Item 12 - Strategic Commissioning Plan
North Lanarkshire Council · 30 November 2022
Back to Health and Social Care Integration Joint Board — 30 November 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 12 SUBJECT: 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)