Item 3 - Minute of Meeting held on 21 September 2022
North Lanarkshire Council · 30 November 2022
Back to Health and Social Care Integration Joint Board — 30 November 2022 and its agenda
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st September 2022 at 2pm-4.30pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Tracy Carragher (Chair) North Lanarkshire Nominated Councillor Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Kirsten Larson North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Amanda Kilburn Chief Finance Officer North HSCP Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative John Watson Employee Representative NLC Unison Officer in Attendance: Ken Adamson (Item 6) Stacey Connor Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddie Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director NLHSCP Marie McFadden Audit Scotland Lucy Munro Medical Director NL Des Murray Chief Executive NLC Soumen Sengupta (Item 8) Chief Officer South Lanarkshire HSCP Dr Tyra Smyth General Practitioner (GP) Lesley Thomson (Item 8) Nurse Director South HSCP APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Neil Findlay NHS Lanarkshire Nominated Non Exec Director Alison Gordon Head of Children & Families & Justice Services
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2 CSWO of NLC Councillor Ayesha Khan North Lanarkshire Council Nominated Councillor Heather Knox Chief Executive NHS Lanarkshire James Muir NHS Lanarkshire Nominated Non Exec Director ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. Special welcome was made to Amanda Kilburn who has taken up position of Chief Finance Officer for North Lanarkshire HSCP. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB 22.6.22 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ IJB Action Log There were no matters arising. Ross McGuffie shared an updated action log to reflect the progression of work since the last committee. Some actions have been deferred to the PFA meeting but they will remain on the IJB action log until resolved. The following updates were noted by the committee: Action 1 Reserve Strategy – Has been delayed until December to allow the new CFO to review information. Action 2 Internal Audit Report- This was shared at today’s committee. Action 5 Category One Responders- Have submitted ourselves for evaluation, West of Scotland RRP is meeting in October and will review all responses; it is planned to report back to the IJB in December. Action 8 MH Continuing Care Contracted Beds - Been delayed due to advice from HIS being required, an options appraisal will be completed soon and a business case presented to the IJB in December.
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3 Action 17 Audited Accounts- Report delayed due to delay in Audit Scotland process, special IJB to be called end of October to sign of the accounts. 5. Finance Report This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 31 July 2022 (Health Care Services) and 22 July 2022 (Social Work and Housing Services). The financial position as at July 2022 is summarised as follows: There is a net underspend of £2.313m on the core budgets within Health Care Services There is a net underspend of £1.487m on the core budgets within Social Care and Housing Services The total underspend of £3.801m represents approximately 0.5% of the total financial envelope available. Section 7.7 provides reasons for variances mostly down to employee costs with number of vacancies and issues with recruitment. There is a £5.5m funding gap for 22/23 looking at budget realignments and savings plans. In 31st March there was £119m in reserves as at July £16m has been drawn down leaving a balance of £103m. Currently in the process of reviewing all reserves if funding is not required will rerouted to other priorities. Brian Moore asked for breakdown of reserves that have already been drawn down. For the covid money it looks like Scottish government will claim some of the money back do we have any details around this. Amanda Kilburn confirmed they are looking at clawing back funds but there are no timescales or details around the amounts. A report detailing the reserves will be tabled at the December IJB committee. Cllr Larson queried with recruitment is Lanarkshire in a similar position to the rest of Scotland. Amanda Kilburn confirmed this is the case across the whole of NHS Scotland. Ross McGuffie noted had a number of new funds allocated in the winter business case but due to recruitment challenges difficult to spend the funding. Cllr Kelly asked if can seek assurance from Scottish Government around funding gaps. Amanda Kilburn noted this is already highlighted at the CFO network regularly. Heather Knox also noted the board have similar concerns that funding would be clawed back then required to be allocated back would cause issues across services. Maddy Halliday queried what the scope of the funding clawed back would be. Amanda Kilburn advised at the minute the discussions are around covid
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4 funding only but this could change. For ring fenced reserves they are related the project already so would be challenging to reallocate them. Trudi Marshall advised for nursing staff having to look at different staffing models as not got nursing workforce volumes need. So will consider career pathways which take time but still require to protect the money to be utilised at the later date. This also support employability and anchor work. The IJB agreed the following recommendations: (1) Note the contents of the report; (2) Note that the financial position in July 2022 is an underspend of £3.801m (NHSL - £2.313m; NLC - £1.487m). This excludes the impact of further recruitment challenges and staff turnover and any potential new Scottish Government funding. 6. Internal Audit Review- Due Diligence Review This report provides details of the Internal Audit Annual Audit Report for the financial year 2021/2022 which also contains the independent annual opinion of the IJB’s Chief Internal Auditors on the adequacy and effectiveness of the IJB’s governance, risk management and internal control arrangements for the year ending 31 March 2022. The Internal Audit Annual Audit Report for 2021/2022, a copy of which is attached, presents a high-level overview of the activity undertaken by the Internal Audit teams during the year and which are reflected in the annual opinion. Based on the work undertaken directly on behalf of the IJB and being informed by internal audit work undertaken independently by each respective internal audit function within NLC and NHSL, it is concluded that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls for the year ending 31 March 2022. A number of recommendations and improvement actions have been agreed with senior management arising from audit work undertaken during the year. Internal Audit will, as part of the 2022/2023 work plan, develop and agree arrangements to undertake follow-up work on the implementation of actions agreed in response to relevant audit recommendations and report on this work to the IJB Performance, Finance and Audit Committee during 2022/2023. Internal Audit staff appreciated the help and co-operation extended to them by the officers of the IJB and the staff within the partnership. Ken Adamson advised working on a draft audit plan with Ross McGuffie and Amanda Kilburn to be shared at a later date. Ross McGuffie requested that
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5 this be reported through IJB PFA for a quicker timescale; this was agreed by the committee. The IJB is agreed the following recommendations: (1) Note the contents of the report; and (2) Endorse the opinion of the Chief Internal Auditors that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control for the year ended 31 March 2022. 7. Covid Update As at 12th September, the seven-day case rate within North Lanarkshire is 66.8 per 100k population, which is a continued decrease to the figures last presented to the IJB on 22nd June when it was 103 per 100k. The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at 12th September, there are 64 covid positive inpatients and a further 24 in offsite facilities. On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. As of today there are 89 covid positive inpatients across 3 acute sites and12 in community. There are 9 care homes in outbreak situations. The rate of infections is 1 in 45 across Scotland which is higher than the rest of the UK. Delayed discharge sitting mid to high 70s generally. Today there are 91 delays but have got good flow through the system, with 50 planned discharges by the weekend. In Wishaw and Cumbernauld areas running home assessment teams; areas should be at full capacity next week. Also had some success for AHP recruitment into the service too. Administered 1.6million doses of the vaccine. Due to changes in travel criteria’s may see a reduction of uptake this will be monitored. Cllr Larson queried how has the relaxation of mask wearing been received and will this link to outbreaks. Ross McGuffie advised never been a static position throughout the pandemic but has moved when required. Trudi Marshall noted for residents in care homes staff wearing face masks has been challenging for communication particularly with dementia patients but there is still the choice to wear masks if the individual wishes. Public Health still have regular outbreak surveillance meetings so they may recommend face masks wearing if required. John Watson noted number of concerns around home care workers having expectation to wear masks and when they don’t can be subject to disciplinary process, how do we ensure those with exemptions are protected from this.
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6 Trudi Marshall advised have in the past worked with specialists to help manage fears for particular situations and will continue to do so. Maddy Halliday noted transmission rates are much lower. Previously VANL tried to put some protection measures in place from a public health point of view and health and safety, as there is no mandatory guidance in place. It was around trying to maintain distance and ensure ventilation for events through risk assessments but this was not well received. Ross McGuffie noted with different national position it is challenging to ask individual to do this in a work environment. Des Murray added would be dependent on individuals and different circumstances. The IJB: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 8. Primary Care Out of Hours GP Service The introduction of the 2004 General Medical Services Contract – where the responsibility for delivery of general practice services during the Out of Hours period transferred from GPs to territorial Health Boards - resulted in a number of unforeseen and adverse consequences, including insufficient participation of GPs in Out of Hours services. The demand for urgent care was growing - particularly for rapidly increasing numbers of frail older people with multiple long-term conditions and complex care needs. The (then) present situation for Primary Care Out of Hours services was fragile, not sustainable and would worsen, unless immediate and robust measures were taken to promote the recruitment and retention of sufficient numbers of GPs working in both daytime and Out of Hours services. The Review’s proposals included that: Future urgent care be delivered by well-led and trained multi-disciplinary and multi-sectoral teams. GPs would no longer be the default health care professionals to see patients for urgent care, but they must continue to be an essential part of multi-disciplinary urgent care teams, providing clinical leadership and expertise, particularly for complex cases. People seeking help need to see the right professional at the right time, according to need. An enhanced capacity multi-disciplinary Primary Care Out of Hours workforce should be rapidly built up, including advanced nurse practitioners (ANPs), community nursing staff, paramedics and other allied health practitioners (AHPs), clinical pharmacists, and social care staff. The
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7 contribution of administrative and support staff is crucial and must be clearly valued and recognised. Future provision of Primary Care Out of Hours and urgent care services should not be constrained by traditional boundaries or demarcations. Soumen Sengupta advised this paper has been taken through the population health committee for endorsement and it has also been taken to the South IJB on 20th September for approval. The service is hosted in South so requires to be approved here but with endorsement of North. There was also a briefing session held for both South & North IJB members in August. Attention was drawn to challenges outlined in the paper under section 5.21. Cllr Kelly queried around multi-disciplinary teams what would be the expectation for social work staff who are already under pressure. Soumen Sengupta advised would consult with relevant services when required. Brian Moore noted looking at the usage of the service to ensure get it right, this key through public engagement. For NHS 24 usage it would need to be a whole system change across all health boards around their approach to risk management and how they use OOH. Brian Moore also queried are there any issues for the service in regard to children’s access to the service Lesley Thomson advised training nurse practitioners for paediatrics to manage the demand profile for children. Maddy Halliday noted reference to public awareness and communication would welcome more information. Soumen Sengupta advised it’s an ongoing area of work and for patients to understand what the service is there for and the pressure the service is under. Maddy Halliday offered to support work in communities if required. She also asked if there are any accessibility issues for both sites as will note suit everyone geographically. Soumen Sengupta advised there are also home visits available and the work stream will review access issues. They are also considering cost of living pressures. Challenges with GP recruitment would welcome more information. Lanarkshire is different in terms of national picture have roughly 11% single handed practices. Need an attractive package to offer GPs and ANPs going forward; can send Maddy additional information if required. The committed acknowledge the work that has gone into this piece of work. IJB members are asked to: Note the position, performance and challenges facing the Primary Care Out of Hours Service in Lanarkshire, reflective of the issues Scotland-wide. Note the activities to progress the previously confirmed refreshed clinical model and supporting project.
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8 Endorse the development of an updated whole system Urgent Care Model. 9. Child & Adolescent Mental Health Services In January 2021, the Specialist Children’s Health Services Unit (SCHSU) was formed bringing a centralised approach to the operational delivery of children’s specialist health services across Lanarkshire. In April 2021, North HSCP received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. The CAMHS Modernisation Strategy 2021-23 articulates how CAMHS in Lanarkshire will implement the National CAMHS Service Specifications in addition to SG directives by March 2023. This has been previously presented to the IJB. In order to co-ordinate the further development of the Child and Adolescent Mental Health Services (CAMHS), NHS Lanarkshire has established the CAMHS Recovery and Renewal Programme Board with broad representation (appendix 2). This is chaired by the Health and Social Care Partnership Medical Director and has support from a Professional Adviser from the Scottish Government. The service has produced a service improvement plan (provided in appendix 2) which covers workforce; CAPA; accommodation; eHealth; communication and engagement; finance; and performance. The Programme Board will monitor timescales and key milestones. Lucy Munro outlined the different work streams as part of the plan. The waiting list initiative started in the last month have put on extra staff in evenings and weekends to reduce waiting lists; currently done over 100 extra appointments. Harry Robertson noted his thanks for the programme of work presented; this was echoed by other committee members. Maddy Halliday advised the CAMHS engagement officer has come to some meetings to discuss the programme. It is an opportunity to invest in community and voluntary sector would welcome some discussion; this was noted. It is recommended that Integration Joint Board: Note the progress of the programme and note further development steps
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9 10. Alcohol & Addiction Services North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on alcohol and drugs use issues locally. Members include agencies with an interest in providing treatment and intervention for people experiencing problem alcohol and drug use, and other key stakeholders. The following actions have been taken to progress NLADP response locally 1. ADP Strategic Lead and support team have established the appropriate structures/representation required to support approval and delivery of the ADP strategy in keeping with national priorities 2. Rapid Review of treatment and care services undertaken (Feb – May 2022) setting out key recommendations, actions and priorities to inform NLADP investment and planning 3. Additional investment for 2022 aligned with new funding streams and allocated 4. Residential Rehab oversight and operational groups established to review/establish robust pathways and processes with spending arrangements in place - details published 5. Residential Rehab training sessions complete with further briefings taking place throughout Autumn 6. Pan-Lanarkshire arrangements in place for MAT standards. Oversight and governance group established in September 2022 to drive forward plans to realise target to implement by March 2024. 7. Proposals and commissioning priorities identified by each sub-group to allow NLADP to configure and commission the most appropriate services beyond 2023 8. Workforce Development needs analysis launched to shape the learning and development programme required to realise the collective skills, knowledge and expertise required to deliver on our priorities 9. Additional funds allocated to support ongoing Test of Change initiatives, local stigma action fund and wellbeing support to tackle some of the root causes of problematic substance use in collaboration with VANL There are 5 work stream supporting to work they are working to national mission priorities to save lives overall. Group involve those with lived experience, front line staff and stakeholders. Action plan will be submitted to Scottish Government at the end of this month. Financial governance arrangements are well in place to manage expectations of funding. Will be bring further detail to the IJB PFA meeting. Brian Moore queried on behalf of Neil Findlay limited expenditures on residential rehab can we anticipate greater use in future. Morag Dendy noted do expect the numbers to increase the reason we had low number in the past is due to other options available. Resources across Scotland are
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10 stretched but reality of getting the right responses. The operational oversight group will seek to understand the decision making processes. Brian Moore asked is there a plan to address those areas identified in the deep dive that are not working. Morag Dendy noted currently reviewing these as part of the working groups. The IJB noted: (1) Note the content of the report; (2) Note the key actions to support the strategic direction of NLADP structures to deliver on the priorities in line with additional investment; (3) Note the additional investment and ring-fenced budget for each priority area; Medication Assisted Treatment (MAT) Standards Residential Rehab Assertive Outreach and Crisis support Harm reduction – including Naloxone provision Whole Family Approach and Family Inclusive Practice Lived and Living Experience (4)Approve NLADP Self-Assessment completion setting out the appropriate governance is in place to deliver the National Mission priorities and The Partnership Delivery Framework objectives. 11. Risk Register The PF&A Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PF&A committee considered the risk register at its last meeting on 31st August 2022. No changes to the risk rating were recommended at that meeting however the actions associated with each risk have been updated. Four new risks were added to the IJB Risk Register following the last meeting of the IJB: IJB 15/22 – Cost of Living impacts IJB 16/22 – National Care Service IJB 17/22 – Unscheduled Care and patient flows IJB 18/22 – Community Alarms There are currently three risks rated as Very High on the IJB risk register. IJB 08/21 – Financial Implications of Responding to Covid IJB 09/21 – Impact on the Strategic Plan due to Covid IJB 17/22 – Unscheduled care and patient flows These risks were reviewed in September 2022 and will be subject to further
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11 review with the new Chief Finance Officer as part of the financial planning exercise for 2022/23. One risk has been downgraded since the last meeting of the Committee, in line with the NHS Board’s decision to move from very high to high due to ongoing developments. IJB 14/22 (CAMHS) moved from very high to high following completion of the waiting list initiative which reduced the total number of waits by 16% and also due to ongoing progress in relation to recruitment with 59/102wte new posts now recruited from the Recovery and Renewal Funded posts. There are seven high rated risks on the IJB risk register. 1. IJB 01/21 - Financial Challenges 2. IJB 04/21 - Notional Set Aside Budget 3. IJB 13/21 - Impact on discharge performance linked to care home 4. IJB 12/21- Staff Health & wellbeing 5. IJB 14/22 - CAMHS 6. IJB 15/22 – Cost of Living 7. IJB 16/22 – National Care Service The IJB Committee is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. It was noted the report shared had cut off the 4 new risks. The committee approved the report subject to updated risk report being shared with the committee for any comments. 12. Participation & Engagement This is a follow up to the report submitted to Committee on 16 February 22 and is intended as a progress update on the development of our approach to supporting Engagement & Participation through the Delivering for Communities agenda. As previously reported, there is a long and established track record of engagement and participation within health and social care in North Lanarkshire. Our approach facilitates the involvement and engagement of people, carers and families, community and voluntary sector organisations and the independent sector in the development of services and support for people across our communities. It has been recognised that while our structure(s) offer opportunity for multiple levels of engagement that is more than purely attendance at meetings, this presents a complex picture across the partnership that can be inflexible and perceived as tokenistic. Our ambition is to create a more robust process that promotes active participation and meaningful engagement that helps shape, inform and develop the whole system into the future.
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12 A review our engagement and participation structure(s) (HSCNL Review of engagement and participation structures - April 22) resulted in recommendations to support our overarching intentions to facilitate active participation, that demonstrates shared accountability, is place based and addresses inequality. To implement the recommendations from the review, a programme of work to create a true co-produced approach, building on the successful partnerships already established across our networks and with third sector providers already delivering services across our communities, is underway. It is intended to: be community led help embed our Engagement & Participation Strategy into practice align with the revised operational structure of the H&SCP establish robust links with Community Boards consider the lasting impact of COVID-19 and recovery of services Ally Boyle queried development of our health together work with engagement and participation. Morag Dendy confirmed have monthly meetings with relevant colleagues to consultant on issues. The Committee is asked to endorse our approach and the contents of the report; this was noted. 13. Strategic Commissioning Plan Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020–23. The 2023–2026 SCP will be the final plan within the ten-year strategy. Along with Safer, Healthier, Independent Lives 2016–2026, the SCP is informed and shaped by The Plan for North Lanarkshire and Achieving Excellence. Achieving Excellence, a plan for person-centred, innovative healthcare for people in Lanarkshire, is currently being refreshed. Expecting a draft version to come back to IJB in December with a final period of consultation before final sign off in March 2023. The IJB agreed the following recommendations: Seeking endorsement of our approach from IJB Seeking promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26
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13 14. National Care Service –Progress Update On the 9th August 2021 the Scottish Government launched a consultation on a ‘National Care Service for Scotland’ as its principle response to the Independent Review of Adult Social Care (IRASC) which it has commissioned the previous year and which reported in February 2021. The National Care Service (Scotland) Bill was introduced to parliament on 20th June, and its accompanying documents on the 21st June, 2022. The Bill seeks to provide a framework for the establishment of a National Care Service within the lifetime of the current parliament. Views will now be collated by the Parliamentary Committees and the whole Parliament will vote on whether to continue with the Bill in its current form in early 2023, concluding Stage 1 of the process. If agreed, MSPs will have the chance to propose amendments to the Bill at Stage 2. Finally, the whole Parliament will again vote on whether to pass the final Bill in summer 2023, concluding stage 3 of the process. There are significant risks to the organisation within the NCS bill so need to work out how to best maximise opportunities and be part of the co-production process. Des Murray noted there has been written evidence submitted by a number of agencies. Social work Scotland noted that all services including children should be part of the bill as if not it will be a great risk. They submitted an open letter last week requested that the process is held as the bill does not meet requirements there is no detailed funding and what scale of service this would cover. COSLA took the decision to not engagement in co design process. Heather Knox added from a health point of view it does fracture acute and community services relationships. It is a costly process at time of a tightening fiscal position so not clear how will be offered. John Watson noted from trade union point of view concerned for member’s pensions and will continue to input into the process. Cathy McGinty asked was any of the consultation input taken into consider, it was confirmed this was not. The IJB Committee noted: The response to the Bill and the next steps in the NCS consultation. 15. Tackling Poverty In line with the Plan for North Lanarkshire and the Council’s Programme of Work, the report attached in appendix 1 sets out the progress on
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14 implementation of the Fuel Poverty Hardship Payment Scheme, which was approved by the Community Empowerment Committee in November 2021. The report covers the period of January to June 2022, where over 8000 applications were received, with payments totalling over £913k being made to households who met the eligibility criteria to date. Crucially, all applicants to the scheme were offered the opportunity of receiving a benefit check, money advice and fuel advice. Proposals for the new scheme to be actioned from October 2022 are currently moving towards approval within North Lanarkshire Council. The fuel poverty hardship payment plays an important role in supporting North Lanarkshire residents through the winter period, which will only be exacerbated by the current cost of living crisis ahead of winter 2022/23. Considering funding a cost of living helpline for a period. Ross McGuffie plans to bring a business case to consider supporting this to a future committee. Cllr Larson queried what would the cost be for the help line. Ross McGuffie advised have previous experience of phone lines for other services so can use this to build into this but not sure of exact costs yet. Cllr Larson also asked how would we measure success of helpline not duplicating the work of the 3rd sector- Ross can share previous data to support quality measures. Ken Adamson advised team are looking to reduce eligibility criteria to get the money moving quicker. The committee noted the report. 16. Financial Inclusion Team Activity In line with the Plan for North Lanarkshire and the Council’s Programme of Work, the report attached in appendix 1 sets out activity within the Council’s Financial Inclusion Team during 2021/22. Over the financial year, the team generated over £35m of additional benefit income for the residents of North Lanarkshire, with externally commissioned services generating over £5m, bringing the overall total to over £40m. The report notes some of the challenges brought about by the pandemic response as well as the continued Welfare Reform agenda and its impact on the local system. The Financial Inclusion Team continues to play a vital role in providing service users and members of the public with advice and assistance on a variety of benefits related issues.
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15 Income maximisation is an ever more crucial role given the current cost of living crisis and work continues to develop the ‘routine enquiry’ across all health and social care services to maximise the number of individuals who can be supported through the service. Brian Moore queried if working with Scotland social security. Des Murray advised meeting with them around joint working arrangements regularly. 17. Risk There was no new risks identified by the committee. 18. Date of Next Meeting 7th December 2022 @ 2pm