reserves - Other Services (1.519) 0.000 5.088 10.394 (3.706) 22.044 28.732 Earmarked Reserves Total (1.666) 42.984 70.050 3.684 0.000 0.000 3.684 Contingency Reserve Total 0.000 0.000 3.684 16.414 (4.190) 40.894 53.118 General Fund Total (8.336) 74.670 119.452 0.000 3.214 (3.214) 0.000 Transfer Between Reserves 0.000 0.000 0.000 16.414 (0.976) 37.680 53.118 Movement In Reserves (Decrease)/Increase (8.336) 74.670 119.452 2020/2021 2021/2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 42 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 12. Related Party Transactions The IJB has related party transactions with NHS Lanarkshire and North Lanarkshire Council. In particular, the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the IJB’s annual accounts are presented to provide additional information on the relationships. 2020/2021 £m Transactions with NHS Lanarkshire 2021/2022 £m (518.560) Funding Contributions received from NHS Lanarkshire (537.845) (23.607) Covid-19 Funding (45.098) 444.518 Expenditure on Services Provided by NHS Lanarkshire 466.753 6.145 Covid-19 Costs 5.347 0.030 Support Services 0.031 (91.474) Net Transactions with NHS Lanarkshire (110.812) Key Management Personnel: The non-voting Board members are not directly employed by NHS Lanarkshire however a contribution of 50% of the cost of the Chief Officer and the Chief Financial Officer is made by NHS Lanarkshire. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. Details of the remuneration of these post holders is included in the Remuneration Report. NHS Lanarkshire provide a range of support services for the IJB including finance services, personnel services, planning services, audit services, payroll services and creditor services. There is no charge from NHS Lanarkshire to the IJB for these support services. 31 March 2021 £m Balances with NHS Lanarkshire 31 March 2022 £m 36.400 Debtor balances: Amounts due from NHS Lanarkshire 87.533 36.400 Net Balance with NHS Lanarkshire 87.533 2020/2021 £m Transactions with North Lanarkshire Council 2021/2022 £m (148.431) Funding Contributions received from North Lanarkshire Council (164.787) (2.507) Service Income received from North Lanarkshire Council (3.800) 0.000 Covid-19 Funding 0.000 190.329 Expenditure on Services Provided by North Lanarkshire Council 204.817 15.197 Covid-19 Costs 8.065 0.182 Key Management Personnel: Non-Voting Board Members 0.183 54.770 Net Transactions with North Lanarkshire Council 44.478
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 43 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 12. Related Party Transactions (Cont.) Key Management Personnel: The Chief Officer is a non-voting Board member and is directly employed by North Lanarkshire Council. The Chief Financial Officer is also a non-voting Board member and is directly employed by South Lanarkshire Council. The cost of the Chief Financial Officer post is shared equally between North Lanarkshire and South Lanarkshire Council. The total cost of the Chief Officer and the Chief Financial Officer is paid by North Lanarkshire Council. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. A contribution of 50% of this cost is met by NHS Lanarkshire. Details of the remuneration of these post holders is included in the Remuneration Report. North Lanarkshire Council also provide a range of support services for the IJB including finance services, personnel services, planning services, legal services, audit services, payroll services and creditor services. There is no charge from North Lanarkshire Council to the IJB for these support services. 31 March 2021 £m Balances with North Lanarkshire Council 31 March 2022 £m 16.718 Debtor balances: Amounts due from North Lanarkshire Council 31.919 16.718 Net Balance with North Lanarkshire Council 31.919 The financial information contained in the IJB annual accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double counting. 13. Covid-19 Costs and Funding Additional funding was provided by the Scottish Government to respond to the Covid-19 pandemic and to support the remobilisation of services. The Covid-19 funding and Covid-19 costs are summarised as follows: 2020/2021 Description 2021/2022 £m £m (23.607) Covid-19 Funding Total (45.098) 6.145 Allocated To NHSL Costs 5.347 15.197 Allocated To NLC Costs 8.065 21.342 Covid-19 Costs Total 13.412 (2.265) Remobilisation Funding Transferred To Reserves (31.686) 14. New standards issued but not yet adopted The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 44 Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2022 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2021/22 (the 2021/22 Code). In my opinion the accompanying financial statements: give a true and fair view in accordance with applicable law and the 2021/22 Code of the state of affairs of the body as at 31 March 2022 and of its income and expenditure for the year then ended; have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2021/22 Code; and have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 10 April 2017. The period of total uninterrupted appointment is 6 years. I am independent of the body in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 45 These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, I report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Financial Officer and the Integrated Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Integrated Joint Board determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The Integrated Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: obtaining an understanding of the applicable legal and regulatory framework and how the body is complying with that framework; identifying which laws and regulations are significant in the context of the body; assessing the susceptibility of the financial statements to material misstatement, including how fraud might occur; and considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 46 The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited part of the Remuneration Report I have audited the part of the Remuneration Report described as audited. In my opinion, the audited part of the Remuneration Report has been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Financial Officer is responsible for other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 P a g e | 47 the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: adequate accounting records have not been kept; or the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or I have not received all the information and explanations I require for my audit; there has been a failure to achieve a prescribed financial objective. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 120 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Brian Howarth ACMA CGMA Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT
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1 REPORT Item No: 7 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 30 September 2022 (Health Care Services) and 1 April 2022 to 14 October 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; and (2) Note that the financial position in September is an underspend of £7.658m (NHSL - £3.838m; NLC - £3.820m). This excludes the impact of further recruitment challenges and staff turnover and any potential new Scottish Government funding. 4. VARIATIONS TO DIRECTIONS 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 September 2022 is summarised as follows: there is a net underspend of £3.838m on the core budgets within Health Care Services 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 North HSCP DATE: 30 November 2022 Yes No N/A
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2 there is a net underspend of £3.820m on the core budgets within Social Care and Housing Services The total underspend represents approximately 1.1% 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 The 2022/2023 Covid-19 costs are being reported to the Scottish Government through the Lanarkshire Finance Performance Return on a monthly basis. There continues to be a significant degree of uncertainty in respect of the financial implications of the Covid-19 pandemic however the Scottish Government have advised IJBs that they will reclaim surplus Covid-19 reserves to be redistributed across the sector to meet current Covid-19 priorities. There is ongoing dialogue with the Scottish Government in respect of this potential reclaim. 6.4 The budget variance is analysed by care services at appendix 1 and the main factors contributing to the financial position are summarised at sections 8 and 9. 7. BUDGET ADJUSTMENTS 7.1 The reconciliation of the budget adjustments between April 2022 and September 2022 is attached at appendix 4 for information. 8. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES 8.1 Locality and Other Services 8.1.1 There is a net underspend of £1.182m. 8.1.2 The net underspend on pay costs totals £1.598m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities totalling 62.46 FTE. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. 8.1.3 In respect of non-pay costs, there is a net overspend totalling £0.416m. The overspend is mainly due to payments in respect of Strathcarron Hospice (£0.285m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. 8.2 Prescribing 8.2.1 A break-even position is reported at this stage. 8.2.2 The prescribing budget has reduced by £0.657m since 31 March 2022. The majority of the budget reduction relates to the savings target and a change in Scottish Government tariff prices. The budget reduction has been partly offset by a 2% inflation uplift. 8.2.3 Prescribing activity figures for the period from April 2022 to July 2022 have been received. Prescribing activity is 3% higher when compared to the same period last year. The cost per item is, however, lower due to a reduction in the tariff price.
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3 8.2.4 There is 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 to be closely monitored. 8.3 Hosted Services Led By North Lanarkshire 8.3.1 The hosted services which are led by the North Lanarkshire HSCP are outlined at Appendix 2. There is a net underspend of £2.159m which includes the following significant variances: Mental Health and Learning Disability Services £0.594m underspend Children and Adolescents Mental Health Services £0.687m underspend Children Services £0.234m underspend Speech and Language Therapy £0.457m underspend Immunisation Service £0.220m overspend 8.3.2 Within Mental Health and Learning Disability Services there is a net underspend on pay costs totalling £588k and a small overspend in Medical due to locum costs. Learning Disability Services, Management Team, Medical, Rehab and Recovery and Perinatal and Infant Mental Health are awaiting further funding from Scottish Government, which will increase the overall underspend. Current vacancies within this area total 61.6 FTE and are mostly within Old Age Psychiatry, Mental Health Addictions and Psychological Services. 8.3.3 Children and Adolescents Mental Health Services underspend is mainly within pay costs as the service currently has 53.55 FTE vacant posts within nursing and admin and clerical. 8.3.4 Children Services are also experiencing an underspend in pay costs due to current vacancies totalling 5.37 FTE within nursing and admin and clerical. This underspend is off setting the overspend of £66k mainly due to equipment costs. 8.3.5 Speech and Language Therapy are also experiencing high vacancies totalling 25.78 FTE which equates to £396k of the reported underspend. 8.3.6 Within the Immunisation Service, the overspend is due to incremental drift within pay costs totalling £112k and an overspend in drugs. 8.4 Hosted Services Led By South Lanarkshire 8.4.1 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. 8.5 Covid-19 Pandemic – Additional Health Care Costs 8.5.1 The additional health care costs which have been incurred in response to the Covid-19 pandemic continue to be reported to the Scottish Government through the Financial Performance Return. The year-to-date costs of £2.020m are included within the financial position reported and will be met by an existing IJB Covid-19 reserve.
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4 8.6 Average Vacancy Factor 8.6.1 The vacancy position against the funded establishment at 30 September 2022 is summarised as follows: 8.6.2 To help cover the current vacant posts, additional hours are worked through bankaide, overtime and excess part time hours, the cost of which is included within the financial position reported. 8.7 Notional Set-Aside Allocation 8.7.1 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. 8.7.2 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. 8.7.3 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). 9. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES 9.1 A net underspend of £3.820m is reported as at 14 October 2022. The main factors contributing to this year-to-date financial position are highlighted below. 9.2 Employee Costs 9.2.1 As previously highlighted, there are ongoing challenges in terms of recruitment and retention due to limited availability of the skills mix required within the workforce market. These are issues that are being faced by IJBs across Scotland, not only in North Lanarkshire. 9.2.2 Expenditure in Home Support Services has also increased as the service continues to support delayed discharges and demand. However, these additional employee costs are being offset by earmarked reserve funding and current SERVICE ESTABLISHMENT (FTE) ACTUAL (FTE) VACANCIES (FTE) VACANCIES (%) North West Locality 385.06 344.69 40.37 10.5% North East Locality 323.52 299.70 23.82 7.4% Adults Services 272.28 249.78 22.50 8.3% Childrens Services 549.14 461.48 87.66 16.0% Mental Health 1,149.94 1,082.98 66.96 5.8% Other 124.87 207.33 -82.46 -66.0% TOTAL 2,804.81 2,645.96 158.85 5.7%
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5 underspends as a result of vacancies. A net underspend across employee costs of £1.846m is therefore reported. 9.3 Payments to Other Bodies 9.3.1 There is an underspend of £1.091m 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. 9.3.2 There is also an underspend in package costs due to slippage in Self-Directed Support service start dates however, it is anticipated that these are in-year underspends only and the full budget will be required in 2023/2024. 9.4 Administration Costs 9.4.1 An underspend of £0.809m is reported in respect of administration costs. This is mainly due to an underspend across the carers budget. The anticipated underspend is reflective of the part-year implementation of contracts and additional funding from the Scottish Government for carers pressures in 2022/2023. As these pressures become evident within social care budgets, the funding will be moved to the relevant care package. 9.5 Covid-19 Pandemic – Additional Social Care Costs 9.5.1 Covid-19 additional costs for 2022/2023 is estimated to be £2.106m. This forecast is related to continued support to care providers in relation to sustainability payments. In line with the current Scottish Government guidance, this is expected to continue until March 2023. 10. RESERVES 10.1 The current reserve balances as at 30 September 2022 are as follows: 10.2 The 2022/2023 IJB Reserves Strategy is presented an additional paper and gives full details of all year-to-date movement and reserves balances. 11. 2022/2023 PROJECTED OUTTURN 11.1 The Scottish Government are currently implementing a plan to recover uncommitted Covid-19 reserves and have also advised IJBs that some 2022/2023 funding will only be made available once all respective reserves have been depleted. This will increase pressure on current budgets and provides uncertainty for funding in future years. There is also increased winter period pressures when Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 66.590 0.000 (17.311) 49.279 NHSL & NLC Earmarked Reserves 26.802 3.075 (1.015) 28.862 NHSL & NLC Risk-Based Reserves 21.894 (3.075) 0.000 18.819 NHSL Contingency Reserves 4.167 0.000 0.000 4.167 119.452 (0.000) (18.326) 101.126Total SUMMARYLEAD
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6 costs tend to escalate along with the uncertainty of future Covid-19 costs as we continue through the recovery stage. 11.2 On the assumption that 2022/2023 funding will be made available if needed and excluding the impact of further recruitment challenges and staff turnover, the projected outturn at year end is estimated to be an underspend of c£14m. 11.3 Subject to IJB approval, this estimated underspend will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional future business plans and any funding gap which may be highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023-2026. 11.4 The total costs and funding available for 2022/2023 is being closely monitored by both partners and the IJB. 12. RISK 12.1 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. 12.2 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. 12.3 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 the recovery, redesign and remobilisation work to reinstate services. The whole system approach continues to be adopted by NHSL, NLC and South Lanarkshire Council. 12.4 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 Term Financial Plan 2023 - 2026 is being compiled. 13. IMPLICATIONS 13.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 13.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. The IJB Medium Term Financial Plan 2023 -2026 is currently being completed. 13.3 FINANCIAL This paper has been reviewed by Finance:
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7 Yes No N/A 13.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 12. The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 13.5 PEOPLE None 13.6 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. 13.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 13.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 14. BACKGROUND PAPERS None. 15. APPENDICES North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Hosted Services Led by North Lanarkshire Appendix 2 Hosted Services Led by South Lanarkshire Appendix 3 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 ........................................... Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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8 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Expenditure Annual Budget Budget Actual General Ring-Fenced Total 2022/2023 September 2022 September 2022 September 2022 September 2022 September 2022 £m £m £m £m £m £m Health Care Services Locality and Other Services 48.533 24.256 23.074 1.182 0.000 1.182 Addiction Services 5.272 1.565 1.132 0.433 0.000 0.433 Medical and Nursing Directorate 4.490 2.234 2.226 0.008 0.000 0.008 Prescribing 69.582 34.791 34.791 0.000 0.000 0.000 Out of Area Services 4.571 2.286 2.292 (0.006) 0.000 (0.006) Area Wide Services 10.502 4.703 4.640 0.062 0.000 0.062 Hosted Services 160.249 75.398 73.239 2.159 0.000 2.159 Family Health Services 107.108 56.025 56.025 0.000 0.000 0.000 Set-Aside Budget 66.858 33.429 33.429 0.000 0.000 0.000 Covid-19 1.812 1.812 1.812 0.000 0.000 0.000 Total Expenditure - NHSL 478.977 236.499 232.660 3.838 0.000 3.838 Social Care Services Social Care Services Gross Expenditure 241.864 110.214 106.484 3.729 0.000 3.729 Social Care Services Gross Income (Including Covid-19 Income) (3.003) (3.746) (3.837) 0.091 0.000 0.091 Social Care Services Net Expenditure 238.861 106.468 102.648 3.820 0.000 3.820 Housing Revenue Account Expenditure 1.870 1.125 1.125 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 241.282 107.762 103.942 3.820 0.000 3.820 Social Care and Housing Services Sub-Total 241.282 107.762 103.942 3.820 0.000 3.820 Total Expenditure - NHSL and NLC 720.259 344.261 336.603 7.658 0.000 7.658 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (460.651) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.717) Scottish Government Funding - Covid-19 and Remobilisation (2.020) Transfer from Reserves (Approved) (16.306) Total Funding - NHSL (532.079) 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 (720.259) Year To Date Year To Date Variance 2022/2023
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9 Hosted Services Appendix 2 Led by the North Partnership Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 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 2.880 1.446 1.379 0.067 1.469 0.737 0.670 0.067 1.411 0.709 0.709 0.000 Continence Services 2.361 1.181 1.204 (0.023) 1.204 0.602 0.625 (0.023) 1.157 0.579 0.579 0.000 Immunisation Services 1.898 0.818 1.038 (0.220) 0.968 0.417 0.637 (0.220) 0.930 0.401 0.401 0.000 Speech and Language Therapy Services 6.082 3.046 2.589 0.457 3.102 1.553 1.096 0.457 2.980 1.493 1.493 0.000 Children and Adolescents Mental Health Services 16.471 5.483 4.796 0.687 8.400 2.796 2.109 0.687 8.071 2.687 2.687 0.000 Childrens Services 12.227 5.948 5.714 0.234 6.236 3.033 2.799 0.234 5.991 2.915 2.915 0.000 Integrated Equipment and Adaptations Store 0.567 0.284 0.275 0.009 0.289 0.145 0.136 0.009 0.278 0.139 0.139 0.000 Dietetics Services 3.827 1.919 1.827 0.092 1.952 0.979 0.887 0.092 1.875 0.940 0.940 0.000 Podiatry Services 4.336 2.173 2.096 0.077 2.211 1.108 1.031 0.077 2.125 1.065 1.065 0.000 Prisoner Healthcare Services 1.699 0.851 0.831 0.020 0.866 0.434 0.414 0.020 0.833 0.417 0.417 0.000 Blood Borne Viruses Services 1.528 0.764 0.703 0.061 0.779 0.390 0.329 0.061 0.749 0.374 0.374 0.000 Hospital at Home 2.228 1.111 1.007 0.104 1.136 0.567 0.463 0.104 1.092 0.544 0.544 0.000 Mental Health and Learning Disability Services 72.540 35.701 35.107 0.594 36.995 18.208 17.614 0.594 35.545 17.493 17.493 0.000 TOTAL 128.644 60.725 58.566 2.159 65.608 30.970 28.811 2.159 63.036 29.755 29.755 0.000 North Share of South Hosted Services 31.605 14.673 14.673 0.000 Hosted Services Total 160.249 75.398 73.239 2.159 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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10 Hosted Services Appendix 3 Led by the South Partnership Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 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 6.944 3.574 3.295 0.279 3.541 1.823 1.823 0.000 3.403 1.751 1.472 0.279 Brain Injury Unit 2.360 0.807 0.883 (0.076) 1.204 0.412 0.412 0.000 1.156 0.395 0.471 (0.076) Out of Hours Services 8.973 4.329 4.302 0.027 4.576 2.208 2.208 0.000 4.397 2.121 2.094 0.027 Palliative Care Services 7.118 3.597 3.556 0.041 3.630 1.834 1.834 0.000 3.488 1.763 1.722 0.041 Physiotherapy Services 10.133 5.080 4.764 0.316 5.168 2.591 2.591 0.000 4.965 2.489 2.173 0.316 Primary Care Services 0.749 0.376 0.361 0.015 0.382 0.192 0.192 0.000 0.367 0.184 0.169 0.015 Occupational Therapy Services 7.909 3.994 3.959 0.035 4.034 2.037 2.037 0.000 3.875 1.957 1.922 0.035 Diabetic Services 4.939 3.057 3.004 0.053 2.519 1.559 1.559 0.000 2.420 1.498 1.445 0.053 Sub Total 49.125 24.814 24.124 0.690 25.054 12.655 12.655 0.000 24.071 12.159 11.469 0.690 Ring Fenced Funding Primary Care Improvement Fund 12.846 3.957 3.957 0.000 6.551 2.018 2.018 0.000 6.295 1.939 1.939 0.000 Primary Care Transformation Fund 0.000 0.000 0.001 (0.001) 0.000 0.000 0.000 0.000 0.000 0.000 0.001 (0.001) Sub Total 12.846 3.957 3.958 (0.001) 6.551 2.018 2.018 0.000 6.295 1.939 1.940 (0.001) TOTAL 61.971 28.771 28.082 0.689 31.605 14.673 14.673 0.000 30.366 14.098 13.409 0.689 South Share of North Hosted Services 63.036 29.755 29.755 0.000 Hosted Services Total 125.007 58.526 57.837 0.689 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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11 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 2022/23 NHSL Financial Allocation to North Lanarkshire HSCP £m 2022/23 NLC Financial Allocation to North Lanarkshire HSCP £m 2022/22 North Lanarkshire HSCP Financial Allocation 506.931 2022/22 North Lanarkshire HSCP Financial Allocation 132.575 Add: Set-Aside Budget 66.858 NLC Funding - Housing Services 1.870 Less: Budget Adjustments NLC Funding - Transport Services 0.551 Social Care Fund -22.964 Add: Budget Adjustments Resource Transfer -23.421 Social Care Fund 22.964 Commissioned Services -6.799 Resource Transfer 23.421 NHSL Financial Allocation at 31 May 2022 520.605 Commissioned Services 6.799 NLC Financial Allocation at 16 September 2022 188.180 Ajustments: Draw Down from Reserves 1.949 Increase to Employers NI 1.262 NES Trainee 1.021 Other Budget Adjustments 0.425 NHSL Financial Allocation at 30 June 2022 525.262 Ajustments: Draw Down from Reserves 0.460 Junior Medical Income -0.040 Other Budget Adjustments 0.023 NHSL Financial Allocation at 31 July 2022 525.705 Ajustments: Draw Down from Reserves 0.453 Child Death Review Funding 22-23 0.024 Increase to Hosted Services Led by South 1.146 Other Budget Adjustments 0.220 NHSL Financial Allocation at 31 August 2022 527.548 Ajustments: Draw Down from Reserves 1.740 Junior Doctor Income 2.274 Adustment to Commissioned Services 0.082 Increase to Hosted Services Led by South 0.433 Other Budget Adjustments 0.002 NHSL Financial Allocation at 30 September 2022 532.079 Budget Adjustments Posted in Month 4 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 5 Budget Adjustments Posted in Month 6
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1 REPORT Item No: 8 SUBJECT: Covid-19 Update TO: IJB Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 30th November 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board: 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 INTEGRATION JOINT BOARD 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 18th November, the seven-day case rate within North Lanarkshire is 35.2 per 100k population, which is a small decrease to the figures last presented to the IJB PFA from 31st October when it was 49.8 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 18th November, there are 53 covid positive inpatients and a further 3 in offsite facilities, which in total is a decrease of 24 compared to the position on 31st October. 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 18th November, there are 5 outbreaks in care homes covering 19 residents and 5 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 18th November, delays are 82, with 18 discharges lined up for the day. Performance has been reasonably consistent in the mid-70s over recent months, but since the second half of October this has spiked into the 80s. 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 Home Assessment Team roll out continues, with capacity continuing to increase in Cumbernauld and Wishaw teams. A soft launch will commence in Airdrie and Motherwell Localities later this month. 5.6 Testing 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 5.7.1 The Covid vaccination programme continues at pace, with uptake as at 18th November as follows: Total doses administered 1,788,949
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5 Individuals with at least 1 dose 559,325 Partially vaccinated 26,535 Fully vaccinated 93,238 Boosters 439,552 5.7.2 The current autumn/winter vaccination programme is scheduled to provide vaccines to the respective population groups, operating 0800 to 2000 hrs, seven days a week across six sites, delivering c3,000 vaccinations per day commencing on 19 September. 5.7.3 Scottish Government modelling for NHS Lanarkshire to complete the programme by 5th December outlined that there would need to be around 92,000 doses of Covid-19 Autumn/Winter booster and around 97,000 adult flu vaccine doses administered in the first 6wks of the programme, with NHSL being beyond trajectory for both at present. 5.7.4 Strong progress has been made in the Care Home sector, but uptake in staff and 2-5yr olds has been lower than anticipated, though this follows national trends. The current DNA rate is around 17%, which is higher than expected and presents a risk to meeting the 80% uptake rate of all eligible groups by 5th December. That said, recent learning is that some DNA cases are now booking alternative appointments, which could at least partially mitigate the risk. 5.7.5 Of particular note is that all care home residents have now been offered both a covid and flu vaccination and uptake is higher than national average. 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. 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:
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6 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: 9 SUBJECT: Quality Assurance – Annual Report 2021/22 TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager, Quality Assurance DATE: 30th November 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 By: Senior Manager, Quality Assurance Reviewed By: Head of Planning, Performance & Quality Assurance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to endorse 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 The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. Our commitment is to provide an annual report on activity carried out in the preceding year. 5.2 The purpose of this report is to update Committee on our Quality Assurance activity over the annual period of 1 April 21 to 31 March 22. 5.3 This report highlights Quality Assurance activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. Full detail of these activities is included in Appendix One. 5.4 Contracts - In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. 5.5 Contract Management - A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. 5.5.1 This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. 5.5.2 The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up-to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. 5.6 Regulatory Activity - During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however,
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3 a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. 5.7 Provider sustainability - Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. 5.8 Procurement - A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement. 5.9 Children, Families and Justice - Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. 5.10 Complaints - Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES We live in communities that are inclusive, empowered, resilient and safe The Plan for North Lanarkshire Priority: Improve North Lanarkshire's resource base Ambition Statement(s): (24) Review and design services around people, communities, and shared resources. (25) Ensure intelligent use of data and information to support fully evidence-based decision making and future planning 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL
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4 There are no direct financial impacts in relation to this report. This paper has been reviewed by Finance: Yes No N/A x 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks are identified and reported on via the relevant risk register. 7.5 PEOPLE Residents across North Lanarkshire who access services, their families/carers and the community, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Fairer Scotland - As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. Equality Impacts are considered as part of procurement and contract monitoring. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A x 8. BACKGROUND PAPERS n/a 9. APPENDICES Appendix One: Quality Assurance Annual Report 2021/22. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Maria Williamson: Senior Manager, Quality Assurance WilliamsonM@northlan.gov.uk
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5 Appendix 1 2021/22 Quality Assurance Annual Report 2021/22
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6 1. Introduction The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. The team support the development and/or maintenance of robust practices that assist in achieving better outcomes for those who access services. Our cycle of monitoring and review ensures services meet the strategic aims of both the Council and the Health and Social Care Partnership. Our commitment is to provide an annual report on activity carried out in the preceding year. This report outlines activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. 2. Contracts In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. Tables 1a and 1b below illustrate graphically the extent of the work that has been carried out in engaging with the independent sector in a proportionate and balanced way to ensure service provision has a legal basis, is provided safely and is of a high quality through our contracting arrangements. As of 31 March 22, 93% of all social work spend had the provision of a formal contracting arrangement, the remaining 7% will be reviewed and prioritised in the coming year and contracts agreed as appropriate. Table 1a
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7 Table 1b 3. Contract Management Framework (CMF) A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. In addition, this approach moves the emphasis of the Quality Assurance Team from a service improvement focus to a contract management arrangement to enhance the principles of consistency, efficiency and effectiveness at the heart of Best Value. The CMF was developed to align with contract development and this process will continue as contracts and procurement exercises change to reflect new models of provision and procurement. It is a whole systems approach which links commissioning, contracting, monitoring, reviewing and re/de- commissioning. The CMF is a redesign of previous and existing monitoring
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8 practice in parallel with the development of the Council’s digital systems to securely exchange and make available information to improve decision making at individual, practitioner and strategic level. For individuals using commissioned services it supports them to: be confident their views are listened to, respected and used to influence service quality. be confident that their best interests/outcomes are at the heart of the approach be able to make informed choice The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up-to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. The processes of monitoring and the accompanying reporting build a body of real time and accessible information regarding the quality-of-service provision, its performance and outcomes over the life of a contract/framework. Table 2 STATUS INDICATED MONITORING LEVEL Red Significant concerns in relation to service performance, contract compliance. TIER 4 Amber (high) Moderate concerns in relation to service performance, contract compliance TIER 3 Amber (low) Minor concerns identified in relation to service performance and contract compliance TIER 2 Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Each Tier suggests a minimum monitoring frequency (Table 3). The basis of monitoring will be the commitments made by the contractor as part of their contractual agreement with the Council including, but not limited to, Standard Terms and Conditions, Data Protection Terms and Conditions, Special Terms and Conditions, commitments made in relation to Fair Work Practices and Community Benefits and relevant national standards.
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9 Table 3 Tier 1 Contract monitoring visit frequency – annually in most cases. Tier 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly. Tier 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Tier 4 Contract monitoring visit frequency – 1 to 4 weekly. For the 2021/22 reporting period, monitoring activity was undertaken on 300+ contractor organisations. Despite a challenging environment in relation to the pandemic response, 72% of contractors had a Tier 1 monitoring status, with Tier 2 at 16%, Tier 3 at 8% and only 3% of contractors at Tier 4 (as of 31 March 22) indicating the value of having close and robust relationships with contractors. Table 4 4. Regulatory Activity During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self- Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. Care Homes in NL: 221 49 22 11 Contractors Tier 1 Tier 2 Tier 3 Tier 4
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10 22 Care Homes were inspected in relation to 1 or more quality indicators in the year to 31 March 22. Key question 7 – ‘How good is our care and support during the Covid 19 pandemic?’ was applied to all inspections. The remaining care homes will receive a fuller inspection in 2022/23. It is worth noting that 2 care homes were the subject of Large-Scale Investigations, under Adult Support and Protection legislation, with significant support provided by the Care Inspectorate and Senior Council Officers to address and improve quality improvement measures. One of these care homes has subsequently closed with Care Inspection registration being removed. Table 5 Table 5 above illustrates the challenging environment care homes were operating in during the pandemic with 14 of the 22 homes assessed as ‘Adequate’ for the category relating to care and support during the pandemic. Care Homes in Scotland (excluding NL): North Lanarkshire Council currently has people placed within 141 care homes that are located elsewhere in Scotland. North Lanarkshire Council retains care management responsibilities for the people living in out of authority care homes. The host authority where the care home is located is responsible for care home contract monitoring, however, not all 32 local authorities operate in the same way. The Quality Assurance Team receives regular updates from host authority contacts in relation to out of authority care homes. Table 6
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11 Table 6 above illustrates the position noted in North Lanarkshire care home settings is similar to the national picture of a sector struggling to meet the challenges posed by a pandemic. 46 of the 83 care homes inspected were assessed as ‘Adequate’. The Quality Assurance Team have worked in close partnership with colleagues from NHS Lanarkshire, the Care Inspectorate and the care homes themselves to support care homes to pursue an improvement agenda. This has included:- Initially weekly meetings with Care Home Managers to provide a means of communication, to discuss issues arising, for example the developing guidance from the Scottish Government, and to seek solutions to local problems through discussion. The meetings are now monthly. The Quality Assurance Team administered the Sustainability Payments Scheme for the care home sector (See Section 5). A series of Collaborative Visits to care homes by Quality Assurance Senior Officers, NHS Lanarkshire Care Home Liaison and Infection, Prevention and Control staff took place to provide support and guidance to care home management and staff. Self-Directed Support (SDS) including Care at Home: Prior to the pandemic, the Care Inspectorate changed their quality inspection themes for registered services. This was fully implemented for Care Homes and some self-directed support contractors. However, 40 of these SDS contractors were still to be inspected using the new themes as of 31 March 22. As previously mentioned, Care Inspection activity has been predominately focused on Care Homes, however, there have been 10 inspections of SDS contractors because of increased notifications to the Care Inspectorate. There are also 10 SDS contractors that were still awaiting an initial inspection as their services have been registered within the past 2 years. Table 7
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12 Table 7 above is primarily based on inspections carried out pre pandemic. However, for the 10 services inspected under the pandemic regime the majority were categorised as ‘Good’ or ‘Very Good’. It is interesting to note, that despite the inspections being because of notification to the Care Inspectorate, 6 out of the 10 inspected were classed as good or very good. 5. Provider sustainability Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. The payments to care homes for underoccupancy have been the biggest proportion of the additional financial support provided through the principles. However, occupancy levels are increasing to pre pandemic levels except for some homes that have been more significantly impacted by outbreaks. For other community-based activity and provision, there has been less of an impact on service delivery, with most providers returning to normal (pre- pandemic) delivery levels. Table 8
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13 6. Procurement A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. As mentioned above, in the 2021/22 reporting period, we have managed to expedite a significant number of procurement exercises that have resulted in 93% of the spend on social care services being covered by some form of formal agreement, ranging from large scale contractual frameworks to individual agreements. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement, none more so than the internal procedure established for the Council’s lower threshold, but regulated, procurement of various Health and Social Care contracts (value range £50- £552k), which in conformance with the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016, permits the Council to consider and award relevant contracts without the need for competition. This has helped immensely in terms of efficiency at a time when there are significant pressures on our resources. It’s also useful to note that Quality Assurance leads on procurement for all social work services including those focussed on children, families, justice services and adults. Table 9 describes a sample of procurement activity undertaken. Table 9 Contract Comments and Benefits Flexible Framework for Self- Directed Support and Care at Home Services £900M value, 10 years, will result in less frequent re-tenders follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 Annual entry and exit points for Contractors Secured an increase in the number of contracted providers, improving the choice and control for supported people PROVIDER SUMMARY NCHC Care Homes Other Total Total Number of Providers 28 45 73 Number in contact for support 26 31 57 Providers Supported to date 26 31 57
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14 Direct Payment Support Service £400k, 3 years, competitively tendered using new toolkit Improved specification and implemented tighter controls supported by the new terms and conditions Befriending Services £360k, 3 years, competitively tendered using new toolkit Improved specification and tighter controls Advocacy Services £1.8M, 3 years, competitively tendered using new toolkit Improved specification and tighter controls Mental Health Services £3M, 3 years, competitively tendered using new toolkit Improved specification and tighter controls Provision of Taxi Hire and Private Hire Services to the Council throughout North Lanarkshire £3.2M, 4 years, competitively tendered using new toolkit Improved specification and tighter controls Flexible Framework for Non- Traditional Respite £4M, 10-year agreement, will result in less frequent re- tenders follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 Covers an existing gap within National ‘Respite’ Frameworks Annual entry and exit points for Contractors Secured an increase in the number of contracted providers, improving the choice and control for supported people Fair Work The Scottish Government’s Fair Work First policy initiative focuses on encouraging and supporting employers to create more diverse and inclusive workplaces where workers have security of pay and contract, can develop and utilise their skills and have an effective voice in the workplace. As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. Potential contractors have committed to provision of community benefits within their tenders, which includes offering employment to people in the local community, youth training and training for people from disadvantaged groups, traineeships and apprenticeships, volunteering opportunities, supporting local supply chain and local community resources. All contractors have indicated they are either already accredited as or are willing to become Scottish Living Wage employers. Work is underway in determining how established contract monitoring processes can incorporate Scottish Living Wage compliance and progress in implementing community benefits commitments. 7. Children, Families and Justice
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15 Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. Quality Assurance has supported Justice Services with Scottish Government funding to secure services to support rehabilitation. Over the reporting period, links have been established with our colleagues in HQ within Education and Families to ensure that we monitor contracts with external service providers and incrementally develop and apply a quality assured approach. Links are well established with Scotland Excel where their Frameworks Agreements have been effective in ensuring optimum service delivery, under difficult financial pressures. Improvements are required to be made in respect of joint working with the council to ensure Children and YP placements are conveyed to the appropriate teams. Quality Assurance will continue to work with each locality to ensure this information is shared. 8. Complaints Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The detail below provides an annual summary and analysis of complaints received over the period 2021/22. Overall, 123 complaints were made in the reporting period, a decrease of 21% from 2020/21. 41% were Children and Families complaints, 59% were Adult Social Work/Community Care complaints. 76% of Children and Families complaints were handled at Stage 1, 24% at Stage 2. 21% of Stage 1 complaints failed to meet target timeframes for closure. Average time for closing Stage 1 complaints was 5.3 days. 17% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 17.3 days. 79% of Adult/Community Care complaints were handled at Stage 1, 21% at Stage 2. 21% of Stage 1 complaints failed to meet target timeframe for closure. Average time for closing Stage 1 complaints was 5.5 days. 7% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 15 days. Overall, there was a slight improvement on performance levels from the previous reporting period. The complexity of the issues at hand, new processes, GDPR, staffing, IT systems and very tight time frames for resolution were some of the contributory factors for failure to close all complaints within the stipulated timescale.
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16 Table 10 highlights the cause of complaints about NLC Social Work throughout the reporting period. 30% of all adult service complaints related to quality of the service, a further 27% were in respect to conduct of staff members. 32% of all children, families and justice complaints related to quality of service, whereas 26% were in respect to conduct of staff members. Table 10 A significant number of complaints did not comment on expected learning outcomes and/or service improvements expected, therefore suggesting that there were no further actions to be considered. Comments that we did receive, in relation to learning outcomes, included improved communication, recording and staff training. To ensure compliance, further training related to complaint handling will be rolled out over the coming year. This will promote competency by enabling all staff managing complaints to comply with the process and capture learning and/or service improvement. Within the reporting period, eight social work complaints were sent to the Scottish Public Services Ombudsman for consideration, none of which were upheld. Those that were investigated found that the Council had acted reasonably. Duty of Candour The Organisational Duty of Candour is a statutory duty on Scottish organisations providing health and social care to be open and honest when something goes wrong that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is a requirement of the Council. Appendix 1 provides a report for 2021/22. 9. To conclude 16 13 8 6 5 2 22 20 12 9 9 2 0 5 10 15 20 25 Quality of Service Conduct of staff members Dealt unfairly or wrong Didn't provide a service on time Didn't provide a service Unhappy with policy/procedure Complaint Cause Adults CFJ
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17 The Covid pandemic challenged all services both in-house and commissioned to a degree not experienced before. Despite this, the Quality Assurance Team have been part of several developments, which have improved the operation of the social work service and the performance of independent social care contractors including:- Procurement processes refined Newsletter established for staff Senior Officer links to Locality teams Senior Officer link to Adult Support and Protection activity Business Continuity Sustainability payments Individual PA process RaciQ developed for procurement process Contract Monitoring Framework Collaborative work with NHS Lanarkshire, Care Inspectorate, Scottish Care Carer Developments, Partnership Agreement Complaint sprint Operational Risk Register Involvement in LSIs Council Website Data Governance, FOIs/SARs and guidance Development of market facilitation plan Planned developments for 2022/23 include:- Further development of market facilitation plan Further development of participation and engagement strategy Plan for in-house service monitoring Commercial pipeline refinement Contract Management Framework development HSCP website This report has covered Quality Assurance activity undertaken during the period 1 April 21 to 31 March 22. The pandemic has had a significant impact on the sector and over the coming year several developments to support and provide assurance will continue. It is expected that future annual reports will continue to update on Quality Assurance measures implemented across the service.
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18 Appendix 1 North Lanarkshire Health and Social Care Partnership Duty of Candour Report: 2021/2022 Introduction North Lanarkshire Health and Social Care Partnership recognises that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental. The duty of candour arrangements, which we have implemented reflect the Scottish Government’s commitment to place people at the heart of health and social care services in Scotland. When harm occurs the focus must be on personal contact with those affected; support, and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 was implemented on 1st April 2018 placing an organisational duty (Duty of Candour) on health, care, and social work services to be open and honest with people in their care. The overall purpose of this duty is to ensure organisations are open, honest, and supportive when there is an unexpected or unintended incident resulting in death or harm as defined in the Act. All health and social care services in Scotland have a duty of candour, a legal requirement which means that when things go wrong and mistakes happen, the people affected understand what has happened, receive an apology, and that organisations learn how to improve for the future. A key part of this duty is that Health and Social Care publish an annual report about the duty of candour in our services. This short report describes how the services we commission, and our own services have operated the duty of candour during the time between 1 April 2021 and 31 March 2022. Information about policies and procedures
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19 All social care organisations have a Duty of Candour policy. All staff who are employed in the sector should be aware that all instances that necessitate implementation of Duty of Candour must immediately be reported. In such instances, a manager will then take the appropriate action, ensuring relevant bodies [depending on the sector] such as Social Work and Care Inspectorate are notified of the event. Where an incident occurs that triggers the duty of candour, managers have responsibility for ensuring that the duty of candour procedure is followed. Information on Duty of Candour and reportable incidents is described in detail within Appendix 1. 82 commissioned organisations were asked to provide information in relation to Duty of Candour activity in the reporting period. Of the 37 [45%] that responded, there were five reported incidents. All North Lanarkshire Council social work in-house services - home support, integrated day services, locality support services and children services were also asked to provide information. There were no Duty of Candour incidents reported from any of the council provided services. Duty of Candour incidents are an integral part of our contract management quarterly monitoring returns. How many incidents happened to which the duty of candour applies? In the reporting period, five incidents have been reported to which the duty of candour applied, one in relation to maladministration of medication, and four where a person fell and sustained physical harm. All incidents reported were from either care at home support or care home services. No Duty of Candour incidents were reported by North Lanarkshire Council in-house social work services. Details of incidents where Duty of Candour applied Nature of incident: Incorrect medication was administered to a service user, resulting in admission to Accident and Emergency. No permanent harm occurred. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. Procedures and training have been revised as a result. Nature of incident: Person fell and fractured hip – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (R) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (L) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of
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20 Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell – sustained a laceration to the head – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Conclusion There were no Duty of Candour incidents from in-house social work services within the reporting period and only five from care home and care at home services, none of which had lasting consequences for the person to whom the duty applied. Appropriate actions were taken, lessons were learned, procedures and training were revised, and where applicable, families were informed, and were invited to meet to discuss in more detail. If in the future, if any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify any lessons learned and the result of any such review will be shared with the relevant person/persons. This approach will minimise the impact on the organisation and the vulnerable people we strive to support. Appendix A – Definition of Harm and appropriate level of response Grading of Harm Definition of Harm Level of Response No harm, incident prevented Any service user safety incident that had the potential to cause harm but was prevented. These incidents are outside of the scope of the duty of candour. Social work professionals may however feel it is appropriate to inform the person involved if it is in their best interest. No harm, incident not prevented Any service user safety incident that occurred but no harm was caused to the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved
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21 and the service user and their family is usually undertaken locally. Low Harm Any service user safety incident that led to the extra observation or minor treatment such as first aid or additional medication for the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Moderate Harm A level of harm that is not permanent but has led to a moderate increase in treatment or prolonged psychological harm of more than 28 days. For example, a return to theatre, an unplanned readmission to hospital, unexpected admission to critical care, a prolonged hospital stay or additional out service user visits. Duty of candour is a statutory requirement. Notification should be given to the person affected or their representative in person including an explanation of the incident, the process for investigation and an apology. This will be followed up in writing and on conclusion of the investigation the findings and outcome will be available to the service user of their representative. Serious Harm Any service user safety incident that has resulted in permanent harm that is directly related to the incident and not the natural course of an illness or the underlying condition of the person affected. Examples of severe harm are permanent lessening of bodily functions, sensory, motor, physiological or intellectual function, removal of the wrong organ or limb or brain damage. Duty of candour is a statutory requirement – see above. Death Any service user safety incident that directly resulted in the death of a person and is not related to their illness or underlying condition. Duty of candour is a statutory requirement – see above. Appendix B Organisations who provided a response: Aspire Invercare Love Crossreach Keane Premier Support Services Beechwood Care Home Support for Ordinary Living
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22 Quarriers PHEW Care One Professional Leonard Cheshire HK Care Angels Key Housing Local Lanarkshire Care Partners in Play All New Beginnings Lanarkshire Association for Mental Health Thera Care Wheatley Care The Richmond Fellowship Scotland HRM Potential Living Capability Scotland Cornerstone Care Solutions Lanarkshire Care Partners Inclusion Scotland C-Change Scottish Autism Cera Care Turning Point Scotland Potential Living Enable Scotland Enhance Supported Living Services Lochside Manor Deanston Care Home
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1 REPORT Item No: 10 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 INTEGRATION JOINT BOARD This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team 3. RECOMMENDATIONS 3.1 The IJB 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: IJB Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 30th November 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 and agreed at the September 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 on 2nd November 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 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 5.7 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 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 High NHSL Corporate
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3 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 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
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4 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 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
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5 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. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY 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. Yes No N/A
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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 31.03.22 Previously IJB6. Reviewed and updated on 15 May 21. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 31.12.2022 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 Report Prepared by Christine Jack on behalf of the Chief Officer Page 1 of 6
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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 31.12.22 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. Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 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 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. Report Prepared by Christine Jack on behalf of the Chief Officer Page 2 of 6
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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 30.11.22 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.11.22 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 Report Prepared by Christine Jack on behalf of the Chief Officer Page 3 of 6
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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 31.12.22 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 31.12.22 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 6
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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.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ 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 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 the IJB. Very High Controls ‐ 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 50% of gap by end of May 2022 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model High medium Ross M cGuffie M orag Dendy IJB,PF&A, SLT 30.11.22 IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups High Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.22 SLT, IJB 31.12.22 SLT, IJB PFA, IJB 30.11.22 IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 23 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equpiment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand Very High M edium Ross M cGuffie Ross M cGuffie CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High M edium Ross M cGuffie Ross M cGuffie IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High Report Prepared by Christine Jack on behalf of the Chief Officer Page 5 of 6
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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.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High CONTROLS 1. Working group established to coordinate all activity 2. Oversight through Home Support Programme Board 3. Reporting to Adult Social Work, Care and Wellbeing Committee 4. Reporting to IJB ACTIONS 1. NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas 2. NLC part of SG once for Scotland procurement process for a new digital alarm receiving centre 3. Communication out to all community alarm service users 4. Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational 5. Engagement with telecommunication suppliers to ensure sight of roll out plans across NL M edium Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.22 Report Prepared by Christine Jack on behalf of the Chief Officer Page 6 of 6
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1 REPORT Item No: 11 SUBJECT: NHS Lanarkshire Whistleblowing Annual Report 2021/2022 TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Kay Sandilands, Director of Human Resources (NHS Lanarkshire) DATE: 30th November 2022 1. PURPOSE OF REPORT Update members on the application of the National Whistleblowing Standards by NHS Lanarkshire. This paper is coming to the IJB for: For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Endorsed by the NHS Board. Prepared Reviewed Endorsed 3. RECOMMENDATIONS The Integration Joint Board is asked to:- (1) note the NHS Lanarkshire Whistleblowing Annual Report for 2021/20; and (2) note the assurance received by the NHS Lanarkshire Board that whistleblowing standards are being followed and learning shared.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Scottish Public Services Ombudsman fulfils the role of the Independent National Whistleblowing Officer (INWO). The aim of the role is to make sure everyone delivering NHS services in Scotland is able to speak out to raise concerns, ultimately contributing to ensuring that the NHS in Scotland is as well run as possible. 5.2 The INWO developed a set of National Whistleblowing Standards that set out the high level principles and a detailed procedure for investigating concerns. An effective procedure for raising concerns (whistleblowing) is: open focused on improvement objective, impartial and fair accessible supportive to people who raise a concern or are involved in the procedure simple and timely thorough, proportionate and consistent 5.3 The National Whistleblowing Standards and Once for Scotland whistleblowing policy (the Standards) were introduced on 1 April 2021. The Standards are applicable across all NHS services. This means that they must be accessible to anyone working to deliver an NHS service, whether directly or indirectly. 5.4 It is a requirement of the Standards to formally and routinely report whistleblowing performance to NHS Boards, including the preparation of an annual report. 6. CONCLUSIONS 6.1 The NHS Lanarkshire Whistleblowing Annual Report for 2021/20 was presented to the NHS Lanarkshire Board at its meeting of 31st August 2022. At that meeting the NHS Board confirmed that it had received assurance that whistleblowing standards are being followed and learning shared (appended). 6.2 For the purposes of good governance and transparency, this Annual Report is being shared with the IJB completeness. Yes No N/A
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3 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have 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 Health and Social Care Services contribute to reducing health inequalities People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing 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) None. 7.3 FINANCIAL None associated with this report. This paper has been reviewed by Finance: Yes No N/A
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Whistleblowing is not currently on the IJB risk register. 7.5 PEOPLE 7.5.1 All those working in Health and Social Care Partnerships can raise concerns about NHS services, whoever their employer is. Any concerns about the delivery of NHS services must be handled in line with the requirements of these Standards, and anyone raising a concern through these Standards can do so to INWO. 7.5.2 If staff do not have confidence in the fairness of the procedures through which their concerns in respect of NHS services are raised, or do not feel assured that concerns raised will be acted upon, there is a risk that they will not raise valid concerns about quality, safety or malpractice. The opportunity to investigate and address these concerns will have been lost, with potentially adverse impact on quality, safety and effectiveness of services. There is also a wider risk to organisational integrity and reputation, if staff do not believe they will be listened to and do not feel senior leaders in NHS Lanarkshire are fulfilling the organisation’s values and promoting a culture of psychological safety. The activity described within this report contributes to the mitigation of such risks. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS NHS Lanarkshire Whistleblowing Annual Report – April 2021 to March 2022 (see appendix 1)
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5 9. APPENDICES Appendix 1: NHS Lanarkshire Whistleblowing Annual Report – April 2021 to March 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. Members seeking further information about any aspect of this report, please contact the following; Name: Kay Sandilands, Director of Human Resources (NHS Lanarkshire) Phone: 01698 752865 Email: Kay.Sandilands@lanarkshire.scot.nhs.uk
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6 Appendix 1: Whistleblowing Annual Report – April 2021 to March 2022 1. Introduction The National Whistleblowing Standards and Once for Scotland whistleblowing policy (the Standards) were introduced on 1 April 2021. NHS Lanarkshire’s performance against the Key Performance Indicators included in the Standards has been reported to the Staff Governance Committee and the board on a quarterly basis. In addition to quarterly reporting boards are also required to prepare an annual report, the contents of which are outlined in the Standards. 2. Key Performance Indicators 2.1 Cumulative total – Whistleblowing Concerns Raised 2021/22 Quarter Appropriate for whistleblowing Stage 1 Stage 2 Outcome Comments 1 1 0 1 Upheld Action plan implemented 2 0 n/a n/a n/a 3 2 (1 appropriate for WB and unnamed. 1 partially appropriate for WB) 1 1 Both mainly upheld. 1 complaint was unnamed and mainly upheld. The second complaint was dealt with under 2 procedures – WB and a separate HR procedure. The latter complaint was mainly upheld at stage 1 4 0 0 0 n/a Total 3 1 2 The Standards require stage 1 concerns to be completed within 5 working days and Stage 2 concerns to be completed within 20 working days. The table below shows the number and percentage of concerns at each stage which were closed in full within the set timescales of 5 and 20 working days, for 2021/22. This reflects any extensions agreed.
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7 Nos received % closed in 5 working days Nos received % closed in 20 working days Stage 1 2 100 Stage 2 1 100 The table below shows concerns raised in 2021/22 where an extension was authorised. Concern Nos received Extension authorised As % of all concerns Stage 1 2 1 50 Stage 2 1 1 100 3. Analysis of numbers of concerns raised Three concerns were raised during 2021/22 and this compares to two during 2020/21, two during 2019/2020, one during 2018/19, three during 2017/18 and none during 2016/17, so numbers remain fairly constant. It would be interesting to compare NHS Lanarkshire’s numbers with those from other Boards but this information is not readily available, unless the Independent National Whistleblowing Officer (INWO) decides to publish national numbers, which would be useful for comparison purposes. 4. Further information on the 3 concerns raised during 2021/22, including service improvements and shared learning. 4.1 The first complaint raised in April 2021 was reported to the Staff Governance Committee in September 2021 and concerned one of the radiology departments. Specifically, concerns were raised about staff rest areas, staffing numbers, management support, enhanced information around incident reporting and wider sharing of departmental protocols, particularly around out- of-hours services. A detailed action plan was developed as a result of this concern being raised and staff have been intrinsic to its development. The agreed actions included a commitment to work on workforce planning, ensuring staff involvement and feedback on progress; consideration of available space for rest areas; reviewing management support within the department including senior management visibility; enhancing information sharing around incident reporting; wider sharing of departmental protocols to improve the patient care journey, particularly out of hours and to develop a departmental action plan which could be shared with all staff. The action plan has been largely monitored through local departmental management meetings and has also been discussed at pan Lanarkshire service meetings, which are attended by clinical leads for all departments, the service manager and team and director and associate medical director. This has enabled learning and service improvements to be shared across the sites. The action plan will also be tabled at the acute divisional management team to log issues and note progress and has been a regular feature at the site departmental monthly staff meetings. This has ensured that staff are aware of the points raised and that outcomes and learning are shared. Specific learning
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8 and quality improvement projects have been generated around some of the themes in the action plan and, in addition to local discussion, these projects have been shared across all of the radiology departments and via the site clinical governance groups. A short life working group has continued ongoing work including use of the workforce planning tool and an SBAR. Locums were contracted to work in radiology to provide additional cover until 8pm and at weekends on an interim basis. A staff well-being hub has been established on the three sites supported by a well-being rep, notice board and signposting. Well-being is a standard item on monthly staff meetings. Management have been attending safety huddles, departmental staff meetings and ensuring a presence across departments. Quality improvement projects have been completed on MRI safety and radiology patient flow and a safety group established to discuss Datix. Overnight Datix incidents are shared and discussed on site daily huddles. The action plan is a standing agenda item at monthly staff meetings where minutes of the groups outlined above and updated actions are shared. 4.2 The second complaint raised concerned cleaning services at one of the acute hospitals where cleaning services are managed by a private contractor. The concern was raised in October 2021 and followed on from a previous and similar complaint raised in December 2020, which was before the introduction of the new Standards. The investigation upheld a number of the issues which had been identified and concluded by providing eight detailed assurance recommendations. These recommendations related to: Appropriate use of equipment Cleanliness of equipment Staff training in relation to domestic sign off sheets and food hygiene documentation Helpdesk sign off processes Process for re-auditing Approach to contract management of soft FM services Need for a root cause analysis of issues highlighted to identify specific improvement actions. An action plan, based on the investigation report and recommendations, was developed by the contractor, in conjunction with the Property & Support Services Division (PSSD). Its aim was to address the issues identified and embed the necessary changes in the contractor’s approach to service delivery. An evidence portfolio to support the implementation of the action plan was compiled and shared with the management team in PSSD through the ongoing monitoring process for Soft FM services at the hospital concerned. The learning and recommendations from the report were also shared with the PSSD team responsible for delivery of PFI contract management services at both University Hospital Hairmyres and University Hospital Wishaw, in order to ensure that learning generated from the issues identified and the subsequent recommendations were reflected across the estate.
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9 The implementation of the action plan was monitored through weekly senior level operational management meetings and also through fortnightly senior management meetings established by the Director of Planning, Property & Performance with PSSD and the contractor. These groups continue to meet to review the performance of the healthcare cleaning service at the hospital concerned, which is subject to daily auditing by the NHS Lanarkshire Facilities Management Team auditor. The Director of Planning, Property and Performance also presented a report to the Healthcare Quality Improvement and Assurance Committee (HQAIC) where there was a high level of engagement from Board members. 4.3 The third complaint concerned culture and behaviours within one of the departments of the HR directorate. Prior to this particular issue being raised the Head of Service had already commissioned a piece of work following a decrease in iMatter scores and a mediation session was held in December 2021 which highlighted a number of areas for improvement. The subsequent investigation into the whistleblowing concern also made a number of recommendations on areas to improve the culture and behaviours within the team. These formed the basis of an action plan which focussed on improving communication, clarifying roles, equitable workload and consistency in application of policies/procedures. The head of service has held three sessions with the staff to take forward the action plan and feedback to date suggests that the culture within the department is improving. The action plan is fluid and will be amended as required, with the aim of achieving an overall improvement in relationships within the team. Implementation of the action plan is monitored by the HR director on a monthly basis and staff have been involved in the process throughout and have driven the development and content of the plan. Key learning outcomes which have been shared across the team include the importance of role clarity, regular and timely communication, two-way feedback and an environment where it is safe to speak up. These learning outcomes were carefully reviewed with a view to potentially sharing them across the directorate. It was concluded that, for reasons of confidentiality as part of the complaint was dealt with under a separate HR policy, this would not be appropriate. The complaint was also reported to the Staff Governance Committee. 5. Whistleblowing themes, trends and patterns The analysis of themes from whistleblowing concerns aids identification of any shared causes and helps to progress learning and improvement in a targeted manner. The categories/classification for whistleblowing concerns are listed in Part 2 of the Standards and are outlined below for information: Patient Safety Patient Care Poor practice Unsafe working conditions Changing or falsifying information on performance
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10 Fraud Breach/breaking any legal obligation Abusing authority Concealment of any of the above Interrogation of the three complaints raised does not initially reveal any obvious thematic concerns, with each being quite distinct and classification covering a number of the categories listed above i.e. patient safety, patient care, poor practice, unsafe working conditions and changing or falsifying information on performance. However, it should be noted that, with regard to the second complaint about cleaning standards, a very similar complaint had previously been raised in October 2020, which was prior to the introduction of the Standards. The actions outlined above and the thorough and high level of scrutiny by the appropriate governance committee (HQAIC) reflect the fact that two very similar complaints had been received, both of which concerned patient safety. 6. Independent primary care contractors A reporting template and targeted communications were developed for independent primary care contractors. Out of those that returned the reporting template, none had received any whistleblowing complaints. It is, however, worth noting that a complaint was received from a GP practice in April 2022 and this will be reported in the quarter 1 report for 2022/23. 7. Experience of Individuals Raising Concern/s during 2021/22 The experience of the individual who raised the concern about radiology services was reported as very positive. No feedback was received from the other two individuals who raised concerns. A further indicator of the satisfaction of those who raise concerns can be derived from the number of concerns escalated to the INWO and no referrals were made to the INWO as a result of concerns raised in NHS Lanarkshire. 8. Communication, Awareness and Training Since the soft launch of the Standards at the beginning of 2021 regular items have appeared in the staff briefing and in the Pulse on-line. Details of confidential contacts have been publicised and a separate briefing has also been sent to all primary care contractors, along with supporting documentation to enable independent contractors to record and report cases. The non-executive whistleblowing champion has presented to the two Health & Social Care Partnerships and Acute management teams and presentations have also been made to both the GP and GDP Sub Committees. Meetings have also been held with both PFI contractors to confirm that the Standards will be made available to their staff who provide services to NHS Lanarkshire patients and the non- executive whistleblowing champion has delivered presentations to the PFI management teams at University Hospitals Hairmyres and Wishaw. Managers in PSSD have been asked to circulate leaflets on whistleblowing for staff who do not have easy access to email. The HR page on FirstPort includes information on whistleblowing, including details of how to raise concerns via the uMatter email address. Further communications have been issued, including items in the staff briefing in September 2021 and January 2022,
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11 emails about the INWO webinars and a video recorded by the non-executive whistleblowing champion. This video appeared with links to social media and the INWO. Training on the Standards is available through TURAS via two modules and NES provides monitoring information on the uptake of the training. To date the training module for all staff has been completed by 151 people and the module for managers/people receiving complaints has been completed by 52 people. It is acknowledged that the numbers completing the training modules are lower than anticipated and directors have now been contacted about this in a bid to increase the uptake of training. 9. Confidential Contacts There are seven confidential contacts in NHS Lanarkshire, all of whom have completed the training modules. Their contact details are regularly publicised in briefings and in the Pulse on line and they are also available on NHS Lanarkshire’s intranet. Two of the confidential contacts are designated for private contractors, including PFIs and one is designated specifically for independent primary care contractors. A network for the confidential contacts has been established to enable them to meet with the Non- Executive Whistleblowing Champion and the HR Director on a bi-annual basis. They are also encouraged to engage with the Scottish Speak Up Network. Priorities for 2022/23 During 2022/23 it is intended to focus on the following areas: 1. Continuing to publicise the Standards and ways to raise concerns. 2. Broadening awareness across independent primary care contractors and encouraging more engagement with data reporting requirements. 3. Developing organisational culture to focus on values and behaviours, leadership and management development, metrics and data and people processes. The work on people processes is yet to be scoped but may include capturing concerns staff may have in relation to the workplace or services such as the use of whistleblowing procedures. 4. Explore the possibility with the Scottish Government of including reference to whistleblowing in iMatter or of developing another national survey which would assist in gauging the level of awareness across the organisation. 5. Use the INWO’s Speak Up week in October to further promote and celebrate speaking up. 10. Conclusion The Board is asked to note the implementation update and the content of this performance report and seek assurance that whistleblowing standards are being followed and learning shared. Kay Sandilands Director of Human Resources July 2022
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1 REPORT Item No: 12 SUBJECT: Draft Strategic Commissioning Plan 2023-26 TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Graeme Cowan, Senior Officer Strategy and Performance DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note This paper provides the draft Strategic Commissioning Plan for 2023-2026, developed through engagement and participation of a wide range of stakeholders. The draft plan will be subject to further consultation in January and February 2023 before final approval in March 2023. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: the Senior Strategy and Performance Manager 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note progress on the completion of the Strategic Commissioning Plan 2023 - 2026 (2) Approve the draft version of the Strategic Commissioning Plan 2023 – 2026 for final consultation in early 2023 (3) Note that the final draft version of the plan will be presented to the IJB at its meeting in March 2023 for final approval. 4. VARIATIONS TO DIRECTIONS
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) Scotland Act 2014 requires each Integrated Joint Board to produce a Strategic Plan. 5.2 Health and Social Care North Lanarkshire published its ten-year strategy “Safer, Healthier, Independent Lives” in 2016 and each year with annual Strategic Commissioning Plans produced between 2016 – 2020, and a three- year plan covering the period 2020 – 2023. The Strategic Commissioning Plans outlining the key intentions to be delivered. 5.3 The Strategic Commissioning Plan is an important document in articulating the response the H&SCP can make to people in local communities to assist them to maximise and maintain their health and wellbeing. The consultation and approval of the current Plan has been heavily impacted by the world health pandemic resulting in acceleration of some of the main ambitions, but for others a slowing down or modification of the routes to achieve them. 5.4 An extensive engagement process has been undertaken to ensure that as wide a range of staff, people who use services and carers have had an opportunity to participate and shape the development of the next three-year commissioning plan which will run from 2023 – 2026. 5.5 Engagement in the drafting of the Strategic Commissioning Plan has included reflection and learning from the Strategic Needs Assessment, also included as an appendix in this report. 5.6 A number of events have taken place to facilitate discussion in localities as well as targeted groups, Community Board members, elected member and IJB members, Strategic Planning Group and Staff Roadshows. 5.7 The intention is that the draft plan is published and widely distributed for final public consultation on the content. Consultation will include the development of an animation to increase accessibility of the content and an on-line survey. 5.8 Along with seeking comments on the draft plan a revised Programme of Work will be developed in early 2023. The Programme of Work will set out in detail the key work programmes that will be undertaken over the three year period to meet the key ambitions set out in the Strategic Commissioning Plan. This will include detail of the aims of each work programme, anticipated performance impact, key deliverables, routes through committee and financial implications. 6. CONCLUSIONS 6.1 Health and Social Care North Lanarkshire has held extensive engagement in the development of the draft Strategic Commissioning Plan 2023-26. 6.2 The draft plan will be subject to further consultation in January and February 2023 before seeking final approval in March 2023. Yes No N/A
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3 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A performance plan will be refreshed with the completion of the Plan and associated Programme of Work setting out the strategic measures and associated trajectories for delivery that the North Lanarkshire IJB is required to deliver. This will be presented once the plan is finalised. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE The associated workforce plan sets out the implications for the implementation of the commissioning intentions. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed: Yes No N/A Each commissioning intention will develop an EQIA as required. 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Draft Strategic Commissioning Plan 2023 - 2026 Appendix 2 North Lanarkshire SCP – Strategic Needs Assessment ...........................................................
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4 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 07939284732.
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5 Appendix 1 Strategic Commissioning Plan 2023-26 Health & Social Care North Lanarkshire
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6 Contents 1. Introduction 3 2. Strategic Context 4 3. Developing the Plan 7 4. Strategic Needs Analysis 9 5. What We’ve Heard 12 6. Our Priorities & Ambitions 2023 - 2026 15 7. Enabling The Plan 18 8. Measuring Performance 21
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7 Introduction Welcome to our Strategic Commissioning Plan for Health & Social Care North Lanarkshire. This plan will cover the period 2023-26 and will cover the final period of our long term Strategic Plan 2016-2026. In developing this plan we have built on the work established in our previous Strategic Commissioning Plan 2020-23, and through engagement and collaboration with local people, service users, members of staff and other key stakeholders this plan sets out our ambitions for improving the health and wellbeing of North Lanarkshire’s population. This plan sets out how community health, social care and social work functions delegated to the Integration Joint Board by North Lanarkshire Council and NHS Lanarkshire will be planned and delivered over the medium term. Despite the significant challenges we have all faced since March 2020, we have made significant achievement and progress in the last three years. This plan gives an overview of some of these achievements and how they have helped to shape our priorities for the next three years. We have set out these priorities for further consultation with you to ensure we are focusing on the right things. We will develop a more detailed implementation plan to support our priorities in the coming months. We continue to experience the long-term and lasting impact of the COVID19 pandemic, working with people to ensure they can access the support and treatment they require following a sustained period of disruption and restriction. We recognise the strength and resilience of our communities, workforce and partners as we move forward with our plans for recovery and renewal. The next three years will undoubtedly present further challenges and uncertainty as we continue our recovery from the pandemic-related disruptions, and also in how we prepare for the establishment of a National Care Service. However, it is clear that we have strong foundations to build upon, working with service users, patients, carers, families and partner organisations to improve the health and wellbeing of North Lanarkshire residents.
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8 Strategic Context While North Lanarkshire’s Integration Joint Board has overall responsibility for planning health and social care services within the area, we have to consider the range of other national and local strategies, plans and policies to ensure our plan is consistent and aligned with the priorities of North Lanarkshire Council, NHS Lanarkshire, other community planning partners, and national priorities. The strategic planning landscape is complex, as outlined in the diagram above. However, through our Strategic Commissioning Plan we are seeking to provide a clarity of direction for the partnership, while ensuring the appropriate linkages are made and due attention is given to our other planning commitments. We have put in place a number of strategies and plans which will be taken forward during the lifetime of this overarching Strategic Commissioning Plan: We are fully committed to working in partnership with our statutory partners and the third and independent sectors. We will continue to work within the community planning structure within North Lanarkshire, recognising that through The Plan for North Lanarkshire, the Health & Social Care Partnership makes a vital contribution to realising the vision of making North Lanarkshire the place to Live, Learn, Work, Invest and Visit. We are also closely engaged in the development of the new, emergent strategy for NHS Lanarkshire, Our Health Together. This new strategy will seek to ensure maximum impact across our whole health and care system with due consideration afforded to recovering services and building resilience and dovetails neatly with the priorities set out in this plan. In working to deliver our priorities, the partnership will support both North Lanarkshire Council and NHS Lanarkshire role as Anchor Organisations. That is, using their resources and influence to effect change to the social, economic and environmental conditions that determine the health and wellbeing of local people. Anchor Organisations are defined by the Joseph Roundtree Foundation as: “…big and locally rooted organisations including the NHS, local authorities, colleges and universities, and private businesses with local HQs. Because they employ many people, spend substantial amounts of money, own and manage land and assets and often deliver crucial services, they have a considerable impact on local communities and economies. Further, they are historically rooted in the physical area, intrinsically connected to the local community and are pivotal to wellbeing.” National policies, legislation, strategies and plans Public Bodies (Scotland) Act 2014 Carers (Scotland) Act 2016 Community Empowerment (Scotland) Act 2015 Equalities (Scotland) Act 2010 Fairer Scotland Duty National Care Service Scotland’s Digital Health and Care Strategy Scotland’s Public Health Priorities Primary Care Improvement Programme Local Strategies & Plans The Plan for North Lanarkshire Our Health Together Lanarkshire Mental Health & Wellbeing Strategy Local Housing Strategy 2021-26 Tackling Poverty Strategy Equality Strategies (NHSL and NLC) Children’s Services Plan Community Solutions Strategic Commissioning Plan North Lanarkshire Alcohol & Drugs Partnership Strategy Community Justice Partnership Improvement Plan Carers Strategy Primary Care Improvement Plan Rapid Rehousing Transition Plan
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9 Crucially, all of our delivery and implementation will be local and our plans are also closely aligned with the new Local Outcome Improvement Plans for each of the eight Community Board areas. Our overall structure for delivery remains with six localities, with three each aligned to a sector (North East and North West), which allows for closer relationship with the two acute hospitals located within North Lanarkshire. The diagram below outlines how our teams and relationships are structured, also including the hosting relationship with South Lanarkshire, and where we deliver services on an area-wide basis. The outcomes that pull all of the strategic and planning strands together are reflected in an agreed set of nine national Health and Wellbeing Outcomes which the Health & Social Care Partnership has a duty to deliver. These are:
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10 Outcome 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. Outcome 3 People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5 Health and social care services contribute to reducing health inequalities. Outcome 6 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. Outcome 7 People using health and social care services are safe from harm. Outcome 8 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. Outcome 9 Resources are used effectively and efficiently in the provision of health and social care services.
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11 Developing the Plan We value the input and contribution from all our stakeholders in all the work we do. In developing the Strategic Commissioning Plan 2023-26 we have been committed to ensuring we engage as widely and as meaningfully as possible across and within our communities, workforce and partner organisations. During 2022, the relaxation of many COVID-19 restrictions offered us the opportunity to have many more in-person events than we had originally anticipated. Through a variety of workshops and local events we have been able to engage with a range of stakeholders through physical, face-to-face meetings. Our ability to use technology to supplement these events and meetings with online workshops has allowed us to offer a wide range of engagement opportunities. To support the development of this plan we engaged with a range of stakeholder groups, including people who use our services, carers of people who use our services, local residents, people who work in health and social care, local community groups and organisations, local elected members, and people who work for partner organisations and other service providers. In each of the events that took place we reviewed the achievements and challenges of the past three years and used a range of information and intelligence to guide our conversations into the opportunities and challenges facing the partnership in the future. The following provides an overview of the types of events and discussions which have taken place over the preceding 3-4 months. Strategic Planning Group Our Strategic Planning Group has the overall responsibility for producing, monitoring and reviewing our Strategic Commissioning Plan. The Group is chaired by our Chief Officer and has a wide-ranging membership, including representation from: senior leaders and managers within the partnership, service user and carer representatives, VANL, and a range of other partner organisations. Consultation and engagement with the group took place via an online workshop and the group will meet again in December 2022 to review the draft plan. Sector and Locality Engagement Our North-East and North-West sectors brought their locality teams and local stakeholders together across two in-person engagement events: one in Cumbernauld New Town Hall and one in Dalziel Park, Motherwell. These events allowed for a large attendance from each of the six localities, with dedicated inputs and workshop sessions on the development of this plan. Staff Roadshows Two staff roadshow sessions were dedicated to engagement on the development of future priorities and reviewing current achievements and challenges. These took place online allowing for a wide range of staff from across a large number of disciplines and services to take part. Community Boards – Strategic Engagement
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12 A Strategic Engagement event took place with members from each of the eight Community Boards in North Lanarkshire with a range of questions and discussion topics focusing on many local issues and priorities. Operational Leads We engaged with senior leaders and managers across our delivery areas, including: Adult Health Services Specialist Children’s Health Services Addiction, Learning Disability & Mental Health Services These sessions provided an opportunity for more tailored discussions and engagement in relation to the specific delivery areas. This version of our plan is a consultative draft which allows us to seek further and final views before we publish our final version in March 2023. Therefore, between December 2022 and February 2023 we will undertake a final consultation on the draft plan. Timeline of Engagement & Consultation
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13 Strategic Needs Analysis A comprehensive needs analysis has been developed with expert support from the Local Intelligence Support Team (Public Health Scotland). The draft analysis is attached as appendix 2 and will be further developed in the early part of 2023, with final publication alongside the SCP in March 2023. Key messages from this detailed work include the following: Population change By mid-2043, it is projected that the overall population of North Lanarkshire will be very slightly lower than current levels (-0.9%), while the overall Scottish population is projected to increase by 2.5%. It projected that by 2043, in North Lanarkshire: those aged 0-15 to shrink by 14.8% those aged 75 and over to increase by 71.4% working age population to shrink by 4% pensionable age population to increase by 26% by 2043 In relation to the forecasted increase in an ageing population, people will be living longer and as a result it is anticipated this will result in an increase in the number of people with long term conditions, and an increase in the number of older people with multiple conditions. As these changes are in addition to current, long standing public health issues such as obesity, physical inactivity, smoking, alcohol and substance misuse – it is expected these changes associated with an ageing population will increase demand for Health and Social care services. The next 20 years will see an ageing population, a continuing shift in the pattern of disease towards long-term conditions, and growing numbers of older people with multiple conditions and complex needs and the impact of this on them and their immediate carers. There will be an increasing number of older family carers and older people within our workforce - many of whom will have their own health needs. The overall impact will be a steadily increasing demand for health and social care. On the one hand, we must ensure that we are able to manage and mitigate the levels of demand from an ageing population on our health and care services. First and foremost, extending the number of years that our population spends living in good health is vital. If people in Scotland live longer, but not healthier lives, then more people will spend a greater proportion of their lives in some kind of ill-health. An outcome of this would be increasing demand on health and care services for a longer period of time across the lifespan. Life expectancy Life expectancy and healthy life expectancy trends in Scotland have not improved since around 2012, and this is also this case for North Lanarkshire. These life expectancy trends indicate the urgency of addressing their underlying causes – the
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14 social and economic circumstances such as poverty, housing, and education that together influence health throughout the life. Poverty and deprivation North Lanarkshire has a higher proportion of its population living in the 20% most deprived datazones compared to the Scottish position – 33% of North Lanarkshire’s population live in the 20% most deprived datazones compared with 19% of Scotland’s population living in the 20% most deprived datazones. This has increased since the 2016 SIMD. Across North Lanarkshire, 50,897 (15%) people are income deprived, the Scottish average is 12%. Of this 50,897 income deprived population – 28,234 live in the 20% most deprived datazones and 21,655 live in the 15% most deprived datazones therefore, 22,663 income deprived people live outside the 20% most deprived datazones and 29,242 income deprived people live outside the 15% most deprived datazones There are 24,796 working age people in North Lanarkshire experiencing employment deprivation. This is 11% of the working age population. In Scotland this is 9%. 13,415 people are employment deprived in the 20% most deprived datazones and 11,205 people are employment deprived in the 15% most deprived datazones, This means 11,381 employment deprived people live outside the 20% most deprived datazones The number of people experiencing income and/or employment deprivation in North Lanarkshire has fallen since the 2016 SIMD. Drugs death rate The drug related death rate for North Lanarkshire is slightly higher than the Scottish average for the most recent figures (2017-21). Alcohol related deaths The age-standardised death rates for alcohol-specific deaths in North Lanarkshire are higher than the Scottish average and fourth highest in 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
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15 (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. Locality Profiles We have developed profiles for each of our six localities – these are still in draft form and will be published in full in March 2023.
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16 What We’ve Heard The conversations which took place across the range of engagement activities highlighted in section above generated a richness of views, experience and intelligence from a range of individuals and stakeholders. Much of engagement focused on reviewing where we thought things were working well and where we felt there were ongoing challenges, or indeed, anticipated challenges in the future. The achievements and challenges highlighted below are a distillation of these conversations and represent some of the common themes which emerged in our engagement activities. Achievements Resilience within the system – staff, carers, service users A common thread through all our engagement activity was the recognition of the efforts and resilience of members of staff from across the health and social care sector, volunteers, carers, service users and family members in dealing with the many challenges of the C-19 pandemic. Focus on staff health, wellbeing and connectedness Training, practical and psychological supports have been developed for staff wellbeing across the Health and Social Care partnership over the past two to three years. These initiatives are now aligned and incorporated within the major strategic workplans of both North Lanarkshire Council, NHSL and Health and Social Care Partnership NL which will inform and shape the way we work going forward, engaging with staff, embedding good practice in our ways of working and improving our methods of supporting staff in the longer term. Use of technology – within a variety of settings The use of technology has expanded considerably over the past three years, and the experience of the C-19 restrictions resulted in the acceleration of our plans to use technology more in relation to online appointments and consultations, technology- enabled care and also as a key element of our communication and day-to-day management. Mental Health Renewal and Recovery The recovery and renewal of our mental health services continues to progress and the importance of linking these efforts with our new priorities was reflected in engagement discussions and feedback. Care Academy The Health and Social Care Academy, based within the Coltness High School campus went live in August 2018, providing curriculum opportunities linked to the health and social care sector. These are targeted at young people in the senior phase of learning from the nine secondary schools in North Lanarkshire’s south locality. It is focused on assisting pupils to gain qualifications as well as work related learning experiences which will help them in gaining employment and assist in meeting the workforce requirements of this sector. The main areas are health and social care, general nursing and allied health professions.
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17 Community Solutions - community capacity building Community Solutions is the community led, health and social care investment programme operating across North Lanarkshire focused on building communities where people can have full, independent lives. The programme, which has been in place since 2013, is a partnership between HSCNL, Voluntary Action North Lanarkshire (VANL), and the community and voluntary sector of North Lanarkshire. Its latest Strategy and Investment Plan 2022-25 was agreed in March 2022, setting out investment plans within the programme to strengthen community capacity and resilience and deliver person-centred, community-based support and services to priority groups. Enhanced Capacity & Resilience In February 2022, the Integration Joint Board approved a £20m business case, utilising both recurring and non-recurring resources to transform the whole health and social care system and build capacity and resilience within it. Building on the wider approach to recovery and renewal across the sector, investment has started to be made in supports and approaches which: Maximise capacity through new staffing, resources and services; Ensure staff wellbeing; Ensure system flow by improving planned discharge from hospital and increasing access to care in a range of community settings; Improve outcomes through collective investment in people, systems, services and supports which deliver the right care in the right setting. Challenges Increasing demand for services, with increasingly complex needs and limited capacity for response With an ageing population, the projected growth in demand for health and social care services over the next 15-20 years is considerable. However, there was also a common view from those who engaged in our discussions that demand for services and support is increasing now and in the short-term and that individuals’ needs are becoming increasingly complex. Cost of living crisis and widening inequalities Given current challenges in relation to the cost of living crisis, the wider issues of poverty and income deprivation were highly prevalent in the discussions and engagement activity that took place. There are significant and persistent inequalities in outcomes across the North Lanarkshire population that have a significant impact on people’s life opportunities and life chances. There is strong evidence to suggest the experience of the C-19 pandemic has widened some inequalities with some sectors of society disproportionately affected by the disruption and restrictions. The current cost of living crisis will also disproportionately affect those with lower incomes. Staff recruitment and retention The wider health and social care sector has experienced challenges related to the recruitment and retention of staff for some time, with the recent experiences of COVID-19 and the United Kingdom leaving the European Union placing further pressure on challenging situation. There is a need to invest in the workforce through training and development, and clear career pathways allied to ensuring we make employment within the sector as attractive as possible. Through a values-based approach we should be offering flexible and positive working environments with an embedded culture of staff wellbeing.
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18 National Care Service The Scottish Government has committed to establishing a functioning National Care Service (NCS) by the end of the parliamentary term in 2026. The aims of the service are centred around early interventions that prevent or delay the development of care needs and reduce care needs that already exist; and the proposed service aspires to design services collaboratively with the people to whom they are provided and their carers’. These aims are reasonable and consistent with the priorities set out in this plan. However, social work and social care staff may transfer to a new organisation as part of the proposals but this is unclear at this point. Over the next 2-3 years, proposed changes will have a direct impact on colleagues working in health and social care and there will be a significant work to prepare for the implementation of the NCS.
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19 Our Priorities and Ambitions for 2023 – 2026 The long term vision for the Health and Social Care partnership which was set out in the original Strategic Plan 2016-2026 remains relevant and will continue as the over- arching vision of this plan. The vision set out in 2016 was that the people of North Lanarkshire will achieve their full potential through: Living safe, healthy and independent lives in their communities. Receiving the information, support and care they need, efficiently and effectively, at the right time, in the right place and in the right way. Ensuring North Lanarkshire is the best place in Scotland to grow up In 2020, we identified six key ambitions that helped to prioritise our areas for action: Do the right thing first time Provide a range of community services to support people to live well in connected communities Focus on what matters to people (outcomes) Be at the forefront of technical and sustainable solutions Promote prevention and early intervention Ensure North Lanarkshire is the best place to work, volunteer and care Following our engagement with stakeholders, taking into account the experience of the past three years and the current and future challenges facing the partnership, it has been agreed to revise our ambitions to the following: Do the right thing first time Increased focus on prevention, early intervention and tackling inequalities by working with communities and people Develop and support a workforce for the future Improve mental health and wellbeing Support people through a whole family approach Do the right thing first time Overarching the whole system is the work to ensure that when people make contact with our services that the response is quick and effective, with a focus on helping people to help themselves first. The continued development of First Point of Contact incorporating good conversations across the Health and Social Care Partnership (HSCP) and embedding the approach with a whole system focus remains a priority and will ultimately support getting it right first time. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people The population and needs analysis within this Plan highlights the need to do things differently, to understand the demographic challenges facing North Lanarkshire and to harness the opportunities of people living healthier lives for longer. Changing the way we deliver services and support people includes acknowledging that in some cases the way we do things attracts higher costs because we focus more on managing crises and late interventions. We need to focus more on prevention, early intervention and empowering people to live fulfilling lives.
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20 By providing ‘upstream’ support at an early stage, we can reduce the demand on intensive health and care service and re-invest in more community focused support services. However, we recognise that early and effective support is not always best provided through health and social care services. Through working with our partners in the Third Sector, we can identify, support and develop local community-based programmes, run by voluntary and independent organisations that focus on the health and care needs of local communities. Work will take place to support and empower people to continue to live healthy, meaningful and more personally satisfying lives as active members of their community for as long as possible. To do this will show ambition and be innovative to develop and try new ways of providing services that haven’t been done before, even that is difficult and sometimes more risky than the easy option. We value and recognise the vital role local people and communities play and through our Engagement and Participation structures we will continue to ensure we provide a voice for local people, service users, patients and carers and ensure we listen to their needs and aspirations. Our strategic planning arrangements don’t stop with publication of a plan, and so engagement and participation from local people will extend into the delivery of our partnership priorities. Develop and support a workforce for the future The increase in ageing population of North Lanarkshire is broadly mirrored within the workforce of the health and social care sector, therefore it is important for us to be cognisant of this and ensure mechanisms are put in place to allow flexibility and support to both our ageing workforce, and our workforce throughout each career level from entry level to ensure their physical and mental health is nurtured. There are also continuing challenges with regards to resourcing, attracting, recruiting and retaining staff. There is an increasing need to support a ‘pipeline’ of workers coming into the profession, for example through highlighting the sector in schools, through other opportunities in developing the young workforce, through wider employability routes, or from career changers. Whole system planning requires further development to better understand the needs and demands of communities including their public health challenges, the types of roles needed to support different Health and Social Care needs, and the availability of different types of workers over time and geographically, as well as the relationships and influences between all parts of the system. Improve mental health and wellbeing We know, through our service information and through speaking to our local communities, that mental health concerns are increasing in the population. This means potentially a greater demand for mental health services and community supports. There is a need for a refreshed and reinvigorated approach to mental health improvement and the delivery of the Lanarkshire Mental Health & Wellbeing Strategy, continuing to focus on the four core areas: Good mental health for all Improving access to mental health supports and services Children and young people’s mental health and wellbeing
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21 Specialist mental health services Supporting people through a whole family approach Our aspiration is to support adults and children of all ages with the tools to set, plan for and achieve their goals together. This puts wellbeing at the heart of our approach and considers the situation that adults and children live in, who they live with and family relationships. This may include helping an adult and their family to think about what may happen in the future, and plan for those possible changes, when the adult needs more care or if a carer becomes unwell; supporting carers of all ages within their caring role and as equal partners in care; supporting families where substance use and other challenges exist. This means in practice understanding each person as an individual, as well as recognising the part they play in their family and community. The approach builds on everyone’s strengths and develops their resilience. Clearly, these priorities are interlinked and we expect them to influence and shape each other as we progress our implementation. Implementation Plan Under each priority area we will develop an agreed set of shorter and medium term goals (Programme of Work) that we plan to address between 2023 and 2026. The Programme of Work will set out in detail the programmes that will be progressed over the next three years. We will update these on an annual basis to ensure that we stay on track and, at the same time, be able to respond to any new or emerging issues that we need to address. We will closely monitor our progress and continue to seek out feedback from service users, carers, and families on the impact we are making.
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22 Enabling Our Plan Medium Term Financial Plan A medium term financial plan will sit alongside the Strategic Commissioning Plan for the period 2023-26. The financial outlook for the public sector is extremely challenging and so it is essential that our strategic ambitions are set against the financial resources we anticipate will be available. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the current significant challenges for both partners. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan was prepared in March 2020 and underpins strong financial planning and management, the achievement of best value and the allocation of resources to support sustainable models of service delivery from a whole system perspective, ensuring our limited resources are targeted to achieve our outcomes. This plan however was prepared before the impact of the emergency response to the Covid-19 pandemic was known. As part of the recovery plan to the Covid-19 pandemic, the IJB Medium to Long Term Financial Plan is being reviewed to reflect the operational and financial challenges. The IJB Chief Finance Officer will continue to consult with both partners about the options available to address all 2022/2023 recurring and non-recurring health and social care cost pressures. Cost reduction options will be explored however this is not expected to release sufficient funding to meet the total increase in all health and social care cost pressures going forward. Reliance will therefore require to be placed on non-recurring funding and reserves. Our joint focus with all our partners and stakeholders will continue to be ensuring that all resources in scope are maximised, health and social care services are remobilised and a whole system approach across North Lanarkshire is adopted which is sustainable and operates efficiently and effectively. Market Facilitation Plan The Plan outlines our approach, sets out our commitment to working in partnership and outlines how we will communicate key messages, enabling a basis for early engagement and consultation with the market on how best to respond to supporting social care and support need. Engagement will take place through existing communication channels and provider forums, with the aim of developing a joint action plan to support the delivery of the Market Facilitation Plan, which will also reflect the Strategic Plan objectives. We need providers to consider these key messages if they wish to be best placed to respond to future market requirements. Developing a Market Facilitation Plan is an evolving process and we will involve all our partner organisations on an on-going basis to help make sure that the changes we wish to make can be delivered and sustained.
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23 Workforce Plan Our workforce planning arrangements are integrated with the Lanarkshire Health and Social Care Integrated Workforce Plan 2022-25 and the Workforce for the Future Strategy. Through our combined efforts with NHS Lanarkshire and North Lanarkshire Council we are seeking to build a flexible, resilient and skilled workforce for the future across the health and social care sector and we will continue to expand and develop the Care Academy model that has already proved successful. Housing Contribution Statement – TO FOLLOW Engagement and Participation Strategy Health and Social Care North Lanarkshire (HSCNL) has a firm commitment to ensuring ongoing meaningful involvement with the communities it serves. This engagement and participation strategy sets out how we will achieve this. This will ensure we have the right systems and supports in place to enable effective engagement between stakeholders and HSCNL and the strategy and approach is a key supporting pillar of the overall Strategic Commissioning Plan. Transformation Plan This Strategic Commissioning Plan seeks to address the need to act now and have a lasting and sustainable impact and build resilience in the whole system supporting people and communities in North Lanarkshire. Investment across the sector must strengthen services and supports in creating additional capacity across our health and care system as well as targeting our efforts to transform and redesign to ensure people can access the right support from the right person at the right time. Recognising that more of the same will not sustain robust services and supports into the future, a Strategic Commissioning Plan Programme Board (SCP PB) has been established to ensure a whole system approach is adopted to support transformational change which capitalises on the availability and use of all of our resources and will drive forward the transformation agenda emanating from this plan. A key element of our Transformation Plan will be an Organisational Development Strategy focusing on our leadership values, culture and behaviours. We will look to build on our strengths to develop a compassionate leadership model which encourages and sustains behaviours of understanding, empathising and helping create inclusive, effective and collective cultures within our teams. We will also further develop our programme management approach to the delivery and implementation of this plan and its programme of work, with identified training and development resources available to leaders and managers to effectively deliver a shared transformation and improvement agenda. Support, Care & Clinical Governance A Support, Care & Clinical Governance framework is in place for integrated services, built upon the national clinical and care governance framework. The framework encompasses the following
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24 Professional regulation, workload and workforce development; Information assurance; Service user experience and safety and quality of integrated service delivery and personal outcomes; Person-centre care; Management of clinical risks; and Learning from adverse event
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25 Measuring our Performance The Health and Social Care Partnership has long been committed to a whole system approach, recognising the co-dependencies that exist across the entire health and social care system. Ensuring we have a performance framework that reflects the whole system requires continued engagement with partners and stakeholders from across the whole system, including but not limited to: HSCP services, Acute services, NLC services, third sector, carers, people with lived experience, etc. We have robust performance monitoring processes in place which allow us to assess how well we are delivering health and care services to the people of North Lanarkshire. As part of our annual performance reporting arrangements, we are required to demonstrate how we perform against the nine national health and wellbeing outcomes. These are: 1. People are able to look after and improve their own health and wellbeing and live in good health for longer. 2. People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3. People who use health and social care services have positive experiences of those services, and have their dignity respected. 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5. Health and social care services contribute to reducing health inequalities. 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being. 7. People who use health and social care services are safe from harm. 8. 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. 9. Resources are used effectively and efficiently in the provision of health and social care services. These nine national health and wellbeing outcomes are underpinned by 23 performance measures which are reported through our Annual Performance Reports. In addition to the reporting on the 23 national indicators, we also publish information a further suite of six indicators set out by the Scottish Governments Ministerial Strategic Group for Health and Community Care.
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26 Appendix 1 List of engagement events and activities Date Forum Type of engagement 7 June 2022 Strategic Planning Group Online event, via MS Teams 9 June 2022 Locality Planning Group Chairs event In person event 4 August 2022 Staff Roadshow Online event, via MS Teams 31 August 2022 North East Sector – Motherwell, Bellshill and Wishaw Localities (staff, stakeholders, elected members and carer/service user representatives) In person event 7 September 2022 North West Sector – North, Coatbridge and Airdrie Localities (staff, stakeholders, elected members and carer/service user representatives) In person event 13 September 2022 Strategic Planning Group Online event, via MS Teams 29 September 2022 Community Board Strategic Engagement Event Online event, via MS Teams 30 September 2022 Session with Public Partnership Forum North In person event 7 October 2022 Adult Health Services Event In person event 7 October 2022 Specialist Children’s Health Services Event In person event 20 October 2022 Session with Access Panel In person meeting 27 October 2022 Staff Roadshow Online event, via MS Teams 2 November 2022 IJB Liaison Session Online event, via MS Teams
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27 Appendix 2 North Lanarkshire Health & Social Care Partnership Draft Strategic Needs Analysis
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28 Contents 1 Introduction ........................................................................................................ 29 2 Demographics ................................................................................................... 31 3 Population Projections ....................................................................................... 34 4 Life Expectancy ................................................................................................. 37 5 Care at Home .................................................................................................... 38 6 Care Home ....................................................................................................... 45 7 Self-Directed Support (SDS) .............................................................................. 50 8 Unscheduled Care ............................................................................................. 56 9 Delayed Discharges ........................................................................................... 71 10 Long Term Conditions ....................................................................................... 73 11 Children and Young People ............................................................................... 75 12 Mental Health .................................................................................................... 77 13 Last 6 months of life ........................................................................................... 78 14 Health Inequalities ............................................................................................. 79
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29 1 Introduction In preparing the previous SCP, a comprehensive needs analysis was completed to support planning decisions and assumptions. This work has continued and also been supplemented by the Local Intelligence Support Team (LIST) from Public Health Scotland who provide specific and expert analysis of current and future demand on health and social care services. To support the planning assumptions, a revised and updated needs assessment was completed as detailed below. However, the information shown represents a small snapshot of the information available in a planning context. Therefore, the needs profiling work will continue as the plan is being implemented, particularly with regards to further information profiling on inequalities and early intervention and prevention data as well as the longer-term impacts of COVID-19. A summary of the needs analysis is provided below. The long-term impact of the Covid-19 pandemic is not yet clear. All projections presented in this report, which assume that pre-pandemic levels and trends will continue post-pandemic, should be interpreted with caution. Between now and 2043, the population of North Lanarkshire is projected to decrease by 1% however the population aged 75+ is projected to increase substantially – by around 58%. In 2018-2020 the average life expectancy in North Lanarkshire was 74.5 years old for men, and 79.2 years old for women: both below the average life expectancy for Scotland overall. North Lanarkshire is more deprived than Scotland as a whole, with all localities apart from North having a higher proportion of the population in the most deprived quintile compared to Scotland. Add in social care points North Lanarkshire has a higher rate per 1,000 population compared to Scotland for several health indicators including: A&E attendances, acute emergency hospital admissions, readmissions, alcohol and drug related hospital admissions, NHS 24 calls North Lanarkshire has a higher percentage of children with a concern at the 27–30-month health visitor review compared to Scotland North Lanarkshire has a lower rate per 1,000 population compared to Scotland for several health indicators including: delayed discharges bed days, Mental Health (psychiatric) emergency bed days, CAMHS referrals In 2021/22, 13.5% of the North Lanarkshire population had three or more long- term health conditions (LTCs). Anxiety/Depression is by far the most prevalent long-term conditions amongst the North Lanarkshire population. The percentage of the last 6 months of life spent in the community has increased in North Lanarkshire since 2013/14. North Lanarkshire populations in the most deprived SIMD quintiles have much higher rates per 1,000 population than those in least deprived quintiles for
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30 many health indicators, and trends over time show this disparity has remained fairly consistent over the last 5 years with no signs of this inequality reducing.
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31 2 Demographics Chart 1: North Lanarkshire 2021 population by locality Source: National Records of Scotland population estimates Table 1: North Lanarkshire 2021 population by locality Area of Residence Mid-2021 population estimate Percentage of North Lanarkshire population Airdrie 56,357 17% Bellshill 41,377 12% Coatbridge 50,330 15% Motherwell 54,205 16% North Lanarkshire North 87,695 26% Wishaw 51,436 15% North Lanarkshire 341,400 100% Source: National Records of Scotland population estimates As of 2021, North Lanarkshire has a total population of 341, 400, with North Lanarkshire North being the most populous locality making up around a quarter the total North Lanarkshire population. Airdrie is the next biggest locality, followed by Motherwell, Wishaw, Coatbridge and then Bellshill. Chart 2: Percentage of 2021 population by area of residence and age group Source: National Records of Scotland population estimates
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32 Table 2: Count of 2021 population by area of residence and age group Age Group Area of Residence 0 to 17 18 to 44 45 to 64 65 to 74 75 Plus Total Airdrie 11,758 19,091 15,840 5,641 4,027 56,357 Bellshill 8,002 13,924 11,879 4,541 3,031 41,377 Coatbridge 10,253 17,019 14,421 4,832 3,805 50,330 Motherwell 11,787 18,812 14,837 4,939 3,830 54,205 North Lanarkshire North 17,984 28,972 24,585 9,437 6,717 87,695 Wishaw 9,967 16,862 14,791 5,476 4,340 51,436 North Lanarkshire 69,751 114,680 96,353 34,866 25,750 341,400 Scotland 1,024,981 1,890,933 1,490,125 595,578 478,283 5,479,900 Source: National Records of Scotland population estimates When compared to Scotland, North Lanarkshire has a higher percentage of its population in the younger age groups – 0 to 17, 18-44 and 45-64 and a lower percentage of its population the older age groups 75Plus age groups. Chart 3: Percentage of 2021 population by area of residence and gender Source: National Records of Scotland population estimates Table 3: Count and percentage of 2021 population by area of residence and gender Gender Female Male Area of Residence Count Percentage Count Percentage Airdrie 29,095 52% 27,262 48% Bellshill 21,298 51% 20,079 49% Coatbridge 26,017 52% 24,313 48% Motherwell 27,749 51% 26,456 49% North Lanarkshire North 45,581 52% 42,114 48% Wishaw 26,331 51% 25,105 49% North Lanarkshire 176,071 52% 165,329 48% Scotland 2,807,338 51% 2,672,562 49% Source: National Records of Scotland population estimates There is a slightly higher proportion of females compared to males in North Lanarkshire, with a similar pattern being shown across the six localities. North
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33 Lanarkshire has a slightly higher proportion (52%) of females than Scotland as a whole (51%). Chart 4: Percentage of 2021 population by area of residence and SIMD quintile Source: National Records of Scotland population estimates, combined with Public Health Scotland population weighted Scottish Index of Multiple Deprivation 2020, which is based on Scottish Government Scottish Index of Multiple Deprivation Table 4: Count of 2021 population by area of residence and SIMD quintile SIMD Quintile Area of Residence Q1 (Most deprived) Q2 Q3 Q4 Q5 (Least deprived) Airdrie 23,279 12,009 10,032 9,335 1,702 Bellshill 17,197 10,569 4,667 5,042 3,902 Coatbridge 20,211 13,991 7,043 7,285 1,800 Motherwell 21,418 9,715 4,197 10,651 8,224 North Lanarkshire North 10,394 27,688 15,116 15,657 18,840 Wishaw 16,919 18,542 7,526 7,273 1,176 North Lanarkshire 109,418 92,514 48,581 55,243 35,644 Scotland 1,077,716 1,082,490 1,097,605 1,129,841 1,092,248 Source: National Records of Scotland population estimates, combined with Public Health Scotland population weighted Scottish Index of Multiple Deprivation 2020, which is based on Scottish Government Scottish Index of Multiple Deprivation North Lanarkshire is more deprived than Scotland as a whole. There is variation across North Lanarkshire for deprivation, with Airdrie having the highest proportion of the population living in most deprived areas (quintile 1) and North Lanarkshire North with the lowest. All localities apart from North Lanarkshire North have a higher proportion of the population living in the most deprives areas. Airdrie, Bellshill, Coatbridge and Motherwell have around double the proportion of the population living in the most deprived areas compared to Scotland. North Lanarkshire has 10% fewer residents living in the least deprived quintile as compared to the national deprivation distribution and 12% more residents living in the most deprived quintile as compared to the national distribution.
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34 Chart 5: Percentage of 2021 population Urban Rural Classification and area of residence Source: National Records of Scotland population estimates combined with Scottish Government Urban Rural Classification Table 5: Count and percentage of 2021 population Urban Rural Classification and area of residence Urban Rural Classification (2-fold) Urban Rural Area of Residence n % n % Airdrie 42,186 75% 14,171 25% Bellshill 41,377 100% 0 0% Coatbridge 46,336 92% 3,994 8% Motherwell 54,205 100% 0 0% North Lanarkshire North 79,139 90% 8,556 10% Wishaw 43,596 85% 7,840 15% North Lanarkshire 306,839 90% 34,561 10% Scotland 4,519,884 82% 960,016 18% Source: National Records of Scotland population estimates combined with Scottish Government Urban Rural Classification The vast majority (90%) of the North Lanarkshire population reside in urban areas; this is higher than Scotland as a whole (82%). There is some variation across the six localities with Airdrie having the largest proportion of its population living in rural areas (25%) whereas Bellshill and Motherwell’s population resides in urban areas only. 3 Population Projections
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35 Chart 6: North Lanarkshire population projections for all ages for 2022-2043 Source: National Records of Scotland population projections Table 6: North Lanarkshire population projections for all ages for 2022-2043 Calendar Year Projected Population Calendar Year Projected Population 2022 340,882 2033 340,516 2023 341,013 2034 340,294 2024 341,134 2035 340,046 2025 341,204 2036 339,770 2026 341,224 2037 339,474 2027 341,242 2038 339,164 2028 341,174 2039 338,824 2029 341,101 2040 338,453 2030 341,008 2041 338,079 2031 340,900 2042 337,646 2032 340,738 2043 337,166 Source: National Records of Scotland population projections The North Lanarkshire population is projected to decrease from around 341,000 in 2022 to around 337,000 in 2043, which is around a 1% decrease from the current population. Chart 7: North Lanarkshire population projection for 2022-2043 for 75+ age group Source: National Records of Scotland population projections
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36 Table 7: North Lanarkshire population projection for 75+ for 2022-2043 Calendar Year Projected Population (75+) Calendar Year Projected Population (75+) 2022 26,705 2033 33,006 2023 27,439 2034 33,733 2024 28,101 2035 34,543 2025 28,661 2036 35,409 2026 29,014 2037 36,478 2027 29,431 2038 37,482 2028 29,925 2039 38,463 2029 30,426 2040 39,540 2030 30,951 2041 40,432 2031 31,571 2042 41,313 2032 32,248 2043 42,131 Source: National Records of Scotland population projections The North Lanarkshire population for people aged 75 or over is projected to increase from over 26,705 in 2022 to over 42,131 in 2043, which is an increase of around 58%. Chart 8: North Lanarkshire population projections by age group, comparing 2023 and 2026 Source: National Records of Scotland population projections Table 8: North Lanarkshire population projections by age group, comparing 2023 and 2026 Calendar Year Age Group 2023 2026 0-17 56,089 53,967 18-44 127,019 126,755 45-64 94,913 93,966 65-74 35,553 37,522 75+ 27,439 29,014 Source: National Records of Scotland population projections NRS population projections show an ageing population between years 2022 and 2026, with the proportion of the population made up by the 60-74 and 75 plus age groups projected to increase and the proportion of the 0-17 age group projected to decrease.
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37 Chart 9: North Lanarkshire population projection, 2020-2040, with under/over 75 years age breakdown Source: National Records of Scotland population estimates and projections Table 9: North Lanarkshire population projection, 2020-2040, with under/over 75 years age breakdown Age Group Calendar Year 0-74 75 plus 2020 315,191 25,353 2025 312,543 28,661 2030 310,057 30,951 2035 305,503 34,543 2040 298,913 39,540 Source: National Records of Scotland population estimates and projections Further inspection of the NRS population projections give further evidence about an ageing population with the proportion of the North Lanarkshire population made up by 75 plus age group increasing steadily from 7% in 2020 to 12% in 2040. 4 Life Expectancy Estimated life expectancy at birth in years, multi-year average over 3 years. Mortality data are based on year of registration. They also include non-Scottish residence so the number of deaths match those produced by NRS. Chart 10: Life expectancy by gender, comparing North Lanarkshire and Scotland
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38 Source: ScotPHO Profiles Tool https://scotland.shinyapps.io/ScotPHO_profiles_tool/, Public Health Scotland/National Records of Scotland (NRS) Table 10: Life expectancy by gender, comparing North Lanarkshire and Scotland Average Male Life Expectancy Average Female Life Expectancy Average Male Life Expectancy Average Female Life Expectancy 3-year period North Lanarkshire Scotland North Lanarkshire Scotland 3-year period North Lanarkshire Scotland North Lanarkshire 2001- 2003 71.9 73.5 77.4 78.8 2010- 2012 74.9 76.5 79.1 2002- 2004 72.4 73.8 77.4 79.0 2011- 2013 75.1 76.8 79.4 2003- 2005 72.8 74.2 77.6 79.2 2012- 2014 75.4 77.1 79.7 2004- 2006 73.1 74.6 78.2 79.5 2013- 2015 75.3 77.1 79.6 2005- 2007 72.8 74.8 78.4 79.7 2014- 2016 75.4 77.1 79.6 2006- 2008 73.3 75.0 78.4 79.8 2015- 2017 75.3 77.0 79.4 2007- 2009 73.9 75.3 78.5 80.0 2016- 2018 75.2 77.1 79.6 2008- 2010 74.5 75.8 78.8 80.3 2017- 2019 75.2 77.2 79.6 2009- 2011 74.8 76.2 79.0 80.6 2018- 2020 74.5 76.8 79.2 Source: ScotPHO Profiles Tool https://scotland.shinyapps.io/ScotPHO_profiles_tool/, Public Health Scotland/National Records of Scotland (NRS) Life expectancy in North Lanarkshire is lower than Scotland, for both males and females. Life expectancy of males in North Lanarkshire has been levelling off over the last few years since 2012, approximately 75 years of age, with now signs that this is decreasing since 2019. Life expectancy for North Lanarkshire females follows roughly the same trend as the males, also with first signs of a decrease in life expectancy following 2019. Females in North Lanarkshire, on average, live approximately 4 years longer than males. 5 Care at Home The care at home analysis below is counting all service users in receipt of services across the financial year and the hours are the total hours that were delivered across the financial year unless otherwise stated. Care at home is delivered to service users via "packages of care". A user's package of care may change over time and could be withdrawn if no longer needed and restarted later if need be. One characterisation of a package of care is the total number of hours required to deliver it over a week.
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39 Chart 11: Number of North Lanarkshire care at home users by financial year Data Source: mySWIS, North Lanarkshire council Table 11: Number of North Lanarkshire care at home users by financial year Financial Year Number of care at home users 2017/18 5,277 2018/19 5,179 2019/20 5,356 2020/21 5,551 2021/22 5,328 Data Source: mySWIS, North Lanarkshire council The number of North Lanarkshire care at home users has continually increased over the 3-year period 2018/19 to 2020/21, increasing from 5,179 to 5,551 in 2020/21. However a decrease has been observed in 2021/22, decreasing down to 5,328. This is likely to be linked to the transition from “traditional” care at home towards Self- Directed Support. See SDS section below. Chart 12: Average annual number of care at home hours supplied per user by financial year for North Lanarkshire Data Source: mySWIS, North Lanarkshire council Table 12: Average annual number of care at home hours supplied per user by financial year for North Lanarkshire Financial Year Average annual care at home hours
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40 supplied per user 2017/18 350 2018/19 366 2019/20 354 2020/21 338 2021/22 357 Data Source: mySWIS, North Lanarkshire council The average annual number of care at home hours supplied per user has remained at a steady rate over the last 5 years. Lowest average hours seen in 2020/21 of 338 and the highest being in 2018/19 at 366 hours. Chart 13: Average weekly care at home package of care (POC) hours as at 31st March for North Lanarkshire Data Source: mySWIS, North Lanarkshire council Table 13: Average weekly care at home package of care (POC) hours as at 31st March for North Lanarkshire Financial Year Average weekly care at home package of care hours 2017/18 11.1 2018/19 11.2 2019/20 11.3 2020/21 12.0 2021/22 11.9 Data Source: mySWIS, North Lanarkshire council The average weekly package of care as at 31st March has increased continuously from 2017/18 to 2020/21, increasing from 11.1 hours per user per week in 2016/17 to 12.0 hours per user per week. 2021/22 has shown a very slight decrease, with the average hours going down to 11.9 per week.
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41 Chart 14: Number of North Lanarkshire care at home users by age group and financial year Data Source: mySWIS, North Lanarkshire council Table 14: Number of North Lanarkshire care at home users by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 571 537 603 608 591 65 - 74 931 918 948 1010 978 75 - 84 2,016 1,965 1,958 2,134 1,982 85 plus 1,759 1,759 1,847 1,799 1,777 Total 5,277 5,179 5,356 5,551 5,328 Data Source: mySWIS, North Lanarkshire council The age group with the highest number of care at home users is the 75-84 age group. Over 70% of North Lanarkshire care at home users are aged 75 or above. Chart 15: Rate per 1,000 population of North Lanarkshire care at home users by age group and financial year Data Source: mySWIS, North Lanarkshire council Table 15: Rate per 1,000 population of North Lanarkshire care at home users by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22
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42 Under 65 2.0 1.9 2.1 2.2 2.1 65 - 74 28.2 27.5 28.0 29.4 28.1 75 - 84 108.6 104.4 101.8 110.1 101.7 85 plus 310.9 305.3 309.5 296.2 283.8 Total 15.5 15.2 15.7 16.3 15.6 Data Source: mySWIS, North Lanarkshire council The older the age group, the higher the rate of care at home users per 1,000 population. The rate per 1,000 population for the 85 plus age group is around 3 times higher than the rate for the 75-84 age group. Chart 16: Average annual number of care at home hours supplied per user for North Lanarkshire by age group and financial year Data Source: mySWIS, North Lanarkshire council Table 16: Average annual number of care at home hours supplied per user for North Lanarkshire by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 354.8 383.5 357.0 375.2 394.5 65 - 74 346.2 376.3 359.4 344.5 361.3 75 - 84 327.7 342.5 336.1 308.9 338.0 85 plus 376.2 382.9 368.1 356.7 363.2 Total 350.1 366.5 353.6 338.1 357.0 Data Source: mySWIS, North Lanarkshire council Over the last 2 years, the average number of care at home hours supplied per user is highest for the under 65 age group. With the 75-84 age group being consistently the lowest.
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43 Chart 17: Average weekly care at home package of care (POC) hours for North Lanarkshire as at 31st March by financial year and age group Data Source: mySWIS, North Lanarkshire council Table 17: Average weekly care at home package of care (POC) hours for North Lanarkshire as at 31st March by financial year and age group Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 11.9 12.2 12.4 13.0 12.0 65 - 74 11.1 11.4 11.6 12.8 12.9 75 - 84 10.5 10.7 10.8 11.4 11.6 85 plus 11.7 11.4 11.3 11.8 11.5 Total 11.1 11.2 11.3 12.0 11.9 Data Source: mySWIS, North Lanarkshire council The younger the age group, the greater the average weekly package of care size. From 2017/18 to 2020/21 the average weekly package of care per user is highest for the under 65 age group. However in 2021/22 the highest can be observed now in the 65-74 age group. Chart 18: Rate per 1,000 population of care at home users by financial year and locality Data Source: mySWIS, North Lanarkshire council
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44 Table 18: Rate per 1,000 population of care at home users by financial year and locality Financial Year Locality 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 15.5 15.7 16.3 17.2 16.8 Bellshill 16.2 15.2 15.7 16.5 16.2 Coatbridge 15.9 15.3 16.9 16.6 16.0 Motherwell 14.6 13.8 14.3 15.0 15.0 North Lanarkshire North 12.4 12.9 12.6 13.5 12.2 Wishaw 20.7 19.9 20.5 20.7 19.9 Data Source: mySWIS, North Lanarkshire council In 2021/22 of the North Lanarkshire localities, Wishaw has the highest rate of care at home users per 1,000 population, with North Lanarkshire North being the lowest. This has consistently been the same pattern for the last 5 years. Chart 19: Average annual number of care at home hours supplied per user by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 19: Average annual number of care at home hours supplied per user by financial year and locality Financial Year Locality 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 369.5 369.4 363.9 351.6 374.2 Bellshill 369.9 397.2 372.8 354.0 348.9 Coatbridge 376.9 408.1 349.1 341.6 396.1 Motherwell 371.0 396.5 390.8 379.2 377.5 North Lanarkshire North 288.1 289.4 294.3 268.4 297.6 Wishaw 347.9 375.4 370.3 358.6 361.6 Data Source: mySWIS, North Lanarkshire council Of the North Lanarkshire localities, Coatbridge has the highest average home care hours supplied by home care user, with North Lanarkshire North consistently being the lowest.
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45 Chart 20: Average weekly care at home package of care (POC) hours as at 31st March by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 20: Average weekly care at home package of care (POC) hours as at 31st March by financial year and locality Financial Year Locality 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 11.3 11.4 11.6 12.4 12.4 Bellshill 12.1 12.1 12.2 12.7 11.8 Coatbridge 11.7 11.7 11.2 12.4 12.6 Motherwell 12.5 11.7 12.3 12.6 11.8 North Lanarkshire North 9.4 9.3 10.0 10.3 10.2 Wishaw 10.9 11.7 11.0 12.0 12.4 Data Source: mySWIS, North Lanarkshire council Of the North Lanarkshire localities, Coatbridge has the highest average home care hours weekly package of care as at 31st March, with North Lanarkshire North consistently being the lowest. 6 Care Home Chart 21: Number of North Lanarkshire care home admissions, discharges and placements at end of period by financial year Data Source: mySWIS, North Lanarkshire council
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46 Table 21: Number of North Lanarkshire care home admissions, discharges and placements at end of period by financial year Financial Year Care Home Admissions Care Home Discharges Care Home Placements at end of year 2017/18 656 635 1,349 2018/19 592 538 1,404 2019/20 623 590 1,436 2020/21 557 689 1,304 2021/22 590 548 1,346 Data Source: mySWIS, North Lanarkshire council The number of North Lanarkshire care home admissions has fluctuated over the last 5 years, however remains at around 600 per year. The number of discharges has been slightly lower than the number of admissions for all years apart from 2020/21, where the number of discharges was higher than normal due to the impact of the COVID-19 pandemic. The number of care home placements at the end of each financial year had been increasing between 2017/18 to 2019/20, there was a decrease in 2020/21 due to COVID-19 pandemic, followed by an increase in 2021/22. Chart 22: North Lanarkshire care home admissions rate per 10,000 population by financial year and age group Data Source: mySWIS, North Lanarkshire council Table 22: North Lanarkshire care home admissions rate per 10,000 population by financial year and age group Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 0.9 0.8 0.7 0.8 0.9 65 - 74 23.6 20.3 22.7 22.1 16.3 75 - 84 135.7 120.7 121.1 113.6 123.1 85 plus 530.3 477.3 491.0 391.8 426.4 Data Source: mySWIS, North Lanarkshire council The rate per 10,000 population for care home admissions is higher in older age groups, with the rate for the 85plus age group being over 3 times higher the rate for the 75-84 age group.
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47 Chart 23: North Lanarkshire care home discharges rate per 10,000 population by financial year and age group Data Source: mySWIS, North Lanarkshire council Table 23: North Lanarkshire care home discharges rate per 10,000 population by financial year and age group Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 0.5 0.2 0.6 0.5 0.6 65 - 74 12.4 11.7 15.9 19.8 14.1 75 - 84 116.4 97.8 92.5 118.2 90.8 85 plus 645.2 534.6 571.4 620.7 485.5 Data Source: mySWIS, North Lanarkshire council The rate per 10,000 population for care home discharges is higher in older age groups, with the rate for the 85plus age group being over 5 times higher the rate for the 75-84 age group. Chart 24: North Lanarkshire care home placements at end of year, rate per 10,000 population by financial year and age group Data Source: mySWIS, North Lanarkshire council
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48 Table 24: North Lanarkshire care home placements at end of year, rate per 10,000 population by financial year and age group Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 Under 65 1.9 2.2 2.1 2.0 2.1 65 - 74 49.6 54.4 51.3 48.6 44.7 75 - 84 262.9 262.1 266.7 232.3 243.2 85 plus 1134.9 1156.0 1154.5 1038.9 1051.0 Data Source: mySWIS, North Lanarkshire council The rate per 10,000 population for care home placements at the end of year is higher in older age groups, with the rate for the 85plus age group being over 4 times higher the rate for the 75-84 age group. Chart 25: North Lanarkshire care home admissions rate per 10,000 population by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 25: North Lanarkshire care home admissions rate per 10,000 population by financial year and locality Financial Year Locality 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 19.0 17.2 16.5 15.4 19.3 Bellshill 14.5 13.4 15.6 11.5 15.7 Coatbridge 18.0 15.7 19.3 20.6 13.7 Motherwell 24.4 17.3 17.1 16.1 14.6 North Lanarkshire North 16.7 16.3 18.2 16.1 17.2 Wishaw 23.8 24.4 22.4 17.6 22.7 Data Source: mySWIS, North Lanarkshire council The rate per 10,000 population for care home admissions by locality has fluctuated over the last 5 years. In 2021/22 Coatbridge had the lowest rate per 10,000 population wit Wishaw having the highest.
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49 Chart 26: North Lanarkshire care home discharges rate per 10,000 population by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 26: North Lanarkshire care home discharges rate per 10,000 population by financial year and locality Financial Year Locality of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 12.6 15.1 16.8 19.4 16.9 Bellshill 14.5 14.6 14.9 14.7 12.6 Coatbridge 22.2 14.1 14.6 23.4 12.7 Motherwell 20.8 18.2 18.0 19.6 14.2 North Lanarkshire North 15.6 12.3 15.7 20.8 14.5 Wishaw 28.0 22.5 24.2 22.0 25.9 Data Source: mySWIS, North Lanarkshire council The rate per 10,000 population for care home admissions by locality has fluctuated over the last 5 years. In 2021/22 Bellshill had the lowest rate per 10,000 population with Wishaw having the highest. Chart 27: North Lanarkshire care home placements at end of year, rate per 10,000 population by financial year and locality Data Source: mySWIS, North Lanarkshire council
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50 Table 27: North Lanarkshire care home placements at end of year, rate per 10,000 population by financial year and locality Financial Year Locality of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 37.0 39.3 38.8 35.0 37.4 Bellshill 32.9 31.9 32.7 29.6 32.9 Coatbridge 35.1 36.7 41.2 38.6 39.7 Motherwell 43.3 42.1 40.7 37.0 37.3 North Lanarkshire North 36.0 40.0 42.0 37.1 39.6 Wishaw 54.8 56.7 55.4 51.4 48.6 Data Source: mySWIS, North Lanarkshire council Over the last 5 years, Wishaw has consistently been the locality with the highest rate per 10,000 population for care home placements at the end of year, with Bellshill consistently the lowest. 7 Self-Directed Support (SDS) Self-directed support was introduced in Scotland on the 1 April 2014 following the Social Care Self-directed Support Scotland Act 2013. Its introduction means that people receiving social care support in Scotland have the right of choice, control and flexibility to meet their personal outcomes. Health and Social Care Partnerships are required to ensure that people are offered a range of choices on how they receive their social care support. The self-directed support options available are: Option 1: Taken as a Direct Payment. Option 2: Allocated to an organisation that the person chooses and the person is in charge of how it is spent. Option 3: The person chooses to allow the council to arrange and determine their services. Chart 28: Number of North Lanarkshire Self-Directed Support (SDS) users Data Source: mySWIS, North Lanarkshire council Table 28: Number of North Lanarkshire Self-Directed Support (SDS) users Financial Year Number of SDS users 2018/19 1,390 2019/20 1,517 2020/21 1,514
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51 2021/22 1,723 Data Source: mySWIS, North Lanarkshire council Over the last 4 years, the number of SDS users in North Lanarkshire has been steadily increasing. There has been an increase of just under 14% over the last year where it has risen from 1,514 in 2020/21 to 1,723 in 2021/22. Chart 29: Average budget of North Lanarkshire Self-Directed Support (SDS) users Data Source: mySWIS, North Lanarkshire council Table 29: Average budget of North Lanarkshire Self-Directed Support (SDS) users Financial Year Average budget per SDS user 2018/19 £36,577 2019/20 £37,974 2020/21 £39,278 2021/22 £37,442 Data Source: mySWIS, North Lanarkshire council From 2018/19 to 2020/21, the average budget of North Lanarkshire SDS users has gradually increased each year. However there has been a decrease in 2021/22, where it has fallen from £39,277 from 202/21 to £37,442 in 2021/22. Chart 30: North Lanarkshire Self-Directed Support (SDS) users rate per 1,000 population Data Source: mySWIS, North Lanarkshire council Table 30: North Lanarkshire Self-Directed Support (SDS) users rate per 1,000 population Financial Year Rate of SDS users per
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52 1,000 population 2018/19 4.1 2019/20 4.4 2020/21 4.4 2021/22 5.0 Data Source: mySWIS, North Lanarkshire council The rate per 1,000 population of North Lanarkshire SDS users has steadily increased each year over the last 4 years. Chart 31: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by age group Data Source: mySWIS, North Lanarkshire council Table 31: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by age group Financial Year Age Group 2018/19 2019/20 2020/21 2021/22 Under 65 4.1 4.3 4.3 4.5 65 - 74 4.2 4.9 4.8 5.3 75 - 84 2.9 4.5 4.1 7.9 85 plus 5.7 10.6 9.2 18.8 Data Source: mySWIS, North Lanarkshire council The rate per 1,000 population of North Lanarkshire SDS users, increases as the age group increases, with the 85 plus age group having the highest rate. There has been a large increase in rate for the 85 plus age group over the last year where it has more than doubled from 9.2 per 1,000 population in 2020/21 to 18.8 per 1,000 population in 2021/22.
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53 Chart 32: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by locality Data Source: mySWIS, North Lanarkshire council Table 32: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by locality Financial Year Locality 2018/19 2019/20 2020/21 2021/22 Airdrie 3.8 5.3 5.1 5.1 Bellshill 4.0 4.3 4.4 4.3 Coatbridge 4.2 4.4 4.6 4.7 Motherwell 3.6 3.5 3.4 4.1 North Lanarkshire North 4.0 4.1 4.2 5.6 Wishaw 5.0 5.2 5.1 6.0 Data Source: mySWIS, North Lanarkshire council Across North Lanarkshire localities, the rate per 1,000 population of SDS users has shown gradual increases over the last 4 years. In 2021/21, the highest rate was found in Wishaw of 6.0 and the lowest in Motherwell at 4.1. Chart 33: Percentage of North Lanarkshire Self-Directed Support (SDS) budget by SDS Type and financial year Data Source: mySWIS, North Lanarkshire council Table 33: Percentage of North Lanarkshire Self-Directed Support (SDS) budget by SDS Type and financial year SDS Type Financial Year SDS 1 SDS 2 SDS 3 2018/19 11% 71% 18%
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54 2019/20 11% 73% 15% 2020/21 12% 73% 15% 2021/22 12% 71% 17% Data Source: mySWIS, North Lanarkshire council SDS 2 (allocated to an organisation that the person chooses and the person is in charge of how it is spent) accounts for over 70% of the North Lanarkshire SDS budget. There has been little change in the percentage breakdowns over the last 4 years. Chart 34: Percentage of Self-Directed Support budget in 2021/22 by SDS Type, for all North Lanarkshire localities Data Source: mySWIS, North Lanarkshire council Table 34: Percentage of Self-Directed Support budget in 2021/22 by SDS Type, for all North Lanarkshire localities SDS Type Locality SDS 1 SDS 2 SDS 3 Airdrie 14% 69% 16% Bellshill 10% 72% 18% Coatbridge 10% 63% 27% Motherwell 9% 75% 15% North Lanarkshire North 14% 72% 14% Wishaw 12% 74% 14% Data Source: mySWIS, North Lanarkshire council In 2021/22, SDS 2 accounts for the majority of the SDS budget in all localities, ranging from 75% in Motherwell to 63% in Coatbridge. Coatbridge is the locality with the highest percentage of SDS budget for SDS 3 with 27%, the next highest locality is Bellshill with 18%. Chart 35: Percentage of Self-Directed Support budget in 2021/22 by SDS Type per age group
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55 Data Source: mySWIS, North Lanarkshire council Table 35: Percentage of Self-Directed Support budget in 2021/22 by SDS Type per age group SDS Type Age Group SDS 1 SDS 2 SDS 3 Under 65s 13% 69% 18% 65 - 74 6% 77% 16% 75 - 84 9% 83% 8% 85 plus 17% 83% 0% Data Source: mySWIS, North Lanarkshire council The older the age group, the higher the percentage of SDS budget for SDS 2. The percentage for SDS 2 ranges from 69% for under 65s to 83% for 75-84 and 85 plus age groups. No SDS 3 was provided to the 85 plus age group.
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56 8 Unscheduled Care Chart 36: Acute emergency hospital admissions rate per 1,000 population by financial year Source: SMR01, Public Health Scotland Table 36: Acute emergency hospital admissions rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 138.1 137.4 146.5 121.6 139.0 Bellshill 140.4 138.1 144.2 114.4 127.6 Coatbridge 152.6 151.0 157.6 125.7 138.4 Motherwell 143.8 149.3 150.6 123.9 144.0 North Lanarkshire North 117.0 119.6 125.8 100.1 116.7 Wishaw 138.8 140.6 146.2 113.9 138.0 North Lanarkshire 136.2 137.4 143.2 115.0 132.4 Scotland 108.7 109.5 112.8 93.7 104.3 Source: SMR01, Public Health Scotland North Lanarkshire have had consistently higher acute emergency hospital admissions rates compared to Scotland over the last 5 years, with both areas following a similar pattern. Both areas had an increasing trend over the period 2017/18 – 2019/20, followed by a decrease in 2020/21 due to the COVID-19 pandemic. Rates have then increased in 2021/22 but are lower than pre-pandemic levels. All North Lanarkshire localities are above the Scotland rate. In 2021/22 Motherwell is the North Lanarkshire locality with the highest rate, North Lanarkshire North the lowest.
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57 Chart 37: Acute emergency hospital admissions rate per 1,000 population 2017/18 – 2021/22, with projected rates from 2020/21 – 2025/26 Source: SMR01, Public Health Scotland; projected rates based on methodology outlined below Table 37a: Acute emergency hospital admissions rate per 1,000 population Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 North Lanarkshire 136.2 137.4 143.2 115.0 132.4 Scotland 108.7 109.5 112.8 93.7 104.3 Source: SMR01, Public Health Scotland Table 25b: Projected acute emergency hospital admissions rate per 1,000 population Financial Year Area of Residence 2020/21 2021/22 2022/23 2023/24 2024/25 2025/26 North Lanarkshire 145.8 149.1 153.0 156.6 160.2 163.8 Scotland 114.4 116.4 119.1 121.5 123.8 126.0 Source: SMR01, Public Health Scotland; projected rates based on methodology outlined below Methodology: 1) These projections are based on pre-COVID-19 pandemic data, showing what could happen if pre-pandemic rates were projected forward. Please treat this with caution. 2) We calculated historical rates of acute hospital admissions for the 5 years 2017/18 – 2021/22 using counts from PHS’s SMR01 data set and population estimates from NRS. These rates were calculated within five age bands: 0-17, 18-44, 45-64, 65-74, 75 plus; 3) The historical rates obtained in step 1), excluding the rates for 2020/21 and 2021/22 which are deemed as outliers due to the Covid-19 pandemic, were used to linearly extrapolate rates for the years 2020/21 – 2025/26; 4) Extrapolated rates calculated in step 2) were combined with population projections (within the same age bands of 0-17, 18-44, 45-64, 65-74, 75 plus) to compute projected counts. The all-ages projected rates presented here are based on projected counts within age bands. 5) We show both actual and projected rates for financial years 2020/21 and 2021/22
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58 Chart 38: Acute emergency hospital admissions rate per 1,000 populations by month Source: SMR01, Public Health Scotland Table 38: Acute emergency hospital admissions rate per 1,000 populations by month Month North Lanarkshire Scotland Month North Lanarkshire Scotland Month North Lanarkshire Apr- 18 11.1 8.8 Aug- 19 11.9 9.5 Dec- 20 9.5 May- 18 11.1 9.2 Sep- 19 11.8 9.4 Jan- 21 9.1 Jun- 18 10.8 8.9 Oct- 19 12.6 10.0 Feb- 21 9.0 Jul-18 10.6 8.8 Nov- 19 12.8 9.8 Mar- 21 11.0 Aug- 18 11.2 9.1 Dec- 19 12.5 9.9 Apr- 21 11.0 Sep- 18 10.9 8.6 Jan- 20 12.5 9.6 May- 21 11.5 Oct- 18 11.8 9.3 Feb- 20 11.4 8.8 Jun- 21 11.8 Nov- 18 11.8 9.3 Mar- 20 10.4 8.3 Jul-21 11.7 Dec- 18 11.9 9.5 Apr- 20 7.1 5.8 Aug- 21 11.5 Jan- 19 12.4 9.7 May- 20 8.9 7.1 Sep- 21 11.0 Feb- 19 11.4 8.8 Jun- 20 9.6 7.7 Oct- 21 11.3 Mar- 19 12.4 9.5 Jul-20 10.3 8.3 Nov- 21 10.9 Apr- 19 11.9 9.2 Aug- 20 10.1 8.4 Dec- 21 10.9 May- 19 12.4 9.8 Sep- 20 10.3 8.5 Jan- 22 10.0 Jun- 19 11.3 9.1 Oct- 20 10.4 8.4 Feb- 22 9.9 Jul-19 11.9 9.5 Nov- 20 9.7 7.8 Mar- 22 11.0
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59 Source: SMR01, Public Health Scotland North Lanarkshire have consistently had a higher rate of acute emergency hospital admissions per 1,000 population compared to Scotland rate while following a similar trend. Acute emergency admissions declined massively both for North Lanarkshire and nationally in April 2020 at the start of the COVID-19 pandemic, rates then increased and have some seasonal variation with decreases for both Jan 21 and Jan 22, likely related to lockdown restrictions. More recently rates are again on the increase but are yet to reach pre-pandemic levels. Chart 39: Acute emergency hospital admissions bed days rate per 1,000 populations by financial year Source: SMR01, Public Health Scotland Table 39: Acute emergency hospital admissions bed days rate per 1,000 populations by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 668.1 645.3 715.5 638.4 692.7 Bellshill 726.6 639.2 670.0 586.2 700.4 Coatbridge 737.5 686.9 787.4 631.5 696.6 Motherwell 692.4 697.7 723.5 606.7 696.8 North Lanarkshire North 752.2 704.4 750.9 662.6 782.4 Wishaw 788.7 753.7 797.0 601.3 828.4 North Lanarkshire 729.2 690.6 743.3 626.5 738.3 Scotland 743.6 729.3 746.9 616.6 704.3 Source: SMR01, Public Health Scotland
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60 The North Lanarkshire rate has generally been close to the Scotland rate over the last 5 years, and in more recent years is slightly higher than the Scotland rate. Rates have followed a similar pattern, fluctuating over the years. In 2021/22 of the 6 North Lanarkshire localities, Wishaw has the highest rate, Motherwell has the lowest. Chart 40: Accident and Emergency attendances rate per 1,000 population by financial year Source: A&E Datamart, Public Health Scotland Table 40: Accident and Emergency attendances rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 398.7 404.4 399.5 316.7 391.5 Bellshill 350.5 360.0 367.1 284.7 341.6 Coatbridge 416.1 428.7 413.0 327.5 399.3 Motherwell 360.5 366.4 368.1 296.2 364.4 North Lanarkshire North 299.2 320.8 323.5 243.8 311.2 Wishaw 368.0 376.6 374.0 297.4 367.6 North Lanarkshire 359.6 371.2 369.4 289.7 358.1 Scotland 276.3 285.3 285.2 204.1 257.9 Source: A&E Datamart, Public Health Scotland North Lanarkshire have had consistently higher accident and emergency attendance rates rates compared to Scotland over the last 5 years, with both areas following a similar pattern. Both areas had an increasing trend over the period 2017/18 – 2019/20, followed by a considerable decrease in 2020/21 due to fewer people attending A&E departments as a result of the COVID-19 pandemic. Rates have then increased in 2021/22 but are lower than pre-pandemic levels. All North Lanarkshire
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61 localities remain above the Scotland rate with Coatbridge currently the highest and North Lanarkshire North the lowest. Chart 41: Accident and Emergency attendances rate per 1,000 population 2017/18 – 2021/22, with projected rates from 2020/21 – 2025/26 Source: A&E Datamart, Public Health Scotland Table 41a: Accident and Emergency attendances rate per 1,000 population Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 North Lanarkshire 359.6 371.2 369.4 289.7 358.1 Scotland 276.3 285.3 285.2 204.1 257.9 Source: A&E Datamart, Public Health Scotland Table 40b: Projected Accident and Emergency attendances rate per 1,000 population Financial Year Area of Residence 2020/21 2021/22 2022/23 2023/24 2024/25 2025/26 North Lanarkshire 386.9 392.3 386.9 392.3 397.5 402.7 Scotland 300.6 305.4 300.6 305.4 310.1 314.7 Source: A&E Datamart, Public Health Scotland; project rates based on methodology outlined below Methodology: 1) These projections are based on pre-COVID-19 pandemic data, showing what could happen if pre-pandemic rates were projected forward. Please treat this with caution. 2) We calculated historical rates of A&E attendances for the 5 years 2017/18 – 2021/22 using counts from PHS’s A&E datamart and population estimates from NRS. These rates were calculated within six age bands: 0-17, 18-44, 45-64, 65-74, 75 plus; 3) The historical rates obtained in step 1), excluding the rates for 2020/21 and 2021/22, which were deemed to be outliers due to the Covid-19 pandemic, were used to linearly extrapolate rates for the years 2020/21 – 2025/26; 4) Extrapolated rates calculated in step 2) were combined with population projections (within the same age bands of 0-17, 18-44, 45-64, 65-74, 75 plus) to compute projected counts. The all-ages projected rates presented here are based on projected counts within age bands. 5) We show both actual and projected rates for financial years 2020/21 and 2021/22. Based on the trends for the period 2017/18 to 2019/20, excluding 2020/21 and 2021/22 as being outliers due to the impact of COVID-19, the rates are projected to
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62 continue to increase for both North Lanarkshire and Scotland, with North Lanarkshire rates continuing to increase at a greater rate than Scotland. This is assuming the trends continue in the same way they did before the pandemic. We can see that the actual rates are increasing but are still lower than the projected rates. Chart 42: Accident and Emergency attendances rate per 1,000 populations by month Source: A&E Datamart, Public Health Scotland Table 42: Accident and Emergency attendances rate per 1,000 populations by month Month North Lanarkshire Scotland Month North Lanarkshire Scotland Month North Lanarkshire Apr- 18 30.6 23.2 Oct- 19 32.1 24.7 Apr- 21 29.5 May- 18 33.4 25.6 Nov- 19 30.8 24.1 May- 21 32.6 Jun- 18 31.4 24.4 Dec- 19 31.0 23.9 Jun- 21 33.7 Jul-18 31.8 24.1 Jan- 20 30.6 23.6 Jul-21 32.5 Aug- 18 30.9 23.9 Feb- 20 28.4 21.8 Aug- 21 32.7 Sep- 18 30.4 23.6 Mar- 20 22.4 17.3 Sep- 21 31.2 Oct- 18 30.9 23.4 Apr- 20 16.2 11.3 Oct- 21 29.2 Nov- 18 30.2 23.1 May- 20 21.9 15.5 Nov- 21 28.3 Dec- 18 30.1 23.5 Jun- 20 25.7 17.7 Dec- 21 26.1 Jan- 19 31.2 23.7 Jul-20 26.8 19.4 Jan- 22 26.4 Feb- 19 28.8 22.1 Aug- 20 29.4 21.0 Feb- 22 26.2 Mar- 19 31.9 24.6 Sep- 20 27.8 20.0 Mar- 22 30.0 Apr- 19 31.8 24.5 Oct- 20 26.3 18.5 Apr- 22 28.2
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63 May- 19 33.6 25.3 Nov- 20 23.9 17.2 May- 22 31.8 Jun- 19 31.6 24.7 Dec- 20 22.7 16.2 Jun- 22 30.2 Jul-19 32.2 24.9 Jan- 21 22.1 14.9 Jul-22 29.1 Aug- 19 33.0 25.2 Feb- 21 20.4 14.1 Aug- 22 30.3 Sep- 19 32.4 25.3 Mar- 21 26.8 18.2 Source: A&E Datamart, Public Health Scotland A&E Attendance rates per 1,000 population have consistently been higher for North Lanarkshire compared to Scotland, with both following a similar trend. This can be observed with regards to the sharp decrease coinciding with the beginning of the Covid-19 pandemic, but since then this has been trending up again to match pre- pandemic levels. Chart 43: Percentage of A&E attendances resulting in a hospital admission by financial year Source: A&E Datamart, Public Health Scotland Table 43: Percentage of A&E attendances resulting in a hospital admission by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 29% 29% 31% 33% 30% Bellshill 31% 30% 32% 35% 33% Coatbridge 31% 30% 32% 34% 31% Motherwell 29% 29% 31% 36% 33%
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64 North Lanarkshire North 30% 29% 31% 33% 29% Wishaw 28% 28% 30% 33% 32% North Lanarkshire 30% 29% 31% 34% 31% Scotland 25% 25% 26% 30% 26% Source: A&E Datamart, Public Health Scotland North Lanarkshire have had consistently higher A&E attendances conversion percentage to hospital admissions compared to Scotland over last 5 years with 2020/21 being the year with the highest percentage however decreasing back down again in 2021/22. In 2021/22 Motherwell is the North Lanarkshire locality with the highest percentage and North Lanarkshire North the lowest. Chart 44: Emergency Admissions average length of stay in days, by financial year Source: SMR01, Public Health Scotland Table 44: Emergency Admissions average length of stay in days, by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 4.8 4.7 4.9 5.2 5.0 Bellshill 5.2 4.6 4.6 5.1 5.5 Coatbridge 4.8 4.5 5.0 5.0 5.0 Motherwell 4.8 4.7 4.8 4.9 4.8 North Lanarkshire North 6.4 5.9 6.0 6.6 6.7 Wishaw 5.7 5.4 5.5 5.3 6.0 North Lanarkshire 5.4 5.0 5.2 5.4 5.6 Scotland 6.8 6.7 6.6 6.6 6.8 Source: SMR01, Public Health Scotland
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65 Over the last 5 years, North Lanarkshire has consistently had a lower average length of stay for emergency admissions compared to Scotland. Highest levels observed can be seen in 2020/21 for all localities. North Lanarkshire North has consistently had the highest average length of stay out of the 6 North Lanarkshire localities, with Motherwell being the lowest in 2021/22. Chart 45: 7 day emergency readmissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 45: 7 day emergency readmissions rate per 1,000 population, by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 11.1 11.7 13.4 9.5 11.8 Bellshill 13.1 13.3 13.5 9.0 12.5 Coatbridge 13.8 12.8 14.8 9.8 10.0 Motherwell 13.5 15.4 15.3 10.7 15.9 North Lanarkshire North 10.7 11.6 12.1 8.2 9.6 Wishaw 14.0 14.6 15.7 9.4 14.5 North Lanarkshire 12.4 13.0 13.9 9.4 12.1 Scotland 10.3 10.6 11.2 8.5 9.5 Source: SMR01, Public Health Scotland North Lanarkshire has had a higher rate of 7 day emergency readmissions compared to Scotland over the last 5 years. Rates had been increasing up to 2019/20, followed by a decrease in 2020/21 then an increase in 2021/22, but still below pre-pandemic levels. Despite North Lanarkshire North generally having the highest average length of stay, they consistently have the lowest 7 day readmission rate each year of the 6 North Lanarkshire localities, with Motherwell the highest in 2021/22.
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66 Chart 46: 28 day emergency readmissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 46: 28 day emergency readmissions rate per 1,000 population, by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 26.0 26.6 29.8 22.1 27.1 Bellshill 28.0 29.2 29.4 20.5 25.1 Coatbridge 30.8 29.6 33.9 22.7 25.2 Motherwell 29.5 31.5 32.1 22.6 30.0 North Lanarkshire North 24.3 25.1 26.4 18.4 21.6 Wishaw 30.2 30.5 33.0 21.1 29.5 North Lanarkshire 27.7 28.4 30.4 21.0 26.0 Scotland 22.2 22.6 23.6 18.0 20.3 Source: SMR01, Public Health Scotland North Lanarkshire have had a consistently higher rate of 28 day emergency readmissions compared to Scotland over the last 5 years. North Lanarkshire North locality has consistently had the lowest 28 day readmission rate over the last 5 years, however all localities remain consistently above the Scotland average year on year. Motherwell has the highest rates of all the North Lanarkshire localities.
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67 Chart 47: Alcohol related hospital admissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 47: Alcohol related hospital admissions rate per 1,000 population, by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 Airdrie 10.2 10.2 10.7 8.9 Bellshill 9.7 8.8 9.8 7.8 Coatbridge 11.5 12.8 12.6 11.4 Motherwell 9.0 8.5 9.7 8.7 North Lanarkshire North 6.7 6.9 6.9 6.3 Wishaw 8.1 8.4 9.4 7.9 North Lanarkshire 8.9 9.1 9.5 8.3 Scotland 6.6 6.6 6.7 6.0 Source: SMR01, Public Health Scotland Alcohol related admission rates have been consistently higher in North Lanarkshire compared with Scotland over the last 4 years. North Lanarkshire rates had been increasing up until 2019/20 and then dropped in 2020/21, likely as a result of the COVID-19 pandemic. Coatbridge has the highest rates of all the North Lanarkshire localities, with North Lanarkshire North the lowest.
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68 Chart 48: Drug related hospital admissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 48: Drug related hospital admissions rate per 1,000 population, by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 1.9 2.0 3.0 2.4 1.9 Bellshill 1.7 1.9 2.2 1.8 1.9 Coatbridge 2.0 2.8 2.6 2.4 2.2 Motherwell 2.3 2.4 3.2 3.5 2.5 North Lanarkshire North 1.3 1.2 1.7 1.5 1.3 Wishaw 1.6 2.0 2.7 2.1 2.4 North Lanarkshire 1.8 2.0 2.5 2.2 2.0 Scotland 1.7 1.9 2.2 2.1 1.8 Source: SMR01, Public Health Scotland North Lanarkshire have had consistently higher rates than Scotland over the last 5 years. Rates has been increasing up to 2019/20, and then decreasing since then. Motherwell has the highest rates of all the North Lanarkshire localities, with North Lanarkshire North the lowest. Chart 49: NHS24 calls - Rate per 1,000 population by financial year
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69 Source: Unscheduled Care Datamart, Public Health Scotland Table 49: NHS24 calls - Rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 289.2 275.6 291.7 289.1 308.4 Bellshill 266.3 261.3 277.9 272.3 302.7 Coatbridge 282.8 271.1 274.8 276.1 298.1 Motherwell 279.9 265.7 265.4 253.3 277.1 North Lanarkshire North 221.4 211.3 227.7 230.6 263.6 Wishaw 283.1 306.4 245.0 239.2 277.7 North Lanarkshire 266.2 260.4 260.3 257.2 285.4 Scotland 250.8 238.5 241.6 227.6 261.9 Source: Unscheduled Care Datamart, Public Health Scotland The rate of NHS24 calls per 1,000 population has largely remained steady in North Lanarkshire between 2017/18 and 2020/21, followed by an increase in 2021/22 which would be due to the different way people are now accessing services following the COVID-19 pandemic. North Lanarkshire has had a higher rate than Scotland over last 5 years. Of the 6 localities, Airdrie tends to have the highest rate per 1,000 population, with North Lanarkshire North the lowest. Chart 50: GP out of hours attendances rate per 1,000 population by financial year
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70 Source: Unscheduled Care Datamart, Public Health Scotland Table 50: GP out of hours attendances rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 164.9 158.8 158.0 164.2 171.0 Bellshill 140.1 139.9 140.5 146.6 160.4 Coatbridge 153.3 150.6 142.0 156.8 159.0 Motherwell 137.6 132.4 131.7 134.3 142.4 North Lanarkshire North 124.7 118.0 121.2 125.4 134.6 Wishaw 128.4 126.5 122.6 127.4 142.9 North Lanarkshire 140.3 136.1 134.8 140.8 150.0 Scotland 160.7 154.8 154.2 142.6 158.5 Source: Unscheduled Care Datamart, Public Health Scotland North Lanarkshire has had a lower rate than Scotland over the last 5 years. Of the 6 localities, North Lanarkshire North Wishaw and Motherwell are consistently below the Scotland average rate with the other above. From 2017/18, Airdrie has remained the locality with the highest GP out of hours attendance rates per 1,000 population, with North Lanarkshire North the lowest.
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71 9 Delayed Discharges Chart 51: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by financial year Source: Delayed Discharges, Public Health Scotland Table 51: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 148.0 141.6 161.8 121.0 86.9 Bellshill 121.9 114.9 139.7 92.8 109.0 Coatbridge 149.1 144.6 164.9 120.1 99.2 Motherwell 135.9 138.4 189.6 126.5 131.6 North Lanarkshire North 126.4 105.1 130.1 103.3 149.8 Wishaw 135.8 134.8 141.1 108.3 105.6 North Lanarkshire 135.7 127.9 152.6 111.8 117.4 Scotland 112.4 118.3 122.3 80.7 121.3 Source: Delayed Discharges, Public Health Scotland North Lanarkshire has had higher delayed discharge rates compared to Scotland over the 4 year period 2017/18 – 2020/21, and then in 2021/22 is now lower than the Scotland rate. The rates had been increasing before the start of the COVID-19 pandemic in 18/19 to 19/20, after which time a decrease can be observed. North Lanarkshire currently has the highest rate of all North Lanarkshire localities and has seen a massive increase in the last year. Airdrie is now the locality with the lowest rate following a substantial decrease in the last year.
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72 Chart 52: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by month Source: Delayed Discharges, Public Health Scotland Table 52: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by month Month North Lanarkshire Scotland Month North Lanarkshire Scotland Month North Lanarkshire Apr-18 8.3 7.6 Oct- 19 10.4 8.5 Apr- 21 5.8 May-18 7.2 7.9 Nov- 19 9.8 8.2 May- 21 6.2 Jun-18 7.4 7.8 Dec- 19 10.3 8.3 Jun- 21 6.7 Jul-18 8.3 8.0 Jan- 20 10.1 8.7 Jul-21 8.5 Aug-18 7.4 8.0 Feb- 20 10.2 8.6 Aug- 21 8.9 Sep-18 8.8 8.4 Mar- 20 10.2 8.2 Sep- 21 8.4 Oct-18 9.4 8.7 Apr- 20 4.1 3.7 Oct- 21 7.2 Nov-18 9.4 8.1 May- 20 6.5 3.9 Nov- 21 6.7 Dec-18 9.0 7.9 Jun- 20 7.6 4.3 Dec- 21 8.3 Jan-19 9.4 8.1 Jul-20 8.4 5.2 Jan- 22 10.1 Feb-19 8.4 7.5 Aug- 20 10.1 5.9 Feb- 22 7.7 Mar-19 9.0 8.0 Sep- 20 9.5 6.0 Mar- 22 8.3 Apr-19 9.3 7.5 Oct- 20 7.5 6.1 Apr- 22 8.7 May-19 10.7 8.2 Nov- 20 7.9 6.1 May- 22 8.8 Jun-19 9.6 7.7 Dec- 20 7.3 6.1 Jun- 22 7.8 Jul-19 11.7 8.3 Jan- 21 7.5 6.4 Jul-22 8.4
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73 Aug-19 10.6 8.6 Feb- 21 5.9 5.6 Aug- 22 8.8 Sep-19 10.6 8.4 Mar- 21 6.4 6.2 Source: Delayed Discharges, Public Health Scotland Looking at the delayed discharges bed days rates by month, North Lanarkshire delayed discharge rates tend to be higher than Scotland from April 2018 onwards with the gap widening up until March 2020 where the rates decreased substantially at the start of the COVID-19 pandemic. North Lanarkshire rates increased between April and October 2020, then remained sporadic until Feb 2021 and have been steadily increasing since then. Most recent Scotland rates now similar to the levels they were at pre-pandemic, which is also mirrored in North Lanarkshire. 10 Long Term Conditions Chart 53: Prevalence counts of long term conditions for North Lanarkshire residents in financial year 2021/22 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 53: Prevalence counts of long term conditions for North Lanarkshire residents in financial year 2021/22 Long Term Condition 2021/22 Prevalence Count Long Term Condition 2021/22 Prevalence Count Anxiety/Depression 91,061 Cerebrovascular Disease 5,632 COPD/Asthma 52,310 Renal Disease 4,300 Hypertension 50,024 Rheumatoid Arthritis 3,811 Chronic Pain 31,214 Heart Failure 2,571 Diabetes 22,951 Chronic Liver Disease 2,416 Gastro-Oesophageal Reflux 20,239 Dementia 2,276 Coronary Heart Disease 17,243 Epilepsy 2,097
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74 Migraines 14,852 Multiple Sclerosis 567 Osteoarthritis 8,759 Other Neurological Diseases 424 Cancer 8,238 Parkinsons 380 Psychosis 8,218 Liver Failure 289 Atrial Fibrillation 6,581 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland The Long-Term Conditions analysis is based on a methodology developed between the PHS Lanarkshire Local Intelligence Support Team (LIST) and NHS Lanarkshire public health, measuring the prevalence of 23 long term conditions based on hospital admissions (SMR data) and/or prescribing data. Anxiety/Depression is by far the most prevalent long-term condition in North Lanarkshire of the 23 conditions analysed with over a quarter of the North Lanarkshire population identified as having the condition in 2021/22. COPD/asthma and hypertension are the next most prevalent conditions, then followed by Chronic Pain and Diabetes. Chart 54: Percentage of the population with 3 or more long term conditions Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 54: Percentage of the population with 3 or more long term conditions Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 13.2% 13.5% 13.6% 13.5% 13.6% Bellshill 14.0% 14.1% 14.1% 13.9% 13.9% Coatbridge 12.9% 13.3% 13.6% 13.5% 13.7% Motherwell 13.2% 13.3% 13.5% 13.1% 13.1% North Lanarkshire North 12.1% 12.4% 12.5% 12.3% 12.3% Wishaw 14.7% 14.8% 15.2% 15.2% 15.3% North Lanarkshire 13.2% 13.4% 13.6% 13.4% 13.5% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland The percentage of the population with 3 or more long term conditions has gradually increased every year up until 2019/20, then there has been a slight decrease in 2020/21 followed by a slight increase in 2021/22. However, this should be treated with caution as the Covid-19 pandemic changed how people accessed health care; reduced hospital admissions and/or changes in prescribing may have had an impact on the number of people with long term conditions identified using this methodology.
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75 11 Children and Young People Chart 55: Child and Adolescent Mental Health Service (CAMHS) Referrals rate per 1,000 population by financial year Source: North Lanarkshire data: TrakCare, NHS Lanarkshire; Scotland data: CAMHS Waiting Times database, Public Health Scotland Table 55: Child and Adolescent Mental Health Service (CAMHS) Referrals rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 34.8 39.0 36.6 22.7 28.3 Bellshill 39.9 35.9 40.2 20.3 28.7 Coatbridge 36.2 35.6 36.8 23.0 27.0 Motherwell 24.8 35.7 33.9 22.8 31.7 North Lanarkshire North 32.3 34.7 31.9 22.4 31.0 Wishaw 39.2 38.4 36.1 27.0 28.0 North Lanarkshire 28.0 40.9 38.9 25.1 30.9 Scotland 32.4 34.8 33.9 28.1 36.7 Source: Lanarkshire data: TrakCare, NHS Lanarkshire; Scotland data: CAMHS Waiting Times database, Public Health Scotland CAMHS referral rates across North Lanarkshire has remained at a relatively stable rate over the years from 2017/18 to 2019/20. However, a large decrease in the referral rates has been seen in the year from 2019/20 to 2020/21 and this pattern has also been observed in the Scotland rate. The reduction in referrals may be linked to the Covid-19 pandemic as opposed to reduced need. Rates have risen again in 2021/22 and show signs of returning back to pre pandemic levels.
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76 Chart 56: Percentage of children with a concern at 27-30 month child health review by financial year Source: CHSP-Pre-School, SIRS, Public Health Scotland Table 56: Percentage of children with a concern at 27-30 month child health review by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 Airdrie 15% 21% 16% 16% Bellshill 17% 21% 19% 15% Coatbridge 17% 17% 17% 18% Motherwell 13% 16% 20% 18% North Lanarkshire North 17% 16% 14% 17% Wishaw 20% 17% 20% 19% North Lanarkshire 16% 18% 17% 17% Scotland 15% 15% 14% 15% Source: CHSP-Pre-School, SIRS, Public Health Scotland North Lanarkshire has a higher percentage of children with a concern at the 27-30 month child health review compared to Scotland for the last 4 years. In 2020/21 Wishaw had the highest percentage of 19% and Bellshill with the lowest at 15%.
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77 12 Mental Health Chart 57: Mental Health (psychiatric only) emergency admissions bed days rate per 1,000 population by financial year Source: SMR04, Public Health Scotland Table 57: Mental Health (psychiatric only) emergency admissions bed days rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 Airdrie 88.0 100.1 75.7 57.1 Bellshill 451.8 386.4 372.1 286.2 Coatbridge 155.8 183.8 147.6 122.5 Motherwell 257.8 275.3 277.5 231.2 North Lanarkshire North 135.5 124.2 98.7 71.5 Wishaw 126.7 120.8 108.0 88.7 North Lanarkshire 187.4 184.3 165.1 130.8 Scotland 224.5 219.2 209.1 185.1 Source: SMR04, Public Health Scotland The rate of bed days from psychiatric emergency admissions has been declining steadily for all areas, with the North Lanarkshire rates being lower than the Scottish average. Of the 6 localities, Bellshill has the highest rate and Airdrie the lowest. The reduction in rates in 2020/21 may be as a result of changes to patients accessing services due to the Covid-19 pandemic.
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78 Chart 58: Prevalence of Anxiety/Depression Rate per 1,000 population by financial year Source: Prescribing Information System (PIS), Public Health Scotland Table 58: Prevalence of Anxiety/Depression Rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 263.4 272.2 277.5 273.6 273.0 Bellshill 271.1 278.2 280.3 275.4 274.9 Coatbridge 247.5 257.5 260.6 259.3 262.1 Motherwell 257.6 265.5 271.0 269.6 272.4 North Lanarkshire North 244.4 252.5 257.4 255.8 255.3 Wishaw 248.7 256.9 265.0 269.6 271.3 North Lanarkshire 254.0 262.4 267.3 265.9 266.7 Source: Prescribing Information System (PIS), Public Health Scotland Over the last 5 years, the rate for Anxiety/Depression has increased across all localities and North Lanarkshire as a whole. However, there has been an observed decrease shown from 2019/20 to 2020/21 within the data. It is likely that this reflects changes in the number of people seeking support during the pandemic and therefore data should be treated with caution. Figures generally show an increase between 2020/21 and 2021/22, showing signs of returning back to pre-pandemic levels and continuing the upward trend. 13 Last 6 months of life Chart 59: Proportion of the last 6 months of life spent in the community for North Lanarkshire Source: Death records, NRS; SMR01 & SMR04, Public Health Scotland
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79 Table 59: Proportion of the last 6 months of life spent in the community for North Lanarkshire Financial Year Percentage of last 6 months of life spent in the community 2013/14 87.0% 2014/15 88.6% 2015/16 88.3% 2016/17 88.5% 2017/18 89.0% 2018/19 88.9% 2019/20 89.0% 2020/21 90.2% Source: Death records, NRS; SMR01 & SMR04, Public Health Scotland The overall trend for residents’ last 6 months of life spent in the community over the last 8 years, has been continually increasing gradually. 14 Health Inequalities Chart 60: Rate per 1,000 population of A&E Attendances for North Lanarkshire residents by SIMD Quintile and financial year Source: A&E Datamart, Public Health Scotland Table 60: Rate per 1,000 population of A&E Attendances for North Lanarkshire residents by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 448.3 457.9 456.9 366.0 441.7 Q2 370.3 381.9 382.9 300.3 372.8 Q3 324.3 334.6 333.0 258.4 324.6 Q4 267.8 287.3 278.3 210.1 271.7 Q5 (least deprived) 231.7 243.2 246.9 188.5 242.6 Source: A&E Datamart, Public Health Scotland The rate per 1,000 population of A&E attendances is higher for North Lanarkshire residents in the most deprived areas compared to the least deprived. The disparity has been consistent over the 5-year period with rates being around 1.8 times higher for SIMD Quintile 1 (most deprived areas) compared with SIMD Quintile 5 (least deprived areas). The rate of A&E attendances has dropped considerably in 2020/21
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80 across all SIMD quintiles due to fewer people attending A&E departments as a result of the COVID-19 pandemic. With figures appearing to be returning back to pre- pandemic levels in 2021/22. Chart 61: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by SIMD Quintile and financial year Source: SMR01, Public Health Scotland Table 61: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 168.9 168.4 176.4 144.4 162.6 Q2 142.3 143.3 149.8 121.2 140.0 Q3 129.8 127.8 136.6 106.2 124.1 Q4 97.6 104.0 105.1 80.8 97.9 Q5 (least deprived) 81.8 86.3 88.3 72.0 85.1 Source: SMR01, Public Health Scotland From 2017/18 through to 2019/20, emergency admissions for North Lanarkshire across all SIMD quintiles have been generally increasing slowly. With the most deprived quintiles having higher rates of admissions compared to the less deprived quintiles. A decrease was observed over the last year in 2020/21 which may be as a result of changes to patients accessing services due to the Covid-19 pandemic, with figures again rising in 2021/22. Chart 62: Rate per 1,000 population of acute emergency admissions bed days for North Lanarkshire residents by SIMD Quintile and financial year
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81 Source: SMR01, Public Health Scotland Table 62: Rate per 1,000 population of acute emergency admissions bed days for North Lanarkshire residents by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 853.1 816.9 902.4 752.7 889.3 Q2 853.2 778.1 818.1 708.3 843.5 Q3 682.1 679.7 725.8 577.3 707.5 Q4 503.9 488.7 491.3 457.3 490.9 Q5 (least deprived) 404.7 376.9 453.1 346.8 427.5 Source: SMR01, Public Health Scotland Similar with admissions, the bed days follows a similar pattern with more the more deprived quintiles in North Lanarkshire having higher rates of bed days, decreasing as the quintiles are less deprived. Rates for the most deprived quintile are around double the rates for the least deprived quintile. Chart 63: Rate per 1,000 population of delayed discharge bed days for North Lanarkshire residents (aged 18 plus) by SIMD Quintile and financial year Source: Delayed Discharges, Public Health Scotland Table 63: Rate per 1,000 population of delayed discharge bed days for North Lanarkshire residents (aged 18 plus) by SIMD Quintile and financial year SIMD Quintile Financial Year 2017/18 2018/19 2019/20 2020/21 Q1 (Most Deprived) 162.0 175.1 211.8 137.3 Q2 156.0 132.3 148.5 129.0 Q3 116.8 119.4 133.9 108.0 Q4 78.4 75.6 102.2 76.1 Q5 (Least Deprived) 63.7 50.2 66.0 38.2 Source: Delayed Discharges, Public Health Scotland
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82 Chart 64: Rate per 1,000 population of Mental Health emergency admission bed days for North Lanarkshire residents by SIMD Quintile and financial year Source: SMR04, Public Health Scotland Table 64: Rate per 1,000 population of Mental Health emergency admission bed days for North Lanarkshire residents by SIMD Quintile and financial year Financial Year SIMD Quintile 2016/17 2017/18 2018/19 2019/20 2020/21 Q1 (most deprived) 190.2 167.1 195.4 169.9 114.0 Q2 220.7 166.9 151.6 156.7 136.1 Q3 329.3 371.6 338.8 282.2 240.0 Q4 278.2 204.9 189.8 157.0 134.3 Q5 (least deprived) 50.8 34.2 26.8 35.7 27.5 Source: SMR04, Public Health Scotland Chart 65: Percentage of North Lanarkshire population with 1 or more long term conditions by SIMD Quintile and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 65: Percentage of North Lanarkshire population with 1 or more long term conditions by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 56.0% 56.8% 57.0% 56.7% 57.0% Q2 54.1% 54.6% 55.0% 54.6% 54.8% Q3 49.2% 49.4% 50.3% 49.9% 50.0% Q4 45.1% 45.4% 45.6% 44.9% 44.7% Q5 (least deprived) 43.1% 43.8% 44.1% 44.0% 44.1% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland
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83 The percentage of the population across North Lanarkshire and its localities with 1 or more Long term condition has been gradually increasing over the last 5 years, with the higher percentages coming from the most deprived quintiles compared to the least deprived. Rates are around 1.3 times higher in most deprived quintile compared to the least deprived. Chart 66: Percentage of North Lanarkshire population with 3 or more long term conditions by SIMD Quintile and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 66: Percentage of North Lanarkshire population with 3 or more long term conditions by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 16.0% 16.3% 16.5% 16.3% 16.4% Q2 14.5% 14.7% 14.9% 14.9% 15.0% Q3 12.1% 12.4% 12.6% 12.4% 12.4% Q4 9.4% 9.6% 9.6% 9.5% 9.4% Q5 (least deprived) 8.0% 8.2% 8.2% 8.2% 8.5% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Over the 5 years, the percentage of population with 3 or more long term conditions has generally remained at consistent levels, however Quintile 2 has observed a gradual increase year on year. Again, least deprived quintiles being much lower in comparison to more deprived quintiles, with rates in the most deprived quintile being around double the rate in the least deprived quintile. Chart 67: Percentage of North Lanarkshire population with 5 or more long term conditions by SIMD Quintile and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland
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84 Table 67: Percentage of North Lanarkshire population with 5 or more long term conditions by SIMD Quintile and financial year Financial Year SIMD Quintile 2017/18 2018/19 2019/20 2020/21 2021/22 Q1 (most deprived) 4.1% 4.3% 4.3% 4.3% 4.3% Q2 3.5% 3.7% 3.8% 3.7% 3.7% Q3 2.9% 2.9% 3.0% 3.0% 3.0% Q4 2.0% 2.1% 2.1% 2.0% 2.0% Q5 (least deprived) 1.4% 1.5% 1.6% 1.5% 1.5% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland A similar pattern as with 1 plus and 3 plus long-term conditions can be seen with 5 plus long term conditions. The rate for the most deprived quintile is nearly 3 times that of the least deprived quintile, showing that the disparity between the most and deprived areas increases as the number of long-term conditions increases. Chart 68: Rate per 1,000 population of A&E Attendances for North Lanarkshire residents by age group and financial year Source: A&E Datamart, Public Health Scotland Table 68: Rate per 1,000 population of A&E Attendances for North Lanarkshire residents by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0 to 17 330.8 338.7 334.3 215.8 342.4 18 to 44 354.9 369.7 365.6 286.4 348.1 45 to 64 315.8 327.2 326.3 279.3 318.9 65 to 74 372.7 379.8 378.6 316.2 357.7 75 plus 622.1 632.7 638.8 511.5 592.0 Source: A&E Datamart, Public Health Scotland A&E Attendance rates is relatively similar across the four lower age groups, with the highest age band (75 Plus) being substantially higher. For the last 5 years, the 45 to 64 age group has consistently had the lowest rate of attendance.
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85 Chart 69: Rate per 1,000 population of delayed discharge bed days for North Lanarkshire residents (aged 18 plus) by age group and financial year Source: Delayed Discharges, Public Health Scotland Table 69: Rate per 1,000 population of delayed discharge bed days for North Lanarkshire residents (aged 18 plus) by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 18 to 44 10.6 10.1 20.4 8.3 45 to 64 45.5 37.1 54.6 37.1 65 to 74 185.1 152.1 179.2 153.3 75 plus 972.5 994.9 1,079.7 794.5 Source: Delayed Discharges, Public Health Scotland Add narrative Chart 70: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by age group and financial year Source: SMR01, Public Health Scotland Table 70: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0 to 17 84.4 84.2 89.9 47.9 78.0 18 to 44 83.0 86.5 91.9 73.7 82.6 45 to 64 129.1 130.7 135.5 121.1 130.3 65 to 74 227.6 225.3 226.2 193.0 210.5
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86 75 plus 444.9 434.1 444.7 358.3 403.6 Source: SMR01, Public Health Scotland As age groups increase in age, the rate of acute emergency admission also increases with 75 plus age group having the highest rate year on year in comparison to lower age groups – generally 5 times higher than 18 to 44 year olds. All age bands have yet to reach levels seen before the impacts of Covid-19 and may indicate levels will continue to rise over the next year onwards. Chart 71: Rate per 1,000 population of acute emergency admissions bed days for North Lanarkshire residents by age group and financial year Source: SMR01, Public Health Scotland Table 71: Rate per 1,000 population of acute emergency admissions bed days for North Lanarkshire residents by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0 to 17 105.9 91.7 105.7 64.7 86.0 18 to 44 221.7 213.5 235.0 180.3 227.5 45 to 64 591.6 576.7 629.0 547.6 661.6 65 to 74 1,621.9 1,482.3 1,540.9 1,326.5 1,478.7 Source: SMR01, Public Health Scotland Chart 72: Rate per 1,000 population of Mental Health emergency admission bed days for North Lanarkshire residents by age group and financial year Source: SMR04, Public Health Scotland Table 72: Rate per 1,000 population of Mental Health emergency admission bed days for North Lanarkshire residents by age group and financial year Financial Year
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87 Age Group 2016/17 2017/18 2018/19 2019/20 2020/21 0 to 17 15.2 15.3 14.9 8.1 5.1 18 to 44 116.3 113.1 145.1 131.0 98.5 45 to 64 192.5 163.2 144.2 142.8 113.3 65 to 74 687.2 538.3 511.5 389.5 346.9 75 plus 854.2 668.2 582.4 558.1 414.2 Source: SMR04, Public Health Scotland Chart 73: Percentage of North Lanarkshire population prevalent with 1 or more long term conditions by age group and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 73: Percentage of North Lanarkshire population prevalent with 1 or more long term conditions by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0-34 29.2% 29.3% 29.5% 29.0% 28.9% 35-49 52.1% 52.5% 53.1% 53.1% 52.8% 50-64 74.9% 75.8% 76.5% 75.2% 75.2% 65-74 78.1% 78.4% 78.0% 77.5% 77.4% 75+ 83.9% 85.1% 84.0% 82.5% 84.3% All Ages 51.5% 52.0% 52.4% 52.0% 52.1% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland The percentage of population with 1 long term condition or more across age groups, as expected, is highest amongst the older age groups in comparison to the younger ones. With approximately 30 percent of individuals in the 0 to 34 age group having one long term condition or more compared to 83% in the 75plus age bracket in 20/21. This trend has remained steady over the last 5 years. Chart 74: Percentage of North Lanarkshire population prevalent with 3 or more long term conditions by age group and financial year
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88 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 74: Percentage of North Lanarkshire population prevalent with 3 or more long term conditions by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0-34 1.9% 2.0% 2.0% 2.0% 2.0% 35-49 9.1% 9.1% 9.3% 9.4% 9.1% 50-64 22.0% 22.3% 22.4% 22.0% 22.0% 65-74 31.7% 31.9% 32.0% 31.1% 30.8% 75+ 44.3% 44.6% 44.1% 42.7% 43.5% All Ages 13.2% 13.4% 13.6% 13.4% 13.5% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland All age brackets except 0-34 have seen a slight decrease in the percentage of population recording 3 or more Long term conditions over the last year, whereas the younger age group has remained at a steady rate. Chart 75: Percentage of North Lanarkshire population prevalent with 5 or more long term conditions by age group and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 75: Percentage of North Lanarkshire population prevalent with 5 or more long term conditions by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 2021/22 0-34 0.1% 0.1% 0.1% 0.1% 0.1% 35-49 1.1% 1.2% 1.3% 1.3% 1.2% 50-64 4.8% 5.0% 5.1% 5.0% 4.8%
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89 65-74 8.8% 9.0% 9.2% 8.8% 8.6% 75+ 15.7% 15.8% 15.4% 14.8% 15.0% All Ages 3.2% 3.3% 3.4% 3.3% 3.3% Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland As seen with three or more long term conditions, a similar pattern is observed when looking at the population percentage with five or more long term conditions by age groups, with the three oldest age groups showing a slight decrease over the last year and the two younger age groups remaining steady.
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90 Chart 76: A selection of health indicators broken down by SIMD quintile comparing North Lanarkshire & Scotland for most recent available data % of children with 6-8 week review recorded 2020/21 Outpatient appontments attended 2021/21 CAMHS Referrals 2021/22 Mental Health Emergency Bed Days 2020/21 A&E Attendances 2021/22 7 Day Readmissions 2021/22 % coverage of 12 month vaccination - MenB 2021/22 Acute Emergency Admissions 2021/22 % with a concern in any developmental domain (13-15 month review) 2020/21Estimated patients prescribed anxiolytics, antipsychotics and/or antidepressants, 2021/22 0 50 100 150 200 250 300 350 400 450 500 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland 0 20 40 60 80 100 120 140 160 180 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland 0 2 4 6 8 10 12 14 16 18 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland 91 92 93 94 95 96 97 98 99 100 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Percent North Lanarkshire Scotland 0 50 100 150 200 250 300 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland 0 2 4 6 8 10 12 14 16 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Percent North Lanarkshire Scotland 90 91 92 93 94 95 96 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) percentage North Lanarkshire Scotland 0 50 100 150 200 250 300 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland 0 5 10 15 20 25 30 35 40 45 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire 0 50 100 150 200 250 300 Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) Rate per 1,000 population North Lanarkshire Scotland
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91 Chart 77: A selection of health indicators broken down by SIMD quintile, comparing North Lanarkshire localities for most recent available data % of children with 6-8 week review recorded 2020/21 Outpatient appontments attended 2021/21 CAMHS Referrals 2021/22 Mental Health Emergency Bed Days 2020/21 A&E Attendances 2021/22 Acute Emergency Admissions 2021/22 7 Day Readmissions 2021/22 % coverage of 12 month vaccination - MenB 2021/22 Estimated patients prescribed anxiolytics, antipsychotics and/or antidepressants, 2021/22 % with a concern in any developmental domain (13-15 month review) 2020/21 0 50 100 150 200 250 300 350 400 450 500 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 20 40 60 80 100 120 140 160 180 200 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 5 10 15 20 25 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 50 100 150 200 250 300 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 5 10 15 20 25 30 35 40 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 50 100 150 200 250 300 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived)
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1 REPORT Item No: 13 SUBJECT: Mental Health Hospital Based Clinical Complex Care TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer Ian Nicol, Programme Manager DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB Sub-Committee For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: the Health and Social Care Partnership Core Management Team 3. RECOMMENDATIONS The Board is asked to: 1) Approve the attached business to consolidate the provision of Hospital Based Complex Clinical Care for old age psychiatry patients at Hatton Lea Care Home, providing a pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. 2) Approve the termination of the existing contract with Four Seasons for HBCCC beds at Cumbernauld Care Home. 3) Approve the use of a proportion of the savings achieved to establish an enhanced multi- disciplinary staffing model at Hatton Lea. 4. VARIATIONS TO DIRECTIONS? No directions required at this stage. Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was signed off by the NHS Board in 2017, which included a specific action around reviewing the model of Mental Health Hospital Based Complex Clinical Care (HBCCC). This is the last outstanding action from the plan, delayed due to the onset of the pandemic. 5.1.2 NHS Lanarkshire’s Mental Health services are hosted within the North Lanarkshire Integration Joint Board, in line with the respective integration schemes of the two Lanarkshire partnerships. 5.1.3 Mental Health HBCCC beds are largely used for patients with dementia exhibiting aggressive or challenging behaviours. Previously, patients would largely remain in HBCCC beds for life, but following a definition change in 2015, when a patient’s presentation changes they are now expected to be moved to a more suitable and homely environment, such as a mainstream Care Home. There is now a simple eligibility question of ‘can your care needs be properly met in any other setting than a hospital?’, and if so, the aim is to support the patient to be moved to a less intensive setting, which is very positive for improving the quality of life of the individual. 5.1.4 At present, NHS Lanarkshire has two contracts for the provision of HBCCC beds, which were originally established in the early 1990’s. These contracts were originally devised to assist in the transition from centralised facilities in Hartwood Hospital and other older outlying facilities such as Cleland Hospital to more modern community placements throughout Lanarkshire. The contracts relate to: Cumbernauld £2,021,180 per annum originally for 60 beds, now reconfigured to 52 beds. Hattonlea Care Home in Bellshill which is operated by HC-One at an annual cost of £3,138,067 per annum originally for 90 beds, now reconfigured to 75 beds. The total cost of both contracts is £5,159,247. Both contracts have a 12-month notice period. 5.1.5 The requirements for inpatient services for this patient group have reduced as alternative clinical models have developed and the occupancy levels within both facilities are now low. As at October 2022: Cumbernauld Care Home: 5 out of 52 available beds occupied (10% occupancy). Hatton Lea Care Home: 46 out of 75 available beds occupied (61% occupancy). 5.1.6 In addition to the contracted HBCCC dementia beds, NHSL has 30 functional illness beds based in Cleland hospital. Within Care of the Elderly (COTE), any beds in can be classified as HBCCC, including those in the off-site facilities. Beds are not cohorted and each case is managed on an individual basis. These COTE beds are not part of the review. 5.1.7 A number of Health Boards/partnerships across Scotland have undertaken similar reviews since 2015 due to the impact on demand of the definition changes.
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3 5.2 DEVELOPING PROPOSALS 5.2.1 Based on this falling demand, the NHS Board and IJBs agreed in March 2020 that a business case be developed for the consolidation of contracted HBCCC provision onto the site at Hatton Lea, providing an enhanced pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. 5.2.2 However, due to the impact of the pandemic, the planned work was delayed as it was not possible to undertake any consultation work within the Care Home environment due to the risk of Covid-19 spread. Work commenced again at the end of 2021. 5.2.3 An Engagement Planning Group was established with patient and carer representatives and staff to work through an options appraisal process to ensure that all options were identified, to test the original proposal against these and carry out an Equalities Impact Assessment. 5.2.4 The options appraisal confirmed the preferred option of consolidating provision establishing an enhanced MDT care model at Hatton Lea Care Home. The business case for the proposed service change is attached at Appendix 1. 5.2.5 The EQIA identified potential disadvantage to carers/family members through centralisation onto a single site. Options the provision of transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea will be agreed by the Engagement Planning Group as part of the implementation plan. 5.2.6 The wider benefits anticipated from this development are as follows: Care on one central site with good transport links will be easier to access for families and carers as well as to assess and follow up by all disciplines of NHS Lanarkshire staff and partners in both North and South Lanarkshire. Opportunity exists to reinvest a proportion of the savings achieved in the service through employment, skills and training to provide best evidence care, treatment and rehabilitation. By consolidating some functions under a single site, the organisation eliminates the possibility of different standards and practices being applied in different areas. This is a major benefit to the patient’s wellbeing. Enhanced medical/nursing/AHP input within Hatton Lea would enable an improved care pathway, including robust multi-disciplinary assessment prior to admission and review focussed resident’s individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes. Meeting each patient’s changing care needs through robust multi-disciplinary assessment will ensure more positive patient /carer outcomes whilst identifying changing care requirements that would precede residents moving to future clinically appropriate care settings. Achievement of NHS Lanarkshire’s strategic objective of achieving best outcomes and value for money, ensuring that all resources are deployed to best effect, achieving transformational change in desired outcomes and value for money. 5.2.7 The health care needs of patients in Cumbernauld Care Home have been reviewed in order to identify those requiring complex clinical care and others who may be able to transition to more traditional care environments. Nearly all of the patients in the Cumbernauld Care Home could now be managed in a mainstream care home and will, therefore, not transfer to Hatton Lea. Families will be fully involved in discussions to agree the future care arrangements for each individual patient. 5.2.7 The Engagement Planning Group will support the implementation of the enhanced model of care at Hatton Lea Care Home to ensure continued engagement with those with a stake in a
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4 new model of contracted hospital-based complex clinical care for older people and to provide a feedback loop on progress to partner organisations and people potentially affected by the service change. 6. CONCLUSIONS 6.1 Following the national change in definition of HBCCC, demand for Mental Health Continuing Care has continued to decrease, resulting in reducing occupancy levels in the contracted beds in Cumbernauld Care Home and Hatton Lea. 6.2 The IJB is asked to approve the attached business case for the consolidation of contracted HBCCC inpatient provision service onto one site for both North and South Lanarkshire residents, subject to endorsement by South Lanarkshire Integration Joint Board and Lanarkshire NHS Board. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have 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 Health and Social Care Services contribute to reducing health inequalities People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing 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) Associated measures include bed occupancy and rates of admission and discharge. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The total cost of the existing contracts totals £5,159,247 per annum. This includes £2,021,180 per annum for 52 beds in Cumbernauld Care Home. £269k will be invested to enhance the multi-disciplinary teams.
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5 Transition costs and consequently the potential savings available for reinvestment will be dependent on the outcome of engagement with Four Seasons and HC-One which may include potential renegotiation of the existing contract and include funding the ongoing care of current patients not meeting complex care criteria. All savings will be split 51/49 between North and South IJBs respectively in line with current funding arrangements. 7.4 PEOPLE There are currently 51 individuals supported through the current arrangements, 5 resident in Cumbernauld Care Home. The health care needs of patients in Cumbernauld Care Home will be reviewed in order to identify those requiring complex clinical care. The next of kin of all Cumbernauld Care Home HBCCC patients will be invited to attend an individual meeting to discuss the outcome of the review and agree ongoing care arrangements. NHS Lanarkshire responsibilities in relation to Four Seasons staff and their existing employment contract which could be protected under the Transfer of Undertakings (Protection of Employment) Regulations have been reviewed, with TUPE unlikely as the current provider is keen and able to retain the staff group in other local Care Homes. 7.5 INEQUALITIES EQIA Completed: Yes No N/A A full Equality Impact Assessment has been completed as part of the business case development (attached at Appendix 2). 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1: Business case Appendix 2: Draft EQIA ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact: Ross McGuffie Chief Officer 01698 858 143
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Appendix 1 Older Adult Hospital Based Complex Clinical Care Beds Business Case Author: Ian Nicol/Marie Rooney Contact: ian.nicol@lanarkshire.scot.nhs.uk marie.rooney2@lanarkshire.scot.nhs.uk Date: 17th Nov 2022 Version: v0.8
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Business Case Page 7 of 26 Contents 1. Purpose .......................................................................................................... 8 2. Background .................................................................................................... 8 3. Strategic Objectives ...................................................................................... 9 4. Benefits .......................................................................................................... 9 5. Risks ............................................................................................................. 10 6. Available Options ........................................................................................ 10 7. Preferred Option .......................................................................................... 12 8. Estimated Costs .......................................................................................... 13 9. Net Benefit Forecast .................................................................................... 13 10. Document Control Sheet.................................... Error! Bookmark not defined.
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Business Case Page 8 of 26 1. Purpose The purpose of this business case is to set out the benefits to be delivered by the proposed changes to contracts with private sector providers for Hospital Based Complex Clinical Care (HBCCC) beds, the risks to achieving the benefits, the costs of delivery, and timescales. 2. Background Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was signed off by the NHS Board in 2017. This included a specific action around reviewing the model of Mental Health Hospital Based Complex Clinical Care (HBCCC). This is the last outstanding action from the plan, delayed due to the onset of the pandemic. NHS Lanarkshire’s Mental Health services are hosted within the North Lanarkshire Integration Joint Board, in line with the respective integration schemes of the two Lanarkshire partnerships. Mental Health HBCCC beds are largely used for patients with dementia exhibiting aggressive or challenging behaviours. Previously, patients would largely remain in HBCCC beds for life, but following a definition change in 2015, when a patient’s presentation changes they are now expected to be moved to a more suitable and homely environment, such as a mainstream Care Home. There is now a simple eligibility question of ‘can your care needs be properly met in any other setting than a hospital?’, and if so, the aim is to support the patient to be moved to a less intensive setting, which is very positive for improving the quality of life of the individual. At present, NHS Lanarkshire has two contracts for the provision of HBCCC beds, which were originally established in the early 1990’s. These contracts were originally devised to assist in the transition from centralised facilities in Hartwood Hospital and other older outlying facilities such as Cleland Hospital to more modern community placements throughout Lanarkshire. The contracts relate to: Cumbernauld £2,021,180 per annum originally for 60 beds, now reconfigured to 52 beds. Hattonlea Care Home in Bellshill which is operated by HC-One at an annual cost of £3,138,067 per annum originally for 90 beds, now reconfigured to 75 beds. The total cost of both contracts is £5,159,247. Both contracts have a 12-month notice period. The requirements for inpatient services for this patient group have reduced as alternative clinical models have developed and the occupancy levels within both facilities are now low. As at October 2022: Cumbernauld Care Home: 5 out of 52 available beds occupied (10% occupancy). Hatton Lea Care Home: 46 out of 75 available beds occupied (61% occupancy). At the most recent census (March 2022), the average length of stay of patients in the two care home was: Cumbernauld Care Home: 6 years 4 months Hatton Lea Care Home: 3 years 2 months In addition to the contracted HBCCC dementia beds, NHSL has 30 functional illness beds based in Cleland hospital. Within Care of the Elderly (COTE), any beds can be classified as HBCCC, including those in the off-site facilities. Beds are not cohorted and
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Business Case Page 9 of 26 each case is managed on an individual basis. These COTE beds are not part of the review. 3. Strategic Objectives The overall objective of this proposal is to optimise NHS Lanarkshire contracted HBCCC bed provision to establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia that will better meet the needs of patients and staff. It will contribute to the achievement of the following NHS Lanarkshire strategic objectives: 1. Modern fit for purpose NHS Lanarkshire, focussed on prevention and speed of treatment – Delivering services that listen and respond to the needs of individuals, patients and carers to continuously improve experiences and outcomes. 5. Achieve best outcome and value for money – ensuring that all resources are deployed to best effect, achieving transformational change in desired outcomes and value for money The case for change also aligns with the three ambitions of NHS Scotland’s Quality Strategy: Safe - There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision- making Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. 4. Benefits Consolidation and centralisation onto a single site to enable multi-disciplinary team- based working that will benefit the patients/residents. A single care provider will allow improved communication and monitoring ensuring continued meaningful and sustained engagement between the provider and NHS Lanarkshire. Care on one central site with good transport links will facilitate easier access for families and carers as well as staff of NHS Lanarkshire and partners in both North and South Lanarkshire to assess and meet the care needs of each patient. Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. Enhanced medical/nursing/AHP input on a single site enabling an improved care pathway, including robust multi-disciplinary assessment prior to admission and review focussed resident’s individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes.
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Business Case Page 10 of 26 Meeting each patient’s changing care needs through robust multi-disciplinary assessment will ensure more positive patient /carer outcomes whilst identifying changing care requirements that would precede residents moving to future clinically appropriate care settings. 5. Risks Business Risk: There is a risk that the inpatient clinical model is not fully funded resulting in the objectives of the project being significantly threatened. Mitigation: Development of a high quality clinical and social care model and robust business case. Patient Care There is a risk of some disruption in service resulting in an unacceptable impact on patient care. Mitigation: Development of retraction plan to ensure smooth transition to include individual meetings with Cumbernauld patients/carers/families to agree the best ongoing care arrangements for each patient, negotiation with providers, a detailed communications plan, engagement with staff, recruitment and training. Staff There is a risk that we cannot recruit or retain staff with the necessary skills and experience. Mitigation: Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. Reputation There is a risk of unfavourable local media coverage resulting in a significant effect on staff morale and public perception of NHS Lanarkshire. Mitigation: Work with HSCNL communications team and providers to develop a communications plan establishment of an Engagement Planning Group to involve with patient groups, communities, staff and other stakeholders in the options appraisal process; engagement with the local community in Cumbernauld, including meeting local elected representatives and attending the Cumbernauld Community Forum. 6. Options Appraisal An Engagement Planning Group was established with patient and carer representatives and staff to work through an options appraisal process to inform the development of the business case. Options The following long list of options was identified: 1. Do nothing. 2. Establishment of an enhanced single-site MDT HBCCC model at Hatton Lea Care Home 3. Repurpose an existing vacant NHS Lanarkshire property
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Business Case Page 11 of 26 4. A new purpose-built facility 5. Smaller, purpose-built units in different parts of Lanarkshire 6. Purchase of Cumbernauld Care Home 7. Purchase beds in private care homes across Lanarkshire The Group took the view that Option 1 could be ruled out as Four Seasons Healthcare intend to close Cumbernauld Care Home. As that will release resources, the best use of these resources can be taken into account in considering each of the other options. Similarly, the Group took the view that Option 7 would not release the resources for the development of an MDT model of care and could also be ruled out. Benefits Criteria The following benefits criteria were agreed to appraise the short-listed options Safe – The extent to which the option will ensure that here will be no avoidable injury or harm to people, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred – The extent to which the option will enable mutually beneficial partnerships between patients and all those involved in their care, which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making Effective – The extent to which the option will ensure that most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated Sustainable – The degree to which the option supports the delivery of the service in the medium to long-term (5-10 years plus) Accessible – The extent to which the option would ensure relatives/carers/the wider care team can be actively involved in the individual care of residents Perception of success – The extent to which the option would be welcomed by stakeholders; is the change achievable and does it have the potential to impact positively on the service?
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Scoring Short-listed Options Benefits Criteria Overall Weighted Score (out of 120) Safe Person- centred Effective Accessible Sustainable Perception of Success Weighting 20% 20% 20% 20% 10% 10% 1. Consolidation of HBCCC provision at Hatton Lea Care Home Score 103 106 104 86 90 87 97.5 Weighted Score 20.6 21.2 20.8 17.2 9 8.7 2. Repurpose an existing vacant NHS Lanarkshire property Score 78 82 79 73 79 79 78.2 Weighted Score 15.6 16.4 15.8 14.6 7.9 7.9 3. A new purpose-built facility Score 93 91 87 79 83 81 86.4 Weighted Score 18.6 18.2 17.4 15.8 8.3 8.1 4. Smaller, purpose-built units in different parts of Lanarkshire Score 85 87 81 85 66 78 82 Weighted Score 17 17.4 16.2 17 6.6 7.8 5. Purchase of Cumbernauld Care Home Score 76 74 68 52 51 53 64.4 Weighted Score 15.2 14.8 13.6 10.4 5.1 5.3 Preferred Option Option 1: Consolidation of contracted HBCCC beds at Hatton Lea Care Home
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7. Estimated Costs Multi-disciplinary staffing model to deliver enhanced model of care: Band WTE Cost (£)* OT 6 0.6 30,891 Consultant Psychiatrist n/a 0.4 57,921 Psychology 8a 0.6 41,847 Admin 3 0.8 24,694 HBCCC Liaison /Delayed Discharge Nurse 7 1 62,051 Physiotherapist 6 0.5 25,743 Pharmacist 6 0.5 25,743 Total 268,891 *Calculated at 2021/22 rates 8. Net Benefit Forecast Investment Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Enhanced MDT team at Hatton Lea: additional staffing costs Revenue 0 269 269 Return on investment Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Savings achieved from termination of Cumbernauld Care Home contract Revenue 0 505 2,021 Net financial benefit Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Savings on Cumbernauld Care Home contract less MDT staffing costs Revenue 0 236 1,752 * Calculation assumes Four Seasons Healthcare notified of intention to withdraw from Cumbernauld in December 2022 and NHS Lanarkshire held to full year notice period; however, negotiations are underway with Four Seasons in relation to the notice period and the terms of the withdrawal.
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EQUALITY IMPACT ASSESSMENT This is a legal document stating you have fully considered the impact on the protected characteristics and is open to scrutiny by service users/external partners/Equality and Human Rights Commission If you require advice on the completion of this EQIA, contact hina.sheikh@lanarkshire.scot.nhs.uk ‘Policy’ is used as a generic term covering policies, strategies, functions, service changes, guidance documents, other Name of Policy Contracted Hospital Based Complex Clinical Care Names and role of Review Team: Marie Rooney, Associate Nurse Director, Mental Health, Learning Disability and Addictions Tracey Truesdale, Service Manager, Mental Health, Learning Disability and Addictions Ian Nicol, Programme Manager Date(s) of assessment: 03/11/2022 SECTION ONE AIMS OF THE POLICY 1.1. Is this a new or existing Policy: Service Change Please state which: Policy Strategy Function Service Change Guidance Other 1.2 What is the scope of this EQIA? NHS Lanarkshire wide Service specific Discipline specific Other (please detail) ______________________________ 1.3a. What is the aim? To establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia that will better meet the needs of patients and staff. 1.3b. What are the objectives? The objective of the proposed service change is to optimise NHS Lanarkshire contracted HBCCC bed provision by consolidating provision on a single, central site at Hatton Lea Care Home to enable multi-disciplinary team-based working that will benefit the patients/residents and those involved in their care, including carers and families. 1.3c. What are the intended outcomes? Appendix 2
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The planned new service model aligns with the three ambitions of NHS Scotland’s Quality Strategy: Safe - There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. 1.4. How have the stakeholders been involved in the development of this policy? An Engagement Planning Group has been established in line with Healthcare Improvement Scotland’s Planning with People guidance, comprising patient and carer representatives and staff, to: Ensure all those with a stake in a new model of contracted hospital-based complex clinical care for older people have been identified and can access accurate information to enable them to engage appropriately and proportionately, in the development and implementation of the new service model; Ensure meaningful contributions, representation, ownership and buy-in from all partners and establishing a partnership approach to planning communications activities; Provide a feedback loop on progress in developing and implementing the new model of care to partner organisations and people potentially affected by the service change; Agree the range of options and carry out an options appraisal for the future provision of contracted hospital based complex clinical care to identify a preferred model of care that is robust, evidence-based and person-centred. To carry out an Equalities Impact Assessment of service redesign to consider the impact on different communities taking into consideration equality, human rights, sustainability and the environment, and ensure actions have been identified to mitigate any adverse impacts. 1.5 Examination of Available Data and Consultation - Data could include: consultations, surveys, databases, focus groups, in-depth interviews, pilot projects, reviews of complaints made, user feedback, academic or professional publications, reports etc)
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Name any experts or relevant groups / bodies you should approach (or have approached) to explore their views on the issues. NHS Lanarkshire Old Age Psychiatry Executive Group HBCCC Engagement Planning Group NHS Lanarkshire Equality and Diversity Manager Third sector patient and carer representatives What do we know from existing in-house quantitative and qualitative data, research, consultations, focus groups and analysis? Prior to the Covid-19 pandemic a review was completed by the Old Age Psychiatry Executive group which confirmed that the current provision of NHSL dementia HBCCC beds was now no longer suitable, it is outdated and clinically does not meet the needs of the increased acuity in the patient group. The Scottish Government and Alzheimer Scotland report ‘Transforming Specialist Dementia Hospital Care’ 2018, was clear in the direction of future care provision for patients with a diagnosis of dementia who require additional inpatient care through HBCCC. This report stipulated: lower bed numbers per ward, environmental specifics, & highly skilled multi-professional staff. Based on this falling demand, the NHS Board and IJBs agreed in March 2020 that a business case be developed that looks to consolidate the provision of services onto the site at Hatton Lea, providing a pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. However, due to the impact of the pandemic, the planned work was delayed as it was not possible to undertake any consultation work within the Care Home environment due to the risk of Covid-19 spread. Work commenced again at the end of 2021. What do we know from existing external quantitative and qualitative data, research, consultations, focus groups and analysis? In 2015, the Scottish Government was clear in its position that people should no longer live in hospital, as per DL 2015 (11). The aim of this guidance was to make the clinical decision regarding place of care more transparent, with the primary eligibility question: ‘Can this individual’s care needs be properly met in any other setting than a hospital?’ This position, and the intent that people should be discharged from hospital when ready, is embraced by the clinical community. However, the model of care currently in existence in Lanarkshire is residual from the previous NHS Continuing Care era, where the assumption was of ongoing care following admission, this assumption is further reinforced by the current provision being within a care home setting. A number of Health Boards/partnerships across Scotland have undertaken similar reviews since 2015 due to the impact on demand of the definition changes. 1.7. What resource implications are linked to this policy? Consolidation and centralisation onto a single site supports new opportunities for multi-disciplinary team-based working and a range of services provided that benefit the patients/residents. Reinvestment of a proportion of the savings achieved through the termination of the Cumbernauld Care Home contract will be invested in the service to put in place enhanced medical/nursing/AHP input within Hatton Lea to
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enable an improved care pathway, including robust multi-disciplinary assessment prior to admission and reviews focussed on patients’ individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes.
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SECTION TWO IMPACT ASSESSMENT Complete the following table, giving reasons or comments where: The Programme could have a positive impact by contributing to the general duty by – Eliminating unlawful discrimination Promoting equal opportunities Promoting relations within the equality group The Programme could have an adverse impact by disadvantaging any of the equality groups. Particular attention should be given to unlawful direct and indirect discrimination. If any potential impact on any of these groups has been identified, please give details - including if impact is anticipated to be positive or negative. If negative impacts are identified, the action plan in appendix 3 form C must be completed Equality Target Groups – please note, this could also refer to staff Positive impact Adverse impact Neutral impact Reason or comment for impact rating 2.1. Age Children and young people Adults Older People X X N/A The service change will establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia. It will should also have a positive impact on the families and others involved in the care of these patients. However, given the age group of the patients, partners/family members/ carers may have mobility difficulties, may have lost their driving licences or may only drive within their local area/at certain times of the day.
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2.2. Disability (incl. physical/ sensory problems, learning difficulties, communication needs; cognitive impairment, mental health) X The new HBCCC MDT model of care will benefit all those assessed as requiring this form of care. The person-centred approach will identify any additional support needs pertaining to existing or acquired disabilities 2.3. Gender Reassignment X The impact of the policy is neutral and it impacts all equally irrespective of gender status, however i Use of gender neutral language, and Gender neutral clinical environment Will support an inclusive environment 2.4 Marriage and Civil partnership X The impact of the policy is neutral and it impacts all equally irrespective of marriage or civil partnership. Partners may need to be consulted in any decision-making process. 2.5 Pregnancy and Maternity (including breastfeeding) X Family members may wish to be on the premises and this could present a need for private space e.g. for breast-feeding. 2.6 Race/Ethnicity X We will need to ensure the centralisation of provision and the new model of care is sensitive to any religious and cultural factors and consider any potential additional support needs required i.e. interpreting services. 2.7 Religion/Faith X We will need to ensure the centralisation of provision and the new model of care is sensitive to any religious factors and consider any potential additional support needs required. 2.8 Sex (male/female) X The impact of the service change is neutral as it impacts all equally irrespective of their sex. Sex specific services may need to be considered for a number of factors.
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2.9 Sexual Orientation Lesbians Gay men Bisexuals X The impact of the service change is neutral as it impacts all equally irrespective of sexual orientation. 2.10 Carers X The impact of the service change on carers should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable both the carer’s role in supporting the patient and their own needs to be taken into account. Whilst Hatton Lea Care Home is in a central location in Lanarkshire, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. 2.10 Homeless X Transitions from Hatton Lea will be to another care setting 2.12 Involved in criminal justice system X Patients subject to MAPPA – it is not thought that such patients will be admitted to Hatton Lea; therefore, not applicable. To be confirmed. 2.13 Literacy X The impact of the service change on those with literacy issues should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s specific needs and capabilities to be taken into account in the planning and delivery of their care. Families/carers, etc. need to be involved, as appropriate, in decision- making.
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2.14 Rural Areas X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. 2.15 Staff Working conditions Knowledge, skills and learning required Location Any other relevant factors X X X Consolidation and centralisation onto a single site will enable multi- disciplinary team-based working that will benefit staff. A single care provider will allow improved communication and monitoring ensuring continuity of care and meaningful and sustained engagement between the provider and NHS Lanarkshire staff, improving patient experience and outcomes. Care on one central site will facilitate easier access NHS Lanarkshire staff of and partners in both North and South Lanarkshire; however, transport difficulties may present for staff, especially shift workers. Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. 2.16. What is the socio-economic impact of this policy / service change? (The Fairer Scotland Duty places responsibility on Health Boards to actively consider how they can reduce inequalities of outcomes caused by socio-economic disadvantage when making strategic decisions) Positive Adverse Neutral Rationale/Evidence Low income / poverty X X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Potential disadvantage to carers/family members through centralisation onto a single site for those who are economically disadvantaged by the centralisation at Hatton Lea. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea.
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Living in deprived areas X As above Living in deprived communities of interest X As above Employment (paid or unpaid) X As above SECTION THREE CROSSCUTTING ISSUES What impact will the proposal have on lifestyles? For example, will the changes affect: Positive impact Adverse impact No impact Reason or comment for impact rating 3.1 Diet and nutrition? X The impact of the service change should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s dietary requirements to be taken into account in the planning and delivery of their care. 3.2 Exercise and physical activity? X The impact of the service change should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s specific needs and capabilities to be taken into account in the planning and delivery of their care. 3.3 Substance use: tobacco, alcohol or drugs? X N/A 3.4 Risk taking behaviour? X N/A
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SECTION FOUR CROSSCUTTING ISSUES Will the proposal have an impact on the physical environment? For example, will there be impacts on: Positive impact Adverse impact No impact Reason or comment for impact rating 4.1 Living conditions? X Hatton Lea is a purpose-built modern facility which more ably facilitates our planned model of care. The Cumbernauld facility is of an older design meaning it has limited scope to be reconfigured/adapt to changes as clinical models of care develop. Care on one central site with good transport links will facilitate easier access for families and carers. 4.2 Working conditions? X A single care provider will allow improved communication and monitoring ensuring continued meaningful and sustained engagement between the provider and NHS Lanarkshire. Care on one central site with good transport links will facilitate easier access for staff of NHS Lanarkshire and partners in both North and South Lanarkshire to assess and meet the care needs of each patient. 4.3 Pollution or climate change? X N/A Will the proposal affect access to and experience of services? For example: Positive impact Adverse impact No impact Reason or comment for impact rating Health care X Enhanced medical/nursing/AHP input on a single site enabling an improved care pathway, including robust multi-disciplinary assessment prior to admission and review focussed resident’s individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes.
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Social Services X Care on one central site and development of the MDT model of care will facilitate stronger links with council and 3rd Sector social care partners in both North and South Lanarkshire. Education X N/A Transport X X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. Potential disadvantage to carers/family members through centralisation onto a single site for those who are economically disadvantaged by the centralisation at Hatton Lea Housing X N/A SECTION FIVE MONITORING How will the outcomes be monitored? Use of evaluation forms with service users to measure progress in terms of mental health and wellbeing recovery Data gathering – all aspects of service What monitoring arrangements are in place? Internal progress reports and external monitoring framework. Internal data collection tools. Who will monitor? The Project Manager and Clinical Lead for the service.
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What criteria will you use to measure progress towards the outcomes? Use of evaluation forms with service users to measure progress in terms of mental health and wellbeing recovery Attendance and evaluation of education and training for staff relating to promoting excellence Data gathering – all aspects of service Recruitment of team members and spend Use of quality improvement methodology to demonstrate continuous improvement PUBLICATION Public bodies covered by equalities legislation must be able to show that they have paid due regard to meeting the Public Sector Equality Duty (PSED). This should be set out clearly and accessibly, and signed off by an appropriate member of the organisation. Once completed, send this completed EQIA to the Equality & Diversity Manager Authorised by Title Signature Date Appendix 3: Form C Identified Negative Impact Assessment Action Plan Name of EQIA: Contracted Hospital Based Complex Clinical Care Date Issue Action Required Lead (Name, title, and contact details) Timescale Resource Implications Comments 18/10/2022 Potential disadvantage to carers/family members through Consider provision of transport and/or meeting the travel Tracey Truesdale TBC TBC Options to be explored/agreed to be developed as part of
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centralisation onto a single site costs for those who are economically disadvantaged by the centralisation at Hatton Lea. implementation plan Further Notes: Signed: Date:
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1 REPORT Item No: 14 SUBJECT: Supporting Unpaid Carers TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager Quality Assurance DATE: 30th November 2022 1. PURPOSE OF REPORT 1.1. This paper is coming to the IJB for: For approval For endorsement To note 1.2. This report is intended to provide an update the support in place for unpaid Carers across our communities and to seek endorsement of our approach to ensure continuation of support. 1.3. We recognise that unpaid Carers of all ages play a vital role in the lives of the people they care for and the Council is committed to supporting Carers to ensure they can continue to provide that care for as long as they wish. 1.4. As previously reported, services were commissioned in March 2019, to undertake the following functions: Direct support for adult Carers: Lanarkshire Carers Carer’s campaigning, information and representation services: North Lanarkshire Carers Together Young Carers Support Services: Action for Children Young Carers Service Community Solutions Programme: Voluntary Action North Lanarkshire
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2 1.5. Support delivered via these commissioned services has enabled us to meet the requirements of the Carers (Scotland) Act 2016. By utilising the allocated ring-fenced funding via Scottish Government to support the implementation of the Act, several initiatives (reported through Committee Nov 2021) were developed to provide additional support to meet some of the priorities set out in the act. 1.6. Our approach to supporting unpaid Carers is closely aligned with our Self- directed Support transformational programme, details on which are contained on a separate report. 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: Prepared with the range of key partners in North Lanarkshire ensuring that services and supports for unpaid carers are effective and responsive, and reviewed by senior management. 3. RECOMMENDATIONS 3.1. The IJB committee is asked to: a) The content of the Report is noted b) Our approach to supporting unpaid Carers is endorsed. c) Note the request to extend service contracts is endorsed to ensure a continuation of support is available for unpaid Carers. 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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3 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1. The Carers (Scotland) Act 2016 came into force on 1st April 2018. The Act was built upon existing legal rights for Adult Carers and Young Carers in Scotland as well as introducing new rights. The aim of the Act was to support Carers through offering a personalised approach to any support required in their caring role and to try to minimise the risk of future crisis, both for the Carer and Cared for person. 5.2 Our Strategy for Adult Carers and Young Carers (2019-2024) cites the last Census completed in Scotland from 2011. This highlighted that approximately 10% of North Lanarkshire’s population identified as being in a caring role and early indications are that this number is set to rise when the most recent census information is published. It should be noted that not all Carers are known to services. 5.3 The impact of the pandemic and the ongoing challenges across health and social care has added significant extra pressure to Carers and families. 5.4 Our commissioned Carer Support Organisations were awarded contracts in March 2019, on a 4+2+1 basis and are now nearing the end of the original contract period. 5.5 The Carer Breather pilot over a period of 18 months is due to end in March 23. Early feedback on the success of the pilot has been very positive, particularly from those who were able to have a break together and for those providing care but who did not necessarily wish to identify with a carer’s organisation. 5.6 We participated in the national Care Inspectorate Inquiry into Carers experiences of adult social work and social care. North Lanarkshire were one of the 5 Health & Social Care Partnership areas participating in a more in-depth inquiry. The Inquiry has now been completed and we await feedback on the outcome. 5.7 Carer support is a key factor in our SDS transformational programme, looking at a whole system approach. Details of the SDS transformational programme are contained within a separate report. 6 Report 6.1 There are three (3) commissioned organisations supporting Carers. To compliment these services, regular and locally based support has been achieved by enhancing and extending Support for Carers, utilising the allocation of ring-fenced funding via Scottish Government to further support the implementation of the Carers (2016) Act. 6.2 At the time of procuring the commissioned services, awards were made with the option to extend based on the original contract terms & conditions. Our intention is to exercise the option to extend these contracts a further 2 years, based on performance, efficacy, and success to date. 6.3 The cost to extend the contract period for all services will be met from recurring ring-fenced funding form Scottish Government and is detailed below:
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4 Provision Provider CURREN T 22/23 Budget 23/24 Budget 24/25 Budget Adult Carer Support Plans Lanarkshire Carers Centre £616,097 £646,90 2 £679,24 8 Young Carers Statements Action for Children £418,481 £439,40 5 £461,37 5 Information & Advice Service North Lanarkshire Carers Together £255,739 £268,52 5 £281,95 2 6.5 Over the past year enhanced support for Carers has been made available through a range of initiatives utilising unallocated ring-fenced funding from the Scottish Government. These initiatives included Carer Breather, the Hospital Support Programme and Short Breaks. Our robust partnership approach with commissioned and community-based services, provides assurance that Carers know how and where to access support. 6.6 The Carers (Scotland) Act 2018 highlights that unpaid Carers should be involved in hospital discharge planning. A development aimed at supporting unpaid Carers in hospital discharge planning is already in place and will be operational until September 2024. 6.7 Imminent amendments to the Carers Act will include a legal right for unpaid Carers to have a break from caring. Expansion of Carer Breather and funding for flexible Short Breaks will ultimately assist in meeting legal responsibilities in a cost effective, sustainable and carer valued and informed way. 6.8 The Carer Breather programme is supported by NLCT within Community Solutions, with initiatives developed directly through listening to the views of Carers. Short Breaks support is managed by Lanarkshire Carers. Having this provision in place has helped reduce carer stress and burn out and mitigated against escalation of carer needs. Engagement and participation activity has demonstrated the success of the current programme, as well as highlighting a greater need and demand for this option – as a valued approach to flexible breaks from caring. 6.9 The intention is it continue to support flexible Short Breaks and expand the Carer Breather programme beyond March 23, by offering additional investment to provide Carer support – both geographical and thematic. The additional funding required will come from specific ring-fenced Carer support monies. The proposed operational timescale will fit with the planned extension to our commissioned services contracts. 6.10 The cost to continue and expand this provision will be met from recurring ring- fenced funding from Scottish Government and is detailed below: Provision 2023/24 2024/25 Total Short Breaks £200,000 £200,000 £400,000
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5 Carer Breather £300,000 £300,000 £600,000 6.11 Carer Breather will continue to utilise the Carer Pathway Toolkit to engage Carers in conversation as part of a light touch early intervention within the local community. 6.12 Our current Carer Strategy runs until 2024. To prepare for reviewing our strategy and implementing any learning from the Care Inspectorate Carers Inquiry, we will refresh the role and function of our Carer Strategy Implementation Group. Members will play a valuable role in our ongoing partnership approach to supporting unpaid Carers. 6.12 The Carers Policy Team are currently developing a National Carers Strategy, which will articulate the Scottish Government’s overall ambitions for unpaid carers and for carer support. The publication of this strategy, the learning from the Care Inspectorate Carer Inquiry and the publication of the Scottish Census information will all inform the refresh of North Lanarkshire’s Carer Strategy. 6.13 A breakdown on how the 2023-2025 funding has been allocated is detailed below: Carer Support Allocation 2023-2024 2024-2025 Provision of Adult Carer Support Plans - commissioned service, which also includes adult carer support £ 646,902 £ 679,248 Provision of Young Carer Statements - commissioned service, which also includes young carer support £ 439,405 £ 461,375 Information and Advice – commissioned service, which also includes Carers Advocacy £ 268,525 £ 81,952 Duty to support adult carers – includes Carer Breather; Community Solutions; SDS including Carer Budgets £ 650,000 £ 800,000 Duty to support young carers – includes PAMIS (provides support to families); SDS including Carer Budgets £ 50,000 £ 50,000 Additional short breaks support £ 200,000 £ 200,000 Local Carer strategies £ 100,000 £ 100,000 Other - Hospital Support £ 145,246 £ 145,246 Unallocated Budget £ 1,032,017 TOTAL £ 3,532,095 £ 2,717,821
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6 6.14 From the expected 2023/24 ring-fenced funding from Scottish Government, the total unallocated £1,032,017 will be utilised to implement any recommendations from the reports (noted at 2.10 above) once published. This approach will ensure that we remain responsive to the needs of Carers across our communities, enabling them to maintain their caring role while leading a full life. 7. IMPLICATIONS 7. NATIONAL OUTCOMES 7.1. The support to unpaid carers impacts on all of the 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 7.5 PEOPLE 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None.
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7 9. APPENDICES Appendix 1 Action for Children, North Lanarkshire Young Carers – Update Oct 22 Appendix 2 Getting Better Together- Carer Support Activity Report Appendix 3 Getting Better Together –Hospital Discharge Support Programme (HDSP) Appendix 4 Lanarkshire Carers Annual Report 21 /22 Appendix 5 Update from Lanarkshire Carers for North Lanarkshire Committee Paper - October 2022 Appendix 6 North Lanarkshire Carers Together (NLCT) – Update Report Oct 22 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 07939284732.
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8 Appendix 1 Action for Children, North Lanarkshire Young Carers – Update Oct 22 NLYC will finally move to the new premises (Enterprise House) in November 2022 after several delays. The new facilities will enhance carer involvement with a new Podcast Suite for young carers as well as a facility for training, educational support, and 1:1 counselling. Enterprise house is a modern, secure and energy efficient building with recently upgraded networking and IT facilities. The new building will also feature a new VR facility for young carers to use for Groupwork and training purposes. (Fire and rescue \ first aid \ medication management and safe lifting & handling.) Upgraded kitchen facilities will allow the service to support young carers to learn new skills in cooking, food preparation and Nutrition. The service has been fully operational since mid – 2021 with a small Covid disruption in Late December 2021. Groupwork supports and individual 1:1 supports have continued since this time. In line with the Carers (Scotland) Act 2016 the service has continued to prioritise identification and support of young carers within North Lanarkshire, including the offering of a Young Carers Statement and review where applicable. A major part of our work has been the continued delivery of a large number of carers led short breaks and residential breaks. Young Carers choose to go to Aberdeen, England, Glasgow, Edinburgh, Dundee, and Ayrshire, as well as attendance at the 2021 Young Carers Festival in Fife. In addition, our young carers have enjoyed a number of concerts, plays and musicals both in Edinburgh, Glasgow and Cumbernauld. Our ability to provide these breaks has been supported by successful applications to funders and also the Lanarkshire Carers Short Breaks Bureau who remain a vital partner and source of support to the service. Through additional funding and support from Action for Children we managed to replace three of our old vehicles with newer, more efficient, models. Supporting Mental Health and well-being remains vital, and the service has continued its successful initiative with counselling services who provided vital emotional supports to a number of young carers. In addition, we have continued our Blues training initiative, and provided training for carers through our partnership with Landed. In addition, we worked with and number of other partners including Reel- time studios, New College Lanarkshire, Lanarkshire Carers and Columba 1400. We also provided a number of specialised ‘sibling’ short breaks with the ‘Over the Wall’ organisation. Our partnership with Motherwell FC community trust remains extremely important and beneficial to our young carers. Recently we held our first ‘post covid’ ‘Fire-reach’ training initiative with Scottish Fire and Rescue in Coatbridge.
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9 Raising awareness of young carers existence remains another major piece of our work, and we have developed a whole new suite of traditional and digital materials which are all QR linked to our updated website. The website provides a wealth of information on what we do, supports available for all carers and also a dedicated referral page. We have had a number of features in the papers, including the Scotsman, Daily Record and also on STV. This has been made possible through support from Action for Children’s media and fundraising teams. We have continued with our Facebook page also. Partner support remains vital to the service, and we celebrated a number of important partnerships with third sector supports and also Education, NHS \ CAMHS, social work, third sector and a number of charity foundations. NLYC continues its partnership with High schools in North Lanarkshire with awareness raising presentations, drop ins and attendance at school events. We are currently piloting a primary school awareness initiative in Bellshill. Ian Sloan Locality Services Manager Action For Children
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10 Appendix 2 Getting Better Together Carer Breather Fund CARER SUPPORT ACTIVITY REPORT In Dec 2021 funding was granted to conduct a localised test of change with regards to the wider introduction of a sitter service in the locality. The Sitting Service has been able to provide peace of mind to carers with a volunteer visiting the home to keep the cared for company while the carer is able to have a break from their caring role. The sitting service is not able to provide domiciliary care but can provide company to those who do not like to be on their own while the carer tends to their own health and/or social needs, allowing for a meaningful scheduled break where plans can made. Having the opportunity of a break is welcomed but for some isolated carers this can present other barriers, such as anxieties about reengaging with the community. The Carer Breather funding has allowed us to develop a Carer Connector post, who can support carers to identify and access other supports in their community. This additional capacity allows a staff member to work one to one with carers supporting them to identify and access activities and supports in their own community. This could be training, volunteering, leisure activities, hobbies etc. As a Healthy Living Centre, we already have a varied activity programme, be we understand that carers who have been isolated for long periods of time can feel anxious. Our Carer Connector can accompany them to offer support and help them to settle in. Opportunities range from physical activities such as guided walks or exercise classes to general social activities. Although all the above can decrease isolation and loneliness, we hope that our carer connector can also provide a preventative service. We have over 30 staff members and many visitors we have into our centre daily, spanning all age groups. A carer can often be in plain sight but has not recognised their role themselves. Our carer connector is visible within the organisation and centre and can identify hidden carers and offer information, advice and signposting if needed. As a Healthy Living Centre, we can identify and offer additional light touch supports that may benefit the carer and the cared for. We have a wide-ranging programme of activities that we can tap into, especially for those carers who have been isolated for long periods of time and unsure of how to move forward. Caring Matters is a peer support group we facilitate to support unpaid carers. The group allows the carer, and cared for, the opportunity for socialisation and time to talk to others in the same situation in a safe supportive environment. Our members can chat and enjoy a light breakfast followed by easy chair exercises. We also provide relaxing raki treatment to reduce any feelings of stress. We have now partnered with North Lanarkshire Council who are delivering meditation music sessions where our members can relax by listening via headphones as they are guided through a
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11 meditation session. We also provided transport to and from these groups, which is vital for carers, or cared for, with mobility issues. April 2022 – Sept 2022 48 Individual Carers Supported 81 Hours Sitter Service provided 18 Carers supported to access or increase benefit income
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12 Appendix 3 Getting Better Together Hospital Discharge Support Programme (HDSP) CARER SUPPORT ACTIVITY REPORT Report activity period: October 21 to September 22 Following on from a discharge to assess test of change with D2A, the service successfully secured additional D2A funding in September 21. This additional funding increased the capacity of the service to meet the increased need for supporting unpaid carers of North Lanarkshire patients age 16+ across Lanarkshire’s NHS sites. To meet this need, the service recruited new additional community liaison officers during the last quarter of 2021. HDSP now has four full-time liaison officers whose main bases are University Hospitals Monklands and Wishaw. Although these sites are our main bases, the carers of North Lanarkshire patients at University Hospital Hairmyres and other NHS sites are visited or contacted when a referral is received. This expansion to four liaison officers increases the service capacity to: Provide information to more unpaid carers about their rights and potential supports available to them. Directly refer into local carer support organisations as well as wider community supports. Expand direct practical and direct support provision to both carers and cared for. Provide more indirect support to carers by arranging supports for more patients which promote carer breaks and help make caring role more manageable (anticipated low level carer support). Liaise with Health and Social care professionals on behalf of carers when required. Provide emotional/listening ear support to carers when appropriate. Raise awareness of carers rights with our Health and Social Care colleagues and teams. Shortly after receiving D2A additional funding, D2A was replaced with new programmes within the acute sites, namely Home First and Home Assessment Teams. These have the same ethos as D2A and HDSP offered it’s support to carers engaged within these programmes. Areas of focus for HDSP with carers has been: Increasing engagement with both carers and professionals. Early discharge planning and support intervention. Reducing admissions by providing quick response supports to carers/cared for. The service continues to be very flexible in its engagement with carers. Although referrals are made to HDSP by our health & social care teams and community and voluntary sector partners, carers are welcome to self-refer. Our liaison officers meet with carers both within wards and during home visits to provide tailored information,
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13 advice and practical support. During the past year, the service received 202 enquiries in which direct contact was made with carers by the team. Following our personal outcome conversations with carers, information about available supports is provided and the service provided 127 carers with information about their rights and the support available to them. This signposting information was provided to carers either in our discharge information packs or by post or email. If consent is granted, onward referrals are made to local carer support organisations such as North Lanarkshire Carer Together, Lanarkshire Carers and North Lanarkshire Young Carers. This promotes access to the wide range of service available to carers from North Lanarkshire’s carer support organisations including Creative Breaks and access to Adult Carers Support Plans and Young Carer Statements. These are anticipated to promote carers health and wellbeing and the right to a life outside of caring. 108 carers responded that they feel more aware of supports available to them following input from the service. In addition to this, information and onward referrals are also made on behalf of carers to a wide range of other supports such as Carer Breather supports which HDSP was a panel member via our membership of the Carers Network. Information provided to carers covers areas such as Local Authority services (such as Social Work, Leisure and Culture) and health promotion literature. Social opportunities. Leisure and physical activities. Future planning. Support to self-manage specific health conditions. Welfare rights. Provide meaningful feedback on the services received and how to become involved in shaping future services. The service submitted 133 direct referrals on behalf of carers to both carer support organisations and wider community, voluntary and statutory supports during the past year. By working in tandem with both carers and patients, the service also indirectly supports carers by either arranging community supports on behalf of patients or by providing practical supports directly to patients. HDSP assisted 406 patients which resulted in 194 direct referrals or supports being made. Many of these indirectly support carers in a wide variety of ways whether this be reducing carers need to provide transport to appointments, requesting community alerts to provide more peace of mind or a social activity that provides a regular break for carers. HDSP also provides an important point of contact for Health and Social Care professionals looking for information and advice regarding support for unpaid carers. The service highlights available carer support and carers rights to colleagues when enquiries are received. Support available to carers and carers rights are also
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14 highlighted by HDSP during awareness raising sessions with teams including hospital social work, physiotherapy, and occupational therapy amongst others. During the past year, HDSP has been involved in numerous awareness raising meetings with newly qualified social workers to highlight carer support and EPIC principles. Other awareness raising sessions include presenting to the Monklands Physiotherapy team. HDSP’s Wishaw team recently distributed carer information to NHS staff during a recent stall, recognising that many of our acute colleagues have unpaid caring roles also. Community based stalls have also now resumed as we learn to live with Covid and HDSP have provided carer information at these also. Expanding our range of practical support provision has been a priority for HDSP during the past year. The service expanded home visits so these can be completed pre discharge, on day of discharge and post discharge. Our pre discharge home visits align closely with the early discharge planning though DWD with which the service has been actively supporting. The range of hands-on practical supports that can be provided expanded to include: • Collecting essential items from home and bring to ward. • Move furniture to accommodate equipment (if possible). • Complete a common-sense assessment of any potential issues and feedback to hospital. • Check heating/utilities are working and assist with gas/electricity top up. • Ensure essential groceries are in place when required. Clear fridges. • Test community alert. These supports are offered to both carers and patients when need is identified. These supports benefit carers in several situations such as when the carer had difficulties due to their own health and mobility or alternatively when the carer lives some distance away or has other responsibilities that make it difficult to take on these tasks. The service has expanded these supports to include a settling in service for the cared for on the day of discharge. This involves HDSP meeting recently discharged patients at their home at the point of discharge, making sure they are comfortable, preparing a light snack and spending a few hours at this initial stage to make sure all is well. To facilitate our settling in service, HDSP attended food hygiene and safer handling training to ensure that we can safely meet recently discharged patients at their home and provide this assistance. Again, this settling in service at point of discharge benefits carers who have difficulty being with their loved one, friend or neighbour at the point of discharge and provides reassurance. In addition to these practical supports, the service provides other direct supports to carers. These are wide ranging, from completing application forms for carers, assisting with making arrangements for cleaning services or for equipment but crucially can include obtaining information and clarifying issues on behalf of carers and raising carer concerns with Health and Social care teams. This communication role supports the Carers (Scotland) Act 2016 – Section 28 regarding keeping carer informed and taking on board carers views. The need to liaise with other
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15 professionals on carers behalf in a low-level advocacy role is particularly beneficial in complex discharges at reducing carer stress quickly and preventing need for formal advocacy. In the period covered by this report, the service provided 42 carers with practical or direct supports. Making the discharge process clear and manageable for carers is a key outcome for carers and our service. 97 carers responded that following the input from the service, the discharge process was made more manageable. HDSP was actively involved throughout the Planned Date of Discharge (PDoD) engagement group. This helped identify a need for a NHS Lanarkshire discharge policy which stated that carers should be informed, involved, and supported in discharge planning. HDSP also conducted carer surveys to obtain carer feedback on their discharge experiences as part of PDoD. HDSP’s input has continued in this area as PDoD evolved into a nationwide programme Discharge Without Delay (DwD). HDSP are currently members of: DwD steering group. Pan-Lanarkshire Discharge Survey group Discharge Passport Group. In each of these, HDSP along with partners are promoting carer engagement during early discharge planning, so carers feel more informed, included, and aware of where to access support. HDSP has also participated in the recent DwD learning webinars, highlighting how the 3rd sector can help support discharge for carers. This has also included a presentation at both the national discharge without delay webinar and the Lothian webinar event showcasing what the 3rd sector currently does to support carers within North Lanarkshire. This is ongoing with HDSP being invited to highlight 3rd sector discharge support with Glasgow and Greater Clyde in October. Out with DwD, HDSP are currently also involved in a Medicine Management and Discharge group to help identify carer issues with medication at the point of discharge. Although at an early stage, the service is currently obtaining carer issues in this area and will be involved obtaining direct feedback from carers on their experiences of assisting with medication when a survey is ready. Aim being to improve carer experiences in this area. Alongside earlier discharge planning, HDSP has also been working alongside the Home Assessment Teams (HAT) to prevent and reduce admissions. HDSP receive referrals from HAT for people who are either presenting emergency departments or are in the community but at risk from being admitted. This involves quick response from HDSP to provide support which can include supporting carers in tandem with patient. Like our pre discharge visits for inpatients, HDSP can visit people we assist in their homes to provide support either independently or as part of a join visit with our Health and Social care colleagues. The service is keen to strengthen our partnership working with our colleagues to assist both unpaid carers and our colleagues as we approach the winter pressures within the acute sites.
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17 Appendix 4
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18 Annual Report 2021-2022 A Caring Culture
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19 Introduction Barbara McAuley Chief Executive Officer Samar Sheikh Chairperson GOVERNANCE
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20 Lanarkshire Carers works with and for carers to develop and deliver services that make a positive difference to their lives. This vision has provided the foundations for our organisation for many years and remains the purpose of our work. The past two years have seen unprecedented change in all aspects of our lives, with many of these changes affecting our working lives. Doing things differently is a recurring theme. Lanarkshire Carers is a pioneering organisation, using every challenge to adapt, learn and develop. We know that trusted relationships lead to effective carer support. We have taken care of our staff, helping them to look after themselves and making sure they have the skills, confidence and resources needed to support carers throughout an extremely demanding period. Daily feedback from carers, about their experiences and the difference our services make, gives our work meaning. It inspires and motivates everyone involved at Lanarkshire Carers. We recognise and value the contribution of carers, everything they do and the impact that caring has. This annual report begins with a thank you to every carer in every community in Lanarkshire. Carers are crucial to the wellbeing of others and many more people have taken on caring roles for family and friends. Caring for someone can have far reaching effects, meaning access to the right support at the right time is important and necessary. Lanarkshire Carers mission is to ensure that carers in Lanarkshire are identified, engaged, well informed, involved, supported and empowered. The Carers Act (Scotland) 2016 extends and enhances the rights of carers. Beginning a conversation at the earliest opportunity helps carers to feel informed, prepared and supported. Lanarkshire Carers is a value-based organisation; our values guide our behaviour and conduct, which are reflected in everything we do. This annual report, for the period April 2021 to March 2022, provides an overview of activities, how we have developed and innovated and the results we have achieved. 2
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21 Governance Lanarkshire Carers is run by carers for carers. The Board of Directors have met throughout the year to oversee the work of the organisation; providing strategic direction and ensuring their legal responsibilities and duties are met. Our new membership structure helps to identify those members who want to support the board with their governance role. Lanarkshire Carers recognises that carers are experts by experience and that they are equal partners who need to be at the heart of our work and involved at every stage. We aim to ensure that carers are able to contribute to all parts of the organisation, to help shape responsive services. Our new membership structure supports new approaches and meaningful carer involvement and participation. We recognise the changing needs and dynamics of caring and a membership level, between full and/or affiliate, can be changed at any time. Engaging with full members is a priority for the Board of Directors. Strategic Framework Lanarkshire Carers published our Strategic Framework in August 2021. ‘Celebrating 25 Years in Lanarkshire’ sets out our journey route, plans and work streams to 2025. Actions for each work stream and how our progress will be measured are detailed in relation to: Plans, Provision, Practice, Partnership, People and Performance. 3 1,766 New carers in contact with Lanarkshire Carers (854 North Lanarkshire, 912 South Lanarkshire) 11,308 Carers known to Lanarkshire Carers (5,863 North Lanarkshire, 5,445 South Lanarkshire) 6,507 Carers accessing our services (3,167 North Lanarkshire, 3,340 South Lanarkshire) 45,545 Services accessed by carers (23,282 North Lanarkshire, 22,263 South Lanarkshire) GOVERNANCE 2,089 Lanarkshire Carers Members (up to 31 Mar 2022) (190 Full Members, 1,899 Affiliate Members)
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4 We have ambitious plans The numbers of people caring is increasing and more of them are contacting Lanarkshire Carers for support. We are preparing for the future, building capacity and growing our organisation in response to this. Recovering from COVID-19 and responding to the long-term implication for carers will remain central to our work. The emerging cost of living crisis and the impact this is having on carers presents new challenges. Our emergency and flexible support funds for carers helps with our response to this. The willingness of our staff team to embrace and contribute to change has been crucial, particularly over this reporting year. Returning to working together as a staff team and seeing carers in person has been a priority in our planning for this year. Staff described our work over the past year as: We moved our premises in South Lanarkshire, staying within the Princes Gate facility but moving to a larger unit. This has created space to develop the carers areas needed and also to provide our staff team with suitable accommodation to return to working from the office. We have equipment, technology and resources that support the delivery of our hybrid service delivery model and the flexibility this offers has further enhanced our accessibility. It has been great to bring staff back together and to start seeing carers in person again. Our premises in North Lanarkshire are in the final stages of refurbishment and we are looking forward to returning, again with better spaces for carers and staff. PLANS
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5 We identified the need for specialised and targeted support for LGBT+ carers and secured funding from Carers Trust, Making Carers Count, for a project to research LGBT+ awareness and identify challenges faced by LGBT+ carers in Lanarkshire. We want to understand the barriers experienced in relation to accessing local and national information and services. This project will inform organisational change and enhance inclusive and proactive service provision. The collaborative focus of this work will ensure our partners will also benefit from an increased recognition, understanding and ability to support carers from under-represented groups. The Scottish Government provided an additional winter support funding package for carers in January 2022. This funding was to be managed locally through Lanarkshire Carers Short Break Bureau and enabled the delivery of a range of additional support for carers. Planning and delivery of this work was a huge undertaking for the organisation within tight timescales and we are extremely proud of our response. We published a separate impact report of this work and have participated in national research to measure success and inform future practice. This year we have reviewed our approach to group work activities. The research has highlighted the changes in approach needed to effectively meet the needs of carers, and how best to make use of our resources to benefit the most carers possible. Our website has a new look and functionality, making it easier to navigate. Our social media platforms support extensive engagement and connections. Across the organisation digital development is helping to streamline our practice and processes. Communication systems enhance agile working and make it easier to handle the large volume of calls we receive. Video conferencing equipment has supported a hybrid approach. A grant management system has made it possible to administer substantially increased and varied grant funding for carers, with due diligence and speed. Our recording and reporting systems support all aspects of our work and planning. PLANS
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6 Information, advice and support for people who care Lanarkshire Carers delivers direct and dedicated information, advice and support for people who care. Early and preventative support and a wide range of flexible service delivery methods, underpinned by our journey route model, offers choice and control for carers to access the right support at the right time. Lanarkshire Carers provides individual emotional and practical support, group work activities, adult carer support plans, emergency and future planning, a carer training programme, a short breaks bureau, grant funding, a carer wellbeing call service, carer card scheme, legal clinics, counselling, bereavement, negotiation and representation support and signposting/referral to other agencies. All our services are provided at no cost to carers across Lanarkshire. Not all carers require or choose to access all of our services, choosing to opt for those that best meet their needs and circumstances at any given time. “You helped me when no one else would. You were patient, kind and super helpful" "It’s an excellent resource that I didn’t even know was available. It is a support that I know I can access when required. But most importantly I do not feel alone“ “I have never accessed any support before and called yesterday, spoke with a Carer Support Worker and when I came off the phone, I felt so good, as if a huge weight has been lifted" 32,435 Unique visits to Lanarkshire Carers website 3,244 Carers signposted. referred or informed about the role of partner organisations (1,575 North Lanarkshire, 1,669 South Lanarkshire) 625 Carers attended one or more training courses (327 North Lanarkshire, 298 South Lanarkshire) "I phoned in a terrible state. The Carer Support Worker I spoke to made such a difference by listening to me and encouraging me to apply for a break. 3 weeks later I feel so much better and have been awarded the break and can’t wait to get away. They will never understand how much they saved me that night on the phone. Thank you for making me see I’m important too. This had allowed me to feel better and also continue my role as a carer“ “I was blown away by your kindness today. I really appreciate it. I didn't expect that. I am looking forward to the yoga and mindfulness. Sounds great” PROVISION
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7 Our generic services are complemented through a targeted approach towards the needs of specific groups such as young adult carers and seldom heard/isolated carers. We raise awareness of and respond to communication, capacity, cultural and language barriers and/or reluctance to engage with services that inhibits identification, self-identification and service uptake.. Lanarkshire Carers Black, Asian and Minority Ethnic (BAME) Carer Support and Equalities Service is a well- established service and is one of very few BAME dedicated services in Scotland. It is recognised nationally for good practice. Our multilingual BAME staff work across Lanarkshire to identify, engage, inform, advise and support carers. Information is available in community languages including Urdu, Polish, Arabic, Chinese, large print and Braille. This work has been highlighted as best practice and is part of Carers Trust Inclusive Communication Guide. Our refreshed website has access to many online services, information and forms and the recently installed software Reachdeck ensures this is available in any language required. 299 Young Adult Carers known to Lanarkshire Carers (166 North Lanarkshire, 133 South Lanarkshire) 69 New carers from Black, Asian and Ethnic Minority (BAME) communities (45 North Lanarkshire, 24 South Lanarkshire) 555 BAME carers known to Lanarkshire Carers (345 North Lanarkshire, 210 South Lanarkshire) 2,153 Carer Card holders (1,100 North Lanarkshire, 1,053 South Lanarkshire) “When you care for your loved one you forget to look after yourself. The support I have received has been fantastic. Thank you for the incredible mindfulness and relaxation sessions. I have truly managed to relax” PROVISION
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Identified, Engaged, Involved, Informed, Supported, and Empowered Staff consistently report that the support that often has the most significant impact on carers starts through contact established with someone who is able to listen. The trust and confidence carers have in the skilled and experienced staff at Lanarkshire Carers is evident and we are often their only form of support. Spending time building a valued relationship early on is key to the good conversations that lead to positive outcomes. Lanarkshire Carers personal outcome-based approach, resources and conversation toolkit were developed with carers for carers. This enables carers to explore various aspects of their lives and focus on what matters to them. Conversations centre around seven wellbeing areas: Lanarkshire Carers has also developed CarerSpace: an online portal that can be accessed at any time by carers to start or continue their conversation with us about their caring role and support needs. Carers can use CarerSpace to note outcomes they have identified themselves or through conversations with families, friends or other supportive helpers They can also access a copy of their Adult Carer Support Plan via the portal once the conversation has progressed to a point where this can be shared. Responsibility lies with the Local Authority to offer and produce Adult Carer Support Plans (ACSP), however both North Lanarkshire and South Lanarkshire Health and Social Care partnerships have commissioned Lanarkshire Carers to deliver
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8 direct support services for carers. Part of this commissioned service is to deliver Adult Carer Support Plans for carers, working in partnership with social work depending on the support needs identified. 8 PRACTICE
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9 Our service delivery model and practice considers all aspects of life in order to understand what is important to each carer and to agree personal outcomes. Carers are encouraged and helped to reflect on what they can do themselves, what support might come from other community and family resources and how the services we offer might help. We work collaboratively with partners from all sectors and signpost/refer carers to other providers and community organisations. Lanarkshire Carers services include direct early and preventative practical and emotional support, utilising a wide range of flexible delivery methods. We offer choice and control for carers to access the right support at the right time to enable them to continue care, to have a life alongside caring and maintain their own health and wellbeing. Lanarkshire Carers personal outcomes toolkit is useful for talking to carers about their support needs, any personal outcomes they want to achieve and how they could achieve these. The responses provided by the carer can be used to progress their conversation with us. Carers have access to individual support and ongoing contact to develop an Adult Carer Support Plan that details a personalised, outcome-based support package. De-escalation and risk management outcomes are always a key priority and when the need is greatest we work collaboratively with social work to establish an effective plan. Our co-location helps build the professional relationships that make a positive difference to this work. We have reviewed and built upon our approach to keeping everyone safe and our contribution to public protection matters. 1,952 Adult Carer Support Plans progressed (1,040 North Lanarkshire, 912 South Lanarkshire) 1,725 Wellbeing calls made to carers (842 North Lanarkshire, 883 South Lanarkshire) "I was incredibly impressed with the professional and personal introduction I received. Whilst the member of staff advised they had only recently joined the team, and given the acute complex facets to my case, they did advise that they may have to stop and ask questions. The staff member's ability to both control and guide the call holistically was impressive. Their recall ability was also exceptional, and I expect that this will only grow with confidence and experience. They evidenced both relatable and personal qualities which underpin the delivery of core principles of social care provision. Perfect example of frontline call handling and understanding of your service in particular! After this call and such a torrid and difficult time, I felt more hopeful, positive and such enabled to meet the challenges ahead. Without your service, that would not have been possible so thank you!“ PRACTICE
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Lanarkshire Carers providing specialist dedicated and commissioned direct support to carers Working with and for carers, member led and involved Engaging and working with national partners Working collaboratively with Statutory Services Links with local community resources, voluntary support services and local businesses Our Partnership Approach This year we have expanded our work with hospital discharge teams and community liaison activities. We now have staff linked to each hospital, providing additional and recognised points-of-contact for both professionals and carers. This work is pivotal to providing continuous care and ensuring that carers voices are heard and their lived experience valued. Our Lanarkshire wide approach increases choice and control for carers and aligns with NHS Lanarkshire’s delivery model that sees people attend hospitals based on need, not location. It also supports the many carers and cared for situations which cross between the two local authorities, acute and community hospital sites. pita We supported a new partnership with the hospitality and tourism sector in Scotland. The ScotSpirit Holiday Voucher p Scheme focused on supporting individuals and families who have been particularly adversely affected by the impact of the pandemic, while at the same time providing financial support to the Scottish tourism sector. Lanarkshire Carers are the delivery partner for this Local and national partnerships provide opportunities to share good practice, inform, learn and influence. All staff in the organisation actively participate in collaborative activity to raise awareness of carers and our services and to meet the needs of carers more effectively. Staff are linked to every locality in Lanarkshire, co-located in social work teams and work in partnership with other third sector and community organisations. We also work closely with community health colleagues and in partnership with the three hospital sites in Lanarkshire. 10 scheme in Lanarkshire. PARTNERSHIP
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To involve carers effectively they need to feel listened to, supported and respected. Their contribution must be valued and have an impact. We aim to encourage and empower carers and increase their confidence to use their voices and influence in our organisation and also in wider activities locally and nationally. As a member led organisation, delivering direct support we have a unique insight into lives of carers and the impact of caring. We have facilitated carer involvement in a variety of local and national research activities, including responding to the National Care Service review and the Carer Allowance Supplement Bill consultation. A carer, supported by our organisation, gave evidence to the Social Justice and Social Security Committee regarding this Bill. Both consultation responses are on our website. In South Lanarkshire, our Carers Connected consultative forum also brings together carers from our organisation as well as carers involved in partner organisations to engage in discussion regarding a range of topics including the strategic commissioning plan, home care, accessibility and safety. Partnership and collaboration is an integral part of our work. Throughout the reporting year this has supported carers to access a diverse range of support and services including for example; PPE, anticipatory care plans, attend anywhere/near me appointments, carer card recognition/discounts, legal services and specialist services from other organisations. Lanarkshire Carers is a committed contributor in delivering joined up, non- duplicating services
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Lanarkshire Carers has strong links with both Third Sector Interface Organisations in Lanarkshire. Working closely with the VASLan, the Chief Officers Group and locality forums/groups in South Lanarkshire and also with VANL, the Community Solutions Programme and locality planning groups in North Lanarkshire. We work closely with organisations across Lanarkshire’s diverse third sector. Every year our organisation recognises and highlights Carers week; a national campaign bringing people together to help Make Caring Visible and Valued. Carers across the country continue to face new challenges as a result of the pandemic, with many people taking on more caring responsibilities for their relatives and friends who are disabled, ill or older and who need support. They need to be recognised for the difficulties they are experiencing, respected for all they are doing, and provided with information, support and understanding. 11 250 Carers attended one or more Carers Week events hosted by Lanarkshire Carers (Lanarkshire wide) PARTNERSHIP
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The performance monitoring of the organisation includes quarterly contract compliance reports, six monthly staff learning and development reports and a variety of other reports throughout the year. All reports highlight the numbers and narrative along with details of carers experiences of the work we do. Carer comments and case studies provide powerful evidence, highlighting the impact of caring and what helps carers to continue to care. Lanarkshire Carers Short Break Bureau must be given particular recognition this year. Established in 2014 Lanarkshire Carers Short Break Bureau has secured and distributed substantial amounts of funding in individual grants to carers. This project has built the infrastructure and processes required to deliver a streamlined and effective grant award system for carers throughout Lanarkshire. There have been many challenges as a result of Covid-19. The restrictions and barriers imposed meant that carers experienced increase stress and many were unable to take a short break from caring, away from their normal routines. Our staff team is experienced and capable of having effective conversations with carers, exploring alternative and creative ways that carers can benefit from a short break tailored to their individual circumstances. As Time to Live Delivery Partner for North and South Lanarkshire, Lanarkshire Carers is awarded one of the largest amounts of funding from the Scottish Government through Shared Care Scotland. Lanarkshire Carers Short Breaks Bureau have many years’ experience delivering large amounts of funding to carers, some of this within a very short timeframe. We have also introduced a management system to cope with the increasing volumes of carers getting in touch with us for funding. 12 £222,302 Creative Breaks Time to Live funding awarded (£128,203 North Lanarkshire, £94,099 South Lanarkshire) £117,796 ScotSpirit Holiday Voucher Scheme allocated (£66,170 North Lanarkshire, £51,626 South Lanarkshire) £101,920 Carer Flexible Support Funding awarded (£50,475 North Lanarkshire, £51,445 South Lanarkshire) £204,359 Other grant funding awarded (£109,429 North Lanarkshire, £94,930 South Lanarkshire) PERFORMANCE 1,970 Carers benefitted from grant funding (1,054 North Lanarkshire, 916 South Lanarkshire)
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Staff Highlights Nickie Murphy (Carer Support Worker) The key highlight for me was the introduction of our counselling and bereavement support service. Whilst a range of support services exist in Lanarkshire, there was a gap in provision of dedicated counselling services for carers and a demand from carers for this type of service. The feedback from carers who accessed this service has been fantastic. It’s great to see us helping carers in new and different ways and being able to meet their needs. Laura Jamieson (Carer Support Worker) As a new member of staff at Lanarkshire Carers, to learn how much support was offered to the carers in Lanarkshire was amazing. One particular highlight of my year has been supporting a carer who was struggling to manage work with her caring role. As an organisation we were able to award the carer funding through the Lanarkshire Carers Flexible Support Fund which helped the carer pay for food and energy bills for 3 months whilst benefit applications were processed. This made a huge difference to the carer as it meant that she didn’t have to worry about missing a day or two of work if her caring role meant that she couldn’t attend. Isbah Khan (Black, Asian and Minority Ethnic (BAME) Carers Services and Equalities Co-ordinator) As Co-ordinator for the BAME Carer Services and Equalities team I have been involved with LGBTQ+ research, engagement, collaboration and recruitment activity throughout the year. I am delighted that we now have a dedicated resource to support carers from the LGBTQ+ community. Changes have been made to our Client Management system to meet the data processing requirements of this project and we have adapted our systems to capture relevant information. I am very much looking forward to seeing this project evolve in the year ahead and beyond. PERFORMANCE
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Lanarkshire Carers delivers personalised support. We champion carers rights and are committed to making caring a positive experience. Staff health and wellbeing is very important within our organisation. We continue to offer learning, development and employee benefits opportunities to promote a positive working environment. Like many organisations, this year we have seen a number of staff move on to new opportunities and different stages of their lives. We have welcomed new staff into our growing and diverse staff team. The wealth of experience and enthusiasm they bring is motivational and exciting. 14 39 Staff Team 8 Board Members 13 Volunteers supporting our work 635 Volunteer hours logged PEOPLE
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Moving to the next phase of our response to the pandemic, our focus continues to be on working together. The key to achieving a sustainable organisation will be involving everyone at Lanarkshire Carers in creating a sustainable organisation. We will achieve a sustainable future by: • Having everyone in the same boat, with two oars, rowing in the same direction • Having the right people in the right roles, doing the right things at the right times and in the right way, all working together • Recognising all paid staff, board members and other volunteers have a role to play Partnership with carers is central to this work and we look forward to working with you all in the coming year. Thank You 15 SUSTAINABLE FUTURE
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Financial Summary 2021-2022 This year a new treasurer was elected and operational staff appointed with new roles in relation to finance. We are reviewing our procedures in response to the changing business needs. We have restructured our staff team to reflect current responsibilities and more effectively deliver our services. The contracts we have from both Health and Social Carer North Lanarkshire (HSCPNL) and South Lanarkshire Health and Social Care Partnership (SLHSCP) meet the majority of salary and operating costs. Our thanks go to both Health and Social Care Partnerships as our main funding partners for their continued support along with Shared Care Scotland, Scottish Council for Voluntary Organisations (SCVO), Carers Trust and the individuals who donate to the organisation. Lanarkshire Carers role distributing small grants to carers continues to be a growing area of our work. The organisation has reported remarkable achievements in relation to this activity. The impact that grants have on carers lives is evidenced through our evaluation and the feedback received. The links between good conversations supporting grant distribution and further support for carers are well established. A copy of the Statement of Financial Activities for the year ended 31 March 2022 from the audited accounts has been provided for reference. A full copy of the detailed audited accounts is available on our website. This year we seek approval of the proposal to appoint a new auditor, Robb Ferguson and thank our outgoing auditor for working with us over recent years. Our Funders FINANCIAL REPORT
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Linda Craig Treasurer and Director 16
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Statement of Financial Activities For the year ended 31 March 2022
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17 FINANCIAL REPORT
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Registered Office Ground Floor Left, Princes Gate 60 Castle Street, Hamilton ML3 6BU Company Number: SC209296 Charity Number: SC029160 Centres Lanarkshire Carers Centre; Hamilton Ground Floor Left, Princes Gate 60 Castle Street, Hamilton ML3 6BU Lanarkshire Carers Centre; Airdrie Airdrie Locality Support Service 92 Hallcraig Street, Airdrie ML6 6AW Board of Directors Samar Sheikh | Chairperson Linda Craig | Treasurer and Director Liz Beattie | Director Kevin McGoldrick | Director Phil Hughes | Director Lynn O’Hara | Director Colin Toal | Co-opted Director Gordon Lennox | Director Bill Craig | Director Auditors Ken Tait & Co Chartered Accountants 16 Haddow Street, Hamilton ML3 7HX
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lanarkshirecarers.org.uk Information, advice and support for people who care South Lanarkshire: 01698 428090 North Lanarkshire: 01236 755550 Email: info@lanarkshirecarers.org.uk
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© 2022 Lanarkshire Carers Centre Ltd Registered Office: Ground Floor Left, Princes Gate, 60 Castle Street, Hamilton, ML3 6BU Charity No: SC029160 | Company No: SC209296
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Appendix 5 Update from Lanarkshire Carers for North Lanarkshire Committee Paper - October 2022 Lanarkshire Carers is commissioned by Health and Social Care North Lanarkshire (HSCNL) to provide an information, advice and direct support services to unpaid carers. The organisation is also commissioned by South Lanarkshire Health and Social Care Partnership (SLHSCP) and therefore provides Lanarkshire wide services across each locality in Lanarkshire. Lanarkshire Carers support service delivers personalised, and case managed, emotional and practical help through meaningful, outcome focussed conversations with trusted, skilled and experienced professionals. Services include telephone and drop in/appointment based daily duty service, along with access to NHS attend anywhere and video conference call facilities. Lanarkshire Carers Short Breaks Bureau supports with a range of activities including individual carer grant funding. Lanarkshire Carers Group Work activities include a comprehensive Carer Training Programme which is carer-led and shaped. Carer Wellbeing Calls support a journey route tiered approach to case management and outgoing/ongoing carer contact. The service also delivers a Lanarkshire Carers Card scheme and independent services in partnership with others, including legal services and carers counselling support, as well as a range of other services available at no cost to carers. Part of this commissioned service includes delegated responsibility for Lanarkshire Carers to discharge some of the duties of HSCNL to deliver Adult Carer Support Plans, a partnership agreement sets out the respective and shared responsibilities for this and collaborative working arrangements that support the approach. Lanarkshire Carers works with and for carers to develop and deliver services that make a positive difference to their lives. They place carers at the heart of their organisation to ensure the services they offer are effective and accessible regardless of personal circumstances or caring situations. Carer self-refer to the organisation and this is the contact most frequently used. Facilities are also in place for professionals from any organisation to make direct referrals. A personal outcomes approach to carers support is integral to the work. They have adopted the language of the Carers Act, providing the 'right information at the right time'. In every interaction with a carer they discuss the impact of their caring role (using the national wellbeing indicators as their guide) and support carers to think about what matters to them – developing personal outcomes which forms an Adult Carer Support Plan. This is underpinned by anticipatory and preventative measures and has a focus on providing tailored support to empower the carer. This plan is agreed in partnership with the carer. Rather than focus on paperwork being
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completed, the emphasis is on the professional relationship and the conversation. This is recorded in a purpose build client relationship management system. Carers do not have to repeat their story as they are already using the outcomes of their conversations to co-produce their Adult Carer Support Plan. The information is all in one place, and all the toolkits and conversations are linked together. Lanarkshire Carers Key Carer figures for North Lanarkshire (from April 2021 to March 2022): 854 new carers in contact with Lanarkshire Carers 5,863 Carers are known to Lanarkshire Carers 3,167 Carers accessed Lanarkshire Carers services in reporting period 23,282 services access by carers from Lanarkshire Carers 166 Young Adult Carers known to Lanarkshire Carers 45 New carers from Black, Asian minority ethnic (BAME) communities, 345 BAME Carers known to Lanarkshire Carers 1,040 Adult Carer Support Plans progressed by Lanarkshire Carers More information around these key highlights, figures and impact can be found in Lanarkshire Carers latest annual report: https://lanarkshirecarers.org.uk/assets/uploads/documents/2021/12/lanarkshire- carers-annual-report-21-22.pdf Adult Carer Support Plan Partnership Statement: This agreement, between Lanarkshire Carers, HSCNL and SLHSCP was developed to maintain a mutual understanding and expectations between key partners in relation to the delivery of Adult Carer Support Plans (ACSP’s). The roles, responsibilities and boundaries of all partners have been defined and agreed. The agreement provides staff with an information and awareness raising tool and ensures that carers have access to accurate information and are signposted and referred appropriately. It was agreed and launched in May 2021 and has been supported through shared communications and staff awareness raising development workshops. A link to the ACSP Partnership Statement can be found here: https://lanarkshirecarers.org.uk/information-and-resources/professionals/lanarkshire- carers-adult-carer-support-plans-partnership-statement Lanarkshire Carers Hospital Linked Project: Lanarkshire Carers has a well- established system for partnership working across the three acute hospital sites in Lanarkshire. The team includes four Carer Support Workers specifically linked to the three NHS Lanarkshire hospital sites and to cottage/community hospitals. Part of a larger locality-based team, the dedicated hospital linked staff are well resourced to support carers involved in hospital admission, treatment and discharge for themselves or the person they care for. Lanarkshire Carers dedicated BAME carer support services is part of the wider team and enhances the hospital linked activity, including through multilingual staff who can communicate in different languages.
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Lanarkshire Carers is building on this established work through the Discharge without Delay phased programme. Developments are underway to work more proactively with partners in acute settings including co-location to help further establish good relationships and to build trust and understanding of Lanarkshire Carers and their role. The Hospital Linked Carer Support Workers already work closely with professionals and partners within these hospital sites, and work continues to further support collaborative working and to make referring to Lanarkshire Carers even more streamlined. Lanarkshire Carers Partnership, Collaboration and Co-location: Local and national partnerships provide opportunities to share good practice, inform, learn and influence. All staff in the organisation actively participate in collaborative activity to raise awareness of carers and their services and to meet the needs of carers more effectively. Lanarkshire Carers have good links with VANL, the community solutions programme and wider third sector along with locality planning groups in North Lanarkshire. The service works with the commissioned provider of NL Young Carers service to develop cross provider referral, collaborative transitional support, access to short break grant funding for young carers and to develop Lanarkshire Carers Young Adult Carer activities. 1575 carers were signposted, referred, or informed about the role of partner organisations (2021-2022) Lanarkshire Carers partnership work and referral pathways are vital within all journey routes with carers. Their staff are actively encouraged to scope the landscape and form relationships with Health and Social Care and third sector organisations to enable carers to be referred/signposted to the right support at the right time. Pre-pandemic, Carer Support Workers were co-located within all social work locality offices throughout North Lanarkshire. This promoted a valuable and effective partnership and helped to build strong working relations. Throughout the pandemic, this arrangement continued virtually and their staff have arrangements to recommence physical co-location from September 2022. Care Inspectorate ‘Understanding carer’s experiences of social work and social care service delivery’ Inquiry: The Care Inspectorate carried out an inquiry in Scotland from 28 March 2022. The purpose of this was to learn how the future support of carers can be developed and improved. North Lanarkshire was selected for a closer inquiry. As the commissioned service for Direct Adult Carer Support and Adult Carer Support Plans, Lanarkshire Carers involvement and contribution supported North Lanarkshire Health and Social Care Partnership with the Care inspectorate inquiry. Lanarkshire Carers identified a lead officer for their organisation and Care Inspectorate short-term working group. 10 Carers attended a focus group (the maximum requested by the Care Inspectorate). 10 Carers took part in individual telephone conversations conducted by the Care Inspectorate
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The unpaid carers national survey was launched on 18 April 2022 and open to 3 June 2022. This was distributed electronically to all carers known to Lanarkshire Carers and wider through their social media channels to ensure maximum engagement and response. Sessions were held with their staff team to inform them of support carers may require completing this. 196 carers (Lanarkshire wide) were supported by Lanarkshire Carers to complete the unpaid carers survey Lanarkshire Carers included an additional BAME carer focus group with interpretation for speakers of other languages. Telephone conversations were also supported through other language interpretation services which they organised. Lanarkshire Carers Black, Asian and Minority Ethnic (BAME) Carer Support and Equalities Service: This is a well-established and recognised service, integral to the work of the broader team. It is one of very few dedicated BAME services in Scotland. It is recognised nationally for good practice, innovation and effectiveness. Their multilingual BAME staff work across Lanarkshire to identify, engage, inform, advise and support carers. Information is available in languages including Urdu, Polish, Arabic, Chinese, large print and Braille. This work has recently been highlighted as best practice and is part of Carers Trust Inclusive Communication Guide. Lanarkshire Carers refreshed website has access to many online services, information and forms and the recently installed software ReachDeck ensures this is available in any language required. Lanarkshire Carers identified the need for specialised and targeted support for LGBT+ carers and secured funding from Carers Trust, Making Carers Count, for a project to research LGBT+ awareness and identify challenges faced by LGBT+ carers in Lanarkshire. This project will inform organisational change and enhance inclusive and proactive service provision. The collaborative focus of this work will ensure partners will also benefit from increased recognition, understanding and ability to support carers from under-represented groups. Carers Week 2022: Lanarkshire Carers celebrate Carers week annually helping to make carers valued and visible with a range of activities and events as part of the national focus in June each year. Several online courses and face-to-face activities were held throughout the week. Highlights included a Ready, Steady, Cook workshop hosted by North Lanarkshire Community Food and Health Partnership, Carers Rights and Services sessions held in Polish and Urdu and a Bollywood Dance workshop. The closing event was held in Chatelherault Park and included outdoor mindfulness, outdoor Tai Chi and a drop-in session, where many carers got involved, took part and accessed support about their caring role. This event was attended and acknowledged by a number of elected representatives and parties. Carer Involvement, Participation and Feedback: Lanarkshire Carers is a carer-led organisation and carer feedback, evaluation and influence is used to plan, adapt, learn and develop. Carers are encouraged to provide feedback on services accessed and carers representatives are involved in a number of work streams, including the Short Break Bureau grant panels. Lanarkshire Carers training programme is carer-led, with topics and suggestions gathered from conversations
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and carer feedback used to shape future programmes. Lanarkshire Carers proactively plan training courses that have been identified as of interest to carers through extensive partnership, outreach and community-based work. Extensive focus group, evaluation and carer satisfaction activity supports Lanarkshire Carers service development and has recently informed for example, CarersSpace, pampering, group work, counselling, anticipatory care planning and keep well provision. The organisation actively supports and encourages carers participation in national research and activities including the Carers Parliament, Coalition and Cross Party Working Group. Lanarkshire Carers continues to raise awareness of Care Opinion as a way for people to share their experiences of health and care services. Lanarkshire Carers quarterly contract monitoring arrangements for the organisation includes the submission of regular case study examples of outcomes achieved, carers quotes and comments. A minimum of 24 case studies are submitted each year along with ad hoc reports as requested/required. The impact of their work is evidenced through both statistical and narrative evidence. Lanarkshire Carers have also introduced #feedbackfriday shared via social media channels to highlight the personal outcomes achieved through their work and individual carer experiences of accessing their services and the difference this made to their lives. Short Breaks Bureau: An integral part of the commissioned service, Lanarkshire Carers Short Breaks Bureau (SBB) provides information, advice, support and activities which highlight and focus on short break opportunities for carers. The team help raise awareness of carers rights, opportunities and the variety of ways short breaks can be supported and accessed. The SBB staff support the wider team and work directly with carers to complement outcome focused conversations in relation to short breaks. In addition to short break grant funding the SBB also has information and access to other support for those in financial hardship and can access help to reduce isolation and exclusion. This includes grant funding which may assist carers through help with the cost of repair/replacement of white goods, equipment, essential items. The SBB also works with partners and professionals, locally and nationally to develop this work. Information is available for statutory, third and private sector organisation’s to raise awareness of the service and the opportunities available for carers to take a short break. 1,054 carers in North Lanarkshire benefitted from grant funding distributed by Lanarkshire Carers in 2021-2022: Creative Breaks Time to Live Fund - £128,203 awarded Carer Flexible Support Fund - £50,475 awarded ScotSpirit Holiday Voucher Scheme - £66,170 awarded Other sources of grant funding - £109,429 awarded Lanarkshire Carers Short Break Bureau secured and distributed substantial amounts of funding in individual grants to carers. The Short Break Bureau, within the commissioned service, are experts in this field and have built the infrastructure and processes required to deliver a streamlined and effective grant application process and award system for carers throughout North Lanarkshire. Their robust procedures support audit trails and due diligence prevents duplication of funding and ensures as
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many carers as possible can benefit from the limited amount of funding available. Grant awards are linked to and recorded in ACSP’s with Lanarkshire Carers outcome-based approach to grant funding having a positive impact on carers lives. This approach is referenced as good practice with Shared Care Scotland’s Rethinking Personalised Short Breaks paper. Carer Support Workers endorse and submit applications on behalf of carers, following a person-centered conversation with the carer to better understand their support needs, the outcomes they want to achieve and how they could achieve them. Taking a conversation-based approach with carers is a more effective way of understanding, helping and supporting carers. Lanarkshire Carers staff team is experienced and capable of having effective conversations with carers, exploring alternative and creative ways that carers can benefit from a short break tailored to their individual circumstances. The Carer Flexible Support Fund was initially established through winter support funding from the Scottish Government, matched and then a further contribution received from Health and Social Care North Lanarkshire. This has been a lifeline for many carers in financial hardship. This funding supports carers in crisis in lots of different ways. Applications are linked to Adult Carer Support Plan conversations and outcomes, enabling Lanarkshire Carers staff to work with carers to address longer term need whilst using funding to support them in the short term. Examples of this are referenced in Lanarkshire Carers Winter Funding Impact Report. Lanarkshire Carers Carer Card Scheme and Respitality Initiatives are also vital for ensuring carers access short breaks from caring when they need it. Additional national funding has been awarded by Shared Care Scotland to develop opportunities such as these, as well as other new initiatives, and to increase capacity of the Short Breaks Bureau. Lanarkshire Carers are involved in the national Promoting Variety Initiative – Helping local commissioning services to better understand and develop a marketplace of short break opportunities for the benefit of carers and those they care for. Scottish Government Winter Funding Package for Unpaid Carers: Following the Scottish Government announcement in January 2022 about additional funding for local carers centres during the winter period, £367,390 of funding was allocated to Lanarkshire Carers for the benefit of carers across Lanarkshire. Lanarkshire Carers was allocated a proportion of funding (in line with Carer Population Equation) to expand and enhance a range of existing support services for carers during the winter period (to be spent by end of March 2022). This included: Introducing wellbeing and counselling services for carers Acquiring IT equipment and assistive technology for carers Providing funded legal services for carers Increasing the amount of grant funding available to carers through the Creative Breaks Time to Live Fund and Carer Flexible Support Fund Enhancing opportunities available for carers through the carer training programme Providing discounted podiatry services for carers
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Purchasing hybrid and other equipment for Lanarkshire Carers to better engage with carers A comprehensive report has been produced that outlines the impact this funding has made to carers in Lanarkshire: https://lanarkshirecarers.org.uk/assets/uploads/lanarkshire-carers-winter-funding- impact-report-2022.pdf Lanarkshire Carers Digital Development 32,435 unique visits to Lanarkshire Carers website 3,494 followers on Facebook 1657 followers on twitter 506 Instagram subscribers 9,626 signed up to Lanarkshire Carers mailing list Lanarkshire Carers has a strong digital presence and audience. They have invested in the development of online/virtual services for carers. A new website has been developed with accessibility and translation tools to be more inclusive and to reach as many new and existing carers as possible. Lanarkshire Carers launched CarerSpace – an online carer conversation toolkit and single point of access for carers to record and share information about their caring circumstances, helping to start or continue a conversation about their caring roles and their support needs. A key benefit of this is that carers are able to log on to CarerSpace independently and can start to consider their caring role by themselves, or with friends, family and other trusted professionals beside them. The tool can be accessed day or night and is therefore available whenever the carer finds the time, energy and focus to think. The responses can be submitted to Lanarkshire Carers, and a Carer Support Worker will then contact the carer to discuss further and look at ways to help address any of the unmet support needs they have identified. Once the conversation with Lanarkshire Carers has progressed, and an Adult Carer Support Plan agreed, carers can also access a copy of their ACSP via the portal too. This can be useful to refer to at any point, to share with professionals/friends/family that they wish, or to let Lanarkshire Carers know if their circumstances have changed. This single point of access for the carer means they are not confused by additional or disjointed paperwork, terminology or barriers in the way of them accessing good conversations to lead to decisions about their support. Virtual/online engagement continues to be a popular and preferred method of communication with many carers in North Lanarkshire. Lanarkshire Carers has invested in new equipment and resources (predominantly funded by external sources) that will enable them to continue engaging with carers in this way, including Video Conferencing equipment for use in one to one or group settings using a range of platforms including Teams, Zoom and NHS Near Me. They invested in new portable equipment for staff, creating a more flexible and agile workforce that can co- locate across the community. They have also invested in software to develop more engaging content for carers and partners. The organisation recognises and values
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the unique and vital place for and impact of in-person services and also recognises the opportunities that digital services offer to further enhance their offer and make best use of limited resources. The extensive service delivery model ensures that carers can be supported in ways which best meet their individual needs and preferences. Governance and Membership: Lanarkshire Carers is run by carers for carers. Their Board of Directors meet regularly throughout the year to oversee the work of the organisation; providing strategic direction and ensuring their legal responsibilities and duties are met. The Strategic Framework – Journey Route to 2025 – is agreed and in place. Their new membership structure helps to identify those members who want to support the board with their governance role and get more involved in consultation and engagement activities. Lanarkshire Carers recognises that carers are experts by experience and that they are equal partners who need to be at the heart of their work and involved at every stage. They aim to ensure that carers can contribute to all parts of their organisation, to help shape responsive services. Their new membership structure supports new approaches and meaningful carer involvement and participation, recognising that the changing needs and dynamics of caring and a membership level between full and/or affiliate can be changed at any time. Staff Health, wellbeing and development: Lanarkshire Carers is committed to ensuring that health, wellbeing and development of their staff remains a key priority for their organisation, ensuring their diverse workforce is highly skilled and able to meet the needs of carers. Development activities throughout the year have included a focus on the future of the organisation and how each member of staff contributes to its success and the delivery and development of services for the benefit of carers through their sustainable future strategy. Protected learning sessions with staff focus on key areas such as Adult Support and Protection, Adult Carer Support Planning, Data Protection and Information Security as well as other topics to ensure their staff team are prepared, informed and knowledgeable. These sessions provided staff with opportunities for confidence building, practicing of skills, involvement and engagement with all areas of their organisation. Increased digital capacity has meant that Lanarkshire Carers have been able to accelerate the pace of learning and development, coming together more frequently in larger groups, without this impacting on service delivery to carers. Digital learning is now facilitated in a regular planned way with ‘Protected Learning Sessions’, as well as having ‘on-demand’ training that can be accessed from a library whenever suitable. Their staff benefits package has been reviewed and enhanced to promote staff wellbeing and improve employee retention and attraction. Their Employee Assistance Programme (EAP) provides information and resources for general wellbeing with access to courses, discounts and perks, fitness programmes, and articles about prioritising mental health. Lanarkshire Carers is a Carer Positive
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employer, Healthy Working Lives accredited, Volunteer friendly and a Living Wage Foundation accredited employer. Carers Census Data: Lanarkshire Carers contributes to the requirement of Carer Census Data returns for North Lanarkshire, shared annually with Scottish Government to measure the impact of the implementation of the Carers (Scotland) Act 2016. They have developed systems to capture and report data on carers who access support through their service. For 2021-2022 reporting period, Lanarkshire Carers included 3,122 carer records in their return to Scottish Government, detailing the types of support carers required and the how Lanarkshire Carers supported these carers to meet their needs. They carry out regular data cleansing activity to ensure the data they record and report on is as accurate as possible. Sustainable Future: Lanarkshire Carers is a local employer of 41 people who mainly all live and work within Lanarkshire, many of whom are carers themselves. The organisation provided an immediate and comprehensive pandemic response, made possible through their business continuity planning activity, that enabled them to deliver a continuous and flexible service for carers. Moving to the next phase of their response to the pandemic, Lanarkshire Carers focus continues to be on developing a leading service for the benefit of carers. The key to achieving this is continued longer term funding which has supported development, improved service provision and enabling the organisation to plan and develop services accordingly. Authors: David McCord, Francine O’Donnell and Barbara McAuley 11 October 2022 Tel: 01236 755550 / 01698 428090
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Appendix 6 North Lanarkshire Carers Together (NLCT) – Update Report Oct 22 North Lanarkshire Carers Together (NLCT) provide a Campaigning and Representation service and are the dedicated Information and Advice service for carers and professionals who come into contact with carers. Information Over the past year the service has provided more than 4,500 pieces of information to more than 1100 carers, of which 625 were newly identified and the service made 623 referrals to a range of services including: Financial Inclusion team Young and Adult carer supports North Lanarkshire Disability Forum Range of Social Work services A lot of information over the past year still revolved around supports directly related to COVID including PPE and information on where and how to access vaccinations. There is a reliance on the NLCT staff team for emotional support and personalised interventions, particularly with the ongoing social care difficulties for those they care for. A new rebranded Carer Information Pack has been developed outlining what a carer is, carer rights, the range of NLCT services and what supports are available across the local authority. Carer Engagement & Representation Carer engagement and representation is essential to the development of local services and policies and to feed into national and local consultations. This also has to be meaningful, supported, funded and crucially the loop needs to close in that there has to be feedback to carers who give their time to contribute. NLCT frame all consultation with their guiding principle ‘We Asked, You Said, We Did’ and is their promise to those carers who form part of their Carer Forum. The Forum meets in-person, digitally and also has a closed private social media group. It has 48 members. This past year, the Carer Forum led within North Lanarkshire the consultation with carers on the proposed National Care Service and with the development of Carer Breather*. NLCT also led locally on the national Care Inspectorate Inquiry into carers experiences of adult social work and social care which included a ‘deep dive’ into 5 Health & Social Care Partnership areas including North Lanarkshire. Feedback and results are always provided to those carers in an accessible format whom participate in engagement. NLCT also represent carers views and needs in the following networks and fora:
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Children, Young People and Families Network BAME Network Strategic Commissioning Planning Group Integrated Joint Board SDS Network Mental Health Communications & Reference Group 3rd sector Health and Wellbeing Network Community Solutions Governance subgroup Community Solutions Carer Support Network Leads Community Boards Community & Voluntary Sector Partnership Group Chair / SLB Rep NL Advice Network NL Social Enterprise Network Old Age Psychiatry Programme Rural Network Campaigning In partnership with the Carer Positive Team at Carers Scotland, the service host 2 events each year identifying and encouraging local partners to become carer positive employers and recently campaigned in support of the private members bill to Westminster for statutory time off for those working alongside a caring role. A key piece of work the service provides is a Carer Aware Programme - delivering training sessions to carers and partners, informing them of the Carers (Scotland) Act 2016, of carer rights, and where and how to access support and services for carers locally. Over the past year they have delivered 17 sessions to 244 carers and partners, which includes 6 sessions to 65 front-line social work staff. The service is currently promoting 1 session per month to Health & Social Care to campaign on the important contribution carers provide to the social care system as Equal Partners. In October this year, a Carer Aware session was delivered to elected members. NLCT has a programme of work with the community partnership team and routinely work in partnership to identify parent carers, inform them of supports available and are currently leading on co-produced cost of living events across the Northern Corridor. NLCT continue to promote Care Opinion to carers and partners and will ensure access to Care Opinion will also be available to carers from the BAME community, with the use of Language Line if necessary. Developments Carer Advocacy NLCT launched an Independent Advocacy Service on 13th September 2021, and it is now operating a waiting list due to demand for the service. Since inception, the Advocacy Worker has supported approximately 50 carers on a range of issues. Family Support
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The service is also entering into its second year commissioned by North Lanarkshire Council Education & Families to provide a family support service to parent carers who have a child or young person with additional needs. The child’s named person, or the Neuro Developmental team in CAMHS can refer into the service where the family receive support such as psychoeducation on the child’s condition, help with strategies, emotional support, information, advice, signposting to relevant statutory and community supports. Carer Breather *For many years the idea of a short break was either traditional respite or a cash grant which often have restricted eligibility criteria, such as caring for someone over 18 or with a specific disability. The service led on a consultation with carers, putting them at the heart of service design to consider alternative and creative ways to provide a short break. Carers fed back that service providers needed to think outside the box and address the need for time out that didn’t only take the form of an annual short break, but that was easily accessible in the community, available on a regular basis and more flexible in terms of availability throughout the day. From these insights, the Carer Breather funded projects were set up to offer activities such as art therapy, health and wellness activities, holistic support, and groups supporting people caring for loved ones with learning disabilities or living with long term conditions. This service is now supported by NLCT as Carer Support Network Leads within Community Solutions. Carers can now access new services across North Lanarkshire that provide breaks from their caring roles and allow them to take some quality time out for themselves. The Carer Breather projects and pilot Sitter Services were developed directly through listening to the views of carers, and will be utilising the Carer Pathway Toolkit to engage carers in conversation as part of a light touch early intervention within the local community. Carer Podcast NLCT recently launched their new and novel way of getting information out to carers and those who come into contact with them through the development of a Carer Podcast early in the new year. Actor Jane McCarry agreed to discuss her previous caring roles and the impact the pandemic has had on mental health and wellbeing of carers and the people they care for in the inaugural recording. There are many plans for future episodes including an interview with a local GP and a carer discussing the impact of the cost-of-living crisis. All NLCT activity is dependent and revolves around sound partnership working and trust across the rich and diverse statutory and community and voluntary sectors.
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REPORT Item No: 15 SUBJECT: Climate Change reporting TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance & Quality Assurance Author(s) of Report Graeme Cowan, Senior Manager, Strategy & Performance DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: The purpose of this report is to provide a summary to the Integration Joint Board (IJB) on Climate Change reporting requirements and seek approval for submission of the annual Climate Change report to the Scottish Government. The IJB is also asked to note correspondence from Michael Mathieson, Cabinet Secretary for Net Zero, Energy and Transport, highlighting a strengthening in Climate Change reporting requirements for public bodies. For approval For endorsement To note 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: prepared by the Planning and Performance Team and endorsed by senior management.
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3. RECOMMENDATIONS 3.1 The IJB is asked to agree the contents of the Climate Change report prior to its submission. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Mandatory reporting legislation in relation to Climate Change came into force in 2015 with the IJB, as a public body, required to report annually on compliance with climate change duties. The relevant legislation is the Climate Change (Duties of Public Bodies; Reporting Requirements) (Scotland) 2015 and the associated amendment order of 2020. 5.2 North Lanarkshire IJB has complied in full with reporting requirements since the enactment of the legislation. Further guidance specific to IJBs was issued by the Scottish Government Domestic Climate Change Division for the 2021-2022 reporting period. This guidance relates to areas that NL IJB already reported on, including the structure of the IJB and its links to the bodies it is in partnership with. There is also a requirement to report on Greenhouse gasses and other emissions, where possible, and as requested, links have been made to the reports to be submitted by North Lanarkshire Council and NHS Lanarkshire, the bodies with responsibilities in these areas. 6. CONCLUSIONS 6.1 The responsibility to enact measures to directly address climate change rests with NLC and NHSL. Emissions data is reported on in detail by those bodies. 6.2 The IJB’s Compliance with the 2021/2022 Climate Change reporting requirements necessitates submission of the attached report by 30 November 2022. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Yes No N/A
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As a public body, the IJB is required to comply with the legislation noted above along with the current guidance issued by the Scottish Government Domestic Climate Change Division. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Finance have provided confirmation of financial information included in the report. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS North Lanarkshire IJB 2022 Climate Change Report. Guidance for IJBs on Climate Change reporting requirements for the 2021-22 reporting period. Correspondence from Michael Mathieson, Cabinet Secretary, ‘Public Bodies’ Leadership on the global climate emergency’
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9. APPENDICES Appendix 1 Public Bodies’ Leadership On The Global Climate Emergency Appendix 2 Climate Change Report CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Graeme Cowan, Senior Manager, Strategy and Performance.
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Cabinet Secretary for Net Zero, Energy and Transport Michael Matheson MSP T: 0300 244 4000 E: scottish.ministers@gov.scot Council Leaders and Chief Executives Chairs and Chief Executives of Public Bodies University and College Chairs and Principals Regional Transport Partnerships Chairs and Leads ___ May 2022 PUBLIC BODIES’ LEADERSHIP ON THE GLOBAL CLIMATE EMERGENCY 2022 is a crucial year for Scotland’s unique system of mandatory annual reporting by public bodies on their statutory climate change duties. This year the reporting duties that were strengthened in 2020 come into effect, which means that for the first time, in your annual climate change reports to be submitted by the end of November, public bodies are required to provide: where applicable, the body’s target date for achieving zero direct emissions of greenhouse gases, or such other targets that demonstrate how the body is contributing to Scotland achieving its emissions reduction targets where applicable, targets for reducing indirect emissions of greenhouse gases how the body will align its spending plans and use of resources to contribute to reducing emissions and delivering its emissions reduction targets how the body will publish, or otherwise make available, its progress to achieving its emissions reduction targets where applicable, what contribution the body has made to helping deliver Scotland’s Climate Change Adaptation Programme. I am delighted that many parts of the public sector in Scotland have already set ambitious climate change targets. Many local authorities have particularly ambitious targets, NHS Scotland, Scottish Water and Colleges Scotland all aim for net zero by 2040, the Environment and Economy Leaders Group has committed to a decade of deep decarbonisation, and Creative Scotland has set a target to become a net zero organisation by 2030. I am also delighted that last year’s response rate among public bodies required to report was excellent. It is important that we continue to have the highest possible compliance with the new reporting duties this year - we need to ensure that the entire carbon footprint of the
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot public sector is covered by targets that are consistent with public bodies’ leadership role and that public services are resilient to the impacts of climate change. In ensuring that public bodies report suitably ambitious targets by end of November, Leaders, Chairs and Chief Executives will need to bear in mind the policy context that sits alongside the strengthened legislation, as set out in the Scottish Government’s new guidance co-developed with Sustainable Scotland Network (SSN): Public Sector Leadership on the Global Climate Emergency, published on 29 October 2021. The Scottish Government and Scottish Green Party Shared Policy Programme commits to developing and agreeing through consultation a series of phased targets for the decarbonisation of public sector buildings starting in 2024, with the most difficult buildings like hospitals being decarbonised by 2038, and for all publicly-owned buildings to meet zero emission heating requirements, with a backstop of 2038. Programme for Government commitments include phasing out the need for fossil fuel cars and vans in the public sector fleet by 2025 and larger vehicles no later than 2030. Public sector leaders must also take strong action to implement Programme for Government commitments to tackle the significant new challenge of decarbonising the £13.3bn of annual public sector procurement. In terms of available support, the Scottish Green Public Sector Estate Decarbonisation Scheme provides a number of support mechanisms for heat decarbonisation and improving energy efficiency across buildings owned by the public sector in Scotland. The Scheme will distribute the £200 million of capital support pledged over the next 5-year period to aid the decarbonisation of Scotland’s public sector estates. Transport Scotland is also assisting the decarbonisation of the public sector fleet. The latest analysis shows that reported Scope 1 and Scope 2 emissions from Scotland’s public bodies have reduced by almost a third in the six years since mandatory reporting began in 2015-16. NHS Scotland has reduced emissions from its buildings by 64% since 1990. I am convinced if we continue to work together to address the challenges of pace, skills and finance that we undoubtedly face in the crucial decade ahead, Scotland’s public sector will continue to show strong leadership in tackling the global climate emergency. I will be addressing the Sustainable Scotland Network Spring Conference on 25 May to emphasise the importance of public sector leadership, and public bodies’ climate change reporting, to Scotland’s national endeavour on climate action. Michael Matheson
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Public Bodies Climate Change Duties Compliance Reporting Template 2021/22 1.Overview This template is provided for public bodies required to report annually in accordance with the Climate Change (Duties of Public Bodies Reporting Requirements) (Scotland) Order 2015, as amended by the Climate Change (Duties of Public Bodies: Reporting Requirements) (Scotland) Amendment Order 2020 which took effect for reporting periods commencing on or after 1 April 2021. Reports must be submitted to ccreporting@ed.ac.uk by 30th November. Late submissions may not be accepted for analysis and may be classed as non-compliant with Public Bodies Duties legislative reporting requirements. 2. Guidance 1. Please save-as this workbook with your organisation's name in the title before completing 2. Question 1f must be completed to ensure the correct emission factors are applied in Q3b, 3. If you need to add more rows please email the file to ccreporting@ed.ac.uk 4. Hybrid/homeworking emissions - please include an estimate of FTEs working remotely - hybrid/home in the designated row provided in table 3b In order for this to be calculated correctly the total no. of FTEs must be entered in Q1c 5. Local Authorities completeing the recommended tab should select their local authority region at the top of the sheet and their emissions will be provided automatically from BEIS datasets
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3. Colour Coding used in the template Dropdown box - select from list of options Uneditable/fixed entry cell Editable cell Public Sector Report on Compliance with Climate Change Duties 2022 Template PART 1 Profile of Reporting Body 1a Name of reporting body Provide the name of the listed body (the "body") which prepared this report. North Lanarkshire Integration Joint Board 1b Type of body Select from the options below Integration Joint Boards 1c Highest number of full‐time equivalent staff in the body during the report year 0 THIS MUS T BE COM
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PLET ED 1d Metrics used by the body Specify the metrics that the body uses to assess its performance in relation to climate change and sustainability. Metric Units Val ue C o m m e n t s Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) 15 Other (please specify in comments) 1e Overall budget of the body
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Specify approximate £/annum for the report year. Budget Budg et Com ment s £702,633,000 1f Report type Specify the report year type Report type Repo rt year com ment s Financial April 21 ‐ Marc h 22 THI S M US T BE CO MP LET ED 1g Context Provide a summary of the body's nature and functions that are relevant to climate change reporting.
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In line with the Public Bodies (Joint Working) (Scotland) Act 2014 and further than the minimum requirements, the strategic planning and monitoring of services set out in North Lanarkshire's (NL) Intergration Joint Board (IJB) Integration scheme have been delegated by the Council and the Health Board to the NL IJB, which then directs the Council and Health Board to deliver these services in line with its Strategic Plan and defined level of financial resources. Most services are provided for the people of North Lanarkshire, however, some services cover the entire the entire NHS Lanarkshire Board area, (for example, Mental Health and Learning Disability services, specialist children's health services, sexual health services, podiatry and dietetics.) The resident population of North Lanarkshire is 341,140 and NHS Lanarkshire is 664,030 (NRS population estimates.) The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statuttory bodies; North Lanarkshire Council and NHS Lanarkshire. Both NLC and NHSL separately submit a Public Bodies Climate Change Duties Report. Public Sector Report on Compliance with Climate Change Duties 2022 Template PART 2 Governance, Management and Strategy Governance and management 2a How is climate change governed in the body? Provide a summary of the roles performed by the body’s governance bodies and members in relation to climate change. If any of the body’s activities in relation to climate change sit outside its own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify these activities and the governance arrangements. Provide a diagram / chart to outline the governance structure within the body.
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North Lanarkshire's Integration Joint Board is responsible for planning, commissioning and overseeing the delivery of community health and social care services for the six localities across North Lanarkshire. It’s membership is drawn from North Lanarkshire Council, NHS Lanarkshire, professional health and care disciplines and third and independent sector organisations. It plans and commissions local support and care services. These are delivered primarily by the council and NHS Lanarkshire working together in teams in a new integrated way, to transform, re‐design and improve the outcomes for people in North Lanarkshire. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. In June 2019, the Council declared a Climate Emergency was declared with a target to achieve net‐zero by 2030. Climate change and carbon management arrangements continue to have a particular focus for both internal audit and risk teams, ensuring that there is a continuous drive for improvement within the organisation. THe council's commitment to continuously improve all aspects of our Climate Action has resulted in the transition of the Climate Change Group to a Board and the Health & Social Care Partnership is a engaged member of this Board ensuring continuity of approach and vision. Health and Social Care North Lanarkshire works in close partnership as part of the council and fully support and contribute (where applicable) towards the council's targets in terms of asset management and energy consumption. Health & Social Care NL is also a key contributor to NHS Lanarkshire's Sustanability & Climate Change Strategy. More detail can be found at https://www.nhslanarkshire.scot.nhs.uk/download/2022‐october‐26‐board‐ papers/?wpdmdl=46337&refresh=63725780911611668437888&ind=1666703138625&filename =2022‐October‐26‐Board‐21b.‐NHSL‐Sustainability‐Climate‐Change‐Strategy‐Final‐Draft‐for‐ Ratification‐20‐October‐2022.pdf <Insert Diagram Here or Attach File> 2b How is climate change action managed and embedded in the body?
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Provide a summary of how decision‐making in relation to climate change action by the body is managed and how responsibility is allocated to the body’s senior staff, departmental heads etc. If any such decision‐making sits outside the body’s own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify how this is managed and how responsibility is allocated outside the body. Provide a diagram to show how responsibility is allocated to the body’s senior staff, departmental heads etc. The accountability and responsibility for the management of decision‐making for climate change action in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarskire's IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both NLC and NHSL submit seperate and more detailed Public Bodies Climate Change Duties Report that will set out their decision making arrangements in detail. The IJB will take best available advice from its partner agencies in any strategic planning of services and considers any climate change impact when taking any planning decisions. <Insert Diagram Here or Attach File> Strategy 2c Does the body have specific climate change mitigation and adaptation objectives in its corporate plan or similar document? Provide a brief summary of objectives if they exist. Wording of objective Name of document Document Link
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2d Does the body have a climate change plan or strategy? If yes, provide the name of any such document and details of where a copy of the document may be obtained or accessed. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. 2e Does the body have any plans or strategies covering the following areas that include climate change? Provide the name of any such document and the timeframe covered. Topic area Name of document Link Time period covered Com ment s
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Adaptation Business travel Staff Travel Energy efficiency Fleet transport ICT Renewable energy Sustainable/renewable heat Waste management Water and sewerage Land Use Other (please specify in comments) Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2f What are the body’s top 5 priorities for climate change governance, management and strategy for the year ahead?
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Provide a brief summary of the body’s areas and activities of focus for the year ahead. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. 2g Has the body used the Climate Change Assessment Tool (a) or equivalent tool to self‐assess its capability / performance? If yes, please provide details of the key findings and resultant action taken. (a) This refers to the tool developed by Resource Efficient Scotland for self‐assessing an organisation’s capability / performance in relation to climate change.
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The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Further information 2h Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to governance, management and strategy. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Public Sector Report on Compliance with Climate Change Duties 2022 Template PART 3 Corpor ate
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Emissi ons, Target s and Projec t Data Emissi ons 3a Emission s from the start of the year which the body uses as a baseline (for its carbon footprin t) to the end of the report year
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Complete the following table using the greenhouse gas emissions total for the body calculated on the same basis as for its annual carbon footprint / management reporting or, where applicable, its sustainability reporting. Include greenhouse gas emissions from the body’s estate and operations (a) (measured and reported in accordance with Scopes 1 & 2 and, to the extent applicable, selected Scope 3 of the Greenhouse Gas Protocol (b). If data is not available for any year from the start of the baseline year to the end of the report year, provide an explanation in the comments column. (a) No information is required on the effect of the body on emissions which are not from its estate and operations. (b) This refers to “The greenhouse gas protocol. A corporate accounting and reporting standard (revised edition)”, World Business Council for Sustainable Development, Geneva, Switzerland / World Resources Institute, Washington DC, USA (2004), ISBN: 1‐56973‐568‐9.
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ENSURE QUESTION 1f IS COMPLETED BEFORE STARTING THIS SECTION, THEN SELECT APPROPRIATE BASELINE YEAR Referen ce year Year Y e a r t y p e Scope 1 Scope 2 Scop e 3 Total Units Comme nts Baseline Year 2020/21 F i n a n c i a l 31,874 15,85 3 15,04 3 62,770 tCO2e All emmiss ions are emcom passed within the organis ational emissio ns of NLC. Please refer to NLC's submiss ion for further detail.
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3 Year 1 carbon footprint F i n a n c i a l ‐ tCO2e 4 Year 2 carbon footprint F i n a n c i a l ‐ tCO2e 5 Year 3 carbon footprint F i n a n c i a l ‐ tCO2e 6 Year 4 carbon footprint F i n a n c ‐ tCO2e
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i a l 7 Year 5 carbon footprint F i n a n c i a l ‐ tCO2e 8 Year 6 carbon footprint F i n a n c i a l ‐ tCO2e 9 Year 7 carbon footprint F i n a n c i a l ‐ tCO2e 10 Year 8 carbon footprint F i n ‐ tCO2e
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a n c i a l 11 Year 9 carbon footprint F i n a n c i a l ‐ tCO2e 12 Year 10 carbon footprint F i n a n c i a l ‐ tCO2e 13 Year 11 carbon footprint F i n a n c i a l ‐ tCO2e
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14 Year 12 carbon footprint F i n a n c i a l ‐ tCO2e 15 Year 13 carbon footprint F i n a n c i a l ‐ tCO2e 16 Year 14 carbon footprint F i n a n c i a l ‐ tCO2e 17 Year 15 carbon footprint F i n a n c ‐ tCO2e
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i a l 3b Breakdo wn of emissio ns sources Complete the following table with the breakdown of emission sources from the body’s most recent carbon footprint (greenhouse gas inventory); this should correspond to the last entry in the table in 3(a) above. Use the ‘Comments’ column to explain what is included within each category of emission source entered in the first column. If there is no data consumption available for an emission source enter the emissions in kgCO2e in the ‘Consumption’ column of one of the “Other” rows and assign the scope and an emission factor of 1. (a) Emissions factors are published annually by the UK Department for Business, Energy & Industrial Strategy Emission Factor Year 2021 The emission factor year is auto‐ assigned based on your answer to Q1f, if it is incorrect please contact SSN. You can now filter
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emission sources by "type" in column C to enable quicker selection of emission source in column D. User defined emission sources can be entered below remote/ homewo rking emission s ‐ rows 101 to 129. If you require extra rows in
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the table please send the templat e to ccreporti ng@ed.a c.uk. Emission Emissio n source S c o p e Consu mption data Units Emis sion facto r Units Emiss ions (tCO2 e) Comme nts Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p ‐
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d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b ‐
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o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop Please select from drop P l e a ‐
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down box down box s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e ‐
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c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m ‐
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d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o ‐
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w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from Please select from P l e ‐
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drop down box drop down box a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from Please select from P l e ‐
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drop down box drop down box a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from Please select from P l e ‐
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drop down box drop down box a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from Please select from P l e ‐
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drop down box drop down box a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from Please select from P l e ‐
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drop down box drop down box a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Please select from drop down box Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Please select from drop down box Please select from drop down box P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Hybrid/ Homew orking emission s S c o p e 3 100.00 % perce ntage of total FTEs 0.300 00 tCO2e/F TE/annu m ‐ Other (please specify in commen ts) P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Other (please specify P l e ‐
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in commen ts) a s e s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Other (please specify in commen ts) P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Other (please specify P l e ‐
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in commen ts) a s e s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o ‐
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m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d ‐
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o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐
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Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Other (please specify in commen ts) P l e a s e ‐
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s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t ‐
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f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r ‐
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o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n ‐
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b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x ‐ Other (please specify P l e ‐
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in commen ts) a s e s e l e c t f r o m d r o p d o w n b o x Other (please specify in commen ts) P l e a s e s e l ‐
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e c t f r o m d r o p d o w n b o x 95 0.0 Total is differen t to that number quoted in Q3a, please check and/or state why in comme
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nts cell above 3c Generation, consumption and export of renewable energy Provide a summary of the body’s annual renewable generation (if any), and whether it is used or exported by the body. Technol ogy Renewable Electricty Renewable Heat Total consum ed by the body (kWh) T o t a l e x p o r t e d ( k W h ) Total consum ed by the body (kWh) Total expor ted (kWh ) Com ment s
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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from
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drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Please select from drop down box Target s 3d Organis ational targets List all of the body’s targets of relevance to its climate change duties. Where applicable, targets for reducing indirect emissions of greenhouse gases, overall carbon targets and any separate land use, energy efficiency, waste, water, information and communication
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technology, transport, travel and heat targets should be included. Where applicable, you should also provide the body’s target date for achieving zero direct emissions of greenhouse gases, or such other targets that demonstrate how the body is contributing to Scotland achieving its emissions reduction targets. Name of target Type of target T a r g e t Units Boun dary/ scope of target Year used as basel ine Baselin e figure Units of basel ine Target comple tion year Progress against target C o m m e n t s Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop Pleas e selec t from Pleas e select from drop Please select from drop down box
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down box drop down box down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from Please select from Pleas e select Pleas e Pleas e select Please select from
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drop down box drop down box from drop down box selec t from drop down box from drop down box drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop Pleas e selec t from Pleas e select from drop Please select from drop down box
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down box drop down box down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from Please select from Pleas e select Pleas e Pleas e select Please select from
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drop down box drop down box from drop down box selec t from drop down box from drop down box drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop Pleas e selec t from Pleas e select from drop Please select from drop down box
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down box drop down box down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from Please select from Pleas e select Pleas e Pleas e select Please select from
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drop down box drop down box from drop down box selec t from drop down box from drop down box drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Pleas e select from drop down box Pleas e selec t from drop down box Pleas e select from drop down box Please select from drop down box 3da How will the body align its spending plans and use of resources to contribute to reducing emissions and delivering its emission reduction targets? Provide any relevant supporting information
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3db How will the body publish, or otherwise make available, it's progress towards achieving its emissions reduction targets? Provide any other relevant supporting information. In the event that the body wishes to refer to information already publshed, provide information about where the publication can be accessed. Projec ts and
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chang es 3e Estimated total annual carbon savings from all projects implemented by the body in the report year If no projects were implemented against an emissions source, enter "0". If the body does not have any information for an emissions source, enter “Unknown”. If the body does not include the emissions source in its carbon footprint, enter “N/A”. Emission s source Total estimat ed annual carbon savings (tCO2e) C o m m e n t s Electricit y Natural gas Other heating fuels Waste
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Water and sewerag e Travel Fleet transpor t Other (please specify in commen ts) Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from
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drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Total ‐ 3f Detail the top 10 carbon reduction projects to be carried out by the body in the report year Provide details of the 10 projects which are estimated to achieve the highest carbon savings during report year. Project name Funding source F i r s t f u ll y e a r o f C O Are these savings figures estimat ed or actual? Capit al cost (£) Oper ation al cost (£/an num) Project lifetime (years) Prim ary fuel/ emiss ion sourc e save d Estimat ed carbon savings per year (tCO2e/ annum) Estimate d costs savings (£/annu m) B e h a v i o u r C h a n g e Co m me nts
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2 e s a v i n g s P l e a s e s e l e c t f r o m d r o p d o w n Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n
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b o x b o x P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x P l e Please select from Pleas e select P l e
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a s e s e l e c t f r o m d r o p d o w n b o x drop down box from drop down box a s e s e l e c t f r o m d r o p d o w n b o x P l e a s e s e l Please select from drop down box Pleas e select from drop down box P l e a s e s e l
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e c t f r o m d r o p d o w n b o x e c t f r o m d r o p d o w n b o x P l e a s e s e l e c t f r o Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o
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m d r o p d o w n b o x m d r o p d o w n b o x P l e a s e s e l e c t f r o m d r o p d Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d
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o w n b o x o w n b o x P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x
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P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x P l e a s e Please select from drop down box Pleas e select from drop P l e a s e
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s e l e c t f r o m d r o p d o w n b o x down box s e l e c t f r o m d r o p d o w n b o x P l e a s e s e l e c t Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t
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f r o m d r o p d o w n b o x f r o m d r o p d o w n b o x P l e a s e s e l e c t f r o m d r Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r
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o p d o w n b o x o p d o w n b o x P l e a s e s e l e c t f r o m d r o p d o w n Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n
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b o x b o x P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x P l e Please select from Pleas e select P l e
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a s e s e l e c t f r o m d r o p d o w n b o x drop down box from drop down box a s e s e l e c t f r o m d r o p d o w n b o x P l e a s e s e l Please select from drop down box Pleas e select from drop down box P l e a s e s e l
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e c t f r o m d r o p d o w n b o x e c t f r o m d r o p d o w n b o x P l e a s e s e l e c t f r o Please select from drop down box Pleas e select from drop down box P l e a s e s e l e c t f r o
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m d r o p d o w n b o x m d r o p d o w n b o x 3g Estimated decrease or increase in the body’s emissions attributed to factors (not reported elsewhere in this form) in the report year If the emissions increased or decreased due to any such factor in the report year, provide an estimate of the amount and direction Emission s source Total estimat ed annual emissio ns (tCO2e) I n c r e a s e o r Comme nts
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d e c r e a s e i n e m i s s i o n s Estate changes P l e a s e s e l e c t f
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r o m d r o p d o w n b o x Service provisio n P l e a s e s e l e c t f r o m d r
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o p d o w n b o x Staff numbers P l e a s e s e l e c t f r o m d r o p d o w
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n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b o x
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Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop P l e a
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down box s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box P l e a s e s e l
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e c t f r o m d r o p d o w n b o x Please select from drop down box P l e a s e s e l e c t f r
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o m d r o p d o w n b o x Please select from drop down box P l e a s e s e l e c t f r o m d r o
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p d o w n b o x Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n
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b o x Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select P
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from drop down box l e a s e s e l e c t f r o m d r o p d o w n b o x Total ‐ 3h Anticipated annual carbon savings from all projects implemented by
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the body in the year ahead If no projects are expected to be implemented against an emissions source, enter “0”. If the organisation does not have any information for an emissions source, enter “Unknown”. If the organisation does not include the emissions source in its carbon footprint, enter “N/A”. Emission s source Total estimat ed annual carbon savings (tCO2e) C o m m e n t s Electricit y Natural gas Other heating fuels Waste Water and sewerag e Travel
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Fleet Transpor t Other (please specify in commen ts) Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box
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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from
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drop down box Please select from drop down box Please select from drop down box Total ‐ 3i Estimated decrease or increase in emissions from other sources in the year ahead If the body’s corporate emissions are likely to increase or decrease for any other reason in the year ahead, provide an estimate of the amount and direction. Emission s source Total estimat ed annual emissio ns (tCO2e) I n c r e a s Comme nts
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e o r d e c r e a s e i n e m i s s i o n s Estate changes P l e a s e s e l e
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c t f r o m d r o p d o w n b o x Service provisio n P l e a s e s e l e c t f r o
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m d r o p d o w n b o x Staff numbers P l e a s e s e l e c t f r o m d r o p
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d o w n b o x Other (please specify in commen ts) P l e a s e s e l e c t f r o m d r o p d o w n b
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o x Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x Please select from P l
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drop down box e a s e s e l e c t f r o m d r o p d o w n b o x Please select from drop down box P l e a s e s
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e l e c t f r o m d r o p d o w n b o x Please select from drop down box P l e a s e s e l e c t
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f r o m d r o p d o w n b o x Please select from drop down box P l e a s e s e l e c t f r o m d
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r o p d o w n b o x Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o
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w n b o x Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x
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Please select from drop down box P l e a s e s e l e c t f r o m d r o p d o w n b o x Total ‐ 3j Total carbon reduction project savings since the start of the year
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body in relation to corporate emissions, targets and projects. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Public Sector Report on Compliance with Climate Change Duties 2022 Template P A R T 4 Adaptation Assessing and managing risk
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4a Has the body assessed current and future climate‐related risks? If yes, provide a reference or link to any such risk assessment(s). The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. 4b What arrangements does the body have in place to manage climate‐related risks? Provide details of any climate change adaptation strategies, action plans and risk management procedures, and any climate change adaptation policies which apply across the body.
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The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Taking action 4c What action has the body taken to adapt to climate change? Include details of work to increase awareness of the need to adapt to climate change and build the capacity of staff and stakeholders to assess risk and implement action. The body may wish to make reference to the Scottish Climate Change Adaptation Programme (“the Programme”).
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4d Where applicable, what contribution has the body made to helping deliver the Programme? Provide any other relevant supporting information The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies
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Climate Change Duties Report that will detail how this is managed. Review, monitoring and evaluation 4e What arrangements does the body have in place to review current and future climate risks? Provide details of arrangements to review current and future climate risks, for example, what timescales are in place to review the climate change risk assessments referred to in Question 4(a) and adaptation strategies, action plans, procedures and policies in Question 4(b).
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The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. 4f What arrangements does the body have in place to monitor and evaluate the impact of the adaptation actions? Please provide details of monitoring and evaluation criteria and adaptation indicators used to assess the effectiveness of actions detailed under Question 4(c) and Question 4(d). The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed.
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Future priorities for adaptation 4g What are the body’s top 5 climate change adaptation priorities for the year ahead? Provide a summary of the areas and activities of focus for the year ahead. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Further information 4h Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to adaption.
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The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Public Sector Report on Compliance with Climate Change Duties 2022 Template PART 5 Procurement 5a How have procurement policies contributed to compliance with climate change duties? Provide information relating to how the procurement policies of the body have contributed to its compliance with climate changes duties.
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North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements. 5b How has procurement activity contributed to compliance with climate change duties? Provide information relating to how procurement activity by the body has contributed to its compliance with climate changes duties. North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements.
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Further information 5c Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to procurement. North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements. Public Sector Report on Compliance with Climate Change Duties 2022 Template P A R T 6 Validation and Declaration 6 a Internal validation process
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Briefly describe the body’s internal validation process, if any, of the data or information contained within this report. N/A 6 b Peer validation process Briefly describe the body’s peer validation process, if any, of the data or information contained within this report. N/A 6 c External validation process
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Briefly describe the body’s external validation process, if any, of the data or information contained within this report. N/A 6 d No Validation Process If any information provided in this report has not been validated, identify the information in question and explain why it has not been validated. N/A 6 e Declaration I confirm that the information in this report is accurate and provides a fair representation of the body’s performance in relation to climate change.
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Name: Julie McGee Role in the body: Senior Officer Date: 21/11/2 022
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1 REPORT Item No: 16 SUBJECT: Cost of Living Helpline TO: Integration Joint Board Lead Officer for Report: Alison Gordon, Chief Social Work Officer Author(s) of Report John Campbell DATE: 30th November 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 Reviewed Endorsed By: The report was prepared by the Chief Social Work Officer in consultation with the Chief Officer and members of the Sector Leadership Team 3. RECOMMENDATIONS It is recommended that the IJB: 1) Approve the proposal for the Helpline; and 2) Approve the funding request for the enhancement of the Tackling Poverty Team. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Key Issues 5.1 There is a cost-of-living crisis in the UK resulting in unprecedented pressures on people already in poverty, and thousands of people in North Lanarkshire will be forced into poverty and have to make tough decisions about when and what they eat, keep their homes, what they can do in life, and when they can afford to heat their home. 5.2 With the highest inflationary increases on food, fuel and other household costs since 1981 and the expected increase on interest rates on mortgages following the impact of the mini budget and further austerity measures planned by UK Government e.g., Benefits and Pensions, wages not increasing in line with Inflation (11.1%) and with wage increases coming in on average at 5%, increases on income tax, public spending cuts, there are real term cuts to people in work and out of work income over the next two to three years. 5.3 The supports coming from both the Scottish and UK governments are evolving, but irrespective of this, the coming winter months and the next 2 years will be extremely challenging for a significant and increasing number of households in North Lanarkshire. Background 5.4 Further to the Fairness Commission Report of 2018, which identified significant challenges with respect to poverty and its wider impacts within North Lanarkshire, the Tackling Poverty Strategy 2020-23 ‘Towards a Fairer North Lanarkshire’ has provided a vehicle for multi- agency action as reflected in the progress report for which link is provided at section 7 below. 5.5 Given the severity of the current cost of living crisis resilience arrangements were however stood up by the Council to support planning of further mitigating measures with partners. The detail of these is reflected in the second report provided at section 7 as a background paper, ‘Cost of Living Response’ 5.6 In view of the likelihood that the current cost of living crisis will exacerbate existing health inequalities through its wider impacts on physical and mental health and well-being and its strong commitment to prevention, the Health and Social Care Partnership have been keen to explore options to enhance the early help and advice available to individuals and families impacted by the current crisis, identifying this as a potential priority which could be supported, if agreed , through current reserves. In particular the partnership has considered the potential to fund and promote a ‘helpline’ resource. 5.7 The Council’s Tackling Poverty Team, currently have a First Point of Contact Team with a single and simple access point for residents, Council Services, NHSL and other Community Planning Partners.
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3 (Telephone number – 01698 332551 and email contact TPTeam@northlan.gov.uk. As well as the Online, self- help/management tools via council website – Cost of living page. 5.8 The Tackling Poverty team also commission External Advice Services on behalf of the Council and have strong links with these services, as well as having long established referral routes with Health and Social Care Services, NHSL Community Link Workers Programme, GP Practices and other Health Services. The Tackling Poverty Team provide advice, information, support and advocacy in relation to income maximisation, debt and money advice, financial education, fuel advice (Home Energy Scotland), representation at social security appeals and in the wider Tackling Poverty agenda, manage the Tackling Food Poverty and Insecurity referral Gateway and ensure that there is a ‘no wrong door approach’, by signposting and connecting residents to other Council Services, NHSL and Third Sector via the Tackling Poverty structure/governance chart. 5.9 The table below demonstrates the increase in demand/referrals to the Tackling Poverty Team for advice and information since 2020/21 and given the above clearly this will continue to increase over the next 2 years and beyond. Month 2020/21 2021/22 2022/23 April 1443 648 791 May 989 639 919 June 603 720 862 July 479 564 755 August 442 643 1039 September 592 703 907 October 700 621 November 683 736 December 434 529 January 706 783 February 576 833 March 746 948 6. CONCLUSIONS Proposal 6.1 Following a range of discussions between lead officers from the Health Social Care Partnership, the Tackling Poverty Team and the wider Tackling Poverty and Resilience structures is proposed that additional support could most effectively be offered through extending the capacity of the Tackling Poverty Team, This would ensure we can maintain and enhance the existing single point of contact for advice on
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4 a range of impacts for the Cost-of-Living Crisis, with the majority of the enquiries expected to be financially related. This would mean one gateway for residents to receive direct advice and where required a direct route to follow up appointments for support rather than being re- directed. It also allows for efficiency of scaling up as the current infrastructure is in place to provide the helpline rather than setting up something bespoke. 6.2 Extending the capacity of the Tackling Poverty team will also allow the team, to support the wider capacity issues for the Third Sector, Health and Social Care Services, Education and Families Services, Housing Solutions, and other Community Planning Partners, by providing advice, support and referral pathways for these services, and the community drop-in centres, North Lanarkshire Council’s -Work Local Hubs (available to all Council, IJB and NHS Lanarkshire staff). 6.3 As recognised above it is inevitable that the pressures and reality of the Cost-of-Living Crisis means many people will also experience negative impacts on their health and wellbeing, therefore the team will undergo additional training in key areas, e.g. mental health and wellbeing to support capacity to recognise and respond to wider needs through the appropriate signposting and referrals. The Tackling Poverty Team and NHS Lanarkshire already have a well-developed approach for financial wellbeing, signposting to other services and referrals pathways, this builds on the learning from the NL Covid (Community Hubs) Helpline. 6.4 It is important also to recognise that staff form agencies will themselves be impacted and that enhancing access to financial advice will support our commitment to staff support and wellbeing. 6.5 The Tackling Poverty Team will require additional staff to maintain and enhance the Helpline/First Point of Contact and to ensure follow up support continues to be offered timeously. The skill mix required will includes Clerical support, Debt Advisors, Income Maximisers and Welfare Rights Officer. This will provide the enhancement required by the Tackling Poverty Team to deliver the Helpline/First Point of Contact, outreach surgeries and provide wider support to Community Planning Partners strengthening access to early support and upholding the partnership’s commitment also to address stigma and empower those requiring support through a ‘cash first’ approach wherever possible. 6.6 The funding required is £300,000, each year over two years 23/24 and 24/25 (£600,000 in total) which will allow the Tackling Poverty Team to recruit staff as soon as possible. 6.7 The Tackling Poverty Team will work with HR and Employability Services to develop a strategy to recruit the staff required as quickly as possible which will look at traineeships, modern apprentices, and other employment opportunities for North Lanarkshire residents. The Tackling Poverty team currently has adverts out just now for Welfare
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5 Rights Officers and Debt Advisors which may allow some of the posts to be filled quickly. 6.8 The Tackling Poverty Team will also monitor and record activity of the helpline, in number of people assisted, reason for referral, income generated, advice given, outcomes, number of people/referrals signposted to other services/agencies. The Tackling Poverty Team will also report on the wider use of the referral pathways with the Third Sector, Council Services, IJB Services and NHS Lanarkshire. 6.9 It would be the intention to report back to the IJB Board under the same cycle of reporting back to the Council’s Wellbeing and Tackling Poverty Committee, with the first update due in February 2023. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Current concerns about cost-of-living issues impact on each of the nine national outcomes, but in particular, outcomes; 3. People who use health and social care services have positive experiences of those services, and have their dignity respected” and, 5. “Health and social care services contribute to reducing health inequalities 7.2 ASSOCIATED MEASURE(S) This report highlights one of a number of initiatives being progressed by NHSL and NLC to address the immediate financial challenges facing individuals, families and communities across North Lanarkshire 7.3 FINANCIAL The funding required will be £600,000 in total over two years 2023/2025 This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report relates to risk IJB 15/22 – Cost of Living impacts currently on the IJB risk register rated as high.
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6 7.5 PEOPLE The funds will support recruitment of 3 welfare benefits advisors, 2 debt and money advice staff and up to 4 support staff. Consideration is being given to accessing the modern apprenticeship scheme to maximise the social economic benefit of this initiative. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY The initiative will reduce inequalities in the community served by North Lanarkshire Council and the IJB. We will undertake an equalities impact assessment when we have finalised the final service and staffing model. EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS 1) Programme of Work (P005.1 (2) & (3) Tackling Poverty and Maximising the Local Authority Economic Recovery Fund - att98916.pdf (northlanarkshire.gov.uk) 2) Cost Of Living Response - att98917.pdf (northlanarkshire.gov.uk) 9. APPENDICES None. ............................................................................. 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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1 REPORT Item No: 17 SUBJECT: Winter Plan TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance & Quality Assurance Author(s) of Report Graeme Cowan, Senior Manager, Strategy & Performance DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement To note 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: prepared by the Planning and Performance Team and endorsed by senior management. 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the contents of the Climate Change report prior to its submission. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Annual ‘whole system’ planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Lanarkshire Health and Social Care system – in common with that across Scotland - continues to face significant challenges. Last winter, health and social care services and staff had to contend with extreme pressures, many of which continue to be issues for the system. 5.1.2 Planning for Winter 2022/23 commenced in July 2022 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Yes No N/A
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2 Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). 5.1.3 Give the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as – and should be understood to be - a dynamic plan and one that is highly likely to be subject to change over the coming months. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific piece of work is being undertaken by NHS Lanarkshire, to take account of the increasingly likely eventuality of a number of concurrent risks which may well align to create increased system pressure. These risks include, inter alia, further waves of Covid 19; increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages in all sectors and grades across the Health and Social Care sector; potential industrial action; public health impact of cost of living crisis/fuel costs and subsequent demand on health and care services; increasing numbers of displaced Ukrainians/Asylum Seekers; inclement weather; and available finances. 5.2 National Guidance / Scottish Government Correspondence 5.2.1 On 04 October 2022, Scottish Government published a Winter Resilience Overview 2022-23 which set out the actions they are taking in an effort to support the sector over the winter period. 5.2.2 That guidance set out the national expectations for those areas that local winter plans would be expected to address. As will be clear from the body of this report most of the areas identified already feature as part of the Lanarkshire winter planning process; are being reviewed/refined to ensure that they are as up to date as can be and resourced appropriately given available capacity. The guidance was further reinforced by subsequent correspondence to Chief Executives and Chief Officers on 12 October 2022 and 17 October 2022, the latter including a checklist for completion. Following a national event on 19 October 2022, further guidance was issued and an associated operational self-assessment on winter preparedness was issued. The submission made by the 7 November 2022 deadline reflected the content of this report. 5.2.3 Discussion is still ongoing at national and local level on available funding to manage the impact of Covid 19 and ongoing pressures associated with both unscheduled and planned care. Work is ongoing between the NHS Lanarkshire Director of Finance, the two Chief Financial Officers of the IJBs and Council Finance Directors to be clear of those monies which have already been committed to meet ongoing service pressures/respond to previous Government policy; and that which may be available to support any new proposals. 5.3 Ongoing Urgent and Unscheduled Care Planning 5.3.1 The national Redesign of Urgent Care programme looks to build on these opportunities to support the public to access the right care in the right place at the right time. As part of the ongoing NHS Lanarkshire Urgent and Unscheduled Care
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3 development programme work has been undertaken to identify those areas where there may be scope to introduce early change such that there can be a beneficial impact on whole system capacity. 5.3.2 As well as a refocus on the Six Essential Actions (nationally developed with the Academy of Royal Colleges) there are a further six main areas where active consideration is now being given to opportunities to support increase “flow” through the system. It should be noted that these areas are all consistent with the Scottish Government guidance from October 2022 referred to above: Hospital at Home - review of the current model and consideration of opportunities for expansion of service. Frailty – pathway development to support admission avoidance and early discharge. Development of a community-based Urgent Care Service. Development of Minors Service Hub. Expansion of the scope of the Flow Navigation Centre (FNC – see below). Development of Discharge Ward Model / Commissioned Beds. 5.3.3 Both Chief Officers of the North and South Lanarkshire IJBs are also closely involved in the Urgent and Unscheduled Care work stream. This is in recognition of the fact that currently almost 95% of patients are discharged from hospital without delay; and, accordingly, it is very important to whole system “flow” that acute services are delivered as efficiently as possible alongside expanding the capacity of and transforming the delivery of more services in the community. 5.4 Discharge Without Delay 5.4.1 A national Unscheduled Care Planning for Winter event was held on 19 October 2022 at which it was reinforced that the delivery of discharge planning by acute hospital staff was vital as part of the Discharge Without Delay programme with its emphasis on Planned Date of Discharge. 5.4.2 NHS Lanarkshire is a pathfinder site for the national Discharge Without Delay programme, which is hosted within the South Lanarkshire HSCP. Considerable work is ongoing to promote and systematise Planned Date of Discharges across all hospital sites; and work is ongoing to embed the necessary steps to improve “flow” (for example, increase pre-noon discharges) across all hospital settings. 5.4.3 Both HSCPs have Home Assessment/Home First Teams which although in their infancy are already making significant improvements in the number of people able to be supported out of hospital with no/little delay. 5.4.4 There are a range of other initiatives that are being implemented to provide better outcomes for patients and service users which also contribute to the better use of available services and reduce pressures on health and social care services. The development of third sector support for hospital discharge includes volunteer recruitment; induction and training; and process and system development to ensure
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4 volunteers and ward staff are clear on what can be done and that patients are supported to feel safe in the knowledge that the volunteers involved are an integral part of the discharge process where applicable. 5.5 Maximisation of Flow Navigation Centre (FNC) 5.5.1 The FNC offers rapid access to a senior clinical decision maker within the multidisciplinary team, optimising digital health through a telephone or video consultation where possible, and minimising the need to attend an Emergency Department. This includes the use of ‘Consultant Connect’ for rapid professional to professional clinical decisions to support clinical decision making, reduce unnecessary attendances, and to navigate patients to the most appropriate place, first time. Both of these services allow GPs to have the opportunity to discuss cases with an appropriate secondary care clinician with a view to ensuring as many patients as possible are managed in a ‘planned’ way. 5.5.2 Accordingly, as part of the planning for winter, work is being undertaken to enhance the FNC to maximise the number of people who can be diverted from Emergency Departments and managed in a different way. 5.6 Surge/Bed Capacity 5.6.1 Acute hospitals that are working close to or at full capacity are a strong indicator of a system that is under significant pressure. Surge capacity generally refers to the ability to maintain a sudden and unexpected increase in patients. 5.6.2 Unlike in previous years and in common with the position across Scotland, the scope for additional surge capacity in NHS Lanarkshire is limited. This is both in terms of workforce and accommodation, recognising other capital works ongoing on the University Hospital Monklands site means that the ward traditionally used to manage “surge” is not currently available. The latter position will be kept under constant review such that if sufficient staffing does become available, then the respective acute beds can be mobilised and introduced to support overall hospital capacity. 5.6.3 Both South and North Lanarkshire HSCPs will also utilise intermediate care beds and interim beds within care homes such that additional flow can be created in the absence of immediately available care at home or a care home of choice. 5.7 Social Care Provider Sustainability 5.7.1 Independent providers of social care in Scotland – notably care homes and care at home providers – have highlighted the extremely difficult operating environment. Coupled to the cost-of-living-crisis and the impact of the pandemic, vacancy pressures are a significant concern for many providers in terms of service viability. 5.7.2 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider context and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care workforce challenges) and statutory/legal parameters. Within North Lanarkshire,
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5 ongoing actions include the HSCP convening the providers’ forums, and regular meetings with Scottish Care. On a Lanarkshire-wide basis, support and quality assurance for Care Homes continues on a whole system basis to be overseen by the pan-Lanarkshire Care Home Assurance Tactical (CHAT) Group; and for Care at Home Services through the equivalent Care at Home Oversight Group. The Care Inspectorate participates in both of these meetings. 5.8 General Practice and pharmacy opening 5.8.1 As in previous years, a local enhanced service to support general practices opening on the fourth day of the weekend/public holidays – that is, on 27 December and 3 January as well as the Saturdays through January 2023 - will be offered. There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, the Primary Care Out of Hours (PCOOH) Service, Emergency Departments and the FNC where possible. 5.9 General Practice sustainability 5.9.1 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. The Scottish Parliament’s Health, Social Care and Sport Committee has highlighted that the rise in complexity of patient needs has led to a substantial increase in the primary care workload in Scotland; and that the problems in maintaining and developing the general practice workforce also exacerbate the overall system challenges. 5.9.2 This was the subject of an extensive presentation at the September 2022 meeting of the South Lanarkshire IJB, which included describing the work ongoing to address capacity and demand – most notably, through the Primary Care Improvement Plan (PCIP) that is reported through to the IJB and NHS Lanarkshire Board as per the expectations within the General Medical Services (GMS) Contract. 5.10 Primary Care Out of Hours 5.10.1 For a considerable period, and similar to most Scottish out of hours services, the NHS Lanarkshire PCOOH Service has had to manage workforce availability challenges (notably in relation to GPs); and has regularly had to contend with escalating levels of demand. 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, alongside a wider review of urgent care arrangements (as has been reported to and approved by both IJBs and the Health Board). In the meantime, work continues to stabilise the service, with contingency and escalation frameworks in place, and as previously reported to the IJB. 5.11 Planned Care 5.11.1 Work is ongoing in estimating the extent of planned care that may require to be stood down during the peak winter period, all the while seeking to minimise this such that the pace of recovery in meeting revised NHS Treatment Time Guarantee
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6 targets can be maintained. In extremis, there may be a requirement to revisit attainment of the targets depending on the impact of winter on overall system flow. 5.12 Contingency Arrangements for Additional Deaths 5.12.1 As set out within national guidance and is the case every year, work is underway – including with local undertakers - to ensure that there is sufficient ‘pace’ of funeral services (both burials and cremations) to support the eventuality of a significant excess of deaths over the winter period. Additional mortuary capacity identified for Covid 19 is still in place and will continue to be available over this winter period. 5.13 Covid 19 and Flu Vaccine Programme 5.13.1 Following final advice on the winter Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), the following groups are being offered an additional Covid 19 booster: Residents in a care home for older adults and staff working in care homes for older adults. Frontline Health and Social Care workers. All adults aged 50 years and over. Those aged 5 to 49 years in a clinical risk group, including those who are pregnant. Those aged 5 to 49 years who are household contacts of people with immunosuppression. Carers aged 16-49 years. 5.13.2 It has been estimated that approximately 300,000 people will be eligible for a Covid 19 vaccine and 380,000 for a flu vaccine as part of the Autumn/Winter Vaccination Programme for 2022. 5.13.3 Work is well underway in pursuit of achieving an 80% uptake by December 2022 - thereby maximising protection to the community and, in turn, to Health and Social Care Services by reducing the risk of increased Covid 19 and flu related hospital admissions or other deteriorations in health such that additional support is required. Significant progress has already been made in relation to residents within the older people’s care home sector; and work is advancing in respect of the cohorts linked with those with illnesses that results in immuno-suppression. 5.13.4 Despite considerable efforts to promote the programme, uptake thus far by NHS- employed staff and social care staff from both Council and independent and voluntary sectors in Lanarkshire has been lower than predicted. This is consistent with the pattern being seen across the rest of the country. Action is being taken to try and increase uptake accordingly. 5.14 Carers Support 5.14.1 An update paper is on the agenda around Carers Support and the use of the Carers (Scotland) Act 2016 funding to enhance operational services and supports for carers in North Lanarkshire.
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7 5.15 Staff Wellbeing 5.15.1 NHS Lanarkshire’s Health and Wellbeing Strategy was launched during its Staff Health and Wellbeing week (31 October to 4 November 2022). Key messages from the Strategy form an integral part of the system wide winter plan, with the emphasis on providing a working environment in all areas across Health and Social Care where staff are able to enhance and maintain their personal and professional wellbeing and to reach their full potential in a culture that’s provides space, time and support for self-care. 5.15.2 The Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded in everything we do and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 5.16 Adverse Weather 5.16.1 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both South and North Lanarkshire Councils have policies in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 5.16.2 A series of actions is open to the organisations – individually and in collaboration - in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations. 5.17 Concurrent Resilience Planning and Risks 5.17.1 As highlighted above, there is a likelihood of concurrent risks aligning to have a significant impact on the wider health and social care services. 5.17.2 Perhaps key amongst these is the threat of industrial action and the impact both directly and indirectly. As well as potential industrial action by NHS and local government staff, so too there is the indirect impact of industrial action in other sectors, for example, Education and Royal Mail. 5.17.3 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. Two ‘Winter Breach’ events have been held this year, a regional event on 26 October 2022 and a Lanarkshire LRP event on 27 October 2022. Learning from both of these events have been taken into account in reviewing the robustness of the planning to date.
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8 5.17.4 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. 5.18 Communications 5.18.1 Work is underway at both local and national levels on the public message in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. South and North Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. 5.18.2 The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment 6. CONCLUSIONS 6.1 Significant whole system planning has been undertaken in preparation for what is widely expected to be one of the most challenging winters for health and social care services on record. 6.2 The IJB will be kept abreast of developments throughout the winter period. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1 The winter planning process impacts on all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) 7.2.1 The IJB and NHS Board will be measured against a number of performance metrics including the 4hr ED target and Delayed Discharges. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 It is recommended that winter planning is added to the IJB risk register due to its potential impact on a wide range of service areas and ability to implement strategic plans.
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9 7.5 PEOPLE 7.5.1 Our winter preparation will have a significant impact on all North Lanarkshire staff and residents as outlined above. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore no impact assessment is required. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES 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