Agenda Pack
North Lanarkshire Council · 22 March 2023
Back to Health and Social Care Integration Joint Board — 22 March 2023 and its agenda
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A meeting of the IJB will be held on Wednesday 22nd March 2023 at 2pm – 4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: AGENDA No Item Action Attachment Reporting 1. Welcome and Apologies 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes of the Meeting of the IJB held on 30.11.22 For Approval Attachment Chair 4. IJB Action Log For Approval Attachment Ross McGuffie PERFORMANCE & FINANCE 5. IJB Reserve Strategy For Approval Attachment Amanda Kilburn 6. Medium Term Financial Plan 2023 For Approval Attachment Amanda Kilburn 7. Financial Monitoring For Noting Attachment Amanda Kilburn 8. Delegated Health & Social Care Budget 2023/2024 For Approval Attachment Amanda Kilburn 9. Annual Audit Plan For Noting Attachment Amanda Kilburn 10. Resilence Update For Noting Attachment Ross McGuffie GOVERNANCE 11. Amendment to Terms of Reference For Approval Attachment Amanda Kilburn
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2 12. Risk Register For Approval Attachment Ross McGuffie 13. Risk Management Strategy For Approval Attachment Ross McGuffie 14. Category One Responders For Noting Attachment Ross McGuffie STRATEGIC PLANNING 15. Strategic Commissioning Plan 2023-2026 For Approval Attachment Morag Dendy 16. HSCP Website Update For Endorsement Attachment Morag Dendy 17. Chryston Community Health Clinic Update For Noting Attachment Maggs Thomson 18. Improving Cancer Journey For Approval Attachment Morag Dendy 19. Chief Social Work Officer Annual Report For Endoresment Attachment Alison Gordon 20. IJB Directions Report For Approval Attachment Ross McGuffie 21. Volunteering Strategy Report For Approval Attachment Maddy Halliday 22. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls 23. Date of Next Meeting For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 30th November 2022 at 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Gerry Brennan North Lanarkshire Nominated Councillor Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Ayeshah Khan (Chair) North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director James Muir 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: Stacey Connor Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Maddie Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director NLHSCP Gillian McCreadie Audit Scotland Marie McFadden Audit Scotland Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) Maggs Thomson Head of Health North HSCP APOLOGIES: Councillor Bob Burgess North Lanarkshire Council Nominated Councillor
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2 Dr Kenneth Dagg Secondary Care Medical Practitioner ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB 21.9.22 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. The following updates were noted by the committee: Item 1 Reserve Strategy- This will be brought to March 2023 committee to align with SCP. Item 4 Addictions Services- Ongoing updates on progress scheduled into forward plan for PFA. Item 5 Category One Responders - Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23. 5. External Auditor Annual Audit Report This report:- 1. Outlines the outcome of the audit by the North Lanarkshire Integration Joint Board’s External Auditor, Audit Scotland: 2. Advises that the External Auditor has submitted an Annual Audit Report setting out their key findings for the consideration of the members of the Integration Joint Board (IJB); and 3. Provides details of the proposed management response to the action points detailed in the External Auditor’s Annual Audit Report.
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3 The External Auditor’s Annual Audit Report on the IJB Annual Accounts extend across several subjects- IJB Annual Accounts 2021/2022, Financial management and sustainability; and Governance, transparency, and best value. The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2021/2022 give a true and fair view of the net expenditure of the year and have therefore issued an unqualified independent report. The report includes the key messages and an action plan on pages 20 to 21 which have been agreed by both the Chief Officer and the Chief Finance Officer. The External Auditor highlighted that there are no significant findings to report the North Lanarkshire IJB Annual Accounts 2021/2022 and no misstatements were identified. Marie McFadden drew the committee’s attention to page 29 within the report. A draft letter of representation has been provided within the report which will be signed prior to report being issued. The recommendations made within the report are as follows: 1) The notice of inspection should state the objection end date and the advert should be posted on the IJB website in addition to the North Lanarkshire Council website. 2) The IJB should develop a reserves strategy for 2022/23 which sets out how and when monies will be spent. 3) The financial regulations should be reviewed to ensure they remain up-to-date and fit for purpose. The chair, Amanda Kilburn and Ross McGuffie are invited to sign off the documents after the committee. Marie McFadden asked the committee to their knowledge is there any suspected fraud activity; members were invited to make contact to advise if this was the case. The committee had no questions. The IJB agreed the following recommendations: (1) Consider the External Auditor’s Annual Audit Report, attached at appendix 2, in advance of the approval of the IJB Annual Accounts 2021/2022; (2) Note that an unqualified audit certificate has been received in respect of the North Lanarkshire IJB Annual Accounts 2021/2022; and (3) Approve the management response to the action points which is highlighted at pages 20 to 21 of the External Auditor’s Annual Audit Report, attached at appendix 2.
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4 6. Audited IJB Annual Accounts The report tabled provides details of the unsigned audited IJB Annual Accounts 2021/2022 for consideration and approval by the IJB. The IJB Annual Accounts 2021/2022 were prepared in accordance with the requirements of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable, and prudent judgement were made, and proper accounting records were maintained. The preparation of the unaudited annual accounts also met the statutory deadline of 30 June 2022. The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2021/2022 give a true and fair of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report. The findings of the audit process have also been reported to the IJB and an action plan approved as set out in the External Auditor’s Annual Audit Report. Maddy Halliday noted the uplift in income is less than the inflation rate. Also it would be good to have wider stakeholder engagement when the website is refreshed; this was noted. Brian Moore asked on p11 of the report in terms of learning from covid has a review been undertaken. Ross McGuffie advised this has been reviewed as part of the SCP engagement work. The IJB agreed the following recommendations: (1) Note that the External Auditor’s audit opinions are all unqualified in respect of the IJB Annual Accounts 2021/2022; (2) Approve the IJB Annual Accounts 2021/2022 for signature; and (3) Note that the signed audited IJB Annual Accounts 2021/2022 will be available to view electronically at the following website: https://www.hscnorthlan.scot/key-documents/ 7. Financial Monitoring The report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 30 September 2022 (Health Care Services) and 1 April 2022 to 14 October 2022 (Social Work and Housing Services). The financial position as at September 2022 is summarised as follows: there is a net underspend of £3.838m on the core budgets within Health Care Services
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5 there is a net underspend of £3.820m on the core budgets within Social Care and Housing Services The total underspend represents approximately 1.1% of the total financial envelope available. There is a net underspend of £1.182m. The net underspend on pay costs totals £1.598m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities totalling 62.46 FTE. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. In respect of non-pay costs, there is a net overspend totalling £0.416m. The overspend is mainly due to payments in respect of Strathcarron Hospice (£0.285m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. The Covid-19 pandemic has created significant financial management and financial planning challenges for both partners and the IJB. These challenges have centred around the difficulties in predicting the costs associated with the recovery from the Covid-19 pandemic. The 2022/2023 Covid-19 costs are being reported to the Scottish Government through the Lanarkshire Finance Performance Return on a monthly basis. There continues to be a significant degree of uncertainty in respect of the financial implications of the Covid-19 pandemic however the Scottish Government have advised IJBs that they will reclaim surplus Covid-19 reserves to be redistributed across the sector to meet current Covid-19 priorities. There is ongoing dialogue with the Scottish Government in respect of this potential reclaim. Cllr Kelly asked for clarity on Scottish Government timescales around claiming back covid 19 reserve and is there any other intelligence from other IJBs. Amanda Kilburn advised there has been no indication when this will happen and what the amount will be, although data has been submitted for period 6 and 7. This is a standing agenda item on the CFO national group; other boards are in the same position. Ross McGuffie noted have submitted projections for spend in year which will be protected and will look at any surplus to redirect into the wider system. So any claw back will be based on this. The challenge is when funding is in reserves can only spend on delegated services. The committee noted the points raised and will consider if an additional meeting is required when clarity is issued from Scottish Government. Des Murray proposed the committee may wish to seek legal advice regarding the situation also.
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6 Brian Moore noted nationally there is a high profile on agency staff, it would be useful to get figures in relation to the spend on this area within Lanarkshire. Ross McGuffie noted this can be included in future reports, there are governance process in place before agency staff are used and require senior management approval. The IJB noted the following recommendations: Note the contents of the report; and Note that the financial position in September is an underspend of £7.658m (NHSL - £3.838m; NLC - £3.820m). This excludes the impact of further recruitment challenges and staff turnover and any potential new Scottish Government funding. 8. Covid Update As at 18th November, the seven-day case rate within North Lanarkshire is 35.2 per 100k population, which is a small decrease to the figures last presented to the IJB PFA from 31st October when it was 49.8 per 100k. As of today got 66 covid positive inpatients, 7 care home outbreaks covering staff and residents- to note care home outbreaks usually indicate increase in community transmissions. Delayed discharges been sitting in 80s/90s there has been an increase in volume of referrals for supported discharge which has been challenging. Had number of delay in moves to care home but this has improved. Currently got 21 complex applications in the system, challenge with these case if there is a guardianship application can take up to 13 weeks to be completed. Adults with Incapacity (AWIs) make up half delayed discharge patients. The Mental Welfare Commission (MWC) and Scottish Government have issued new guidance on AWIs, hoping this change in legislation will aid individuals to move quicker through the acute system. Ross McGuffie advised there was a whole system planning session held on 24th November which include the health board, South HSCP and North HSCP colleagues. An action plan has been agreed to be completed by the end of the year. 1.8m covid vaccine doses have been provided to date, still not as high as anticipated which has been an issue nationally. Promoting communication and clinics to encourage uptake. The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at 18th November, there are 53 covid positive inpatients and a further 3 in offsite facilities, which in total is a decrease of 24 compared to the position on 31st October.
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7 Cllr Kelly noted tribute to staff across the partnership supporting patients to get back to the community. Ross McGuffie will pass this on. Cllr Kelly also asked can we cope with covid currently levels and have we looked at projection of potential staff absence levels. Also what has been the impact of flu this year. Ross McGuffie acknowledged it is challenging to predict absence levels, Public Health’s view is seeing a rise in younger age groups but the school holidays will aid a break. Although acknowledge that things can change quickly if any new variants become apparent. More concern around flu cases this year, acute sector is running at capacity currently so it would be a concern if there was a great increase in demand. Dr Lucy Munro noted flu numbers are above baseline and they are being monitored due to impact in Southern hemisphere. The IJB noted: (1) 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. 9. Quality Assurance The report highlights Quality Assurance activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. Key part of the work are outlined below: Contracts - In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. Contract Management - A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up-to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring
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8 frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. Regulatory Activity - During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. Provider sustainability - Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. Procurement - A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement. Children, Families and Justice - Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. Complaints - Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. Maddy Halliday noted complaints are included in the paper is there any scope to include user satisfaction and feedback in future. Also may be an opportunity to link with community solutions. Morag Dendy noted in refresh of SCP will be inclusive of this information. Brian Moore noted the report focuses on council contact processes, should reflect integration arrangements around duty of candour. Morag Dendy
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9 noted did meet colleagues in NHS procurement, information will be included in future reports in a more reflective way. Trudi Marshall noted there is a whole remit of work which could also be included in this. Cllr Brennan noted complaints received within the report are relatively low. Need to work on duty of candour issues as note no family wanted to be involved in reflective process. Morag Dendy acknowledge the team have considered different ways of involving families in the process and were assured they were supported exhaustively. The Committee endorsed the contents of the report. 10. Risk Register The purpose of this report is to provide a summary to the Integration Joint Board (IJB) on risk management activity, noting any amendments or additions to the current risk register. Four new risks were added to the IJB Risk Register and agreed at the September meeting of the IJB: IJB 15/22 – Cost of Living impacts IJB 16/22 – National Care Service IJB 17/22 – Unscheduled Care and patient flows IJB 18/22 – Community Alarms 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 on 2nd November 2022 and will be subject to further review with the new Chief Finance Officer as part of the financial planning exercise for 2022/23. There are seven high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21 - Staff Health & wellbeing IJB 14/22 - CAMHS IJB 15/22 – Cost of Living The IJB noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business.
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10 Ross McGuffie noted CAMHS and Staff Health Well-being risks have been updated after discussion at PFA. The risk sharing form is being updated to be used across the 2 partner organisations, adapting to include council risk as part of updated policy; planned to bring to March IJB. Maddy Halliday queried for the cost of living risk should this be rated very high risk as opposite to just high; particularly around the impact on staff. Ross McGuffie noted in terms of organisation risk this is being picked up on the finance risk register also but will continue to review and see what other mitigating measures need to be in place to manage the risk. Cllr Brenan noted in relation to community alarms why is the risk rated as high and how many workers do we have in the service. Ross McGuffie noted high risk is due to digital change over. At PFA approved on going procurement of devices to mitigate changes and working closely with providers. As part of winter business case looking to expand staff within the service. 11. Whistleblowing Annual Report The National Whistleblowing Standards and Once for Scotland whistleblowing policy (the Standards) were introduced on 1 April 2021. The Standards are applicable across all NHS services. This means that they must be accessible to anyone working to deliver an NHS service, whether directly or indirectly. It is a requirement of the Standards to formally and routinely report whistleblowing performance to NHS Boards, including the preparation of an annual report. The NHS Lanarkshire Whistleblowing Annual Report for 2021/20 was presented to the NHS Lanarkshire Board at its meeting of 31st August 2022. At that meeting the NHS Board confirmed that it had received assurance that whistleblowing standards are being followed and learning shared. Lesley McDonald noted all concerns raised last year related to acute hospitals.; for those concerns partially upheld it has led to staff improvements. The Integration Joint Board: 1) note the NHS Lanarkshire Whistleblowing Annual Report for 2021/20; and 2) note the assurance received by the NHS Lanarkshire Board that whistleblowing standards are being followed and learning shared. 12. Strategic Commissioning Plan The 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.
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11 Health and Social Care North Lanarkshire has held extensive engagement in the development of the draft Strategic Commissioning Plan 2023-26. The draft plan will be subject to further consultation in January and February 2023 before seeking final approval in March 2023. 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. 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. 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. There are 5 priorities and ambitions within the draft plan: 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 Cllr Brennan asked how does links with the housing department work in practical terms in relation to delayed discharges. Particularly to look at areas where there is capacity in the system to aid the discharge processes. Morag Dendy noted it links to the housing strategy as part of the SCP to work together which is integral to the plan. The programme of work will better demonstrate the details and housing colleagues are part of local planning groups and part of Planned Date of Discharge (PDD) meetings too. Going forward can consider how best to evidence this support. Brian Moore drew attention to the strategic needs assessment, how do we use this information to be more targeted to local intelligence to those in need of more resources. Morag Dendy noted this is considered as part of local planning groups. Maddy Halliday noted the report would benefit by being more upfront to show links to whole system. Morag Dendy noted this is 1st draft so some of the language will be refined further as we get closer to a final report.
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12 The IJB: (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. 13. MH HB CCC Beds At present, NHS Lanarkshire has two contracts for the provision of HBCCC beds, which were originally established in the early 1990’s. These contracts were originally devised to assist in the transition from centralised facilities in Hartwood Hospital and other older outlying facilities such as Cleland Hospital to more modern community placements throughout Lanarkshire. The contracts relate to: Cumbernauld £2,021,180 per annum originally for 60 beds, now reconfigured to 52 beds. Hattonlea Care Home in Bellshill which is operated by HC-One at an annual cost of £3,138,067 per annum originally for 90 beds, now reconfigured to 75 beds. The total cost of both contracts is £5,159,247. Both contracts have a 12- month notice period. Based on this falling demand, the NHS Board and IJBs agreed in March 2020 that a business case be developed for the consolidation of contracted HBCCC provision onto the site at Hatton Lea, providing an enhanced pan- Lanarkshire service within the existing terms and conditions of the contract with HC-One. However, due to the impact of the pandemic, the planned work was delayed as it was not possible to undertake any consultation work within the Care Home environment due to the risk of Covid-19 spread. Work commenced again at the end of 2021. An Engagement Planning Group was established with patient and carer representatives and staff to work through an options appraisal process to ensure that all options were identified, to test the original proposal against these and carry out an Equalities Impact Assessment. Following the national change in definition of HBCCC, demand for Mental Health Continuing Care has continued to decrease, resulting in reducing occupancy levels in the contracted beds in Cumbernauld Care Home and Hatton Lea. The IJB is asked to approve the attached business case for the consolidation of contracted HBCCC inpatient provision service onto one site for both North
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13 and South Lanarkshire residents, subject to endorsement by South Lanarkshire Integration Joint Board and Lanarkshire NHS Board. Once final approval is reached will begin engagement with provides to start the changes. Looking a reinvesting to expand MDT as part of the cost saving exercise to enhance care on offer, any saving will be split 51/41 across South IJB. Maddy Halliday queried for residents in Hattonlea are they fully funded. Ross McGuffie confirmed this is fully funded NHS care in a specialist unit. The IJB agreed the bellow recommendations: 1) Approve the attached business to consolidate the provision of Hospital Based Complex Clinical Care for old age psychiatry patients at Hatton Lea Care Home, providing a pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. 2) Approve the termination of the existing contract with Four Seasons for HBCCC beds at Cumbernauld Care Home. 3) Approve the use of a proportion of the savings achieved to establish an enhanced multi-disciplinary staffing model at Hatton Lea 14. Supporting Unpaid Carers This report is intended to provide an update the support in place for unpaid Carers across our communities and to seek endorsement of our approach to ensure continuation of support. We recognise that unpaid Carers of all ages play a vital role in the lives of the people they care for and the Council is committed to supporting Carers to ensure they can continue to provide that care for as long as they wish. The Carer Breather pilot over a period of 18 months is due to end in March 23. Early feedback on the success of the pilot has been very positive, particularly from those who were able to have a break together and for those providing care but who did not necessarily wish to identify with a carer’s organisation. Liz Seaton noted some of the stories at carers together are harrowing due to cost of living pressures, so it is well received to see this report outlining support offered. Cllr Kelly noted some of the issues are out with carers control so this will need to become more of national issue to offer the support required. Maddy Halliday if unpaid carers can’t continue to provide support formal system will have additional pressures leading to them struggling to manage. So this work forms a foundation for early prevention and intervention work.
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14 Cllr Brennan asked how we identify unpaid carers prior to a patient discharge is there a support plan put in place. Mora Dendy noted doing a lot work in communities so there is an opportunity for those who don’t automatically identify as a carer to still be supported. Currently involve important family member as part of the discharge process. The IJB committee note: a) The content of the Report is noted b) Our approach to supporting unpaid Carers is endorsed. c) Note the request to extend service contracts is endorsed to ensure a continuation of support is available for unpaid Carers. 15. Net Zero The purpose of this report is to provide a summary to the Integration Joint Board (IJB) on Climate Change reporting requirements and seek approval for submission of the annual Climate Change report to the Scottish Government. The IJB is also asked to note correspondence from Michael Mathieson, Cabinet Secretary for Net Zero, Energy and Transport, highlighting a strengthening in Climate Change reporting requirements for public bodies. Mandatory reporting legislation in relation to Climate Change came into force in 2015 with the IJB, as a public body, required to report annually on compliance with climate change duties. The relevant legislation is the Climate Change (Duties of Public Bodies; Reporting Requirements) (Scotland) 2015 and the associated amendment order of 2020. North Lanarkshire IJB has complied in full with reporting requirements since the enactment of the legislation. Further guidance specific to IJBs was issued by the Scottish Government Domestic Climate Change Division for the 2021-2022 reporting period. This guidance relates to areas that NL IJB already reported on, including the structure of the IJB and its links to the bodies it is in partnership with. There is also a requirement to report on Greenhouse gasses and other emissions, where possible, and as requested, links have been made to the reports to be submitted by North Lanarkshire Council and NHS Lanarkshire, the bodies with responsibilities in these areas. Maddy Halliday noted could support a partnership initiative going forward; this was noted. The IJB is agreed the contents of the Climate Change report prior to its submission. 16. Cost of Living Helpline Report Given the severity of the current cost of living crisis resilience arrangements were however stood up by the Council to support planning of further
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15 mitigating measures with partners. The detail of these is reflected in the second report provided at section 7 as a background paper, ‘Cost of Living Response’ In view of the likelihood that the current cost of living crisis will exacerbate existing health inequalities through its wider impacts on physical and mental health and well-being and its strong commitment to prevention, the Health and Social Care Partnership have been keen to explore options to enhance the early help and advice available to individuals and families impacted by the current crisis, identifying this as a potential priority which could be supported, if agreed , through current reserves. In particular, the partnership has considered the potential to fund and promote a ‘helpline’ resource. The funding required is £300,000, each year over two years 23/24 and 24/25 (£600,000 in total) which will allow the Tackling Poverty Team to recruit staff as soon as possible. This will provide additional support to the Lanarkshire population. It would be the intention to report back to the IJB Board under the same cycle of reporting back to the Council’s Wellbeing and Tackling Poverty Committee, with the first update due in February 2023. Cllr Kelly noted the cost of living covers all aspects for people, need to ensure individuals running the helpline have information and resources available that are required. Also how will the service be promoted. Ross McGuffie advised have press release ready to go if the business case is approved. As part of this process working with the team to ensure there is wrap around support to look at where people are being sign posted to and to look at having the right supports in place. Maddy Halliday noted VANL have been liaising with council colleagues to advise of services available from them. Dr Lucy Munro noted Vicki Trim within the Health Improvement team is doing further tests of change with community nursing and linking with our AHPs regards routine enquiry. Brian Moore noted would be seeking regular updates from the work and would like to be clear where the funding is coming from as an audit trail. Ross McGuffie noted this will be included in the reserve strategy at year end. The IJB agreed the following recommendations: 1) Approve the proposal for the Helpline; and 2) Approve the funding request for the enhancement of the Tackling Poverty Team. 17. Winter Plan Planning for Winter 2022/23 commenced in July 2022 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire
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16 approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). On 04 October 2022, Scottish Government published a Winter Resilience Overview 2022-23 which set out the actions they are taking in an effort to support the sector over the winter period. That guidance set out the national expectations for those areas that local winter plans would be expected to address. As will be clear from the body of this report most of the areas identified already feature as part of the Lanarkshire winter planning process; are being reviewed/refined to ensure that they are as up to date as can be and resourced appropriately given available capacity. The guidance was further reinforced by subsequent correspondence to Chief Executives and Chief Officers on 12 October 2022 and 17 October 2022, the latter including a checklist for completion. Following a national event on 19 October 2022, further guidance was issued and an associated operational self-assessment on winter preparedness was issued. The submission made by the 7 November 2022 deadline reflected the content of this report. Discussion is still ongoing at national and local level on available funding to manage the impact of Covid 19 and ongoing pressures associated with both unscheduled and planned care. Work is ongoing between the NHS Lanarkshire Director of Finance, the two Chief Financial Officers of the IJBs and Council Finance Directors to be clear of those monies which have already been committed to meet ongoing service pressures/respond to previous Government policy; and that which may be available to support any new proposals. Ross McGuffie brought attention to discharge without delay work being reviewed ahead of the festive period. Looking to create some additional capacity in the system based on learning from frailty unit in Monklands. Part of this includes looking to identify wards with highest levels of falls. Looking to increase community capacity as much as possible too. Adverse weather is looking an increased risk, getting access to 4x4 and joined up visits are being planned. Supporting patients to access rights service via communications to save pressure at front doors. Cllr Kelly noted majority of patients go into to hospital and are discharged without delays. Also around staff well-being are we linking to cost of living work particularly around fuel costs etc. Ross McGuffie noted staff communication has included information on supports available. Brian Moore queried for interim beds are care homes still not interested in engaging. Ross McGuffie advised some individuals did meet this criteria but
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17 could only identify limited beds which took 7 days for them to be ready. Need to be careful if using this approach ensuring it is right for individuals. Maddy Halliday noted if some providers are unable to continue their services this would put additional pressures on the services, what is the awareness around some of those close to this. Ross McGuffie noted this is challenging to obtain data on as each provider is different but there are some providers struggling already so supporting them as best we can currently Have the sustainability payments for providers to access. John Watson noted vacancies across the council are at a critical staffing levels, need to look at attracting new staff and also on how to retain current staff not moving to other areas. Ross McGuffie advised currently working on some resilience work to see what is available and maximise recruitment learning from approaches used by other partners. Alison Gordon advised been working with HR colleagues to manage issues- looking at general support and also support around finance. Alison offered to meet John Watson to discuss out with the meeting to discuss most recent work undertaken. Cllr Kelly offered assurance that concerns raised are being managed. Cllr Brennan asked would there be merit to look at short liaise with those providing meals. Ross McGuffie certainly something can look into in future. The IJB agreed the contents of the Climate Change report prior to its submission. 18. Risk Ross McGuffie noted there will be continual review of cost of living risk by the HSCP team prior to next meeting 19. Date of Next Meeting Stacey Connor to issue members with future dates.
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. June 2021 November 2021 – deferred to IJB December 2021 deferred to March 2023. Complete Reserve strategy presented to IJB PFA on 16th Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda
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2 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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3 meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Complete Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IIJB PFA
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4 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. March 2021 September 2021 December 2021 Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23 6. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB March 2022 – draft guidance shared with NLC and awaiting comment December 2021 December 2022 Ongoing Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final business case to Dec IJB.
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5 Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete. 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update to be provide after year- end figures 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete
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6 ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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7 CLOSED ACTIONS 1. NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 2. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 3. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete
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8 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care Community Alarms (Analogue to digital) National Care Service September 2022 Complete
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1 REPORT Item No: 5 SUBJECT: IJB Reserves Strategy 2022/2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves and seeks approval to establish new reserves in line with the planned commitments and Scottish Government guidance. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Finance Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; (2) Approve the proposed transfers to earmarked reserves in section 7.5 and (3) Approve the proposed realignment of reserves in appendix 1. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Consistent with a number of other Health and Social Care Partnerships, an underspend was reported to the IJB on 22 June 22 totalling £74.67m and was transferred to reserves. This 2021/2022 underspend included funding received to meet the ongoing cost and recovery to the Covid-19 pandemic and also funding made available by the Scottish Government to progress policy commitments and national priorities. 6. CONCLUSIONS 6.1 The IJB Reserves Strategy 2022/2023 provides an opportunity to strengthen long- term financial sustainability by considering the allocation of the 2021/2022 underspend to the strategic priorities of the IJB and both partners. The IJB Reserves Strategy 2022/2023 will enable the IJB to balance current commitments whilst planning and addressing financial risks. Yes No N/A
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2 6.2 It is essential for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that section 106 public bodies do not over- commit themselves financially. 7. IJB RESERVES STRATEGY 2022/2023 7.1 As detailed in the summary table below, the reserves balances at 31 March 2022 were £119.452m. This figure comprised of £70.05m earmarked reserves to support the delivery of projects which span financial years and £45.718m ring-fenced monies to enable the IJB to deliver on specific Scottish Government funded programmes. The remaining balance of £3.684m, is contingency reserves which are not held to meet any specific liability and offer the IJB some flexibility to deal with unforeseen events or emergencies. 7.2 A further in-year analysis and review was carried out with both partners in respect of all reserves to ensure the reserves held in 2022/2023 were still required and sufficient to meet on-going pressures. 7.3 As a result of this review, it was evident that some of the reserves were no longer required for their original purpose. This has been driven by two key factors; (i) due to the pandemic, delay to specific projects has resulted in changes and redesign to services, making the held reserve no longer fit for purpose; and (ii) the need to consider the utilisation of reserves in the context of the IJB Strategic Commissioning Plan 2023-2026 and the range of uncertainties that remain as a result of the National Care Service proposals and December emergency budget. 7.4 Following on from the above, a proposed realignment of reserves has been determined, as summarised in Appendix 1. The revised structure of the reserves will continue to enable the IJB to meet its agreed strategic objectives, and Scottish Government policy requirements. 7.5 In particular, it is proposed that new earmark reserves are created for the following purposes: £3.498m home support resilience reserve to support the effective recruitment and retention of home support staff by maintaining and increasing the number of pool cars available to the service and offering home support worker incentives. £2.4m staff training academy reserve to assist the development of staff by offering apprenticeships and support to implement a HSCP ‘Grow our Own’ initiative in recognition of the ongoing challenges in recruitment and retention and a national shortage of key skills. Balance As At 31 March 2022 £m Ring-Fenced Reserves 45.718 Earmarked Reserves 70.050 Contingency Reserves 3.684 Total 119.452 SUMMARY
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3 £2.653m Local Government pay award reserve to assist with the on-going staffing pay pressure. This will cover 2023/24 financial year only and will be replaced by a recurring budget in 2024/25. £1.208m vulnerable and complex cases reserve to provide co-ordinated, person- centred, care managed approach with individuals who have often become disengaged and need assistance to be re-directed and reconnected to appropriate services within the Health and Social Care settings or the community. £828k breast feeding team reserve to introduce a peer support model to improve breastfeeding initiation and reduce attrition and to introduce a seven-day support provision to deliver person centred care through the mother’s postnatal journey from hospital discharge to one year post birth. £600k IJB cost-of-living helpline reserve to maintain and enhance the existing single point of contact for advice on a range of impacts from the cost-of-living crisis. This would provide one gateway for residents to receive direct advice and where required a direct route to follow up appointments for support. £550k three-year investment within the neonatal unit to provide dietetic support to preterm and sick infants. This earmarked reserve will provide premature babies with dietetic intervention aimed at reducing morbidity and mortality rates, reducing length of hospital stays, improving short and long-term neurodevelopment and growth outcomes and providing support to parents/carers. £450k Stigma Free Lanarkshire reserve to continue investment in addressing challenging mental health stigma and discrimination in line with the outcomes in the Lanarkshire Mental Health Strategy. £444k long covid pathways reserve to support people with long term effects of Covid- 19 where their physical and mental wellbeing has suffered. This earmarked reserve will allow continued investment in recruitment to deliver improved care and support for people living with long Covid and will ensure it remains a priority. £212k Chryston Community Health Clinic reserve to fund the repatriation of services under ‘The Plan for North Lanarkshire’ which sets out an estates strategy to develop community hubs and campuses. £187k HR employability staffing reserve to fund a dedicated HR team within health with the cost split 50:50 between North and South Lanarkshire partnerships. £260k organisational development reserve to support the 2023/24 organisational development plan focussing heavily on sector and unit management team development. £98k funding for additional posts within Psychology to help with the substantial waiting lists by extending trainee contracts until March 2023. £90k assistive technology reserve which will fund a 12-month contract that provides a service to the council in assessing, recommending, and procuring assistive technologies to enable our employees with a disability or impairment to maximise their ability to work effectively. 7.6 The IJB is therefore asked to approve the realignment of reserves as summarised in the table at appendix 1.
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4 7.7 Following approval from the IJB the revised summary position is below with a detailed analysis at appendix 2. 8. COVID-19 RESERVE 8.1 Scottish Government have processed the return of uncommitted North Lanarkshire Covid-19 reserves totalling £24.051m. 8.2 The table below shows the current position: 9. RISK 9.1 As part of the development of the financial plan and in line with the North Lanarkshire IJB Medium to Long Term Financial Plan 2020/21 to 2029/30, if possible, it is recommended that the risk-based and contingency reserves are established as a percentage of the financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 9.2 The IJB contingency reserves currently equate to 2% of the financial envelope, however, following completion of the 2022/2023 financial year end, it is anticipated this percentage may increase. 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 10.3 FINANCIAL This paper has been reviewed by Finance: Opening Balance After Review Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) - 119.453 (23.944) (26.271) 69.237 LEAD SUMMARY Total Opening Balance As At 1 April 2022 Drawdown from Reserves Return of Covid-19 Reserves to Scottish Government Revised Balance As At 31 March 2023 £m £m £m £m Covid-19 Funding 29.677 (2.957) (24.051) 2.669 Covid-19 Funding - Unscheduled Care 1.944 (1.620) 0.324 TOTAL 31.621 (4.577) (24.051) 2.993 Ring-Fenced Covid-19 Reserve
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5 Yes No N/A 10.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 8. 10.5 PEOPLE None 10.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC have both been consulted on the proposed IJB Reserves Strategy 2021/2022 for the North Lanarkshire IJB. 10.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDICES HSCP Reserves Realignment Appendix 1 Movement of Reserves Year to Date Appendix 2 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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6 Opening Balance As At 1 April 2022 Transfers / Drawdown From Reserves New Reserves Awaiting IJB Approval Proposed Realignment Revised Balance As At 31 March 2023 £m £m £m £m £m Advocacy Services 0.123 (0.045) - 0.061 0.139 Business Case - Non-Recurring NLC Costs 5.380 (1.941) - 0.537 3.976 Covid-19 Funding 29.742 (27.008) - (0.065) 2.669 Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 - - 2.776 3.776 Integrated Authority Support 6.076 - - (1.150) 4.926 Kylepark Works 1.000 - - 0.608 1.608 Planned Date of Discharge - Discharge To Assess 0.200 (0.074) - 0.241 0.367 Planned Date of Discharge - Locality Social Work Manager Post 0.055 (0.051) - 0.096 0.100 Regrading of Posts Including Backpay 0.125 - - 0.125 0.250 Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.109 (0.004) - 0.386 0.491 Social Care Contracting Staff within Quality Assurance Services 0.047 (0.052) - 0.028 0.023 Social Care Demand 6.117 (0.069) - (2.130) 3.918 Contingency Fund Reserve 4.167 (0.194) - 0.925 4.898 Closed Reserves 20.244 (4.328) - (15.916) 0.000 Existing Reserves 74.385 (33.766) 0.000 (13.478) 27.141 Assistive Technology Contract x 12 months (ATC) - (0.062) 0.090 - 0.028 Breast Feeding Team (2 year funding) - - 0.828 - 0.828 Development of Chryston Community Health Clinic - - 0.212 - 0.212 Home Support Resilience (2 year funding) - - 3.498 - 3.498 HR Employability Team (2 year funding, 50:50 split between North and South) - - 0.187 - 0.187 IJB Helpline (2 years funding) - - 0.600 - 0.600 Local Government Pay Award 23/24 - - 2.653 - 2.653 Long Covid Pathways - - 0.444 - 0.444 Neonatal & Paediatrics Dieteics Intervention (3 year funding) - - 0.550 - 0.550 Organisational Development Fund - - 0.260 - 0.260 Psychology Posts 2 x Band 6 - - 0.098 - 0.098 Staff Training Academy - - 2.400 - 2.400 Stigma Free Lanarkshire (3 year funding) - - 0.450 - 0.450 Vulnerable and Complex Cases - Test of Change - - 1.208 - 1.208 New Reserves 0.000 (0.062) 13.478 0.000 13.416 TOTAL REALIGNMENT 13.478 (13.478) APPENDIX 1 HSCP Reserves Realignment
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7 North Lanarkshire IJB APPENDIX 2 Movement on Reserves Audit Trail NHSL & NCL Opening Balance After Review Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) - 119.453 (23.944) (26.271) 69.237 Opening Balance After Review Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.154 (2.800) 0.354 NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 0.167 NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 0.255 NHSL Blood-Borne Viruses Services 0.146 0.146 NHSL Children and Adolescent Mental Health Services 5.333 (3.082) 2.251 NHSL Community Living Change Fund 1.298 1.298 NHSL Covid-19 Funding 29.742 (24.116) (2.957) 2.669 NHSL Covid-19 Funding - Unscheduled Care 1.944 (1.620) 0.324 NHSL Mental Health and Learning Disability Services - Action 15 3.019 (3.016) 0.003 NHSL Mental Health and Learning Disability Services - Veteran's First Point 0.026 0.026 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.429 0.429 NHSL Mental Health Improvement Fund - Psychology 0.553 (0.448) 0.105 NHSL Mental Health Psychology Services Capacity Building 0.117 0.117 NHSL Mental Health Psychology Services - Recovery and Renewal Phase 1 & 2 0.614 (0.430) 0.184 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 1.840 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 NHSL Shielding - Social Care Support Fund 0.038 0.038 NHSL Staff Wellbeing 0.254 0.254 NHSL Test and Protect Funding 0.520 0.520 NHSL Third Sector Initiatives To Improve Health 0.306 0.306 49.903 (24.116) (14.353) 11.434 Opening Balance After Review Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.941 (0.001) 1.940 NLC Adaptations Fund 0.289 (0.200) 0.089 NLC Adult Protection (share with C&F and NHSL) 0.050 (0.017) 0.033 NLC Advocacy Services 0.123 0.061 (0.045) 0.139 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 0.123 NHSL Area Wide Services - NES Training 0.132 0.132 NHSL Area Wide Services - Pre School Vision Screening 0.075 0.075 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 0.034 NHSL Area Wide Services - Refugees and Displaced Persons 0.400 (0.132) 0.268 NLC Assistive Technology Contract x 12 months (ATC) 0.090 (0.062) 0.028 NHSL Breast Feeding Team (2 year funding) 0.828 0.828 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.794 (1.213) 0.581 NLC Business Case - Non-Recurring NLC Costs 5.380 0.537 (1.941) 3.976 NHSL Care Homes Allocation 0.318 0.318 NLC Carers Act 2018 - Support 0.852 0.852 NHSL Champions Board Funding 0.172 0.172 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 0.346 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.645 (0.231) 0.414 NHSL Development of Chryston Community Health Clinic 0.212 0.212 NHSL Dietetics Services - Double Running Costs 0.110 0.110 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.694 (0.064) 0.630 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 3.776 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.566 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 (0.173) 0.527 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.107 NHSL Distinction Awards 0.036 0.036 NLC Financial Strategy - Changes to LA Services Muirpark 2.973 (1.242) 1.731 NHSL Forensic Band 3 x 5 WTE 0.147 0.147 NHSL GPIT Reprovisioning Gap 0.181 0.181 NHSL Health Inequalities - Screening 0.098 (0.024) 0.074 NHSL Health Visiting Students/Trainees 0.840 (0.356) 0.484 NLC Home Support Resilience (2 year funding) 0.000 3.498 3.498 NHSL Hospital at Home Services - Support Development 0.414 (0.043) 0.371 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.187 0.187 NLC IJB Helpline (2 years funding) 0.600 0.600 NHSL Integrated Authority Support 6.076 (1.150) 4.926 NHSL Kylepark Works 1.000 0.608 1.608 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 0.118 NLC Local Government Pay Award 23/24 2.653 2.653 NHSL Long Covid Pathways 0.444 0.444 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.107 (0.074) 0.033 NHSL Minor Capital Works 1.387 (0.209) 1.178 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 0.550 NHSL Organisational Development Fund 0.260 0.260 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.908 (0.027) 0.881 NLC Planned Date of Discharge - Discharge To Assess 0.200 0.241 (0.074) 0.367 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.055 0.096 (0.051) 0.100 NHSL Podiatry Services - Foot Screening 0.459 (0.033) 0.426 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.070 NHSL Psychology Posts 2 x Band 6 0.098 0.098 NHSL Regrading of Posts Including Backpay 0.125 0.125 0.250 NHSL Scottish Clinical Leadership Fellowship 0.045 (0.011) 0.034 NHSL Sexual Health Services - Forensic Medical 0.222 (0.047) 0.175 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.109 0.386 (0.004) 0.491 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 (0.052) 0.023 NLC/NHSL Staff Training Academy 2.400 2.400 NHSL Stigma Free Lanarkshire (3 year funding) 0.450 0.450 NHSL Supervisor Training 0.077 (0.012) 0.065 NLC Unmet Saving 21/22 - IDS/LSS (merging building Coatbridge & Cumbernauld) 0.086 (0.068) 0.018 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.030 NHSL Vulnerable and Complex Cases - Test of Change 1.208 (0.088) 1.120 31.661 17.186 (6.494) 42.353 LEAD SUMMARY TOTAL EARMARKED RESERVES LEAD RING-FENCED RESERVES TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES Total
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8 Opening Balance After Review Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC Long Covid Contingency 3.000 (0.727) 2.273 NHSL Prescribing Fund 4.361 4.361 NLC Social Care Demand 6.117 (2.130) (0.069) 3.918 13.478 (2.130) (0.796) 10.552 Opening Balance After Review Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Contingency Balance Held By NHSL 4.167 1.032 (0.301) 4.898 4.167 1.032 (0.301) 4.898 Opening Balance After Review Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Administration Support Services 0.240 (0.239) (0.001) - NHSL Area Wide Services - Admin 0.080 (0.080) - NHSL Area Wide Services - Audiology Equipment 0.011 (0.011) - NHSL Area Wide Services - Locality Funding 0.432 (0.432) - NHSL Area Wide Services - Mental Health Pharmacy, PCIP and NES SLA with GPs 1.048 (1.048) - NHSL Area Wide Services - Update Consolidated Health Information (CHI) 0.015 (0.015) - NHSL Assistant Support Worker - Promise 0.026 (0.026) - NLC Carers Act 2018 - Waving of Charges 0.580 (0.580) - NHSL Children and Adolescent Mental Health Services - Choice and Partnership Approach (CAPA) Team 0.717 (0.717) - NHSL Children and Adolescent Mental Health Services - Service Improvement Post (Band 7 - 18 months) 0.088 (0.088) - NHSL Children and Adolescent Mental Health Services - Waiting List Co-ordinator (Band 5) 0.038 (0.038) - NHSL Childrens Services - Childrens Inspection Senior Nurse (3 months) 0.017 (0.017) - NHSL Childrens Services - Manager Post (1WTE) 0.040 (0.040) - NHSL CLAN Cancer Support Funding 0.095 (0.095) - NHSL Clinical Fellow Funding 0.080 (0.080) - NHSL Clinical Guidelines Post 0.023 (0.023) - NHSL Clinical Pharmacist - Additions 0.035 (0.035) - NHSL Community Assessment and Rehabilitation Service - Rehabilitation Pilot 0.023 (0.023) - NHSL Community WIFI 0.342 (0.342) - NHSL Development of Health Promoting Culture 0.141 (0.141) - NHSL Dietetics Services 0.046 (0.046) - NHSL Dietetics Services - Band 6 0.114 (0.016) (0.098) - NHSL Dietetics Services - Diabetes Type 2 and Adult Weight Management 0.024 (0.024) - NHSL Dietetics Services - Oral Nutrition 0.038 (0.038) - NHSL Dietetics Services - Weight Management 0.049 (0.049) - NHSL Eating Disorders Funding 0.111 (0.111) - NLC Financial & Strategic Planning 2023/2026 5.416 (5.416) - NHSL Health Inequalities - Health Promotion Posts 0.006 (0.006) - NHSL Health Inequalities Funding 0.024 (0.024) - NHSL High Resource User Posts 0.025 (0.025) - NLC Home Support Development 0.217 (0.217) - NHSL Hospital at Home Services - Shortfall 0.110 (0.110) - NLC IJB Financial Plan Contingency - Allocated to NLC 3.000 (3.000) - NLC Impact of Covid-19 Pandemic Review 0.100 (0.100) - NHSL Integrated Support Worker 0.153 (0.153) - NHSL IT Federated Trust Environment Strategy 0.214 (0.214) - NHSL Joint Equipment Store 0.554 (0.554) - NHSL Kings Fund Organisational Development 0.014 (0.014) - NHSL Long Term Conditions (LTC) Lead Clinician 0.010 (0.010) - NHSL Maternity and Neonatal Psychological Interventions 0.044 (0.044) - NHSL Medical Director - Associate Medical Director (MR) 0.074 (0.074) - NHSL Medical Director - Child Death Review Funding 0.021 (0.021) - NHSL Mental Health and Learning Disability Services - Distress Brief Intervention 1.552 (1.552) - NHSL Mental Health Infant - NES Funding 0.013 (0.013) - NHSL Mental Health PDN 0.2wte for 20/21 spend previously approved 0.011 (0.011) - NLC Mental Health Practice Assessor 0.006 (0.006) - NHSL Mental Health Perinatal and Infant 0.532 (0.532) - NHSL Mental Health Practice Development (HF) 0.047 (0.047) - NHSL Mental Health Support for Those Hospitalised with Covid-19 0.172 (0.172) - NHSL Motherwell Rehabilitation Team Leadership 0.058 (0.058) - NHSL Neurodevelopmental Pathway OT 0.095 (0.095) - NHSL Nursing Appointments 0.119 (0.119) - NHSL Nursing Services 0.125 (0.125) - NHSL Nursing Services - District Nurse 0.292 (0.292) - NHSL Nursing Services - Extend Health Improvement Unit posts to March 2020 0.075 (0.075) - NHSL Nursing Services - Family Nurse Partnership 0.033 (0.033) - NHSL Nursing Services - Nursing Assoicate Post Band 7 x 0.2 WTE 0.011 (0.011) - NHSL Nursing Services - Queens Nursing Institute Grants 0.004 (0.004) - NHSL Nursing Services - Quest Patient Safety Posts 0.003 (0.003) - NHSL Nursing Services - School Nursing 0.162 (0.162) - NHSL Nursing Services - Solihull Training 0.018 (0.018) - NLC Payment to Voluntary Org - Glenboig 0.006 (0.006) - NHSL Pre School Screening Exclusion Incident Audit 0.025 (0.025) - NHSL Project Manager - Adverse Events 0.036 (0.036) - NHSL Public Health Intelligence Data Analysts 0.061 (0.061) - NHSL Return to Nursing Students 0.107 (0.107) - NLC SDS Transformational Team 0.025 (0.025) - NHSL Sexual Health Services - Health & Homeless Post 0.004 (0.004) - NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) (2 clinics for 2 years) 0.386 (0.386) - NHSL Sexual Health Services - Sexually Transmitted Infections 0.122 (0.010) (0.112) - NHSL Speech, Language and Therapy Services 0.807 (0.807) - NHSL Speech, Language and Therapy Services - Contract 0.250 (0.250) - NHSL Test of Change - High Intensity Service Users 0.027 (0.027) - NHSL Training Fund 0.246 (0.246) - NHSL Vulnerable Population Post - Health Improvement Funding 0.068 (0.068) - NLC Winter Plan 0.300 (0.300) - NHSL Winter Plan - Discharge To Assess 0.010 (0.010) - 20.244 (15.916) (4.327) 0.000 119.453 (23.944) (26.271) 69.237TOTAL RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES APPENDIX 2 CONT. TOTAL CONTINGENCY FUND RESERVES LEAD CLOSED RESERVES TOTAL CLOSED RESERVES
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REPORT Item No: 6 SUBJECT: IJB Medium Term Financial Plan 2023 - 2026 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report advises the IJB of the medium-term financial outlook for North Lanarkshire IJB as set out in the attached Medium Term Financial Plan 2023 – 2026. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Finance Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the assumptions and context of the financial plan; and (2) Approve the Medium-Term Financial Plan 2023 - 2026. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Medium-Term Financial Plan (MTFP) outlines the financial challenges and opportunities the Health and Social Care Partnership (HSCP) face over the next three years and provides a framework which will support the HSCP to remain financially sustainable. It will complement the Strategic Commissioning Plan 2023 – 2026, highlighting how we will support the delivery of the IJBs strategic objectives and priorities. 6. MEDIUM TERM FINANCIAL OUTLOOK 6.1 Looking into 2023/24 and beyond, it is anticipated that the public sector in Scotland will continue to face a number of challenges in the short and medium term. There is significant uncertainty over what the scale of this is likely to be and it is therefore important that the IJB plans for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner over the coming years. Yes No N/A 1
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6.2 As a consequence, the IJBs financial planning arrangements remain subject to active review using a scenario-based approach in recognition of the scale of variability in the potential future pressures and funding for the IJB. Using a range of outcomes across our key financial risks, including the likely impact, reduces the risk of future challenges and will help to enable financial sustainability of the IJB. 7. FINANCIAL CHALLENGE 7.1 In view of the current scale of uncertainty, and in line with previous financial plans, potential outcomes have been considered over optimistic, envisaged, and pessimistic projected positions. 7.2 Using the above range of scenarios, current projections for the life of the plan include a wide range of assumptions in respect of key cost pressures and demand. On the basis of this projected outlook, and subject to active review over the coming months and years, the Chief Finance Officer (CFO) recommends that the IJB progresses with a financial planning strategy based on the envisaged scenario. This assumed position does not take into account potential future additional funding for any pressures from either the Scottish Government or our partners. 7.3 The MTFP is based on a range of demand and cost pressures which could be faced by the IJB over the medium term. These assumptions are informed by both the local and national context and future funding contributions from partners for which there remains significant and real uncertainty. 7.4 Detailed below are the main areas of cost pressures and demand which will be subject to ongoing review: Future funding allocations Future pay settlements Cost of living crisis and inflation Contractual pressures and the living wage commitments Demand led services including deprivation and health issues Prescribing costs and availability 7.5 Additional funding streams have been provided by the Scottish Government in respect of multi-disciplinary teams, providing interim care, investing in staff and wellbeing and health care support. This will help to address recognised winter pressures and ongoing challenges presented by the pandemic and cost of living crisis. However, the difficulty in utilising non-recurring and/or ring-fenced funds whilst seeking to continue to deliver business as usual within a balanced budget should not be underestimated. Such funding impacts directly on the nature of the services that can be delivered in the timeframe and in pursuit of the outcomes associated with the funding. 7.6 Looking beyond this financial year and into the term of the financial plan, it is inevitably more difficult to forecast. It is important the IJB adopts a plan, not just in the delivery of strategic outcomes and services, but also from a financial perspective to ensure medium to long term risks to the financial sustainability of the IJB are identified early, even though there may be uncertainty over the specific timing, scale, and ultimate effect. 2
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8. MEDIUM-TERM FINANCIAL PLAN 8.1 Our MTFP consists of seven components which collectively support the transformational change required to deliver financial balance whilst delivering safe and sustainable services. This strategy is set out in the diagram below: 9. RESERVES 9.1 As part of the development of the financial plan and in line with the North Lanarkshire IJB Medium to Long Term Financial Plan 2020/21 to 2029/30, if possible, it is recommended that the risk-based and contingency reserves are established as a percentage of the financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 9.2 The IJB contingency reserves currently equate to 2% of the financial envelope, however, following completion of the 2022/2023 financial year end, it is anticipated this percentage will increase. 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 3
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10.5 PEOPLE None 10.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC have both been consulted on the proposed IJB Reserves Strategy 2021/2022 for the North Lanarkshire IJB. 10.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDICES Medium-Term Financial Plan 2023 - 2026 Appendix 1 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362. 4
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North Lanarkshire Integration Joint Board Medium Term Financial Plan 2023 – 2026 5
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Contents Page • Introduction 3 • Executive Summary 4 • Purpose 5 • National Context • Impact of European Union (EU) Withdrawal 6 • Covid-19 Pandemic 6 • Cost of Living 6 • Increase in Demand 6 • National Direction 7 • Local Context • Our Budget 8 • Hosted Services 9 • A Profile of North Lanarkshire 10 • Projected Population Change 12 • The Impact of Covid-19 13 • Strategic Objectives 14 • Medium Term Financial Outlook • Reserve Strategy 16 • Financial Planning Assumptions 17 • Financial Pressures 18 • Sensitivity Analysis 20 • Financial Sustainability Approach 20 • Financial Performance 22 • Key Risks and Uncertainties 22 • Appendix 1: Estimated Impact of Cost and Demand Pressures for 2023-2026 23 • Appendix 2: Financial Strategy to Address Funding Pressures for 2023-2026 24 6
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Introduction The North Lanarkshire Integration Joint Board (IJB) was established as a corporate body by Scottish Government and became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. It is a joint venture between NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC). The IJB has responsibility for the strategic planning and commissioning of a wide range of services within North Lanarkshire. The North Lanarkshire Health and Social Care Partnership (HSCP) is responsible for the operational delivery of the IJB strategic directions. This includes the service we are required to provide, the funding allocated and the monitoring of performance. The services include: • Accident and emergency services provided in a hospital; • Inpatient services related to general, geriatric, respiratory and rehabilitation medicine; • Palliative care services; • Community health services including Lanarkshire wide hosted services; and • Social care services. Our Purpose 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 and in the right way 7
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Executive Summary The North Lanarkshire IJB Medium to Long Term Financial Plan 2020 – 2030, outlined the anticipated financial challenges and opportunities that the partnership expected over the ten-year period and provided a framework which would support the partnership to remain financially sustainable. The impact of Covid-19 on health and social care services and the economy created considerable unanticipated pressures, and therefore the partnerships governance arrangements were reviewed and adapted to support the response, recovery, and redesign of services. Whilst many of the elements in the previous Medium to Long Term Financial Plan remain, the pandemic and ensuring cost of living crisis has accelerated the delivery of some of our objectives, made others increasingly important and lowered the priority of some of our previously agreed actions. Alongside the development of the new Strategic Commissioning Plan 2023 – 2026, it is consequently necessary to update our supporting plan to a Medium-Term Financial Plan (MTFP). The new Medium-Term Financial Plan 2023 – 2026 reflects the impact of recovering from Covid-19 and other challenging factors facing the IJB. It has been condensed to a three-year plan rather than the original ten-year plan due to the pending formation of the National Care Service (NCS) and the continuing uncertainty around future funding. As was the case prior to the pandemic, the IJB’s financial planning arrangements remain subject to active review, to enable us to continue to plan for a range of potential outcomes and scenarios. This helps us to manage emerging financial risks and challenges and the likely impact these could have on the financial position of the IJB. The financial position for public services continues to be challenging and it is therefore important that our ambitions are set within the content of the funding available. The aspiration to prepare a balanced budget covering a longer term will support the development of strategic savings plans and ensure the available resources are allocated effectively across competing priorities. This aspiration however is dependent on the certainty of the financial settlements from the Scottish Government. Both partners have a proven track record of managing budgets effectively over many years. A clear strategy is required to ensure the IJB continue to remain financially sustainable over the medium term. The limited financial and workforce resources will require to be focussed on services which are sustainable and are targeted to those with the greatest need. To prepare this financial plan, a co-ordinated and strategic approach across the partnership has been adopted with both partners including the cost pressures in relation to their delegated functions. A range of outcomes will continue to be analysed and the financial planning assumptions updated as the most likely scenarios emerge for future years. The Scottish Governments aspiration to move to multi-year settlements in the future is welcome and would reduce the uncertainty which is currently impacting on strategic commissioning activity across the health and social care partnership. 8
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Purpose In respect of the functions delegated to the IJB, the IJB MTFP sets out the financial outlook for the next three years 2023/24 to 2025/26. The purpose of the MTFP is to set out challenges facing the IJB in maintaining financial stability whilst achieving the strategic commissioning intentions. The MTFP therefore provides an overview of the financial planning assumptions in relation to projected cost pressure arising from demographic growth, legislative and policy developments, employee costs and inflation alongside potential partner funding contributions in future years. The plan will deliver a number of benefits to North Lanarkshire HSCP including: • Aligning with the Strategic Commissioning Plan to progress the shift in the balance of care to a community setting; • Working alongside partners to achieve common goals; • Providing sustainable services to support transformation and local communities; and • Maintaining a balanced and transparent budget. Medium Term Financial Plan Strategic Commissioning Plan Engaging with Partner Bodies Supporting Transformation Budget Setting Process 9
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National Context IJB’s operate in a complex, challenging and changing environment where national issues can have an impact on what and how services are delivered along with the financial resources, they have available to meet this. The emergency caused by the Covid-19 pandemic has only escalated these challenges along with changes to policy, legislation, and future funding from the Scottish Government. Impact of European Union (EU) Withdrawal The withdrawal from the EU is currently still a factor contributing to the uncertainty of the economic outlook. There is an ongoing impact on supply chains and labour markets which creates a risk to the financial planning assumptions upon which the financial plan is based. The Covid-19 pandemic makes it difficult to assess the sole impact of the EU withdrawal however, some of the direct consequences which have been experienced across the UK include the removal of a large pool of EU workers, which many UK business rely, a reduction in the UK’s Gross Domestic Product (GDP), supply chain shortages, increased bureaucracy and an increase in prices. The full impact will be realised over the coming years. Covid-19 Pandemic The last 24 months has brought unprecedented challenges due to the Covid-19 pandemic and this looks set to continue for the foreseeable future. Although the full impact is still to be understood, it is clear, that there is and will be a significant impact on the health and wellbeing of our staff and communities. The impact on both the UK and Scottish economy will underpin policy direction and funding of our services. Cost of Living The volatility of the UK inflation, impacted by the record global energy costs, will present a considerable challenge to the IJB over the short to medium term. Currently at 10.1%, inflation is at its highest level in 30 years far exceeding the Bank of England 2% target. Such pressures will impact on the sustainability of our external providers who will struggle to cope with the rising cost of goods and services, our service users as they battle with the concept of ‘heat’ or ‘eat’ and the IJB directly due to rising costs from providers and increased demand on all services as we continue to help those most in need. Increase in Demand The demand for services is increasing with Scottish Government estimating that the need for health and social care services would rise by between 18% and 29% throughout 2010 to 2030. Statistical information indicates the following: • One in four adults has a long-term illness or disability and around two million people in Scotland have at least one long-term condition. • People in Scotland are living longer, but more of these people aged over 75 are living with a long-term condition and/or significant frailty. • The population over 75 is expected to increase by 63% over the next 20 years. 10
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National Direction The independent review of Adult Social Care recommended the creation of a National Care Service (NCS) and a system of care which took a human right based approach with a focus on incorporating the views of those with lived experience about what needs to change to make real and lasting improvements. The aspirations of the NCS represent a progression from the Scottish Government’s Health and Social Care Delivery Plan1 and supports their long-standing desire to shift the balance of care and support from hospital to a community care setting. The outcome of this review is currently subject to ongoing consultation. This will be used to shape and develop the new legislation, which was introduced in the Scottish Parliament in 2022, with the intention that the NCS will be fully functioning by the end of the Parliamentary term in 2026. This will impact on the delivery of services and will be closely watched to understand how this will shape service provision and the direction of IJB resources. 1 Scottish Government Health and Social Care Delivery Plan 11
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Local Context Our Budget North Lanarkshire IJB delivers and commissions a range of health and social care services to our local population. This is funded through budgets delegated from both NHS Lanarkshire and North Lanarkshire Council. The resources available to the IJB in 2022-2023 to take forward the commissioning intention in line with the Strategic Commissioning Plan, are circa £738m. Included in the above table is a ‘Large Hospital Service’ (National Set Aside) budget totally £66.858m. This budget is in respect of those functions delegated by the Health Board which are carried out in a hospital within the Health Board area. The Set Aside resource for delegated services provided in acute hospitals is determined by apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJB based on postcode. The IJB is responsible for the strategic planning of these services but not their operational delivery. North Lanarkshire Council £188.18m National Set Aside £66.858m NHS North Lanarkshire £482.813m NORTH LANARKSHIRE IJB RESOURCES AVAILABLE 2022-2023 12
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Hosted Services In seeking to identify the most appropriate disposition of services within North Lanarkshire HSCP, some services required to be delivered on a pan- Lanarkshire basis. In delivering these services the IJB has primary responsibility for the provision of the service and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such, the full costs of these services will be included within all financial statements. The resourcing of each of the hosted services is based on a 51:49 split between North and South partnerships, with the total budget for each transferred to the host area. Information regarding the proportionate costs incurred by North and South Lanarkshire HSCPs are included in the Annual Accounts of both IJBs and are regularly reported to each board via each partnerships financial monitoring reports. The table below shows the split of hosted services between North and South Lanarkshire: HOSTED SERVICES BY PARTNERSHIP Led by the North Partnership Led by the South Partnership Sexual Health Services Community Dental Services Continence Services Brain Injury Unit Immunisation Services Out of Hours Services Speech and Language Therapy Services Palliative Care Services Children and Adolescents Mental Health Services Physiotherapy Services Children Services Primary Care Services Integrated Equipment and Adaptations Store Occupational Therapy Services Dietetics Services Diabetic Services Podiatry Services Primary Care Improvement Fund Prisoner Healthcare Services Primary Care Transformation Fund Blood Borne Viruses Services Hospital at Home Mental Health and Learning Disability Services 13
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A Profile of North Lanarkshire Our Population According to the latest official statistics from the National Records of Scotland (NRS)2, the population of North Lanarkshire is 341,400. The estimated future breakdown of this figure into age group is shown in the following graph. Between 2018 and 2028, the 0 to 15 age group is projected to see the largest percentage decrease (-9.8%) and the 75 and over age group is projected to see the largest percentage increase (+21.8%). Health 13.5% of North Lanarkshire residents are living with three or more long term conditions such as anxiety/depression and COPD/asthma. North Lanarkshire has had consistently higher accident and emergency attendance rates compared to Scotland over the last five years. 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. All North Lanarkshire localities remain above the Scotland rate with Coatbridge currently the highest and North Lanarkshire North the lowest. Carers 10% of North Lanarkshire’s population is identified as being in a caring role and early indication are that this number is set to rise when the most recent census information is published. It should be noted that not all carers are known to services. 2 National Records of Scotland (NRS) 14
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Life Expectancy In North Lanarkshire, life expectancy at birth was higher for females (78.8 years) then for males (74.1 years) in 2019 -2021, however both male and female life expectancy remains below that of the Scottish average. Deprivation The Scottish Index of Multiple Deprivation (SIMD) assesses 6,976 small areas known as data zones. 34% of our data zones are in the 20% most deprived data zones compared with 20% of Scotland’s population. Income Deprivation Across North Lanarkshire 50,897 (15%) people are income deprived. The Scottish average is 12%. • 28,234 live in the 20% most deprived data zones and 21,655 live in the 15% most deprived data zones. • Therefore, 22,663 income deprived people live outside the 20% most deprived data zones and 29,242 income deprived people live outside the 15% most deprived data zones. 15
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Employment Deprivation 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 data zones and 11,205 people are employment deprived in the 15% most deprived data zones. • This means 11,381 employment-deprived people outside the 20% most deprived data zones. Projected Population Change of North Lanarkshire Between 2018 and 2028, the population of North Lanarkshire is projected to increase from 340,180 to 341,174. This is an increase of 0.3% which compares to a projected increase of 1.8% for Scotland as a whole. • North Lanarkshire is expected to have the 4th highest population out of the 32 council areas in Scotland in 2028. • Over the next 10 years, the population of North Lanarkshire is projected to decrease by 1.7% due to natural change (more deaths than births). • Total net migration is projected to result in a population increase of 1.9% over the same period. • The average age of the population of North Lanarkshire is projected to increase as the baby boomer generation ages and more people are expected to live longer. Between 2018 and 2028, the number of households in North Lanarkshire is projected to increase from 151,744 to 157,469. This is a 3.8% increase, which compares to a projected increase of 4.9% for Scotland as a whole. • North Lanarkshire is projected to have the 4th highest numbers of households in 2028, out of all 32 council areas in Scotland. • In 2028, the household type ‘one adult’ is projected to remain the most common (35.2%) and the household type ‘one adult, one or more children’ is projected to remain the least common (7.8%) in North Lanarkshire. • The household type ‘two or more adults, one or more children’ is projected to see the largest percentage decrease (-4.0%) and the household type ‘two adults’ is projected to see the largest percentage increase (+8.1%). While many older people are expected to enjoy better health than their predecessors did at an equivalent age, they will still have significant health needs living with potentially multiple and complex conditions. The impact of this will be a steadily increasing demand on our health and social care services, including home care support, care homes, increases in demand for community-based healthcare, equipment and adaptations and an increased demand for GP services and medication. 16
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The Impact of Covid-19 The Covid-19 pandemic has had a profound impact on our health, economy, and society, with damaging impacts on the way of life and wellbeing of people in North Lanarkshire and across Scotland. A key finding is that the impacts of the pandemic have been, and are likely to continue to be, borne unequally. Unequal outcomes between different groups existed pre-Covid, and the effects of the pandemic have only worsened this. It has produced disproportionate impacts across a range of outcomes for several groups, including households on low incomes or in poverty, low-paid workers, children and young people, older people, disabled people, minority ethnic groups and women. The direct and indirect health impacts of the pandemic are significant, and this is likely to have a negative impact on people’s health in the short and long term. Reduced or paused services during the pandemic and delays in seeking health care, as well as longer waiting times due to backlogs, will continue to impact on many health and social care services and their users. On a positive note, the Covid vaccination programme has been very successful in Lanarkshire, with the current position noted below, following the autumn/winter programme roll out: Total Doses Administered 1,835,182 Individuals With at Least 1 Dose 560,175 Partially Vaccinated 26,294 Fully Vaccinated 92,277 Boosters 441,604 Ongoing Resilience Response There remains significant ongoing pressure in all health and social care systems across Scotland. High demand and patient acuity, coupled with increased flu and covid numbers in recent months has placed even greater demand on our system. In Lanarkshire, there is a genuine whole-system focus to our resilience response and there has been a tremendous effort across the whole system, including third and independent sectors, communities, and public partners in the continued response to the pandemic and more recent system pressures. 17
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Strategic Objectives Our Strategic Commissioning Plan 2023-2026 sets out our commitment to work with you to achieve our long-term ambitions. Only by working together, can we bring about real change to improve the overall health and wellbeing of the people of North Lanarkshire. We very much value your input and feedback as the services we plan to design and deliver are your services, for your families and neighbours. We continue to experience the long-term and lasting impact of the Covid-19 pandemic, whilst 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 new Strategic Commissioning Plan 2023-2026 will help to inform financial planning and how we allocate our resources to the programme of work 2023- 2026. To enable us to measure how well we are doing, our achievements will be measured and reported against a range of national and local performance measures including the nine national health and wellbeing outcomes below. NATIONAL HEALTH & WELLBEING OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer. People, including those with disabilities or long-term conditions or who are frail, are able to live as far as reasonably practicable, independently and at home or in a homely setting in their community. People who use health and social care services have positive experiences of those services, and have their dignity respected. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Health and social care services contribute to reducing health inequalities. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. People using health and social care services are safe from harm. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide. Resources are used effectively and efficiently in the provision of health and social care services. The long-term vision for the Health and Social Care partnership which was set out in the original Strategic Plan 2016-20263 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; and • Ensuring North Lanarkshire is the best place in Scotland to grow up. 3 Strategic Plan 2016-2026 18
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This approach underpins our Strategic Commissioning Plan and will be facilitated by our financial resources, enabling investment in our ambition statements: AMBITION STATEMENTS Do The Right Thing First Time When people contact our services, we need to respond quickly and effectively, with a focus on helping people to help themselves first. We will continue to develop ‘First Point of Contact’ by incorporating good conversations across the HSCP and prioritising and embedding the whole system approach to get it right first time. Increased Focus on Prevention, Early Intervention and Tackling Inequalities by Working with Communities and People The population and needs analysis highlighted 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. We need to keep changing the way we deliver services and support people, focusing more on prevention, early intervention, and empowering people to live fulfilling lives. By providing ‘upstream’ support at an early stage, we can reduce the demand on intensive health and care services and re-invest in more community focused support services. By 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. We will continue 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 by showing ambition and innovation to develop and try new ways of providing services. We value and recognise the vital role local people and communities play by continuing to ensure we listen and provide a voice to their needs and aspirations. We will continue to engage and participate with local people as we 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 our workforce to ensure their physical and mental health is nurtured. There are also continuing challenges with regards to resourcing, attracting, recruiting, and retaining staff. Whole system planning requires further development to better understand the needs and demands of communities including the public health challenges, the types of roles needed to support different care needs, and the availability of different types of workers over time and geographically. Improve Mental Health and Wellbeing Mental health concerns are continuing to increase in the population which could lead to a greater demand for mental health services and community supports. There is a need for a refreshed and reinvigorated approach to mental health improvement with the focus on the four core areas within the Lanarkshire Mental Health and Wellbeing Strategy: • Good mental health for all • Improving access to mental health supports and services • Children and young people’s mental health and wellbeing • 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 and achieve their goals together. This puts wellbeing at the heart of our approach by considering the situation that adults and children live in, who they live with and their family relationships. In practice, this means understanding each person as an individual, as well as recognising the part they play in their family and community. This approach builds on people’s strengths and resilience. 19
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Medium Term Financial Outlook Reserves Strategy The IJB has the same legal status as a local authority and is therefore able to hold reserves under section 106 of the Local Government (Scotland) Act 1973. A reserves strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The use of reserves must be prudent and controlled and are generally held for the following purposes: • To create a working balance to help cushion the impact of uneven income flows. • To create a contingency to cushion the impact of unexpected events or emergencies. • To create a means of building up funds, to meet known or predicted liabilities. • To fund non-recurring costs and to help with payment profiles straddling more than one financial year. • To enable the implementation of longer-term savings proposals. The North Lanarkshire IJB Reserves Policy allocates funding to a ring-fenced, earmarked, risk-based or contingency reserve. For each reserve there should be a clear protocol setting out the reason/purpose of the reserve, how and when the reserve can be used and the review timescale to ensure continuing relevance and adequacy. IJB reserves will be held for four specific purposes as follows: Ring-fenced Reserves This reserve will be established when funding has been received for a specific purpose. Earmarked Reserves An earmarked reserve will be established when funding has been allocated by the IJB to commission services in line with agreed directions. Risk-Based Reserves A risk-based reserve will be established to provide a contingency to address a specific financial risk. Contingency Reserves A contingency reserve will be established by the IJB to cushion the impact of unexpected events and emergencies. As part of the development of the financial plan and in line with the North Lanarkshire IJB Medium to Long Term Financial Plan 2020/21 to 2029/30, if possible, it is recommended that the risk-based and contingency reserves are established as a percentage of the financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 20
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Page | 17 Financial Planning Assumptions Financial planning requires assumptions to be made about demand and cost pressures which could be faced by the IJB and our partners. This financial plan focuses on the likely cost pressures that we can reasonably expect over the next three years. These assumptions have been informed by the local and national context within which we operate. Our MTFP has seven components which collectively support the transformational change required to deliver financial balance whilst delivering safe and sustainable services. This strategy is set out in the following diagram: Medium Term Financial Plan Reserves Strategy Engaging with Partner Bodies Supporting Transformation Workforce Planning Strategic Commissioning Plan Financial Management and Planning Budget Setting Process Supporting service redesign Integrated working and shifting the balance of care Investing in staff development, health, and well- being Plan and commission our services in the most cost- effective way Robust financial planning and governance Achieving more together Whole system approach working groups Delivering safe and sustainable services within budget Prevention and early intervention Delivering on our statutory requirements and national policy Making North Lanarkshire a better place to work and live 21
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It is widely expected that the public sector in Scotland will continue to face a very challenging short and medium-term financial outlook. Whilst the provision of recurring investment in 2021-2022 and non-recurring reserves will help, there remains significant uncertainty over increasing cost pressures and what the scale of the likely reduction in available funding will be over the medium term. It therefore remains important that the IJB ensures sufficient flexibility to manage in a sustainable manner the position which emerges over the coming years, with the likely scenario that a significant level of further recurring savings will be required. Consequently, the IJB’s financial planning arrangements remains subject to active review using a scenario-based approach in recognition of the significant uncertainty over raising costs and the scale of variability in the potential funding available to the IJB. Taking the 2022-2023 budget as the new baseline, this plan updates the financial planning assumptions in relation to funding sources and increased cost pressures arising from employee costs, inflationary cost pressures, demographic growth and demand, local cost pressures and legislative and policy developments. Due to the continuing changing financial environment we are currently facing, the reliance which can be placed on the financial costings decreases the further into the future the projections relate to. Using a range of scenarios, current projections for the period 2023-2026 highlight potential cost pressures within a range of £19.823m to £44.459m for this period (Appendix 1). Based on these projections, and subject to clarification over the coming months and years, the Chief Finance Officer (CFO) recommends that the IJB progresses with a financial planning strategy based on the envisaged scenario showing potential cost pressures within a range of £26.105m to £29.326m per annum, over this three-year period. This assumed scenario and the financial strategy to address it can be found at Appendix 2. Financial Pressures Detailed below are the main areas of cost pressures and demand which will be subject to ongoing review as clarification of the position of each emerges. These assumptions are based on the budget position and assumptions in January 2023 and represent a similar picture to the pressures we identified in our previous North Lanarkshire IJB Medium to Long Term Financial Plan 2020/2021 to 2029/2030. Pay Pressures - Employee costs represent a large portion of IJB net budgets with any increase in pay awards impacting directly on current and future cost pressures. At the time of writing some areas of the pay offer for 2022-2023 is still to be agreed however, the assumption is Scottish Government will fund this additional cost burden on a recurring basis. In relation to 2023-2026, an estimated 2.5% has been assumed for staff employed within NLC and 2% for staff employed within NHSL, to reflect the pay award expected to be managed within IJB resources. In the event of an uplift greater than that estimated and no additional government support, the envisaged forecast gap could potentially change materially. Consideration is also given to the challenges of recruiting and whether pay settlements are keeping pace with industry standards, particularly considering the burden placed on employees in the health and social care sector throughout the pandemic and cost of living crisis. 22
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Inflationary Cost Pressures - A significant cost pressure relates to the National Care Home Rate Contract (NCHR) which is negotiated annually. The level of increase for future years is unknown but it is prudent to assume, based on past year trends and the on-going cost of living crisis that this is likely to increase significantly over the life of this plan. Health and social care services including independent home support are also commissioned. Increases in the Scottish Living Wage significantly impact on the cost of these services and service level agreements with other health boards. In the current challenging financial economic environment with raising inflation and energy costs, it will be even more difficult for services to manage budgets. Inflationary cost pressures will remain under review with updates provided as necessary through subsequent Financial Monitoring Reports. Demographic Growth and Demand - Health and social care services are experiencing increasing demand due to demographic growth, an ageing population, complexity of care needs, deprivation, and health issues. It remains to be seen how detrimental the lasting impacts of Covid-19 will be on our communities, but we project this will result in negative impacts on the health of North Lanarkshire in the future and subsequently as a direct result, an increase in pressure on health and social care services. Prescribing - The cost of drugs prescribed by GPs usually increases year on year. The prices of drugs are set nationally and influenced by factors such as supply and demand, currency movements and patents. Prescribing activity is a clinical decision made by individual GPs. At the time of writing, the current prescribing budget is projected to overspend by year end. Based on this trend, a volume and price uplift has been included in future projections to mitigate against deteriorating health within our population and the continuing uncertainties experienced in supply and demand due to the withdrawal from the EU. Legislative and Policy Developments - There are a range of legislative and policy developments which have and are continuing to be implemented across the partnership. These include the Carer’s Act, Alcohol and Drug Partnership (ADP), Primary Care and Mental Health developments. To date, additional funding has been made available by the Scottish Government to take these policies forward and it is assumed that the expenditure will be contained within the funding available. Recognising this, no variation in the cost projection is therefore considered, however, if future funding from Scottish Government is withheld or withdrawn, the envisaged forecast gap could potentially change. Local Cost Pressures - A range of local priorities are included in the MTFP including digital and IT technology improvements, investing in home support, tests of change pilots and continued recovery from the pandemic. Depending on when the cost commitment is expected to be incurred and expected duration, the cost pressures will be recognised in the year it is forecast to materialise. Although the preferred approach is to identify recurring funding solutions, until this is achieved, consideration will need to be given to establishing earmarked reserves to fund these commitments. 23
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Sensitivity Analysis This MTFP is a financial model. As the financial planning assumptions are likely to vary over the duration of the plan, it is prudent to consider a range of financial outlooks. To test the assumptions used in the modelling of our three scenarios (envisaged outlook, optimistic outlook, and pessimistic outlook), sensitivity analysis was carried out to determine the impact of any material changes on our current assumptions. The following table shows the impact if our key assumptions increased by 1% against our envisaged outlook: A one percent increase would increase our current cost pressures by £7.056m in year one rising to £7.569m by year three. Financial Sustainability Approach The financial sustainability approach considers a range of interventions. The IJB ambitions are set out in the Strategic Commissioning Plan and further detailed in the Programme of Work. The following key principles underpin these strategies: Efficiency The IJB has a statutory duty to deliver best value in its use of public funds. The cost of services therefore requires to be kept under review and sources of income which are available to fund services should also be secured and maximised. Service Redesign and Innovation Service redesign and innovation involves significantly changing the way in which services are planned and delivered, working in partnership with stakeholders, service users and carers to better support them to achieve their personal outcomes and aspirations. Redesign opportunities also need to take into consideration digital, telehealth, telecare, and e-health strategies. 2023/24 2024/25 2025/26 2023/24 2024/25 2025/26 TOTAL £m TOTAL £m TOTAL £m TOTAL £m TOTAL £m TOTAL £m Contractual Pressures 9.065 9.495 9.971 11.250 11.762 12.328 Demand Pressures 7.063 7.578 8.130 8.033 8.618 9.246 Pay Pressures 4.929 5.053 5.179 6.901 7.074 7.251 Local Cost Pressures 1.212 2.037 2.037 1.224 2.057 2.057 Prescribing 3.835 3.912 4.009 5.753 5.868 6.014 TOTAL 26.105 28.075 29.326 33.161 35.379 36.896 Envisaged Outlook Type of Pressure on Base Budget Increased by 1% 2023/24 2024/25 2025/26 TOTAL £m TOTAL £m TOTAL £m 2.185 2.266 2.357 0.970 1.040 1.116 1.972 2.021 2.072 0.012 0.020 0.020 1.918 1.956 2.005 7.056 7.304 7.569 Impact of 1% Change 24
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Shifting the Balance of Care A whole system approach to service redesign and savings options is critical. The management of the volume of delayed discharges is an essential consideration going forward to deliver future cost reductions. This however is dependent on capacity being available in community care which is currently a major issue. Service Prioritisation and Reduction The scale of the financial challenge will require the IJB to consider prioritising, reducing, or stopping some services to stay within the funding available. Should demand continue to increase, it is likely that a reduction in service levels will be required to ensure a balanced budget. It is important to note that some services delivered across the health and social care partnership are difficult to transform or reduce as service users are dependent on these services to support their daily living. Prescribing Efficiencies and Medicines Management Mitigating the risk of the rising costs of primary care medicines will remain a focus for the partnership. A range of measures locally and regionally are being progressed to control prescribing volumes and where possible, reduce cost per item. This includes implementing a range of alternatives to prescribing medicines and engaging with our community in self-management and prevention measures. Realistic Care and Realistic Medicine Our users have a key role in deciding what care and treatment best meets their needs. It is therefore important that individuals are better informed about what they can realistically expect from health and social care services. Resources should be directed to achieve realistic goals and manage expectations of what future services can deliver. Early Intervention and Prevention There is strong evidence that early intervention and prevention is very cost effective. Increased emphasis on prevention is an important element of the transformation of services. Recovery approaches which are peer led also provide unique and personalised support opportunities for self-management. Providing our users with the correct service at the right time, first time is critical in avoiding unnecessary and prolonged intervention. 25
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Financial Performance Through regular updates to the IJB from the CFO and by ensuring decisions are taken with both partners to support the financial sustainability, the HSCP has successfully managed to deliver year on year financial balance. This has been achieved through a combination of: • Flexible use of recurring and non-recurring resources. • Creation and use of reserves for specific commitments. • Delivery of approved savings through service redesign and removing duplication. • Workforce planning and focusing on services that are sustainable in line with our Strategic Commissioning Plan. • Implementing a co-ordinated and strategic approach across the partnership. • Effective governance and audit controls. Key Risks and Uncertainties Given the current political climate and the associated economic uncertainty, there are a number of financial challenges facing the IJB which have the potential to affect the partnerships financial sustainability and consequently, future service delivery. These include but are not limited to: • Future funding levels from our partner organisations and Scottish Government. • Our ability to recruit and retain quality staff to continue to deliver services and manage increasing demand. • Continued increasing costs and raising inflation including future pay awards. • Unexpected shortage of supplies and materials. • Changing political factors which influence the UK and Scottish Government priorities and policy initiatives. • The cost and implications due to targets and the impact of the Climate Change. • Introduction and impact of the National Care Service. The IJB maintains a strategic risk register and both partners maintain operational risk registers. Strategic and operational risks are regularly monitored and updated by senior officers across the health and social care partnership. 26
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Estimated Impact of Cost and Demand Pressure for 2023 – 2026 Appendix 1 In early November 2022, the Scottish Government published their Emergency Budget Review (EBR)4 in light of the cost-of-living crisis and inflationary pressures. The EBR sets out reprioritisation of spend of c£0.4 billion within the health and social care portfolio to support pay and wider pressures in the sector. To minimise the impact on existing services, this reprioritisation of spend will largely focus on previously planned additional funding and new allocations. At time of writing, further details of changes to budgets are uncertain and the plan will be adjusted as and when these become clear. 4 Emergency Budget Review: 2022 to 2023 - gov.scot (www.gov.scot) 2023/24 2024/25 2025/26 £m £m £m Contractual Pressures 8.871 9.268 9.686 Demand Pressures 3.879 4.162 4.466 Pay Pressures 3.944 4.022 4.103 Local Pressures 1.212 2.037 2.037 Prescribing 1.918 1.937 1.956 TOTAL 19.823 21.426 22.248 2023/24 2024/25 2025/26 £m £m £m Contractual Pressures 9.065 9.495 9.971 Demand Pressures 7.063 7.578 8.130 Pay Pressures 4.929 5.053 5.179 Local Pressures 1.212 2.037 2.037 Prescribing 3.835 3.912 4.009 TOTAL 26.105 28.075 29.326 2023/24 2024/25 2025/26 £m £m £m Contractual Pressures 12.403 13.364 14.430 Demand Pressures 9.698 10.406 11.165 Pay Pressures 7.887 8.203 8.531 Local Pressures 1.212 2.037 2.037 Prescribing 7.670 7.977 8.296 TOTAL 38.870 41.986 44.459 Type of Pressure on Base Budget - Envisaged Outlook Type of Pressure on Base Budget - Pessimistic Outlook Type of Pressure on Base Budget - Optimistic Outlook 27
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Financial Strategy to Address Funding Pressure for 2023 – 2026 Appendix 2 The IJB will address the potential funding pressures for the next three years using a combination of re-profiling of cost pressures by using a mixture of redesign and budget realignment, making best use of available reserves and by addressing pressure points through management actions and interventions. This will include identifying potential recurring savings and completing an in-year analysis and review of all remaining reserves to identify those no longer required for their original purpose. As previously stated, due to the continuing changing financial environment we are currently facing, the reliance which can be placed on the financial costings and mitigation to address these pressures, decreases the further into the future the projections relate to. The CFO will continue to update and refresh the assumptions as new financial information and certainty becomes available. NORTH LANARKSHIRE IJB 2023/24 2024/25 2025/26 MEDIUM TERM FINANCIAL PLAN 2023 - 2026 TOTAL £m TOTAL £m TOTAL £m Total Envisaged Outlook 26.105 28.075 29.326 2023/24 2024/25 2025/26 TOTAL £m TOTAL £m TOTAL £m Use of Reserves 8.219 9.958 0.864 In Year Re-Profiling of Cost Pressures 7.008 1.329 1.329 Resource Forecast 10.878 11.301 11.767 Management Actions 5.487 15.366 Total Financial Strategy 26.105 28.075 29.326 2023/24 2024/25 2025/26 TOTAL £m TOTAL £m TOTAL £m NET TOTAL 0.000 0.000 0.000 ENVISAGED FUNDING GAP Financial Strategy to Address Funding Pressures: 28
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1 REPORT Item No: 7 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB): For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 3 February 2023. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer Reviewed By: Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; and (2) Note the financial position is a year-to-date underspend of £13.75m 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in the following table, the IJB year to date position is an underspend of £13.75m and the projected outturn for 2022/23 is an underspend of £16.199m, assuming the current trajectory of spend continues throughout this financial year. Service Year to Date Position £m Projected Year End Outturn £m Health Care Services £6.264m £7.352m Social Care Services £7.486m £8.847m SUBJECT: Financial Monitoring Report 2022/2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 22nd March 2023 Yes No N/A
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2 Total North Lanarkshire HSCP £13.75m £16.199m 6.2 Subject to IJB approval, this estimated underspend will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional future business plans and any funding gap which may be highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023-2026. 6.3 The following provides a high-level summary of the key pressures and the main reasons why the IJB is currently projecting an underspend against its budget this year: Employee Costs net underspend of £12.205m: as previously highlighted there are ongoing challenges in terms of recruitment and retention issues across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. These are issues that are being faced by IJBs across Scotland. Home Support net overspend of £0.542m: within Home Support Services, employee costs have increased as the service continues to support delayed discharges and demand however, this additional cost is being part funded from an earmarked reserve and the current number of vacant posts throughout other parts of the partnership. Payments to Other Bodies net underspend of £2.840m: the underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the self-directed support commissioning framework. There is also an underspend in package costs due to slippage in Self-Directed Support (SDS) start dates. It is anticipated these are in-year underspends only and the full budget will be required in future years. Independent Care Homes net overspend of £0.788m: there are currently 1,503 care packages within this service however when the budget was set for this financial year, it was based on 1,461 care packages. Included within this overspend is £252k interim care bed expenditure, which will be offset by a 25% funding allocation from Scottish Government in relation to winter planning. Admin Costs net underspend of £1.884m: within the carers funding there is currently an unallocated budget of £1.8m. Work is continuing to allocate this is relevant carers package in 2022/23. At year end, any remaining underspend will be transferred to a dedicated earmark reserve to fund carers pressures in 2023/24. Prescribing net overspend of £0.300m: activity and cost per item within prescribing is 4.6% higher compared to the same period last year, which has caused this budget to move from a breakeven position when last reported to the current overspend position. Due to the uncertainty around costs and prescribing activity and the three-month time lag in receiving the data, the volatility experienced within prescribing is likely to continue for the foreseeable future.
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3 6.4 Throughout the financial year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and the table below shows the current year to date allocations received from Scottish Government: Scottish Government Allocations 2022/23 £m Multi-Disciplinary Teams 1.743 Community Extended Care Pilot 0.933 North Family Nurse Partnership 0.070 ICU Bed Capacity Uplift 0.044 Hospitals at Home 0.250 District Nursing 0.608 Long Covid Support Funding 0.320 Learning Disability Health Checks 0.123 Alcohol and Drug Partnership – Tranche 1 2.179 Veteran 1st Point 0.126 Naloxone for Police Scotland 0.031 TOTAL 6.427 7. RESERVES 7.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statue and is part of a range of measures in place to ensure that s106 public bodies do not over-commit themselves financially. 7.2 The current IJB reserves position for 2022/23 is a revised balance of £69.237m and is summarised in the table below. A detailed analysis of these reserves is presented within the IJB Reserves Strategy 2022/2023. 7.3 The IJB Reserves Strategy 2022/2023 has been updated to include the revised structure of the reserves to continue to enable the IJB to meet its agreed strategic objectives, and Scottish Government policy requirements. 8. CURRENT VACANCY POSITION Opening Balance After Review Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) - 119.453 (23.944) (26.271) 69.237 LEAD SUMMARY Total
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4 8.1 As highlighted throughout this report, employee costs are projecting a significant underspend within all services. Recruitment continues to be progressed for vacant posts in all areas. 8.2 The table below shows the current full time equivalent (FTE) vacancy numbers within each service against the budgeted establishment: 8.3 To help cover the current vacant posts, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at Appendix 5. 9. DELEGATED SERVICES 9.1 The following table shows the costs of other North Lanarkshire Council services delegated to the IJB. The IJB remain accountable for these services, however, they continue to be delivered by North Lanarkshire Council. North Lanarkshire HSCP monitors the delivery of these services on behalf of the IJB. 9.2 The projected outturn position to 31 March 2023 is a breakeven position for both services. Service Annual Budget £m Projected to Year End £m Variance £m Housing 1.870 1.870 - Breakeven Establishment Actual FTE FTE FTE % North West Locality 384.98 344.68 40.30 10.5% North East Locality 323.53 298.57 24.96 7.7% Adult Services 274.01 248.56 25.45 9.3% Children Services 553.69 473.43 80.26 14.5% Mental Health 1,146.60 1,092.47 54.13 4.7% Social Care Services 834.20 660.40 173.80 20.8% Home Support 1,000.07 991.89 8.18 0.8% Other 177.02 216.79 -39.77 -22.5% TOTAL 4,694.10 4,326.79 367.31 7.8% Service Vacancies Overtime Excess Part Time Bankaide Agency £m £m £m £m North West Locality 0.118 0.033 0.437 0.040 North East Locality 0.072 0.041 0.199 - Adult Services 0.048 0.066 0.153 0.057 Children Services 0.148 0.085 0.304 0.013 Mental Health & Learning Disabilities 0.403 0.072 1.840 2.297 Social Care Services 0.879 - - 0.099 Home Support 3.529 - - - Other 0.025 0.015 0.019 - TOTAL 5.223 0.312 2.952 2.506 SERVICE Year to Date Cost
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5 Transport 0.551 0.551 - Breakeven Total 2.421 2.421 - Breakeven 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. The IJB Medium Term Financial Plan 2023-2026 is currently being completed. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary, and are included in a separate report to the IJB. 10.5 PEOPLE None 10.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the North Lanarkshire IJB. 10.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDICES North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Hosted Services Led by North Lanarkshire Appendix 2 Hosted Services Led by South Lanarkshire Appendix 3 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 Analysis of Additional Employee Costs Appendix 5
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6 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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7 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Expenditure Annual Year To Date Variance Budget Budget Actual Total 2022/2023 January 2023 January 2023 January 2023 £m £m £m £m Health Care Services Locality and Other Services 51.907 32.325 29.999 2.326 Addiction Services 5.827 2.885 2.605 0.279 Medical and Nursing Directorate 5.296 3.940 3.447 0.492 Prescribing 69.582 52.187 52.487 (0.300) Out of Area Services 4.571 3.428 3.620 (0.192) Area Wide Services 11.099 7.482 7.220 0.262 Hosted Services 158.901 116.858 113.462 3.396 Family Health Services 113.512 85.714 85.714 0.000 Set-Aside Budget 66.858 55.715 55.715 0.000 Covid-19 2.766 2.766 2.766 (0.000) Total Expenditure - NHSL 490.319 363.299 357.035 6.264 Social Care Services Social Care Services Gross Expenditure 241.758 187.698 180.617 7.081 Social Care Services Gross Income (Including Covid-19 Income) (2.896) (0.620) (1.025) 0.406 Social Care Services Net Expenditure 238.861 187.078 179.592 7.486 Housing Revenue Account Expenditure 1.870 1.667 1.667 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 Social Care, Housing and Transport Services Net Expenditure 241.282 188.915 181.428 7.486 Total Expenditure - NHSL and NLC 731.601 552.214 538.463 13.750 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (471.076) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.718) Scottish Government Funding - Covid-19 and Remobilisation (2.766) Transfer from Reserves (Approved) (16.477) Total Funding - NHSL (543.421) NLC Funding - Social Care Services (185.759) NLC Funding - Housing Services (1.870) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (188.180) Total Funding - NHSL and NLC (731.601) 2022/2023 Year To Date
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8 Hosted Services Appendix 2 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 2.986 2.243 2.118 0.125 1.523 1.144 1.019 0.125 1.463 1.099 1.099 0.000 Continence Services 2.361 1.771 1.776 (0.005) 1.204 0.903 0.908 (0.005) 1.157 0.868 0.868 0.000 Immunisation Services 1.898 1.423 1.852 (0.429) 0.968 0.726 1.155 (0.429) 0.930 0.698 0.698 0.000 Speech and Language Therapy Services 6.114 4.589 3.959 0.630 3.118 2.340 1.710 0.630 2.996 2.249 2.249 0.000 Children and Adolescents Mental Health Services 12.448 8.591 7.581 1.010 6.349 4.381 3.371 1.010 6.100 4.209 4.209 0.000 Childrens Services 12.444 9.030 8.755 0.275 6.346 4.605 4.330 0.275 6.097 4.425 4.425 0.000 Integrated Equipment and Adaptations Store 0.567 0.426 0.508 (0.082) 0.289 0.217 0.299 (0.082) 0.278 0.208 0.208 0.000 Dietetics Services 3.856 2.897 2.663 0.234 1.967 1.477 1.243 0.234 1.890 1.419 1.419 0.000 Podiatry Services 4.357 3.266 3.160 0.106 2.222 1.666 1.560 0.106 2.135 1.600 1.600 0.000 Prisoner Healthcare Services 1.707 1.281 1.248 0.032 0.870 0.653 0.621 0.032 0.836 0.627 0.627 0.000 Blood Borne Viruses Services 1.529 1.147 1.103 0.044 0.780 0.585 0.541 0.044 0.749 0.562 0.562 0.000 Hospital at Home 2.502 1.749 1.518 0.232 1.276 0.892 0.661 0.232 1.226 0.857 0.857 0.000 Mental Health and Learning Disability Services 73.762 55.827 54.602 1.224 37.619 28.472 27.247 1.224 36.143 27.355 27.355 0.000 TOTAL 126.530 94.238 90.842 3.396 64.530 48.061 44.665 3.396 62.000 46.177 46.177 0.000 Led by the North Partnership South Lanarkshire IJB - 49% Share Year to Date Annual Budget 2022/2023 Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% ShareYear to DateAnnual Budget 2022/2023 Hosted Services Appendix 3 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 7.488 5.545 5.053 0.492 3.819 2.828 2.828 0.000 3.669 2.717 2.225 0.492 Brain Injury Unit 2.365 1.414 1.322 0.092 1.206 0.721 0.721 0.000 1.159 0.693 0.601 0.092 Out of Hours Services 8.919 6.629 6.600 0.028 4.548 3.381 3.381 0.000 4.370 3.248 3.220 0.028 Palliative Care Services 7.215 5.437 5.312 0.124 3.680 2.773 2.773 0.000 3.535 2.664 2.540 0.124 Physiotherapy Services 10.209 7.666 7.279 0.387 5.207 3.910 3.910 0.000 5.003 3.756 3.369 0.387 Primary Care Services 0.806 0.600 0.556 0.044 0.411 0.306 0.306 0.000 0.395 0.294 0.250 0.044 Occupational Therapy Services 7.988 6.017 5.541 0.476 4.074 3.069 3.069 0.000 3.914 2.948 2.473 0.476 Diabetic Services 4.948 4.007 3.947 0.059 2.524 2.043 2.043 0.000 2.425 1.963 1.904 0.059 Telehealth 0.660 0.421 0.228 0.192 0.336 0.215 0.215 0.000 0.323 0.206 0.014 0.192 Sub Total 50.598 37.735 35.839 1.896 25.805 19.245 19.245 0.000 24.793 18.490 16.594 1.896 Ring Fenced Funding Primary Care Improvement Fund 12.874 6.617 6.617 0.000 6.566 3.375 3.375 0.000 6.308 3.243 3.242 0.000 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Sub Total 12.874 6.617 6.617 0.000 6.566 3.375 3.375 0.000 6.308 3.243 3.242 0.000 TOTAL 63.471 44.352 42.456 1.896 32.370 22.620 22.620 0.000 31.101 21.733 19.836 1.896 Annual Budget 2022/2023 Year to Date South Lanarkshire IJB - 49% Share Led by the South Partnership Annual Budget 2022/2023 Year to Date Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% Share
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9 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 2022/23 NHSL Financial Allocation to North Lanarkshire HSCP £m 2022/23 NLC Financial Allocation to North Lanarkshire HSCP £m 2022/22 North Lanarkshire HSCP Financial Allocation 506.931 2022/22 North Lanarkshire HSCP Financial Allocation 132.575 Add: Set-Aside Budget 66.858 NLC Funding - Housing Services 1.870 Less: Budget Adjustments NLC Funding - Transport Services 0.551 Social Care Fund -22.964 Add: Budget Adjustments Resource Transfer -23.421 Social Care Fund 22.964 Commissioned Services -6.799 Resource Transfer 23.421 NHSL Financial Allocation at 31 May 2022 520.605 Commissioned Services 6.799 NLC Financial Allocation at 16 September 2022 188.180 Draw Down from Reserves 1.949 Increase to Employers NI 1.262 NES Trainee 1.021 Other Budget Adjustments 0.425 NHSL Financial Allocation at 30 June 2022 525.262 Draw Down from Reserves 0.460 Junior Medical Income -0.040 Other Budget Adjustments 0.023 NHSL Financial Allocation at 31 July 2022 525.705 Draw Down from Reserves 0.453 Child Death Review Funding 22-23 0.024 Increase to Hosted Services Led by South 1.146 Other Budget Adjustments 0.220 NHSL Financial Allocation at 31 August 2022 527.548 Draw Down from Reserves 1.740 Junior Doctor Income 2.274 Adustment to Commissioned Services 0.082 Increase to Hosted Services Led by South 0.433 Other Budget Adjustments 0.002 NHSL Financial Allocation at 30 September 2022 532.079 Draw Down from Reserves 1.039 Scottish Government Funding Health Care Support Workers 1.743 Scottish Government Funding for Band 2-4 (North Allocation) 0.933 Increase to Hosted Services Led by South 0.634 Other Budget Adjustments 0.160 NHSL Financial Allocation at 30 October 2022 536.588 Draw Down from Reserves 1.275 Medical Pay Award 4.5% 0.979 Junior Medical 0.132 Increase to Hosted Services Led by South 2.450 Other Budget Adjustments 0.022 NHSL Financial Allocation at 30 November 2022 541.446 Adjustment to Reserves -2.321 Junior Medical & Trainee Income 0.073 Learning Disabilities Health Checks 0.123 Increase to Hosted Services Led by South 4.085 Other Budget Adjustments 0.015 NHSL Financial Allocation at 31 December 2022 543.421 Budget Adjustments Posted in Month 9 Budget Adjustments Posted in Month 8 Budget Adjustments Posted in Month 6 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 4 Budget Adjustments Posted in Month 5 Budget Adjustments Posted in Month 7
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10 Analysis of Additional Employee Costs Appendix 5 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 44,000 32,000 17,500 35,500 209,500 2,000 340,500 2 44,000 32,000 17,500 35,500 209,500 2,000 340,500 3 53,000 34,000 22,000 30,000 205,000 3,000 347,000 4 54,000 30,000 17,000 38,000 216,000 5,000 360,000 5 49,000 33,000 17,000 41,000 212,000 4,000 356,000 6 43,000 31,000 12,000 34,000 196,000 4,000 320,000 7 53,000 32,000 17,000 43,000 221,000 6,000 372,000 8 46,000 33,000 24,000 40,000 186,000 7,000 336,000 9 51,000 -58,000 9,000 7,000 185,000 -14,000 180,000 TOTAL 437,000 199,000 153,000 304,000 1,840,000 19,000 2,952,000 North West Locality £ Adult Services £ Children Services £ Learning Disabilities £ Mental Health £ Social Care Services £ TOTAL £ 1 1,396 6,804 9,018 19,329 72,766 109,313 2 406 6,804 1,303 37,927 338,077 384,517 3 2,527 6,804 42,413 184,579 236,323 4 4,348 4,796 37,915 199,682 246,741 5 5,698 4,988 38,211 212,758 261,655 6 759 4,797 1,627 49,939 193,626 250,748 7 2,817 4,796 59,821 234,119 301,553 8 10,554 4,796 97,273 182,799 7,204 302,626 9 11,584 12,168 754 63,042 232,980 13,336 333,864 10 20,796 20,796 11 57,701 57,701 TOTAL 40,089 56,753 12,702 445,870 1,851,386 99,037 2,505,837 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 13,187 8,071 10,569 12,294 49,952 8,427 109,798 4,808 217,106 2 12,032 8,789 3,582 9,091 42,880 73,558 285,090 1,096 436,118 3 21,425 6,426 4,508 7,572 29,605 76,713 277,793 2,558 426,600 4 12,482 4,153 2,223 16,873 30,022 74,719 290,873 2,923 434,268 5 17,069 10,685 3,218 9,750 53,447 87,187 321,181 1,541 504,078 6 10,687 7,575 4,373 14,542 48,147 76,800 326,698 2,629 491,451 7 13,149 4,503 6,412 21,905 55,807 84,165 362,809 4,290 553,040 8 9,351 9,011 7,230 27,429 58,631 113,755 503,326 2,800 731,533 9 8,914 12,937 5,770 28,958 34,450 118,428 420,088 2,046 631,591 10 86,099 254,737 340,836 11 79,279 377,024 456,303 TOTAL 118,296 72,150 47,885 148,414 402,941 879,130 3,529,417 24,691 5,222,924 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,869 5,164 12,800 6,579 10,496 889 42,797 2 3,401 4,223 7,228 5,775 8,002 796 29,425 3 4,231 6,891 8,791 6,755 9,229 656 36,553 4 3,007 4,827 5,230 8,288 7,947 2,269 31,568 5 3,801 3,348 5,450 7,051 9,240 4,532 33,422 6 3,660 3,937 5,002 11,180 7,207 649 31,635 7 2,077 1,879 6,954 12,542 8,465 1,605 33,522 8 2,447 3,914 6,168 12,599 6,428 1,591 33,147 9 3,517 6,460 8,221 14,474 5,392 1,790 39,854 TOTAL 33,010 40,643 65,844 85,243 72,406 14,777 311,923 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE AGENCY COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period
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1 REPORT Item No: 8 SUBJECT: 2023-24 Delegated Health and Social Care Budget TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report describes the financial allocation and budgets made available to the Integration Joint Board (IJB) for 2023/24 by North Lanarkshire Council and NHS Lanarkshire. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Finance Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Agree to accept the delegated social care budget for 2023/24 in section 9.4; (2) Agree to accept the delegated health budget for 2023/24 in section 10.4 subject to: the expected uplift of 2% reflecting the boards uplift for 2023/24; any final adjustments in relation to recurring budget adjustments at month 12; and any further funding allocated by the Scottish Government. (3) Approve a drawdown of reserves, if required, in order to fund any shortfall in funding for 2023/24 and (4) Approve increases to the IJB’s contingency reserves in 2023/24, through the appropriate utilisation of permitted financial flexibilities, in order to protect the financial resilience of the IJB. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire IJB is a legal entity in its own right created by Parliamentary Order, following ministerial approval of the Integration Scheme between North Lanarkshire Council and NHS Lanarkshire. It is accountable for the stewardship of public funds and ensuring that its business is conducted under public sector best practice governance arrangements, including ensuring that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. Yes No N/A
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2 5.2 The budget delegated by our two partner bodies, is used by the IJB to commission services, which are delivered by North Lanarkshire Health and Social Care Partnership (HSCP). The principles of the funding allocated by the two partner organisations is set out in the Integration Scheme, however, utilisation of this funding is delegated to the IJB. 5.3 Under the terms of the Integration Scheme, partner organisations should make appropriate arrangements to fund pay awards, contractual uplifts, the impact of demographic changes and determine efficiency targets as part of their respective budget setting processes. 5.4 The role of the Chief Finance Officer (CFO) for the IJB includes both the adherence to professional standards as well as compliance with the Local Government (Scotland) Act 1973. For the IJB this includes the requirement to ensure a balanced budget is set. 6. CONCLUSIONS 6.1 This report sets out the implications of the Scottish Government budget for 2023/24 and provides an overview of the IJB’s budget allocation for 2023/24. 6.2 Over the medium term, significant uncertainty remains, and the IJB will require to continue to plan for a wide range of potential scenarios. During the past number of years, the IJB has taken a medium-term view of its financial position, agreeing transformation and savings plans which have ensured a balanced budget year on year. However, the impact of Covid-19 and the cost-of-living crisis, continues to provide uncertainty resulting in spikes in demand for services and the need for ongoing review and realignment of future transformation and savings plans. 6.3 In this context, it is more than likely that we will need to draw on the financial flexibilities available to the IJB to provide non-recurring support to balance the annual revenue budget position each year over the medium-term basis. 7. SCOTTISH GOVERNMENT BUDGET 2023/2024 7.1 On 15 December 2022, the Scottish Government published their budget for 2023/24. Included within the condition of the budget was the continued prioritisation of financial support for social care and integration, with a further £95m which recognises the recurring commitments on adult social care pay in commissioned services and inflationary uplift on Free Personal Nursing Care rates. This is offset by the non- recurring interim care money ending. Funding Scotland (£m) North Lanarkshire (£m) Living Wage to £10.90 100 6.042 Uprating of Free Personal Care 15 0.186 Interim Care -20 -1.183 Total 95 5.045 7.2 Following the announcement of the Scottish Government budget for 2023/24, the Director of Health Finance and Governance issued a letter to NHS Chairs, NHS Directors of Finance, Integration Authority Chief Officers, and Integration Authority Chief Finance Officers outlining the details of the funding settlement. A copy of this letter is attached in Appendix 1.
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3 8. SUMMARY OF 2022/23 BUDGET POSITION 8.1 As reported throughout this financial year, the IJB will deliver an underspend on its core budget. The IJB projected underspend of £16.199m for 2022/23 financial year takes into account the ongoing challenges in terms of recruitment and retention across all service areas. These are issues that are being faced by IJBs across Scotland. 8.2 The landscape in relation to additional funding streams released throughout the year by Scottish Government to a number of priority areas is exceptionally complex with continued uncertainty around the scale and timing of future funding. The development of the Medium-Term Financial Plan 2023/26 and continued importance placed on risk-based and contingency reserves will help to mitigate this risk. 9. DELEGATED SOCIAL CARE BUDGET 2023/24 9.1 Similar to 2022/23 and as previously highlighted, demographic, and socio-economic factors continue to drive significant demand and cost pressures for 2023/24 relating to: Funding for 2023/24 pay award. Cost pressures arising from contractual arrangements which are subject to renewal. Financial impact of the negotiated application of the increased living wage across the sector. Increases associated with the National Care Home Rate (NCHR) contract. Ongoing pressures on home support service in relation to costs associated with shifting the balance of care, supporting people to live safely at home for as long as possible and facilitating prompt discharge from hospital. Increasing investment in self-directed support packages required to support adults and carers to achieve improved outcomes and live independently. 9.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for social care services in 2023/24 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £16m. 9.3 At its meeting of 23 February 2023, North Lanarkshire Council approved a recurring net uplift to the social care budget of £5.045m. This increase is in line with the conditions of the letter of the 15 December 2022 from the Director of Health Finance and Governance. 9.4 The following table provides a summary of the social care budget 2023/24: Social Care Budget 2023/24 £m Opening Budget 185.759 Delegated Services 2.421 2023/24 Recurring Uplift 5.045 Total 2023/24 Budget 193.225 9.5 The CFO recommendation to the IJB is, to note and accept the delegated social care budget offer from North Lanarkshire Council for 2023/24.
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4 10. DELEGATED HEALTH BUDGET 2023/24 10.1 Similar to social care, demographic and socio-economic factors continue to drive significant demand and cost pressures for our delegated health services in 2023/24 including: Pay inflation and the impact of agenda for change. Inflationary cost pressures across service level agreements on non-pay budgets. Prescribing cost, volume, and short supply impact. 10.2 Using a range of informed assumptions, the CFO has estimated that the demand and cost growth for health services (not including Set Aside) in 2022/23 linked to the areas highlighted above, is likely to be in the region of a gross increase of circa £10m. 10.3 The NHS Lanarkshire Health indicative budget offer for 2023/24, is based on an uplift of 2% and is in line with the letter of the 15 December 2022 from the Director of Health Finance and Governance. It is anticipated that a formal budget offer will be issued following NHS Lanarkshire board approval. 10.4 The following table provides a summary of the indicative health budget 2023/24: Health Budget 2023/24 £m Opening Budget 291.629 Set Aside Budget 66.858 2023/24 Recurring Uplift 5.833 2023/24 Set Aside Uplift 3.606 Total 2023/24 Budget 367.926 10.5 The CFO recommendation to the IJB is, to note and accept the delegated health budget offer from NHS Lanarkshire for 2023/24 subject to the expected 2% uplift and any final adjustments when the outturn for 2022/23 financial year has been finalised in relation to recurring budget adjustments at month 12, and any further funding allocated by Scottish Government. 11. FINANCIAL STRATEGY 2023/24 11.1 The Medium-Term Financial Plan (MTFP) 2023/26 reflects the economic outlook, adopting a strategic and sustainable approach linked to the delivery of priorities in our Strategic Commissioning Plan 2023/26. These strategic priorities will continue to provide a focus for future budget decisions, where the delivery of core services must be balanced with the resources available. Our MTFP and Reserves Strategy focuses on financial sustainability, acknowledging the uncertainty around key elements and the need to redirect resources to support the delivery of key priorities. 11.2 In addition, it is clear from North Lanarkshire Council and NHS Lanarkshire financial outlook, that both partners anticipate they will be subject to significant pressure over the medium term with a further period of constraint and potential reduction in core funding. In this context, there is a greater risk that any future uplifts in funding to the IJB similar to that provided in previous years may not be deliverable.
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5 11.3 On this basis, the IJB should continue to plan for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner. Looking to the future, the likely scenario is that a significant level of savings and redesign will be necessary to continue to deliver sustainable and modern services which meet the needs of service users and their families. 11.4 It is therefore essential that the IJB continues to focus on the medium-term financial challenges and where appropriate generate reserves to help: Address medium-term pressures on the assumption that the financial position is more than likely to become challenging. To provide temporary funding to drive transformation. To build contingency reserves which will be crucial in ensuring the financial sustainability of the partnership in the medium term. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 12.5 PEOPLE None 12.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC have both been consulted on the proposed IJB Reserves Strategy 2021/2022 for the North Lanarkshire IJB. 12.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 12.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 13. BACKGROUND PAPERS None.
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6 14. APPENDIX Director of Health Finance and Governance 2023/24 Budget Letter Appendix 1 Chief Finance Officer Members seeking further information, please contact Amanda Kilburn on 07816 126362.
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7 Directorate for Health Finance and Governance APPENDIX 1 Richard McCallum, Director T: 0131-244 3464 E: richard.mccallum@gov.scot Chief Executives, NHS Scotland Copy to: NHS Chairs NHS Directors of Finance Integration Authority Chief Officers Integration Authority Chief Finance Officers Issued via email 15th December 2022 Dear Chief Executives Scottish Government Budget 2023-24 Following the announcement of the Scottish Government’s Budget for 2023-24 by the Deputy First Minister in Parliament today, I am writing to provide details of the indicative funding settlement for Health Boards. A breakdown of this is provided in Annex A to this letter. The Deputy First Minister has set out this budget in the context of the current cost of living crisis and funding parameters set by the Chancellor of the Exchequer in November 2022. This budget sets out the next steps to deliver the Health and Social Care commitments outlined in the Programme for Government, taking into account the current economic environment and recent Emergency Budget Review. As in previous years, the position will be subject to any amendments agreed through the Scottish Parliament’s Budget Bill process, as well as recognising the further work that we will undertake with you specifically in relation to Covid-19 and pay funding arrangements. I will keep you up to date with any changes to our planning assumptions. Budget Uplift Compared to 2022-23 budgets, Boards will receive a total increase of 5.9% for 2023-24. This includes recurring funding for pay in 2022-23 and a baseline uplift of 2% for 2023-24. Within this total, those Boards furthest from NRAC parity will receive a share of £23.2 million, which will continue to maintain all Boards within 0.8% of parity. In terms of pay, given the challenging and uncertain outlook for inflation, the need to conclude some pay deals for the current year and the associated implications for spending baselines, the Government has not set out a public sector pay policy alongside the 2023-24 Budget and we will say more on 2023-24 pay (covering Agenda for Change and other staff groups) at an appropriate point in the new year. As part of Boards recurring adjustments for 2022-23, amounts have been included based on pay offers for Agenda for Change and Medical and Dental staffing in 2022-23. The Agenda for Change pay deal remains subject to
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8 agreement, and we will work with Directors of Finance to finalise this position once the outcome is known. I will write to Boards in 2023 to confirm finalised baseline budgets following the conclusion of this work. Health & Social Care Levy Funding I can confirm that the £69.1 million allocated in 2022-23 to support Boards with the costs of the additional National Insurance levy in 2022-23 will remain with Boards. Following the change in policy by UK Government, this funding is not ringfenced and it is to be determined locally how this resource is utilised. Covid-19 Funding Whilst the scale of Covid-19 costs has reduced significantly in 2022-23 and projected to reduce further in 2023-24, we recognise that there are specific legacy costs that will require additional funding support in the new financial year. This includes funding for: - Vaccinations staffing and delivery; - Test & Protect activities including Regional Testing facilities; - Additional PPE requirements; and - Some specific Public Health measures. Following today’s budget we will seek to provide early clarity as to the total funding to be provided to support these costs. However, beyond the above, NHS Boards and Integration Authorities should expect to meet remaining costs from baseline funding and should continue to drive these costs down as far as possible. Policy Funding In addition to the baseline uplift outlined, funding aligned to policy commitments and recovery of health and social care services will be allocated to Boards and Integration Authorities in 2023-24. It is our intention to provide early indication of allocations, where possible, and to align this to the planning guidance that will be issued in relation to Annual Delivery Plans, setting out the priorities for health and social care in the coming year. Recognising the level of funding that is provided through in-year non-recurring allocations, and to maximise flexibility in delivery, we intend to review funding arrangements ahead of 2023-24. As part of this work, we will seek to bundle and baseline funding where this is appropriate. We will work closely with both Territorial and National Boards to establish a suitable approach. Health and Social Care Integration In line with previous years, 2023-24 NHS payments to Integration Authorities for delegated health functions must deliver an uplift of 2% over 2022-23 agreed recurring budgets and make appropriate provision for 2022-23 pay. The Health and Social Care Portfolio will transfer net additional funding of £95 million to Local Government to support social care and integration, which recognises the recurring commitments on adult social care pay in commissioned services (£100 million) and inflationary uplift on Free Personal Nursing Care rates (£15 million). This is offset by non-recurring Interim Care money ending (£20 million).
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9 The overall transfer to Local Government includes additional funding of £100 million to deliver a £10.90 minimum pay settlement for adult social care workers in commissioned services, in line with Real Living Wage Foundation rate. The funding allocated to Integration Authorities should be additional and not substitutional to each Council’s 2022-23 recurring budgets for services delegated to IJBs and, therefore, Local Authority social care budgets for allocation to Integration Authorities must be at least £95 million greater than 2022-23 recurring budgets. Capital Funding The Health Capital settlement for 2023-24 is in line with the expectations of the Capital Spending Review. Therefore I can confirm that Boards’ Capital Resource Limit will be in line with that for 2022-23, plus additional funding will be provided for legally committed projects. The capital programme and commitments is subject to ongoing review by the National Infrastructure Board and the Capital Investment Group, and Boards will be advised at the earliest opportunity on any further allocations for projects in development during 2023-24. 2023-24 Financial Planning As previously confirmed, where Boards are indicating that financial support is required in 2022-23, we have asked Boards to submit financial recovery plans in the new year, setting out a return to financial balance in the next three years. I expect that Boards are taking proactive steps to develop these plans. We will be requesting that financial plans for 2023-24 are submitted in the new year and will be issuing guidance to this effect shortly. As noted in my letter on 12 September, all Boards are expected to be engaging with the Sustainability and Value (S&V) programme, reflecting this work at a local level to support delivery of a cost reduction target of 3% per annum and productivity and related improvements in line with the four aims. The S&V board is now meeting regularly as are the working groups taking forward specific ideas. Value propositions have been set out to bring various elements of this work together which will be shared in due course. Longer term work is required as we move out of recovery, towards transformation and renewal of our health services to deliver world-class, safe, person-centred, and sustainable healthcare for the people of Scotland. This will build on and prioritise specific areas of work in a joined-up way, whilst working in parallel to develop longer term transformation and renewal of our health services. It is clear that there is significant financial challenge in 2023-24 and we will continue to work closely with Chief Executives to address this. I thank you again for your support to date and your continued engagement moving into the next financial year. Yours sincerely Richard McCallum Director of Health Finance and Governance
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10 Annex A – Board Funding Uplifts 2022-23 Allocation Recurring Allocations* 22-23 Pay** Total 2022-23 Allocation Uplift*** 2023-24 Total Allocation Uplift from 2022- 23 NRAC Funding Distance from NRAC Parity HSC Levy Funding (retained by Boards) **** Uplift from 2022-23 (inclusive of HSC Levy) NHS Territorial Boards £m £m £m £m £m £m % £m % Ayrshire and Arran 806.8 (0.6) 27.4 833.5 16.7 850.2 5.4% 0.0 -0.4% 4.4 6.0% Borders 234.8 (0.1) 8.0 242.6 6.0 248.6 5.9% 1.1 -0.8% 1.3 6.5% Dumfries and Galloway 334.1 (0.2) 11.3 345.3 6.9 352.2 5.4% 0.0 1.9% 1.8 6.0% Fife 749.4 (0.5) 25.5 774.3 16.5 790.8 5.5% 1.0 -0.8% 4.0 6.1% Forth Valley 598.1 (0.3) 20.3 618.1 13.0 631.1 5.5% 0.6 -0.8% 3.2 6.1% Grampian 1,072.2 (0.9) 36.4 1,107.7 22.2 1,129.9 5.4% 0.0 -0.4% 5.8 6.0% Greater Glasgow and Clyde 2,504.0 (1.4) 85.0 2,587.6 51.8 2,639.4 5.4% 0.0 1.7% 13.6 6.0% Highland 725.6 (0.5) 27.8 752.9 15.3 768.2 5.9% 0.2 -0.8% 3.9 6.4% Lanarkshire 1,346.8 (0.8) 45.7 1,391.8 32.3 1,424.1 5.7% 4.5 -0.8% 7.3 6.3% Lothian 1,639.3 (1.3) 55.7 1,693.7 49.6 1,743.3 6.3% 15.7 -0.8% 8.9 6.9% Orkney 57.1 (0.1) 1.9 59.0 1.2 60.2 5.5% 0.1 -0.8% 0.3 6.0% Shetland 57.0 0.0 1.9 59.0 1.2 60.1 5.5% 0.0 2.3% 0.3 6.1% Tayside 856.5 8.7 29.1 894.3 17.9 912.2 6.5% 0.0 -0.7% 4.7 7.1% Western Isles 84.5 (0.0) 2.9 87.3 1.7 89.0 5.4% 0.0 11.5% 0.5 6.0%
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11 Territorials Total 23.2 60.0 6.3% NHS National Boards National Waiting Times Centre 0.9 12.8% Scottish Ambulance Service 2.0 10.0% The State Hospital 0.3 7.0% NHS 24 0.7 16.7% NHS Education for Scotland 2.8 5.7% NHS National Services Scotland 1.5 7.0% Healthcare Improvement Scotland 0.2 11.0% Public Health Scotland 0.7 10.8% Nationals Total9.1 8.3% Total NHS Boards69.1 6.5% * Includes recurring allocations from 2021- 22 ** Includes estimated funding for Agenda for Change and Medical & Dental pay uplift in 2022-23. *** Includes NRAC parity adjustments. **** Included in Boards 2022-23 Baseline Budgets St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot 1,066.1 2.0 379.0 11,447.1 252.2 11,699.2 5.7% 68.1 0.0 6.2 74.3 1.5 75.8 11.3% 305.9 5.6 16.2 327.7 6.6 334.2 9.3% 40.0 0.0 1.7 41.7 0.8 42.5 6.3% 78.4 5.5 5.0 88.9 1.8 90.7 15.7% 492.3 1.4 13.8 507.5 10.1 517.6 5.1% 355.3 5.6 10.4 371.2 7.4 378.6 6.6% 30.4 1.1 1.4 32.9 0.7 33.6 10.4% 52.1 0.2 3.5 55.8 1.1 56.9 9.3% 1,422.6 19.5 58.0 1,500.1 30.0 1,530.1 7.6% 12,488.7 21.5 437.0 12,947.2 282.2 13,229.3 5.9%
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Prepared for North Lanarkshire IJB March 2023 North Lanarkshire Integration Joint Board Annual Audit Plan 2022/23
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Annual Audit Plan 2022/23 2 Contents Introduction 3 Financial statements audit planning 5 Wider Scope and Best Value 8 Reporting arrangements, timetable, and audit fee 10 Other matters 13 Appendix 1. Your audit team 15
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Introduction | 3 Introduction Summary of planned audit work 1. This document summarises the work plan for our 2022/23 external audit of North Lanarkshire Integration Joint Board (IJB). The main elements of our work include: • an audit of the 2022/23 annual accounts to support our opinions on the financial statements • work to support our opinions on the other statutory information published within the annual accounts including the Management Commentary, the Governance Statement, and the Remuneration Report • consideration of the arrangements in relation to the four audit dimensions that frame the wider scope of public sector audit: financial management; financial sustainability; governance and transparency and value for money • consideration of Best Value arrangements • review North Lanarkshire IJB’s arrangements for preparing and publishing its Annual Performance Report. Audit Appointment 2. We are pleased to be appointed as the external auditor of North Lanarkshire IJB for the period 2022/23 to 2026/27 inclusive. You can find a brief biography of your audit team at Appendix 1. 3. In the first year of the audit appointment, we invest significant time gaining an understanding of your business and identifying and assessing the risks of material misstatement to the financial statements. While we use our initial assessment of risk to inform our planned audit approach, we keep our assessment of risks under review as the audit progresses. We will inform you of any significant changes in assessed risks and any resulting changes in our planned audit work. 4. The audit team will actively engage with you over the course of the audit to ensure our audit work continues to be focused on risk. Adding value 5. We aim to add value to North Lanarkshire IJB through our external audit work by being constructive and forward looking, by attending meetings of the Integration Joint Board and the Performance, Finance and Audit Committee and by recommending and encouraging good practice. In so doing, we will help North
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Introduction | 4 Lanarkshire IJB promote improved standards of governance, better management and decision making and more effective use of resources. Respective responsibilities 6. The Code of Audit Practice 2021 sets out in detail the respective responsibilities of the auditor and North Lanarkshire IJB. Key responsibilities are summarised below. Auditor responsibilities 7. Our responsibilities as independent auditors are established by the Local Government (Scotland) Act 1973 and the Code of Audit Practice (including supplementary guidance) and guided by the Financial Reporting Council’s Ethical Standard. 8. Auditors in the public sector give an independent opinion on the financial statements and other information within the annual accounts. We also review and report on the arrangements in place at North Lanarkshire IJB to manage its performance and use of resources. In doing this, we aim to support improvement and accountability. North Lanarkshire IJB and Chief Officer responsibilities 9. North Lanarkshire IJB is responsible for maintaining accounting records and preparing financial statements that give a true and fair view. 10. North Lanarkshire IJB has the primary responsibility for ensuring the proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance and propriety that enable them to deliver their objectives.
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Financial statements audit planning | 5 Financial statements audit planning Introduction 11. The annual accounts are an essential part of demonstrating the North Lanarkshire IJB’s stewardship of resources and its performance in the use of those resources. 12. We focus our work on the areas of highest risk. As part of our planning process, we prepare a risk assessment highlighting the audit risks relating to each of the main financial systems relevant to the production of the financial statements. Materiality 13. The concept of materiality is applied by auditors in planning and performing the audit, and in evaluating the effect of any uncorrected misstatements on the financial statements. We are required to plan our audit to obtain reasonable assurance that the financial statements are free from material misstatement. The assessment of what is material is a matter of professional judgement over both the amount and the nature of the misstatement. Materiality levels for the 2022/23 audit 14. The materiality values for North Lanarkshire IJB are set out in Exhibit 1. Exhibit 1 2022/23 Materiality levels for North Lanarkshire IJB Materiality Amount Planning materiality – This is the figure we calculate to assess the overall impact of audit adjustments on the financial statements. For the year ended 31 March 2023 we have set our planning materiality at 2% of gross expenditure based on the audited financial statements for 2021/22. £13.7 million Performance materiality – This acts as a trigger point. If the aggregate of errors identified during the financial statements audit exceeds performance materiality, this could indicate that further audit procedures should be considered. Using our professional judgement, based on audit planning and risk assessment we have set planning performance materiality at 75% of planning materiality. £10.2 million
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Financial statements audit planning | 6 Reporting threshold (i.e. clearly trivial) – We are required to report to those charged with governance on all unadjusted misstatements greater than the ‘reporting threshold' amount. £250 thousand Source: Audit Scotland Significant risks of material misstatement to the financial statements 15. Our risk assessment draws on our cumulative knowledge of North Lanarkshire IJB, its major transaction streams, key systems of internal control and risk management processes. It is informed by our discussions with management, meetings with internal audit, attendance at committees and a review of supporting information. 16. Based on our risk assessment process, we identified the following significant risks of material misstatement to the annual accounts. This risk has the greatest impact on our planned audit procedures. Exhibit 2 summarises the nature of the risk, the sources of assurance from management arrangements and the further audit procedures we plan to perform to gain assurance over the risk. Exhibit 2 2022/23 Significant risks of material misstatement to the financial statements Significant risk of material misstatement Sources of management assurance Planned audit response 1. Risk of management override of controls International Auditing Standards require that audits are planned to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes the risk of fraud due to the management override of controls. Owing to the nature of this risk, assurance s from managem ent are not applicable in this instance • Agreement of balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports / ledger / correspondence. • Assurances will be obtained from the auditors of NHS Lanarkshire and North Lanarkshire Council over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year-end where we consider there to be greatest risk of material misstatement through
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Financial statements audit planning | 7 17. As set out in International Standard on Auditing (UK) 240: The auditor’s responsibilities relating to fraud in an audit of financial statements, there is a presumed risk of fraud over the recognition of income. There is a risk that revenue may be misstated resulting in a material misstatement in the annual accounts. The IJB is wholly funded by NHS Lanarkshire and North Lanarkshire Council. We assess that the risk of material misstatement arising from fraud over income is limited. This limitation is to such an extent that we have rebutted the risk of fraud over income from our significant audit risks. 18. In line with the Financial Reporting Council’s Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom, as most public-sector bodies are net expenditure bodies, the risk of fraud is more likely to occur in expenditure. We have rebutted the risk of material misstatement caused by fraud in expenditure in 2022/23 as we do not consider this to be a significant risk for the IJB. This is on the basis that all transactions are processed by the partner bodies rather than the IJB directly and that all expenditure is undertaken by the partners who are public sector bodies. 19. We have not, therefore, incorporated specific work into our audit plan in these areas over and above our standard audit procedures. Our audit testing will maintain an oversight of any unusual transactions or accounting entries. Other areas of audit focus 20. As part of our assessment of audit risks, we have identified other areas where we consider there are also risks of material misstatement to the financial statements. Based on our assessment of the likelihood and magnitude of the risk, we do not consider these to represent significant risks. We will keep these areas under review as our audit progresses. 21. The areas of specific audit focus are: • IJB funding - The Scottish Government wrote to all IJBs in September 2022 indicating that, due to changes in public health policy, it intended to reclaim and re-distribute some IJB reserves which relate to Covid funding to meet current Covid priorities. It is anticipated that this will be achieved through a reduction in NHS funding allocations, ultimately reducing NHS Lanarkshire’s funding contribution to the IJB. We will review the disclosure of this within the annual report and accounts management override of controls. • Review of financial monitoring reports during the year.
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Wider Scope and Best Value | 8 Wider Scope and Best Value Introduction 22. The Code of Audit Practice sets out the four areas that frame the wider scope of public sector audit. The Code of Audit Practice requires auditors to consider the adequacy of the arrangements in place for the wider scope areas in audited bodies. 23. In summary, the four wider scope areas cover the following: • Financial management means having sound budgetary processes. We will consider the arrangements to secure sound financial management including the strength of the financial management culture, accountability and arrangements to prevent and detect fraud, error and other irregularities. • Financial sustainability – as auditors, we consider the appropriateness of the use of the going concern basis of accounting as part of the annual audit. We will also comment on financial sustainability in the longer term. We define this as medium term (two to five years) and longer term (longer than five years). • Vision, leadership and governance – we conclude on the arrangements in place to deliver the vision, strategy and priorities adopted by North Lanarkshire IJB. We also consider the effectiveness of the governance arrangements to support delivery. • Use of resources to improve outcomes – we will consider how North Lanarkshire IJB demonstrates economy, efficiency and effectiveness through the use of financial and other resources. Wider scope risks 24. We have not identified any wider scope risks, however we recognise the challenges facing the IJB and the importance of ensuring it strategically plans the delivery of health and social care services within the area in a sustainable way. We will conclude on our wider scope work in our Annual Audit Report. Climate Change 25. Tackling climate change is one of the greatest global challenges. The Scottish Parliament has set a legally binding target of becoming net zero by 2045 and has interim targets including a 75% reduction in greenhouse gas emissions by 2030. The public sector in Scotland has a key role to play in ensuring these targets are met and in adapting to the impacts of climate change. 26. The Auditor General and Accounts Commission are developing a programme of work on climate change. In 2022/23, we will gather information on North
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Wider Scope and Best Value | 9 Lanarkshire IJB’s arrangements for responding to climate change covering areas such as the development of climate change strategies and the monitoring and reporting of progress against targets for reducing emissions. Cyber Security 27. There continues to be a significant risk of cyber-attacks to public bodies, and it is important that they have appropriate cyber security arrangements in place. A number of recent incidents have demonstrated the significant impact that a cyber-attack can have on both the finances and operation of an organisation. In 2022/23, we will consider North Lanarkshire IJB’s arrangements for managing and mitigating cyber security risks. Best Value 28. Auditors have a duty to be satisfied that bodies that fall within section 106 of the 1973 Act have made proper arrangements to secure Best Value. We will consider how North Lanarkshire IJB demonstrates that it is meeting its Best Value responsibilities and we will report our findings as part of our Annual Audit Report.
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Reporting arrangements, timetable, and audit fee | 10 Reporting arrangements, timetable, and audit fee Reporting arrangements 29. Audit reporting is the visible output for the annual audit. All Annual Audit Plans and the outputs, as detailed in Exhibit 4, and any other outputs on matters of public interest will be published on our website: www.audit-scotland.gov.uk. 30. Matters arising from our audit will be reported on a timely basis and will include agreed action plans. Draft management reports will be issued to the relevant officers to confirm factual accuracy. 31. We will provide an independent auditor’s report to North Lanarkshire IJB and the Accounts Commission setting out our opinions on the annual accounts. We will provide North Lanarkshire IJB and the Accounts Commission with an annual report on the audit containing observations and recommendations on significant matters which have arisen during the audit. 32. Exhibit 4 outlines the target dates for our audit outputs, and we aim to issue the independent auditor’s report by the statutory deadline of 30 September 2023. Exhibit 4 2022/23 Audit outputs Audit Output Target date IJB Committee Date Annual Audit Plan 31/03/2023 22/03/2023 Independent Auditor's Report 27/09/2023 27/09/2023 Annual Audit Report 27/09/2023 27/09/2023 Source: Audit Scotland Timetable 33. To support an efficient audit, it is critical that the timetable for producing the annual report and accounts for audit is achieved. We have included a proposed timetable for the audit at Exhibit 5 that has been discussed with management.
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Reporting arrangements, timetable, and audit fee | 11 34. Covid-19 has had a considerable impact on the conduct and timeliness of the audit. We recognise that it is in the best interests of public accountability to get the reporting of audited accounts back to pre-pandemic timelines. We are identifying ways to work more efficiently to expedite the 2022/23 audits whilst at the same time maintaining high standards of quality. 35. We intend to take a hybrid approach to the 2022/23 audit with a blend of onsite and remote working. We will continue to work closely with management to identify the most efficient approach as appropriate and will keep timeframes and logistics for the completion of the audit under review. Progress will be discussed with management and finance officers over the course of the audit. Exhibit 5 Proposed annual report and accounts timetable Key stage Provisional Date Latest submission date for the receipt of the unaudited annual report and accounts with complete working papers package. 24 July 2023 Latest date for final clearance meeting with the Director of Finance (or equivalent) 1 August 2023 Issue of draft Letter of Representation and proposed Independent Auditor’s Report 12 September 2023 Agreement of audited and unsigned annual report and accounts 12 September 2023 Issue of Annual Audit Report to those charged with governance. 27 September 2023 Signed Independent Auditor’s Report 27 September 2023 Source: Audit Scotland Audit fee 36. In determining the audit fee, we have taken account of the risk exposure of the North Lanarkshire IJB and the planned management assurances in place. The proposed audit fee for 2022/23 is £31,470 as set out in Exhibit 6. 37. Our fees have increased in 2022/23 and this is a reflection of the current audit market and the rising costs in delivering high quality audit work. There are increased regulatory expectations and risks placed on audit and its quality, as well as a widening in the scope of work audit must cover.
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Reporting arrangements, timetable, and audit fee | 12 Exhibit 6 Audit fees (including VAT) Fee component Fees (£) External Auditor Remuneration 33,680 Contribution to Audit Scotland costs 1,280 Contribution to Performance and Best Value 6,410 Sectoral Cap Adjustment (9,900) Total 2022/23 Audit fee 31,470 Source: Audit Scotland 38. In setting the fee for 2022/23 we have assumed that North Lanarkshire IJB has effective governance arrangements and will prepare comprehensive and accurate accounts for audit in line with the agreed timetable for the audit. The audit fee assumes there will be no major change in respect of the scope of the audit during the year and where our audit cannot proceed as planned, a supplementary fee may be levied.
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Other matters | 13 Other matters Internal audit 39. North Lanarkshire IJB’s internal audit function is provided jointly by the internal audit teams of NHS Lanarkshire and North Lanarkshire Council. 40. While we are not planning to place formal reliance on the work of internal audit in 2022/23, we may consider aspects of internal audit’s work in respect of our wider audit dimension responsibilities. Independence and objectivity 41. Auditors appointed by the Auditor General for Scotland or Accounts Commission must comply with the Code of Audit Practice and relevant supporting guidance. When auditing the financial statements, auditors must also comply with professional standards issued by the Financial Reporting Council and those of the professional accountancy bodies. These standards impose stringent rules to ensure the independence and objectivity of auditors. 42. Audit Scotland has robust arrangements in place to ensure compliance with these standards including an annual ‘fit and proper’ declaration for all members of staff. The arrangements are overseen by the Executive Director of Innovation and Quality, who serves as Audit Scotland’s Ethics Partner. 43. The appointed auditor for North Lanarkshire IJB is John Boyd, Audit Director. Auditing and ethical standards require the appointed auditor to communicate any relationships that may affect the independence and objectivity of audit staff. We are not aware of any such relationships pertaining to the audit of North Lanarkshire IJB. Audit Quality 44. Quality is at the core of public audit in Scotland and is the foundation for building consistency and confidence across all audit work. High quality audits provide assurance, add value and can support public bodies to achieve their objectives. 45. Until 2021/22, the applicable audit quality standard was International Standard on Quality Control 1 (ISQC (UK) 1). This set out an audit practice’s responsibilities for its system of quality control for audits. 46. ISQC(UK) 1 has been replaced by two new audit quality standards: Internal Standards on Quality Management (ISQM (UK) 1) applicable from 15 December 2022 and (ISQM(UK) 2) effective for the 2023/24 audits. Work is underway at Audit Scotland to meet the requirements of these quality standards.
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Other matters | 14 47. Audit Scotland is committed to delivering high quality audits. The foundation of our quality framework is our Audit Guide, which incorporates the application of professional auditing, quality and ethical standards and the Code of Audit Practice (and supplementary guidance) issued by Audit Scotland and approved by the Auditor General for Scotland. To ensure that we achieve the required quality standards, Audit Scotland conducts peer reviews and internal quality reviews. Additionally, the Institute of Chartered Accountants of England and Wales (ICAEW) have been commissioned to carry out external quality reviews. 48. As part of our commitment to quality and continuous improvement, Audit Scotland will periodically seek your views on the quality of our service provision. We welcome feedback at any time, and this may be directed to the engagement lead.
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Appendix 1. Your audit team | 15 Appendix 1. Your audit team The audit team involved in the audit of North Lanarkshire IJB have significant experience in public sector audit. John Boyd Audit Director jboyd@audit-scotland.gov.uk John has overall responsibility for the Audit Engagement. He has considerable audit experience across public sector audits including local government, IJB, pension, health and central government sectors. John is the Audit Scotland Audit Services Group Lead for local authority audit and is a member of the Local Authority (Scotland) Accounting Advisory Committee (LASAAC). Pauline Murray Senior Audit Manager pmurray@audit-scotland.gov.uk Pauline has over 14 years of public sector audit experience and has delivered external audit services to a range of bodies including local authorities, health boards and central government bodies. Fiona Owens Audit Manager fowens@audit- scotland.gov.uk Fiona has 10 years of experience in planning and delivering audits and has delivered external audit services to a range of bodies including local authorities, health boards and central government bodies. Paul Carey Auditor pcarey@audit-scotland.gov.uk Paul has 4 years of experience in delivering audits. Paul will complete the majority of the audit work and work alongside the Audit Manager, Senior Audit Manager and Audit Director to deliver the audit. 49. The local audit team is supported by a specialist technical accounting team, all of whom have significant experience of public bodies and work with accounting regulatory bodies.
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Appendix 1. Your audit team | 16 North Lanarkshire Integration Joint Board Annual Audit Plan 2022/23 Audit Scotland’s published material is available for download on the website in a number of formats. For information on our accessibility principles, please visit: www.audit-scotland.gov.uk/accessibility For the latest news follow us on social media or subscribe to our email alerts. Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit-scotland.gov.uk www.audit-scotland.gov.uk AS.4.0
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1 REPORT Item No: 10 SUBJECT: Resilience Response TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Kirsty Orr, Head of Planning and Development, NHSL Ross McGuffie ,Chief Officer North HSCP DATE: 7th March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board: For approval For endorsement To note 1.2 This paper sets out the actions taken to date during the pandemic response. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note that NHS Lanarkshire stood down its Covid Live Incident down in January 2023, though command structures have been adapted to continue to focus on ongoing wider resilience challenges, specifically around service pressures (2) Note that NHS Lanarkshire was able to move from black to red status on 6th March 2023, following a successful ‘firebreak’ as part of Operation Flow 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. Yes No N/A
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2 5.1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 Operation Flow is the whole system strategic planning approach aimed at supporting a sustained recovery of the entire health and social care system. Language matters and consequently the use of the word FLOW within the context of this work has a clear purpose as outlined below: • Focused – a time limited intervention with exit to a sustainable service model • Lanarkshire– recognising the various geographies and demographics affecting our services across the County • Optimal – focusing on improvement rather than completely fixing the system during the project timescale, including learning from other systems • Whole System – the project must be truly whole system covering the whole patient journey into and out of our health and social services 5.2.2 Flow is underpinned by the Lanarkshire Discharge Without Delay programme. 5.3 Stabilising our system through a Firebreak 5.3.1 It was clear that progressing improvement work across our system would be exceptionally challenging when our 3 acute sites and community services continued to be in escalation and full capacity. Consequently, it was agreed to attempt to stabilise and decompress our system through implementation of a “Firebreak” to allow sustained improvement work to progress at pace. 5.3.2 It was recognised no single specific action could achieve this and the firebreak aimed to coordinate a range of actions, including some that were already underway, to gain the scale of response required. 5.3.3 Following extensive whole-system collaboration and planning, the Firebreak commenced on 23rd February and ran until Friday 3rd March 2023, covering the following coordinated actions: Mobile multi-agency team undertaking daily review of all acute inpatients across the 9 days, with the aim of identifying actions that can be taken to facilitate discharge or transfer to a more appropriate location to reduce the number of additional patients across our Acute Hospitals. Mobile multi-agency team undertaking daily review of all patients in an offsite bed across the 9 days to create flow from our Acute sites. Mobile Multi-agency teams capturing the number of clinically stable patients who are waiting for a diagnostic test by modality to expedite these tests/procedures to facilitate discharge.
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3 Provision of professional to professional clinical decision making support for care home residents prior to conveying to hospital. SAS crews using consultant connect to access support / advice from Emergency Medicine colleagues for patients prior to making a decision to convey to hospital (excluding 999 category patients). Reduced number of access routes to hospital based urgent and emergency care. All potential referrals to Emergency Department, Care of the Elderly and Hospital @ Home from SAS crews via Consultant Connect to determine if there are other alternative care options rather than hospital (excluding 999 category patients). Expanded access to Ambulatory Care during the Firebreak period by increasing hours of operation over the weekend period and redirection of patients referred by NHS 24 on 111 to treatment rooms for wound care, minor burns etc. Increased senior clinical decision maker resource in Hospital @ Home to support more people in the community for the duration of the Firebreak period. Increased capacity within Home Assessment Teams within Wishaw and Cumbernauld areas to support discharge. 5.4 Measuring Impact 5.4.1 At the end of the firebreak on Friday 4th March, hospital occupancy had decreased significantly to 96% in University Hospital Wishaw, 92% in University Hospital Hairmyres and 90% in University Hospital Monklands. 5.4.2 In addition, capacity was further improved by increased pre-noon discharges (up to 25% across the three sites) and increased use of the discharge lounges (up to 17% across Lanarkshire). 5.4.3 Each ward was given a target number of daily discharges, the ‘ward beat’, with Haimryres reaching 88% of its target over the 9 day firebreak and Monklands and Wishaw achieving 92%. This was a very positive outcome given it was the first time running this methodology. 5.4.4 Consequently, ED performance also improved, including over the weekend of the firebreak:
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4 5.4.5 The Flow Navigation Centre supported four key pathways during the firebreak: Hospital at Home – 99 referrals were supported through the firebreak (week before firebreak was 49) Treatment Rooms – 10 patients (9 North, 1 South) were redirected to the Treatment Room Care Home pathway – 10 patients were referred and reviewed by the GP OOH service, with only 1 requiring admission Consultant Connect – 96 NHS24 patients were diverted away from ED by self-care advice or redirection to another service such as Pharmacy, District Nursing or GP Practice. 5.4.6 The Scottish Ambulance service received 1968 emergency calls during the firebreak, with 42% resolved without the need to attend a hospital. Referrals to Hospital at Home also increased markedly, with 16 referrals during the firebreak and use of Consultant Connect was above average throughout. Ambulance turnaround times at the acute sites also decreased, being below average throughout the firebreak. 5.4.7 Overall, the firebreak has been very successful, demonstrating a genuine whole system effort. Feeback from staff involved has also been positive, with staff feeling both listened to and supported and noting that the sites are feeling much safer, e.g. earlier identification of deteriorating patients. 5.4.8 Whole system learning sessions are now being taken forward to identify key learning from the firebreak, including crucially how we create sustainable ways of delivering some of the key aspects of the firebreak activity. The Flow Foundation Bundle is one of those key aspects, setting out a combined set of simple rules for all receiving and inpatient wards to improve flow: Discharge beat for each ward MDT Board Rounds each day Planned Date of Discharge Criteria-Led Discharge Pre-noon discharge and use of the discharge lounge Real-time updating of patient movements on Trakcare Daily site huddles to ensure situational awareness and resolution of flow challenges
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5 5.5 Improvement Actions 5.5.1 Operation Flow aims to use the decompression of the firebreak to then move into rapid and sustained improvement for urgent and unscheduled care as a priority for the Lanarkshire system. 5.5.2 Four layers of improvement activity have been identified across the system as a whole, with activity already underway to implement key aspects: Layer 1 - Supporting at Home – service improvement actions that support people to remain in a community setting e.g. telehealth, community care, pharmacy. Reablement and actions to avoid escalation. Expand the alternative methods of care delivery including expanding the scope of Consultant Connect and Hospital @ Home, enhanced connections with Housing, Third and Voluntary Sectors Layer 2 – Redirection/Triage at Front Door – service improvement actions that direct people to stay away from front doors including FNC e.g. call before you convey, scoping the concentration of staff resource at EDs to support re-direction for the 7 -14-day period (senior medical staff, pharmacy, ENP, SAS etc) Enhancement of ambulatory care models e.g. OPAT, scope further opportunities for Hospital @ Home or to alternative methods of care delivery e.g. Ambulatory Care Layer 3 – Emergency Department Flow – service improvement actions that revise our ED and Front door processes inc. Continuous Flow Model, Assertive Flow management, increased scheduling of minor injuries through 111 / FNC, Review of ED processes, Implementation of REACT model across the 3 sites, Implementation of Continuous Flow Model and Assertive Flow management, Scheduling of minor injuries Layer 4 – Discharging – service improvement actions that enhance Ward Discharge Planning Processes including expanded use of the Discharge Lounge, PDD, am Discharge, Criteria Led Discharge, Discharge to Assess across all localities, Diagnostic Virtual Wards, maximising the use of Home Assessment/Home First and Reablement as an alternative to prescriptive referrals, supporting assessment in the individual’s own home and maximising rehab opportunities and independent living 5.6 Delayed Discharge 5.6.1 One of the key aims of the Firebreak was to utilise multi-agency teams to review all inpatients on a daily basis, with the aim of improving the flow of the 95% of patients who don’t need supported discharge, but also supporting earlier identification of the 5% who will require support. 5.6.2 Consequently, one of the anticipated outcomes of the firebreak was the identification of a significant number of referrals for Social Work/Social Care support, though it is hoped that once the backlog of newly identified patients is cleared, the more proactive identification of patients will help to reduce delays in future. Over the nine-day firebreak, 180 referrals for supported discharge were received in North Lanarkshire, with a further 81 in the three days running up to the start. To put this into context, during peak winter pressures in 2019/20, North Lanarkshire averaged 77 referrals per week for supported discharge, which was the highest rate in Scotland. 5.6.3 However, despite the spike in demand, the recently improved performance in delayed discharge has been maintained. At the start of the firebreak, there were 84 delays in the system, with 40 of these on the acute sites, and at 7th March, this has reduced to 70 delays, with 27 on the acute sites.
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6 5.6.4 There remains a risk of short-term increases in delays due to the very high number of referrals for complex assessment (14 referrals in a single day for complex assessments on one site alone in the middle of the firebreak). While additional Social Work capacity has been identified to support these cases through the assessment process, there is a risk that a number will become delays before complete. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan Operation Flow and to enact the firebreak at scale and pace. 6.2 The reduction in occupancy levels across all three sites has allowed NHS Lanarkshire to move from black to red status on 6th March 2022, following over 6 months in black status. 6.3 Attention has now moved to make the most of the system decompression to move forwards with the ambitious change programme identified to ensure the positive performance improvements can be sustained and indeed further improved over time. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and is currently rated at very high. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES
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7 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 11 SUBJECT: Terms of Reference Performance, Finance & Audit Committee (PFA) TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB). For approval For endorsement For noting 1.2 To review the Terms of Reference for the PFA and approve any proposed amendments. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Finance Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to approve the revised Terms of Reference for the PFA noting the changes outlined in section 6.3. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Terms of Reference for the Integration Joint Board are formally set out in the Public Bodies (Joint Working) Integration Joint Monitoring Committees (Scotland Act) Orders 2014 with particular reference to the Scottish Statutory Instruments 2014 No.285. http://www.legislation.gov.uk/ssi/2014/285/pdfs/ssi_20140285_en.pdf 5.2 The Terms of Reference for the PFA were formally approved at the IJB meeting on 23 November 2017 and formally reviewed in March 2018 and December 2020. 5.3 The IJB is asked to approve a further extension to the PFA Terms of Reference which is detailed at section 6. 6. PROPOSED AMENDMENT 6.1 The IJB Terms of Reference, which was approved on 23 November 2017, currently reserves the following specific power for the IJB: Approve the annual accounts. Yes No N/A
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2 6.2 The IJB is asked to delegate to the PFA the power to approve the IJB Annual Accounts, effective from the financial year 2022/2023 and each year thereafter. This amendment would give flexibility allowing the accounts to be approved within the scheduled timetables of either the IJB or the PFA and would reduce the need for a further meeting to be convened. 6.3 The financial information reported in the IJB Annual Accounts has been reported to both the IJB and PFA throughout the financial year. 6.4 Subject to the approval of the proposed amendment by the IJB, the above responsibilities in respect of the consideration of the External Auditors Annual Audit report and the approval of the IJB Annual Accounts would be delegated to the PFA. The revised Terms of Reference for the PFA are attached at Appendix 1. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT N/A 7.5 STAKEHOLDER ENGAGEMENT N/A 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. APPENDIX Terms of Reference Performance, Finance & Audit Committee (PFA) Appendix 1 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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3 APPENDIX 1 TERMS OF REFERENCE COMMITTEE: PERFORMANCE, FINANCE AND AUDIT COMMITTEE DATE: March 2023 Version 4 1. Purpose The Performance, Finance and Audit Committee has been established by the Integration Joint Board (IJB) to: Oversee a range of matters relating to finance, internal audit, and external audit. Ensure financial and other controls are in place to operate effectively, including processes for audit and risk management. Oversee the development of the annual integrated budget and financial statement. Oversee a range of matters relating to service provision and performance reporting. Ensure the delivery of the highest possible quality of service to users by monitoring performance and considering audit inspection reports. Oversee the development of the annual performance report. 2. Membership and Quoracy Meetings will be held four times a year. Additional meetings may be held as necessary. The IJB shall appoint members to the Committee and nominate a Chair and Vice Chair. The Committee will comprise of 13 members as follows: 4 voting members appointed by the NHS Lanarkshire Health Board (NHSL). 4 voting members appointed by North Lanarkshire Council (NLC). 5 non-voting members representing stakeholders. The quorum for meetings of the Committee is four voting members, comprising two NLC members and two NHSL members. The Chief Accountable Officer and the Chief Finance Officer will attend all meetings. Attendance by other staff and officers will be agreed by the Chair in advance. Any updates or proposed variation to membership will be approved by the IJB in line with the IJB Terms of Reference and Statutory Instruments. 3. Reporting Arrangements The Committee will report to the IJB. The minutes of Committee meetings will be submitted to the next appropriate meeting of the Committee for approval as a correct record and will then be submitted to the next IJB meeting for noting.
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4 4. Key Responsibilities In relation to finance matters, the PF&A Committee is authorised to: Provide financial governance and scrutiny of the in-scope budget for the IJB. Review the annual budgets with recommendations to the IJB. Review the overall internal control arrangements of the IJB and ensure that appropriate levels of accountability, scrutiny and discussion are undertaken in the key areas of business. Ensure that the senior management team maintain effective controls within their services which comply with financial procedures and regulations. Ensure effective arrangements are in place to register all finance and audit risks as soon as possible and that the appropriate lead officer is notified to ensure compliance and mitigating actions are detailed. Review risk management arrangements and receive regular risk management updates and reports, as appropriate. Report and review the IJB’s financial strategy in support of the strategic commissioning plan and recommend approval to the IJB. Receive reports on any new and emerging national policy developments related to health and social care and consider any impact on the financial position. Consider the unaudited Annual Accounts and oversee the preparation of the Governance Statement before submission to and approval by the IJB. Approve the Annual Accounts. In relation to audit matters, the Committee is authorised to: On an annual basis, approve the risk-based Internal Audit plan, including Internal Audit’s resource requirements. Consider reports from Internal Audit on their activity and performance during the year including the Internal Audit annual opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control. Consider the external auditor’s annual plan and all relevant external audit reports issued to those charged with governance. Consider, where appropriate, responses to internal and external audit and scrutiny reports and to monitor any subsequent recommendations and requirements emanating from these. Consider and review strategic financial risks pertaining to the IJB’s responsibilities. In relation to performance matters, the Committee will: Review service performance reporting processes. Review quarterly performance and recommend remedial action to address concerns.
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5 Consider response/actions in relation to any external scrutiny reports that relate to service provision. Oversee the implementation of any recommendations made within external scrutiny reports. Ensure a rigorous and systematic approach to the monitoring of delivery of national and local priorities. Ensure effective arrangements are in place to identify and register all performance and finance risks as soon as possible and review high rated risks at each meeting to ensure effective mitigating actions are being followed and risks regularly updated. Oversee the development of the annual performance report. Ratified by Integration Joint Board: Version 1 – December 2017 Version 2 – March 2018 Version 3 – December 2020 Version 4 – March 2023 Review Date: The Terms of Reference for the Performance, Finance & Audit Committee will be reviewed every 3 years and approved at the Integration Joint Board. Planned Review Date – March 2026
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REPORT Item No: 12 SUBJECT: Risk Management: IJB Risk Register TO: Integration Joint Board Committee Lead Officer for Report: Support Services / Project Manager Author(s) of Report Stacey Anderson DATE: 22nd March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB; For approval For endorsement To note The purpose of this report is to provide a summary to the Integration Joint Board on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Operational & Business Manager and Chief Officer for H& SC NL. 3. RECOMMENDATIONS 3.1 The IJB is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. Yes No N/A
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BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PFA committee considered the finance and performance risks at its last minute on 14th February 2023. 5.3 A full review of the risk management reporting within the IJB is currently in progress as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. These developments will include review of how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session has been scheduled for the next IJB Liaison Session and a full report of changes/ developments will be provided to the IJB PFA and IJB at the next meeting. 5.4 Following discussions at the last meeting of PFA on 14th February 2023, there has been a number of changes in the risk register: 3 risks closed: o IJB 03/21 – EU withdrawal o IJB 08/21 – Financial Implications of Covid o IJB 09/21 – Impact of pandemic on implementation of the strategic plan 1 risk increased: o IJB 06/21 – Prescribing – increased due to the projected increased costs facing the partnership in 2023/24 2 new risks identified: o IJB 19/23 – Service sustainability – a broader risk on sustainability challenges, replacing previous risks on EU withdrawal and Covid o IJB 20/23 – Workforce sustainability – a broader risk on sustainability challenges, replacing previous risks on EU withdrawal and Covid 5.5 There are currently two risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 17/22 – Unscheduled Care 5.6 There are eight high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 14/22 – CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service IJB 19/23 – Service sustainability IJB 20/23 – Workforce sustainability 5.7 There are a number of high/very high rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services and these are highlighted below.
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No Risk Risk Rating Lead Organisation/Area 1882 Acute Sector Bed Capacity - availability of acute beds due to delays experienced for onwards movement of patients 'fit for transfer' to care homes, those requiring care at home, exacerbated by rising cases of Covid and high demand Very High NHSL Corporate 2085 Capacity within NHSL to respond to ongoing challenges due to Covid 19 and associated variants Very High NHSL Corporate 1379 Delayed Discharge Performance and Impact High NHSL Corporate 1984 Impact From Stepping Down Non-Urgent Services High NHSL Corporate 1832 Compliance with the Health & Care (Staffing) (Scotland) Bill: Clinical Workforce due to issues of availability, recruitment and retention. High NHSL Corporate 1710 Public Protection: There is a risk that NHSL could fail to identify harm to any vulnerable person, child or adult, or prevent harm to others resulting from the complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. High NHSL Corporate 659 Failure to deal effectively with major emergency Very High NHSL Corporate 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. Very High NHSL Corporate 1992 Continuous Covid Response & impact on routine PH Screening & surveillance programmes High NHSL Corporate 1587 Sustainability of the two-site model for the Out-of-Hours Service Very High NHSL Corporate 2004 Potential Impact on patients resulting from disruption of day to day clinical care in response to Covid pandemic Very High NHSL Corporate 1989 Ability to maintain a workforce commensurate with the need to suppress Covid, deliver Vaccination Programme, Recover & Remobilise Very High NHSL Corporate 2014 Recovery of Performance 2021/22 Very High NHSL Corporate 2086 Sustaining GP Services Very High NHSL Corporate NLC RIA0000446 Unable to deliver services due to funding issues Very High NLC - Social Care/Social Work NLC RIA0000448 Availability of workforce to deliver services within legislative and regulatory compliance requirements. High NLC – Social Care/Social Work NLC RIA0000449 Information & Data Protection – non- compliance with information governance High NLC – Social Care/Social Work
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legislation, standards and processes and data security and inability to retrieve relevant data with deadlines NLC RIA0000450 Health & Safety of staff in SW & partnership companies – failure to ensure the health safety and welfare at work of the service, employees, partners and provider agencies High NLC – Social Care/Social Work NLC RIA0000453 Supplier failure or services not provided to required standard. Insufficient number of providers. High NLC – Social Care/Social Work NLC RIA0000457 Inadequate supervision, governance and monitoring across professional workforce High NLC – Social Work/Social care NLC RIA0000458 IT system not fit for purpose High NLC – Social Work/Social care NLC RIA0000459 Integration – there is a risk that services and not integrated effectively thus impacting on improving the outcomes for individuals receiving care and support High NLC – Social Work/Social care NLC RIA0000460 Performance & planning – increasing expectations and changing performance demands will result in a failure to provide performance information internal, external and including S Govt, High NLC – Social Work/Social care NLC RIS0000414 Community alarm and assistive technology – unable to continue to support people with a community alarm system and develop use of assistive technology Very High NLC – Social Work/Social care NLC RIS0000415 Mental Health Officers – Failure to comply with legal obligations High NLC – Social Work/Social care NLC RIS0000417 Communications strategies and engagement plans – Inadequate strategies not aligned with strategic objectives High NLC – Social Work/Social care NLC RIS000419 Non- compliance with Information Governance & Data Protection High NLC – Social Work/Social care NLC RIS000426 Analogue to digital transition & ability to provide a working community alarm service High NLC – Social Work/Social care 6. CONCLUSIONS 6.1 The IJB currently has 17 risks identified on its IJB risk register with 10 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S)
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N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Financial risks are identified in the risk register. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE N/A 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and can contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPER None 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Christine Jack on telephone number 01698 752590.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB02. 21 Financial Reputational 01/04/2021 Ineffective Governance Arrangements There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e-learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. . The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Decleration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.03.24 Previously IJB6. Reviewed and updated on 15 May 21. Reviewed and updated on March 2023. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 31.05.23 IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programmes which adversely impact on the HSCP's ability to deliver services. 9. In-year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2022/2023 has been agreed and is being reviewed regularly. 7. Capacity plans in place to maximise efficiency. 8. IJB Integration Scheme setting out the budget recovery processes. 9. IJB Financial Regulations and financial procedures. 10. Consultation and involvement with key stakeholders including service users and carers. 11. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 12. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. Financial sustainability payment arrangements in place to 31 March 2023 to support external social care providers. 16. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. Work is ongoing with both partner organisations to confirm the final 2023/24 budget. Once complete, a new risk will be created to reflect the final 2023/24 financial plan. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2023/2024 is being presented to March 23 IJB. 3. The review and update of the IJB Medium Term Financial Plan is being presented to March 23 IJB. HIGH Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 1 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB04. 21 Financial Strategic 01/04/2021 Notional Set-Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set-aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set-aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set-aside budget. This arrangement continues to be in place for 2022/23 ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.05.23 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co-operate to ensure a pan-Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.23 08.03.23 CLOSED 08.03.23M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.23 IJB03. 21 Financial Strategic 01/04/2021 Impact of European Union Withdrawal There is a risk that the IJB is unable to implement the Strategic Plan because of the operational and financial challenges posed by European Union (EU) withdrawal leading to a failure to achieve the desired strategic aims and an adverse impact on both operational service delivery and the achievement of financial balance. The impact on health and social care services of leaving the EU continues to be difficult to forecast. The following significant risks continue to be monitored at a national level. (1) The UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology. (2) In respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. (3) There is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non-EEA countries are subject to the same immigration rules. The new points-based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast-track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. (4) The Mutual Recognition of Professional Qualifications Directive is an EU-wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. (5) There continues to be a risk of disruption to the supply chains, part of the risk in respect of which was minimised with mitigating actions such as stockpiling. (6) The future of Scottish patients' healthcare in other European countries and the impact of reciprocal healthcare and the free movement of healthcare including the impact of the changes to the European Health Insurance Card (EHIC). M edium CONTROLS 1. Silver command' group formed for HSCP. 2. On 24 December 2020 a new EU-UK trade and co-operation deal was agreed. 3. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 4. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 5. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 6. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one-off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 7. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 3 stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. 9. Reciprocal health care is subject to the Withdrawal Agreement, the collection of guidance outlining the rules in each state, the completion of relevant visa applications and the payment of the Immigration Health Surcharge in order to access NHS services (where applicable). The rights of access for EU citizens who need work or study in the UK for less than six months was still being decided. Global Health Insurance Cards have been implemented to cover both urgent and routine medical treatment. 10. In respect of reciprocal health care, the rights of access to health care for UK citizens who move to the EEA after the transition period is being decided independently by each member state and will differ substantially between them. ACTIONS 1.HSCP fully participates in the NLC and NHSL resilience arrangements. 2.HSCP workshops undertaken. 3. Business Continuity Plans revisited and updated for all services and sites. Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 2 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. M edium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. VERY HIGH LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.03.23 Previously IJB11. IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long-term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.23 Previously IJB16. IJB08. 21 Financial Strategic 01/04/2021 Financial Implications of Responding to and Recovering from the Covid-19 Pandemic There are a range of IJB risks associated with the response to and recovery from the Covid-19 pandemic. Additional funding was received from the Scottish Government in 2020/2021 to meet the additional costs of the Covid-19 pandemic. Further funding for 2021/2022 is being discussed to meet the additional costs of responding to and recovering from the Covid-19 pandemic however the total amount for 2021/2022 has not yet been confirmed by the Scottish Government. There is therefore a risk that the HSCP may not be fully reimbursed in respect of the additional costs of responding to and recovering from the Covid-19 pandemic in 2021/2022. The IJB projected outurn 2021/2022 is not available to meet the 2021/2022 Covid-19 costs. The projected underspend requires to be retained to implement the Business Case and to recover and redesign health and social care services. Insufficient reimbursement of funding from the Scottish Government would impact on the implementation of the Response, Recovery and Redesign Plans. The 2021/2022 Savings Plans may also not be achieved in part or in full due to key resources continuing to be diverted to respond to the Covid-19 pandemic. This risk could lead to significant operat+D12ional, financial, legal and/or reputational harm to the HSCP and also adversely impact on the Strategic Plan outcomes. VERY HIGH CONTROLS 1.Governance arrangements are in place in respect of the approval and monitoring of additional Covid-19 costs and the recovery and redesign plans. 2 Delivery of savings will continue to be tracked and monitored. 3.The financial position is being monitored on an ongoing basis by SLT, IJB PFA and IJB. 4. The IJB Chief Officer and the Chief Financial Officer are actively engaging with the Scottish Government and other Networks and providing regular updates on the mobilisation and remobilisation plans and the associated costs. ACTIONS 1. All costs associated with responding to the Covid-19 pandemic are being tracked and reported to the Scottish Government through the completion of the Remobilisation Plan Financial Returns. 2. A financial tracker on Covid-19 related expenditure (as part of the Local Remobilisation Plan) is updated on a 4 weekly basis. Quarterly updates are submitted to the Scottish Government. 3. The IJB Reserves Strategy 2021/2022 has been discussed with the Scottish Government Officers. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.21 08.03.23 CLOSED 08.03.23 - included in Risk IJB01.21 and will be further updated as part of new risk for financial outturn in 2023/24 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 3 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements Due To the Covid-19 Pandemic 1. There is a risk that the intensity of the required response to Covid-19 could result in a failure of governance impacting on the effectiveness of the IJB decision-making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended Covid-19 legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work-based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid-19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front-line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. ACTIONS 1. Staff health and well being is a key priority for both partners and all key stakeholders. The commitment to staff health and well being is being actively promoted through all available forums. M EDIUM LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.23 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 31.12.23 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.21 08.03.23 CLOSED 08.02.23 - new risk to be formed around implementation of new 2023-26 SCP IJB09. 21 Financial Strategic 01/04/2021 Impact on the Strategic Plan Due to the Covid-19 Pandemic 1. Social Care providers continue to be significantly impacted by the Covid-19 pandemic. There are risks associated with the ongoing financial stability of providers during the Covid-19 pandemic and some external providers may be unable to continue operating without ongoing financial and operational support. If providers are unable to safely staff services, there could be a risk of harm to service users and failure of the provider. 2. Providers are operating under unique and significantly detrimental conditions including continuity of service being disrupted due to the requirement to focus on priority services only, increased infection control measures and associated costs, increased staff absence and associated costs, reduced availability of back-up staff and social distancing requirements. Premises may not be suitable to deliver services in these circumstances. 3. Increased reporting requirements to provide data to regulatory bodies are stretching limited resources. 4. Sufficient emergency/additional services to continue to respond to the Covid-19 pandemic may not be available. Hospital admissions may not be avoided and discharges from hospital may be delayed. General Medical Services may not be sustainable. There are whole system capacity constraints across primary care services impacting on Acute Services. 5. Discharges from hospital may impact on care at home, residential care, nursing care and respite provision. 6. There is an increase in demand for a range of health and social care services as a result of the Covid-19 pandemic. There is insufficient workforce capacity and there is a risk the Working Time Directive may be breached. There is insufficient equipment for key areas e.g. ventilators, pumps, etc. Personal Protective Equipment and supplies may be limited. The required service specification and standard may not be procured. There may be insufficient mobile IT devices. 7. There may be constraints in respect of the supply of vaccinations. 8. There are significant risks associated with the mutation of the Covid-19 virus and the new variants. 9. There is an adverse impact on the progress of transformation service redesign opportunities including implementing agreed efficiency savings. 10. Prioritising the impact of the response to the Covid-19 pandemic may divert limited resources away from key essential services which may lead to additional resource requirements and costs over the medium to longer term. 11. There may be a lack of HSCP management capacity and resilience to co‐ordinate the response to the pandemic. This may lead to an adverse impact on service delivery and financial overspends. 12. The risk status across NHS Lanarkshire has been moved to 'Black', the highest risk level. VERY HIGH CONTROLS 1. Scottish Government and COSLA guidance is being complied with. 2. NHS National Services Scotland are supporting primary care and social care services. PPE is available in line with Health Protection Scotland guidance. 3. Chief Medical Officer guidance as adopted by the four nations has been published, put into effect and endorsed by the Scottish Government/COSLA. Updates are also adopted. 4. Scottish Government are focusing on the care home sector to support continuity of service delivery. A national protocol to support discharge of Covid-19 patients is in place. Care home liaison nurses are in place. 5. Remote working and flexible working arrangements are also in place. There is an increase in the number of agile workers and an increase in the number of laptops/tablets provided. A blended approach to home/work-based working is being developed going forward. 6. Arrangements are in place across the partnership to review service user and carer prioritisation in terms of accessing service and support. Resources are targeted to those with critical or substantial needs. 7. Arrangements are in place to support carers in their caring role, working in partnership with voluntary organisations to provide early intervention and preventative supports. 8. Reliance was placed on the Social Care Sustainability Payments by External Social Care Providers up to 31 October 2021. The HSCP continues to liaise and support providers to ensure there is early identification of problems and early intervention if necessary. 9. The Response, Recovery and Redesign Remobilisation Plan has been developed and is regularly updated. Response, Recovery and Redesign Plans are in place across the IJB and both partners. 10. Safe systems of working have been adopted. Regular cleaning regime is in place across all premises. All workplace appropriate social distance signage is in place. 11. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid-19 Risk Register in place. 12. The Scottish Government is taking appropriate action to mitigate the impact of the variants of the Covid-19 virus as far as possible. ACTIONS 1. Emergency Command and Control structures have been established by each partner. Infection Prevention Control and Social Distancing requirements are being complied with. 2.Up-to-date information is disseminated to all staff across the HSCP as the situation develops and a consistent communication strategy is in place with employees across IJB, NHSL and NLC websites 3.IJB and partner business continuity plans are being regularly reviewed. 4.The HSCP is actively engaging with the third and independent sector in relation to service opportunities to meet the low/moderate needs of service users/patients and their associated costs. 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid-19 funding is expected to be confirmed in February 2022 following the submission of the quarter 3 Lanarkshire Mobilisation Plan 2021/2022. 6. The vaccination programme is continuing to be rolled out. 7. Having regard to the assessment of risk across NHS Lanarkshire as 'Black', action is being taken to mitigate the impact of the Covid-19 pandemic over the winter period and COP26 in consultation with the Scottish Government. The position is being closely monitored. VERY HIGH M EDIUM Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 4 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness abscence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding recieved by Scottish Government specificaly targeting staff well being programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation 4. Audits of adherence to sickness absence policy being undertaken HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 31.05.23 IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. The financial support for social care providers during the Covid-19 pandemic is being reviewed. Payments in respect of under-occupancy in care homes were extended to 31 October 2021. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. Staff and visitor testing in place. 4. All care homes advised to use PPE in line with national addendum. medium medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 31.12.21 IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS - There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non-clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Controls - 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 50% of gap by end of May 2022 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model High medium Ross M cGuffie M orag Dendy IJB,PF&A, SLT 31.05.23 IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High M edium Ross M cGuffie Ross M cGuffie SLT, IJB 31.05.23 IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co-design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023-26. High CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups High Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 5 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equpiment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long-term service demand 8. Whole system 'firebreak' and associated improvement cycle in development for Feb/Mar 23 Very High M edium Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB 28.02.23 IJB.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High CONTROLS 1. Working group established to coordinate all activity 2. Oversight through Home Support Programme Board 3. Reporting to Adult Social Work, Care and Wellbeing Committee 4. Reporting to IJB ACTIONS 1. NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas 2. NLC part of SG once for Scotland procurement process for a new digital alarm receiving centre 3. Communication out to all community alarm service users 4. Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational 5. Engagement with telecommunication suppliers to ensure sight of roll out plans across NL M edium Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 30.06.23 IJB.19. 2023 Performance 27/02/2023 Service Sustanability Due to competing service priorties and workforce/ operational and finacial challenges there is a risk that the IJB will be unable to implement the strategic plan/commision plan . Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety High Controls 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan is regulary reviewed and agreed. 7. Capacity plans in place to maximise efficiency. 8. Consultation and involvement with key stakeholders including service users and carers. 9. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 10. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 11. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions 1. Sustainability plans to be reviewed regulalry 2. Re-introduction of scruity panels 3. Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. 4. Review of reporting process into IJB to ensure contionus review of services/ service developments. High Low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 6 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed - Changes By MM IJB.20. 2023 Workforce Sustanability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provsion, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawl there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non-EEA countries are subject to the same immigration rules. The new points-based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast-track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU-wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. High CONTROLS 1. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one-off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 2. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 3. Development of the Care Academy 4. Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS 1. Annual workforce plan being prepared 2. NHSL programme underway to support international recruitment 3. On the day recruitment events being trialled in Home Support 4. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment High M edium Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 7 of 7
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REPORT Item No: 13 SUBJECT: Risk Management Strategy TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Ross McGuffie, Chief Officer Stacey Anderson, Support Services Manager, Project Manager DATE: 22nd March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB; For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Operational Business Manager and Chief Officer for HSCNL and endorsed by the Risk Managers for North Lanarkshire Council and NHS Lanarkshire. 3. RECOMMENDATIONS 3.1 The IJB Committee is asked to: Approve the new IJB Risk Management Strategy 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Within the North Lanarkshire Integration Scheme, NHS Lanarkshire and North Lanarkshire Council committed to deliver an integrated risk management strategy for the then establishment of the North Lanarkshire Integration Joint Board. 5.2 This initial Risk Strategy was put in place for December 2015, and was since updated and approved at the IJB in January 2018. Yes No N/A 1
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5.3 Over the last year, there has been significant development in the IJB’s approach to risk management, with the risk reports now forming a much more substantial item of business at IJB meetings. 5.4 There are three main risk registers across the partnership: IJB Register outlining the strategic risks to the Integration Joint Board Health operational register, hosted within the NHSL system Social Work operational register, hosted within the NLC system 5.5 Strong ties have been maintained with the corporate risk managers in both partner organisations and the updated strategy has been developed in conjunction with those leads. The IJB strategy aims to link closely to both the North Lanarkshire Council and NHS Lanarkshire Risk Management Strategies. 5.6 A significant development in the updated strategy is the agreement of a risk sharing form so that any shared risks from across the system can be notified to each partner (see appendix 1 of the attached Risk Strategy). This will ensure a more integrated approach to risk management in North Lanarkshire. 6. CONCLUSIONS 6.1 Ensuring the management and reporting of risks is undertaken appropriately is a key responsibility of the IJB. 6.2 The IJB is asked to approve the risk management strategy at appendix 1. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The risk management strategy will assist the identification, recording and mitigation of risks, thereby supporting the achievement of organisational outcomes by prioritising and managing risks which may threaten them. 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The risk management strategy will support the identification, prioritisation and management of risks which may threaten financial balance and governance. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE 2
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The risk management strategy will support the identification, prioritisation and management of risks which may threaten the safety of staff and patients/service users. 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and can contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A The risk management strategy will support the identification, prioritisation and management of risks which may impact on inequality. 8. BACKGROUND PAPER None 9. APPENDICES Appendix 1: IJB Risk Management Strategy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752590. 3
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Version No. Final 2.0 Date Effective: 31/01/2018 Review Date: 31/01/2020 Appendix 1 North Lanarkshire Joint Integration Board Risk Management Strategy Executive Lead: Ross McGuffie, Chief Officer Authors: Carol McGhee, Corporate Risk Manager, NHS Lanarkshire, Lauren Anthony, Risk and Insurance Manager, North Lanarkshire Council 4
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 CONTENTS Policy – The Risk Management approach ................................................................................................................... 5 Strategy ‐ Implementing the policy ............................................................................................................................. 7 1. Introduction ......................................................................................................................................................... 7 2. Risk management process ................................................................................................................................... 8 3. Application of good risk management across the IJB activities ........................................................................... 8 Realising the risk management vision ......................................................................................................................... 9 4. Risk management vision and measures of success ............................................................................................. 9 Risk leadership and accountability ............................................................................................................................ 10 5. Governance, roles and responsibilities .............................................................................................................. 10 Resourcing risk management .................................................................................................................................... 11 6. Resourcing the risk management framework ................................................................................................... 11 7. Resourcing those responsible for managing specific risks ................................................................................. 11 Training, learning and development ......................................................................................................................... 11 8. Risk management training and development opportunities ............................................................................. 11 Monitoring activity and performance ....................................................................................................................... 12 9. Monitoring risk management activity ................................................................................................................ 12 10. Monitoring risk management performance ...................................................................................................... 12 Communicating risk management ............................................................................................................................ 12 11. Communicating, consulting on and reviewing the risk management framework ............................................ 12 5
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Risk Management Glossary Key Definitions Acceptable Risk An everyday risk, minor in nature, occurring on a routine basis. Adverse Event Any incident/near miss, event or circumstance arising during service provision that could have or did lead to unexpected harm, loss or injury Assurance Stakeholder confidence in our service gained from evidence showing that risk is well managed Control Any action, process, policy, practice or operation undertaken to contain a risk to an acceptable level, or increase the probability of a positive outcome. Exposure The susceptibility to loss. Governance The framework of accountability to users, stakeholders and the wider community, within which organisations take decisions and lead and control their functions to achieve their objectives. Impact Effect or consequences of a risk. Incident Occurrence of a particular set of circumstances Inherent risk The exposure arising from a specific risk if no risk controls were in place. Initial risk Based on the likelihood x impact, this is the assessed level of risk if no controls were in place Likelihood A qualitative description of a probability or frequency of the risk event occurring. Mitigating action Action taken to reduce the likelihood or impact of a risk event to an acceptable level. Operational risk Risks associated with the day to day issues facing the organisation in its service delivery. Opportunity An uncertain event with a positive probable impact. Probability Extent to which a risk event is likely to occur. A measure (expressed as a percentage) of likelihood. Residual risk The level of risk remaining taking existing or planned risk control measures into account. Risk The chance of something happening that will have an impact on business objectives. It is defined as “the probability (likelihood) of an event happening and its consequences (impact) when it occurs. Risk analysis The use of information to work out how often specified events might occur and the magnitude of their consequences. 6
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Risk appetite The organisation’s attitude towards risk taking, which in turn dictates the amount of risk it considers tolerable or acceptable. Risk assessment The overall process of risk identification, risk analysis and risk evaluation. Risk control An action undertaken that will reduce risk to an acceptable level either by reducing the likelihood of an adverse event, the severity of its consequences or both. Risk evaluation The process of understanding the net effect of the identified threats and opportunities on an activity when aggregated together. Risk financing The provision of funds to meet the cost of implementing risk treatments including, but not limited to, insurance. Risk identification The process by which risk events, which could affect the organisation’s objectives, are identified, described and recorded. Risk management The culture, processes and structures that are directed towards realising potential opportunities whilst managing adverse effects. Risk management A high‐level statement showing how risk management will be handled Policy throughout the IJB Risk management Describes the goals of applying risk management to the activity, a description Strategy of the process that will be adopted, the roles and responsibilities, risk thresholds, the timing of risk management interventions, the deliverables, the tools and techniques that will be used and the reporting requirements. Risk matrix A model that visually displays the relationship between the likelihood and impact of specific risks. Visually it is a 5 x 5 box that plots likelihood and impact as low, medium, high or very high. Risk profile The overall picture of the organisation’s risks including number of risks and their scores. Risk prioritisation The process of ranking risks into a logical order by establishing how significant they are in terms of likelihood and impact (NB Impact is given priority over probability when prioritising risks). Risk register A formal listing of identified risks, together with the results of the risk analysis and risk evaluation procedures, as well as details of any risk treatments. Helps Managers prioritise resources to minimise risk to best effect and provide assurances that progress is being made. Risk tolerance line The delineation on the risk matrix, risks above which cannot be accepted without referring them to a higher authority. Risk treatment Selection and implementation of appropriate options for dealing with risk. Strategic risk Risk concerned with where the organisation wants to go, how it plans to get there and how it can ensure survival. 7
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Tolerate/Tolerable An informed decision to accept the likelihood and impact of a particular risk rather than trying to mitigate it usually because there are certain benefits to be gained, or further control measures may be disproportionate to the risk. 8
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Policy Statement – the Risk Management approach 1.1 The North Lanarkshire Integration Joint Board (IJB) aims to provide safe and effective care and treatment for patients and clients, and a safe environment for everyone working within the IJB and others who interact with the services delivered under the direction of the IJB. 1.2 Therefore, the IJB is committed to a culture where its workforce is encouraged to develop new initiatives, improve performance and achieve goals safely, effectively and efficiently by appropriate application of good risk management practice. 1.3 The IJB believes that appropriate application of good risk management will prevent or mitigate the effects of loss or harm and will increase success in the delivery of better clinical and financial outcomes, objectives, achievement of targets and lead to fewer unexpected problems. 1.4 The IJB seeks to promote an environment that is risk aware and strives to place risk management information at the heart of key decisions. This means that the IJB can take an effective approach to managing risk in a way that both addresses significant challenges and enables positive outcomes. 1.5 The IJB’s Risk Appetite is described as the amount of risk the IJB is prepared to accept, tolerate or be exposed to at any one time. Any risk with a current risk matrix score of 10 or above (high or very high graded risks) is considered to exceed the IJB’s risk appetite and further actions will be taken to mitigate to the lowest possible level. Risks of a score of 9 or less (low or medium graded risks) are considered to be within the IJB’s level of risk appetite and will be subject to regular monitoring. 1.6 In normal circumstances, regular monitoring of risks will be as follows: Very High, High Risks Very High risks (score of 16+) will be reviewed on a monthly basis and High risks (score of 10‐15) will be reviewed on a 2‐3 monthly basis by the Chief Officer and reported to the IJB Sub‐Committee. Medium Risks Medium graded risks (score of 4‐9) will be reviewed on a 5‐6 monthly basis by the Chief Officer and reported to the IJB Sub‐Committee. Low Risks Low graded risks (score of 1‐4) will be reviewed annually. Key benefits of effective risk management: appropriate, defendable, timeous and best value decisions are made; risk aware decisions are based on a balanced appraisal of risk and allow acceptance of certain risks in order to achieve a particular goal; high achievement of objectives and targets; high levels of morale and productivity; better use and prioritisation of resources; high levels of user experience/ satisfaction with a consequent reduction in adverse incidents, claims and/ or litigation; and a positive reputation established for the IJB. 9
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 1.7 This can be seen clearly in the following matrix: 1.8 The IJB promotes the pursuit of opportunities that will benefit the delivery of the Strategic Plan. Opportunity‐related risk must be carefully evaluated in the context of the anticipated benefits for patients, clients and the IJB. 1.9 The IJB will receive assurance reports on the adequacy and effectiveness of its risk management arrangements and will consequently value the contribution that risk management makes to the wider governance arrangements of the IJB. 1.10 The IJB will implement risk management arrangements in line with the Risk Management strategy which covers procedures, the risk management process, systems and risk management roles and responsibilities. This will contribute to the IJB’s wider governance arrangements. Likelihood Impact 1 ‐Negligible 2 ‐Minor 3 ‐Moderate 4 ‐Major 5 ‐Extreme 5 ‐ Almost certain 5 Medium 10 High 15 High 20 Very high 25 Very high 4 ‐ Likely 4 Low 8 Medium 12 High 16 Very high 20 Very high 3 ‐ Possible 3 Low 6 Medium 9 Medium 12 High 15 High 2 ‐ Unlikely 2 Low 4 Low 6 Medium 8 Medium 10 High 1 ‐ Rare 1 Low 2 Low 3 Low 4 Medium 5 Medium 10
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Version No. Final 2.0 Date Effective: 31/01/2018 Review Date: 31/01/2020 Strategy ‐ Implementing the Policy 2. Introduction 2.1 The primary objectives of this strategy will be to: promote awareness of risk and define responsibility for managing risk within the IJB; establish communication and sharing of risk information through all areas of the IJB; initiate measures to reduce the IJB’s exposure to risk and potential loss; and, establish standards and principles for the efficient management of risk, including regular monitoring, reporting and review. 2.2 The strategy takes a positive approach to risk management. The scope applies to all risks, whether relating to the clinical and care environment, employee safety and wellbeing, business risk, opportunities or threats. 2.3 Strategic risks represent the potential for the IJB to achieve (opportunity) or fail to meet (threat) its desired outcomes and objectives as set out in the Strategic Plan, and typically these risks require strategic leadership in the development of activities and application of controls to manage the risk. 2.4 Operational risks represent the potential for impact (opportunity or threat) within or arising from the activites of an individual service area or team operating within the scope of the IJB’s activities. Parent bodies will retain responsibility for managing operational risks as operational risks will be more ‘front‐line’ in nature and the development of activities and controls to respond to these risks can be led by local managers and team leaders. Where a number of operational risks impact across multiple service areas or, because of interdependencies, require more strategic leadership, then these can be proposed for escalation to ‘strategic risk’ status for the IJB. 2.5 All risks will be analysed consistently with an evaluation of risk as follows: Risk Score Review Very High 16+ Monthly High 10‐15 Every 3 months Medium 4‐9 Every 6 months Low 1‐4 Annually 2.6 The IJB’s Risk Appetite is described as the amount of risk the IJB is prepared to accept, tolerate or be exposed to at any one time. Any risk with a current risk matrix score of 10 or above (high or very high graded risks) is considered to exceed the IJB’s risk appetite and further actions will be taken to mitigate to the lowest possible level. Risks of a score of 9 or less (low or medium graded risks) are considered to be within the IJB’s level of risk appetite and will be subject to regular monitoring as detailed above. 11
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Version No. Final 2.0 Date Effective: 31/01/2018 Review Date: 31/01/2020 3. Risk management process 3.1 Risk Management is about the culture, processes and structures that are directed towards realising potential opportunities whilst managing adverse effects1 It is pro‐active in understanding risk and uncertainty, it learns and builds upon existing good practice and is a continually evolving process that has an important role in ensuring that defendable and beneficial decisions are made. 3.2 The IJB embeds risk management practice by consistent application of the risk management process shown in the diagram on the right, across all areas of service delivery and business activities. 3.3 All reports to the IJB will detail the relevant risks associated or emergent. 4. Application of good risk management across the IJB activities 4.1 Standard procedures (4.1.1 – 4.1.12) will be implemented across all areas of activity that are under the direction of the IJB in order to achieve consistent and effective implementation of risk management. 4.1.1 Full implementation of the risk management process. This means that risk management information should be used wherever possible to guide major decisions in the same way that cost and benefit analysis is used. 4.1.2 Identification of risk using standard methodologies, and involving subject experts who have knowledge and experience of the activity or process under consideration. 4.1.3 Risks should be described in three parts, covering: The root cause (weakness) ie “There is a risk that..........” The trigger (initiating event or action) ie “ because of......” And the impact (consequence) : “resulting in...............” 4.1.4 Categorisation of risk under the headings below: Strategic Risks: such as risks that may arise from Political, Economical, Social, Technological, Legislative and Environmental factors that impact on the delivery of the Strategic Plan outcomes. Operational Risks: such as risks that may arise from or impact on Clinical Care and Treatment, Social Care and Treatment, Customer Service, Employee Health, Safety & Well‐being, Business Continuity/ Supply Chain, Information Security and Asset Management. 4.1.5 Appropriate ownership of risk. Specific risks will be owned by/assigned to whoever is best placed to manage the risk and oversee the development of any new risk controls required. 4.1.6 Consistent application of the agreed risk matrix to analyse risk in terms of likelihood of occurrence and potential impact, taking into account the effectiveness of risk control measures in place. The risk matrix to be used is shown at 1.7 and a list of the impact descriptors for both partner organisations is detailed in Appendix 2. 1 Australia/ New Zealand Risk Management Standard, AS/NZS 4360: 2004 12
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 4.1.7 Risks will be scored initially without consideration of controls to provide an inherent (initial) risk score. Thereafter risks will be scored taking account of controls measures in place to mitigate the risk, giving a residual (current) risk score. 4.1.8 Consistent response to risk that is proportionate to the level of risk. This means that risk may be transferred elsewhere (ie to another partner or third party); rejected; accepted as it is; or, mitigated with cost effective measures to bring it to a level where it is acceptable or tolerable for the IJB in keeping with its appetite/ tolerance for risk. In the case of opportunities, the IJB may take an informed risk in terms of tolerating it if the opportunity is judged to be (1) worthwhile pursuing and (2) the IJB is confident in its ability to achieve the benefits and manage/ contain the associated risk. 4.1.9 The IJB recognises the importance of working in partnership with all relevant internal and external stakeholds, most notably North Lanarkshire Council, NHS Lanarkshire, South Lanarkshrie IJB, externally commissioned services and third sector partners. A memorandum of understanding is in place with North Lanarkshire Council and NHS Lanarkshire to ensure an integrated approach to risk management (see appendix 1). 4.1.10 Implementation and maintenance of risk registers as a means of collating risk information in a consistent format allowing comparison of risk evaluations, informed decision‐making in relation to prioritising resources and ease of access to information for risk reporting. 4.1.11 Reporting of strategic risks and key operational risks to the IJB on an ongoing basis. 4.1.12 Operation of a procedure for movement of risks between strategic and operational risk registers will be facilitated by the Chief Officer. 4.2 Routine reporting of risk information within and across teams and a commitment to a ‘lessons learned’ culture that seeks to learn from both good and poor experience, will support the sharing of good practice and reductions in adverse events, associated complaints and claims. Realising the risk management vision – 5. Risk management vision and measures of success – Appropriate and effective risk management practice will be embraced throughout the IJB as an enabler of success, whether delivering better outcomes for the people of North Lanarkshire, protecting the health, safety and well‐being of everyone who engages with the IJB or for maximising opportunity, delivering innovation and best value, and increasing performance. 5.1 In working towards this risk management vision the IJB aims to demonstrate a level of maturity where risk management is embedded and integrated in the decision making and operations of the IJB. 5.2 The measures of success for this vision will be: Successful delivery of the strategic plan, objectives and targets Successful outcomes from external scrutiny Improved safety Promotion of innovation Assurance that information is accurate and that controls and systems are robust and defensible Fewer unexpected/ unanticipated problems Positive financial outcomes for the IJB Fewer incidents/ accidents/ complaints Fewer claims/ less litigation Consistent reporting and presentation of risks Recording the risk management process 13
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Risk leadership and accountability 6. Governance, roles and responsibilities There needs to be clarity of ‘who does what’otherwise risk remains unidentified, causing loss that could otherwise be controlled or avoided. The strategy defines individual and organisational arrangements across the IJB and Health and Social Care Partnership. 6.1 Joint Integration Board 6.1.1 Members of the IJB are responsible for: oversight of the IJB’s risk management arrangements; receipt and review of reports on strategic risks and any key operational risks that require to be brought to the IJB’s attention; and, ensuring they are aware of any risks linked to IJB reports concerning new priorities, policies or emerging from performance updates. Risks associated with such proposals should be recorded in the ‘other implications’ section of the relevant IJB report. 6.2 Chief Officer 6.2.1 The Chief Officer has overall accountability for the IJB’s risk management framework, ensuring that suitable and effective arrangements are in place to manage the risks relating to the functions within the scope of the IJB. The Chief Officer will keep the Chief Executives of the IJB’s partner bodies informed of any significant existing or emerging risks that could seriously impact the IJB’s ability to deliver the outcomes of the Strategic Plan or the reputation of the IJB. 6.3 Chief Finance Officer 6.3.1 The Chief Finance Officer will be responsible for promoting arrangements to identify and manage key business risks, risk mitigation and risk financing. 6.4 Senior Leadership Team (SLT) 6.4.1 Members of the Senior Leadership Team are responsible (either collectively, or by nominating a specific member of the team) for: supporting the Chief Officer and Chief Finance Officer in fulfilling their risk management responsibilities; arranging professional risk management support, guidance and training from partner bodies; receipt and review of regular risk reports on strategic, shared and key operational risks and escalating any matters of concern to the IJB; and, ensuring that the standard procedures set out in section three of this strategy are actively promoted across their teams and within their areas of responsibility. 6.5 Individual Risk Owners 6.5.1 It is the responsibility of each risk owner to ensure that: risks assigned to them are analysed in keeping with the agreed risk matrix; data on which risk evaluations are based are robust and reliable so far as possible; risks are defined clearly to make explicit the scope of the challenge, opportunity or hazard and the consequences that may arise; risk is reviewed not only in terms of likelihood and impact of occurrence, but takes account of any changes in context that may affect the risk; controls that are in place to manage the risk are proportionate to the context and level of risk. 14
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 6.6 All persons working under the direction of the IJB 6.6.1 Risk management should be integrated into daily activities with everyone involved in identifying current and potential risks where they work. Individuals have a responsibility to make every effort to be aware of situations which place them or others at risk, report identified hazards and implement safe working practices developed within their service areas. This approach requires everyone to: understand the risks that relate to their roles and activities; understand how their actions relate to their own, their patient’s, their services user’s/ client’s and public safety; understand their accountability for particular risks and how they can manage them; understand the importance of flagging up incidents and/ or near misses to allow lessons to be learned and contribute to ongoing improvement of risk management arrangements; and, understand that good risk management is a key part of the IJB’s culture. 6.7 Partner Bodies 6.7.1 It is the responsibility of relevant specialists from the partner bodies, (such as internal audit, external audit, clinical and non clinical risk managers and health and safety advisers) to attend meetings as necessary to consider the implications of risks and provide relevant advice. It is the responsibility of the partner bodies to ensure they routinely seek to identify any residual risks and liabilities they retain in relation to the activities under the direction of the IJB. 6.8 Senior Information Risk Owner 6.8.1 Responsibility for this specific role will remain with the individual partner bodies. Resourcing risk management 7. Resourcing the risk management framework 7.1 The parties will make relevant resources avilable to support the IJB in it’s risk management arrangements. 7.2 Much of the work on developing and leading the ongoing implementation of the risk management strategy for the IJB will be resourced through the Senior Leadership Team’s arrangements (referred to in 6.4). 8. Resourcing those responsible for managing specific risks 8.1 Where risks impact on a specific partner body and new risk control measures require to be developed and funded, it is expected that the costs will be borne by that partner organisation. 8.2 Financial decisions in respect of the IJB’s risk management arrangements will rest with the Chief Finance Officer. Training, learning and development 9. Risk management training and development opportunities 9.1 To implement this strategy effectively, it is essential for people to have the competence and capacity to managing risk and make risk judgements with confidence, to focus on learning from events and past 15
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 experience in relation to what has worked well or could have been managed better, and to focus on identifying malfunctioning ‘systems’ rather than people. 9.2 Training is essential in embedding a positive risk management culture across all activities under the direction of the IJB and in developing risk management maturity. The Senior Leadership Team will regularly review risk management training and development needs and source the relevant training and development opportunities required (referred to in 6.4). Monitoring activity and performance 10. Monitoring risk management activity 10.1 The IJB operates in a dynamic and challenging environment. A suitable system is required to ensure risks are monitored for change in context and scoring so that appropriate response is made. 10.2 Monitoring will include review of the IJB’s risk profile at Senior Leadership Team level. 10.3 The IJB risk register will be reviewed regularly at the Senior Leadership Team and at the IJB Sub‐ Committee and IJB five times per year. 10.4 It is expected that partner bodies and the IJB will share risk reports and information for the purpose of highlighting and managing those risks that may have a common impact; and giving assurance within the guiding principles of “no surprises”. Risk sharing arrangements are set out in 4.1.9. 11. Monitoring risk management performance 11.1 Measuring, managing and monitoring risk management performance is essential to the effective delivery of key objectives. 11.2 Appropriate monitoring arrangements will be put in place to provide assurance on the effectiveness of mitigating control measures. For example, specific clinical incident data can provide assurance that risks associated with the delivery of clinical care are controlled, or, budget monitoring performance indicators can provide assurance that key financial risks are under control. 11.3 The performance data linked to the Strategic Commissioning Plan will also inform the identification of new risks or highlight where existing risks require more attention. Communicating risk management 12. Communicating, consulting on and reviewing the risk management framework 12.1 Good communication of risk management information across the IJB is essential to developing a consistent and effective approach. 12.2 This strategy will be widely circulated via the Senior Leadership Team and will form the basis of any risk management training arranged by the IJB. 12.3 This strategy will be reviewed regularly to ensure that it reflects current standards, best practice in risk management and fully reflects the IJB’s business environment. 16
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 12.4 Reviewing the IJB’s risk management arrangements on a regular basis will constitute a “Plan‐Do‐Study‐ Act” review cycle that will shape future risk management priorities and activities, inform subsequent revisions of this strategy, and drive continuous improvement in the management of risk. 17
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Integrated Risk Management: Risk Registers Memorandum of Agreement (MoA) In continuing to strengthen the risk management partnership arrangements, it will be necessary to agree how some emerging risks may have impact on more than 1 partner. This MoA sets out the process for discussions that will enable risks to be directed to the relevant risk register(s) for effective ownership and mitigation. Emerging Risk identified by: Select Division Date of identification of emerging Risk: Enter Date Describe nature of emerging Risk Set out mitigation required Agree ownership of the nature of the risk and mitigating controls, noting that they may be different for each partner with an interdependency on the hosting arrangements, delivery and commissioning aspect of the risk and leads for mitigating controls Initial Assessed Level of Risk = Likelihood Scoring x Initial Impact Scoring Who else may this affect? Select Division L I K E L I H O O D IMPACT 1 2 3 4 5 5 5 ☐ 10 ☐ 15 ☐ 20 ☐ 25 ☐ 4 4 ☐ 8 ☐ 12 ☐ 16 ☐ 20 ☐ 3 3 ☐ 6 ☐ 9 ☐ 12 ☐ 15 ☐ 2 2 ☐ 4 ☐ 6 ☐ 8 ☐ 10 ☐ 1 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ Select Division Select Division Appendix 1 18
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Does this Risk affect / impact on: Strategic Commissioning Intentions ☐ Strategic Planning Intentions ☐ Service Delivery ☐ Performance Targets ☐ Staff, Financial or Clinical Governance Implications ☐ CMT for consideration with agreement on the risk and impact for one or more partners Agreed Outcome - risk to be added to the following risk registers. Description, assessment and mitigation of the risk may vary according to the nature of the impact and the responsibility for mitigation. Yes No NHSL Corporate Risk Register ☐ ☐ NHSL Acute Divisional Risk Register ☐ ☐ North IJB Risk Register ☐ ☐ North H&SCP Risk Register (health and / or social care component part) ☐ ☐ South IJB Risk Register ☐ ☐ South H&SCP Risk Register (health and / or social care component part) ☐ ☐ North Lanarkshire Council ☐ ☐ Date discussed and agreed at CMT: Enter Date 19
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 Appendix 2 - Risk Assessment Impact Descriptors North Lanarkshire Council 20
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Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final 2.0 Superseded Version: N/A Date Effective: 31/03/2023 Review Date: 31/03/2025 NHS Lanarkshire Risk Types and Sub Types with Impact Guidelines 21
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1 REPORT Item No: 14 SUBJECT: IJBs Category 1 Responders in Civil Contingencies Act 2004 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Ross McGuffie, Chief Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integrated Joint Board: For approval For endorsement To note 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared Reviewed Endorsed By the Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB is asked to: 1. Note the progress made in confirming identified resilience leads; 2. Note that local resilience plans will be updated once further guidance is received. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 The Civil Contingencies Act 2004 was established with the aim of minimising disruption in the event of an emergency and to ensure that UK as a whole is better prepared to deal with a range of emergency situations. 5.1.2 Part 1 of the Act provides a focus on local arrangements for civil protection, establishing the statutory framework of roles and responsibilities for local responders. Yes No N/A
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2 5.1.3 Part 2 of the Act focuses on emergency powers and establishes a framework for the use of special legislative measures that may be required to deal with exceptionally serious emergencies. 5.1.4 On 24th September 2020, the Cabinet Secretary for Health and Sport wrote to confirm the intention of the Scottish Government to pass legislation that will include Integration Joint Boards as Category 1 Responders under Schedule 2 of the Civil Contingencies Act, 2004. 5.1.5 The North Lanarkshire IJB responded to the consultation, noting the positive local relationships and the importance of IJBs and HSCPs being central to the resilience response in local partnerships. 5.1.6 On 15th January 2021, the Cabinet Secretary for Health and Sport wrote to confirm the intention to include IJBs as Category 1 Responders on conclusion of the consultation. 5.2 Progress Update 5.2.1 The Chief Officer of the IJB has been a long-standing member of the Local Resilience Partnership (LRP) and this has continued since the changes to the Act were confirmed. In addition, the Chief Officer now attends the West of Scotland Regional Resilience Partnership (WosRRP). 5.2.2 Through the WoSRRP, a short-term working group was convened with IJB Chief Officers and West of Scotland leads to gain assurance around the IJBs’ preparedness and integration into the wider resilience community following their categorisation as Category One organisations in 2021. 5.2.3 Through this process it was agreed to conduct a survey with all West of Scotland IJB’s and Local Resilience Partnerships to gain assurance that the IJBs were now fully embedded within the local resilience structures, in line with the expectations set out in the Act. 5.2.4 Within the Lanarkshire Resilience Partnership, a collaborative process was undertaken to complete the survey in conjunction with the two Councils, NHS Lanarkshire and the two IJBs. 5.2.5 The North Lanarkshire IJB response is included in Appendix 1. 5.2.6 The WoSRRP paper summarising progress is included in Appendix 2. 5.2.7 As set out in the return in appendix 1, the North Lanarkshire IJB/HSCP is well embedded in the Local Resilience Partnership structures, at both the strategic and operational levels. The IJB/HSCP has active Business Continuity Plans; is tied into the multi-agency emergency plans and has played a full and active role in a number of planning exercises. 5.2.8 WoSRRP intend to undertake a follow up survey later in 2023 to track progress. 6. CONCLUSIONS 6.1 The North IJB welcomed the proposed change to make IJBs formal Category 1 Responders, whilst noting the positive local arrangements already in place that have seen the IJB fully embedded in the local resilience partnership processes for some time.
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3 6.2 The attached survey responses provide further assurance that the IJB/HSCP is meeting the requirements set out in the Act, with a further review to be undertaken later in 2023. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 PEOPLE 7.4.1 The IJB remains committed to collaborative working with local partners. 7.5 INEQUALITIES EQIA Completed: Yes No N/A 7.6 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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4 Appendix 1 WoSRRP Integration Joint Boards Category 1 Responder Questionnaire This questionnaire seeks to look at operating practice following Integration Joint Boards gaining Category 1 responder status in April 2021. Its seeks to establish how each IJB is meeting the duty and establish any good practice or areas for improvement in the partnership. This information is intended to reflect on implementation, provide assurance locally and be a basis for further improvement. Please complete this questionnaire in conjunction with your local resilience partnership. Required 1.Name of the Integration Joint Board Responding North Lanarkshire IJB. Given the close working arrangements in place in Lanarkshire, we have collaborated with our partners in South Lanarkshire in the development of our response. 2.Since the Integrated Boards became Category 1 responders in April 2021, how have they been represented within the LRP, at a strategic and tactical/operational level? The Chief Officer and designated senior officers are core members of the LRP. Similarly, the Chief Officer is a core member of the individual respective ‘Command Structures’ in NHS Lanarkshire and North Lanarkshire Council. Throughout the pandemic response, the Chief Officer held weekly meetings with the IJB Chair and Vice Chair and every IJB meeting included a resilience update to ensure the IJB was kept informed at all stages. 3.Does the IJB have resilience related risks reflected in its risk register and are these consistent across the LRP? Yes 4.Does the HSCP have up to date business continuity plans and when were these last reviewed? Yes. Reviewed on an ongoing basis and put into practice over the last few years as part of the combined response to Covid and the attendant elements to be managed therein. BCP reviews have been undertaken by all partners throughout the pandemic response to ensure all learning is identified. 5.Are the roles and responsibilities of the IJB/HSCP fully embedded within the LRP multi-agency emergency plans, and how have you described these? Yes. The role the H&SCPs have in providing community health and social care support to emerging issues forms a core part of the multi-agency plans. The roles are described in the respective elements as well as their being part of the initial escalation of the ‘command structure’ arrangements as required. 6.How does the IJB/HSCP take part in assessing risk, writing plans, delivering exercises, debriefs and learning lessons with the resilience partnership?
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5 The H&SCP has a risk register that is shared with both the Council and NHS Lanarkshire and, in turn, resilience/BCP linked risks identified and shared therein. There is also a series of linked BCP planning review sessions, e.g. most recently Blackstart re loss of power and the two H&SCPs have contributed singularly and collectively to shared exercises. 7.During a major incident and subsequent multi-agency response, how will the IJB/HSCP be alerted and what role will they take? Both IJB/H&SCPs are core members of the respective command structures and will be asked to participate as same established. There is also a 24/7 on call system that means the respective officers can be called to participate at all hours. The role the IJB/H&SCP will take will be dependent on the issue in question. For example, during the Wannacry Cyber-attack, the H&SCPs took a lead role in ensuring all general practice and other independent practitioners were protected as far as possible and also a supporting role in so far as they were part of the overall decision making structure that sought to identify where best to place resources to mitigate the impact of the event. As described earlier, the H&SCPs have taken a lead role in the response to Covid, with a series of lead roles across specific groups and particular responses, e.g. establishment of Community Covid Assessment Centres; creation of PPE hubs; development of Care Home and Care at Home Assurance structures; and managing the Covid and associated vaccines programme on behalf of the LRP. 8.Given the IJB/HSCP role in delivering health and social care services, how has the LRP linked in with the IJB/HSCP to develop local Care for People arrangements? (e.g., coordinating psychosocial support, resourcing emergency assistance centres, etc) Both H&SCPs are core members of the LRP and key players in the ‘Care for People’ arrangements described above. This ranges from direct provision of services, supporting rest centres, staffing MIST teams and so on. The HSCPs also have strong links with third sector organisations that have provided vital supports as part of the care for people arrangements throughout the pandemic response. 9.Do HSCP staff fully participate in LRP training? (please provide practical examples) Yes. As described above, the series of Blackstart training exercises is the most recent of these, notwithstanding the lived experience of the last two years. 10. As the newest member of the Category 1 group of agencies, how can the IJB/HSCP better support the LRP and are there any clear gaps that need to be addressed? In Lanarkshire, even before the change in the legislation, both H&SCPs were already core members of the Lanarkshire LRP and associated command structures. As such, there are no ‘clear gaps’ that we are aware of. 11.Since the introduction of IJBs as Category 1 responders, have you had to enact your resilience plans and what learning was identified (beyond Covid-19)?
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6 There have been a few occasions where LRP arrangements have been utilised, these include the joint response to the arrival of Supported Asylum Seekers and Ukrainians and the need to mobilise services accordingly. 12.Have you identified any specific actions to progress as a consequence of completing this self-assessment? No
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7 Appendix 2: WoSRRP Report Date: 04/10/22 Agenda Item No: 7 Integration Joint Boards; Synopsis of Short terms Working Group Survey Purpose: FOR NOTING Background At the meeting of the West of Scotland RRP Strategic Group held on 31 March 2022, a short-term working group, comprising of IJB Chief Officers and others, was commissioned to conduct a survey of the partnership’s constituent IJB/HSCPs. Their task was to apprise the partnership of their resilience preparedness and integration into the wider resilience community following their categorisation as a Category One organisation in 2021. This report is a synopsis of that survey, which was conducted by means of a questionnaire sent to each of the partnership’s thirteen IJB Chief Officers. Eleven responses were received. The questionnaire results are available in the RRP archive on Resilience Direct, where the full responses can be viewed. Question 1: ‘Since the Integration Joint Boards became Category 1 responders in April 2021, how have they been represented within the LRP, at a strategic and tactical/operational level?’ There is evidence that all IJBs are represented at all three levels of command. Some involve the direct involvement of their Chief Officer; others involve officials with delegated authority. At a strategic level, representation is often made on a rotational basis, with Chief Officers representing colleagues, pro tem. Question 2: ‘Does the IJB have resilience related risks reflected in its risk register and are these consistent across the LRP’ Half of the respondents confirmed that resilience specific risks were included in their risk register, with some articulating use of the Risk Preparedness Assessment process to inform their activities. Others outlined that, although resilience risks were not specified per se, they were inherent in other risks detailed in their registers. One respondent commented that risk and activity was informed by outputs from the LRP, but there were no identified shared risks, so the work was not fully integrated yet. Question 3: ‘Does the HSCP have up to date business continuity plans and when were these last reviewed?’
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8 All respondents confirmed they had current business continuity plans, however, there was a variance in the review timescales for each, ranging from six to twelve months. It was noted that several of the respondents had not reviewed their plans according to these timescales due to the onset of the Covid 19 pandemic. This has, however, been recognised and work is underway to address the issue. Question 4: ‘Are the roles and responsibilities of the IJB/HSCP fully embedded within the LRP multi-agency emergency plans, and how have you described these?’ Eight of the respondents confirmed that IJB/HSCPs are fully embedded into their plans, primarily through the role of the HSCPs as the delivery arm of the IJBs. These have formed part of their plans for some time, primarily under the ‘Care for People’ sections. One respondent highlighted that their IJB/HSCP remains at the periphery of the LRP, with no involvement in planning outwith its own operational area. Question 5: ‘How does the IJB/HSCP take part in assessing risk, writing plans, delivering exercises, debriefs and learning lessons with the resilience partnership?’ Ten of the respondents highlighted a series of activities which demonstrated cooperative working with partners. This included participation in, and development of, exercises and simulations; membership of Contingency Planning Liaison Groups (CPLGs); inclusion in BCP reviews involving shared risk registers amongst partners and regular invitations to HSCP members to attend training and exercising opportunities within the LRPs. However, one respondent commented that, although there was representation at LRP meetings and an opportunity was afforded to contribute at this forum, there were no specific activities as noted. Internal debriefs are carried out, but no participation through the partnership is evident. Question 7: ‘During a major incident and subsequent multi-agency response, how will the IJB/HSCP be alerted and what role will they take?’ This question elicited a variance in the mechanisms of major incident response notifications. Several respondents articulated a clear understanding of tried and tested processes, typically routed through their Chief Executives, civil contingencies or other ‘on-call’ resources. Others cited their ‘care for people’ leads as the conduit through which their services would be engaged. Evidence was provided that demonstrated the role of the HSCP can be more than the traditional ‘care for people’ activities, citing the example of an HSCP being involved in the response to a significant cyber-attack. The HSCP’s lead role in ensuring all general practice and other independent practitioners were protected as far as possible, in addition to a supporting role that sought to identify where best to place resources to mitigate the impact of the event, showed the value of being integrated into the wider resilience community. This allowed agencies the opportunity to add value outwith traditional operational silos.
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9 Question 8: ‘Given the IJB/HSCP role in delivering health and social care services, how has the LRP linked in with the IJB/HSCP to develop local Care for People arrangements?’ All respondents highlighted established and well-developed local processes to address this question. For most, it involved their ‘Care for People’ plans, either as a standalone or as part of wider multi-agency response plans. To compliment this, specific roles have been identified within the HSCPs to support and co-ordinate activities, i.e., BCP Co-ordinators. Operationally, contact lists and directories have been refined and made available to key personnel to improve the call-out process and ease the establishment of rest centres etc. Question 9: ‘Do HSCP staff fully participate in LRP training?’ All respondents commented that HSCP personnel are included within the training and exercising programme of their respective LRPs. Although specific metrics were not included, the onset of the pandemic is likely to have impacted in this area, with room to improve take up rates in the future. That said, training is ongoing and HSCPs recognise the importance of their staff taking part in multi-agency training and exercising. Question 10: ‘As the newest member of the Category 1 group of agencies, how can the IJB/HSCP better support the LRP and are there any clear gaps that need to be addressed?’ Most respondents were confident that well established relationships, fostered prior to the categorisation of IJBs, were working well and provide the necessary conduits between the respective organisations. There are numerous pieces of work ongoing at present to develop these, and partners are critically examining current processes to identify areas for improvement. Greater involvement in the planning process is one such area in addition to work underway to define the various incident types and the specific roles the HSCP/IJB could perform. Some Chief Officers are considering a temporary increase in resourcing to assist with this work. Question 11: ‘Since the introduction of IJBs as Category 1 responders, have you had to enact your resilience plans and what learning was identified (beyond Covid-19)?’ Half of the respondents have enacted their resilience plans to meet a variety of challenges including the pandemic response, building collapses and asylum seeker management. As with all operational activities, learning opportunities were evinced, including the need for MTPAS SIMs for HSCP personnel to allow effective
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10 communications during emergencies, the requirement to develop protocols for elected representatives to visit the locations involved in responding to emergencies and the need to improve communication flows between those responding. Question 12: ‘Have you identified any specific actions to progress as a consequence of completing this self-assessment?’ Three of the respondents have identified specific actions in respect of this question. These include conducting a bench marking exercise across Scotland to share and understand best practice, greater use of the Risk Preparedness process to identify specific risks for the HSCP and comparing this with peers to ensure consistency of approach and the review of the HSCP ‘Care for People’ plan in addition to a greater involvement in the training and exercising opportunities within the LRP. Conclusion & Recommendation It is evident that the onset of the Covid-19 pandemic had significant impact on much of the day-to-day resilience work of IJB/HSCPs – particularly in the fields of training and exercising, and this has resulted in some respondents being in a less developed position than would otherwise be the case. One respondent highlighted several areas where they could be better integrated into their resilience partnership. That said, broadly, there is evidence that HSCPs are well engaged with their respective local partnerships and see the value in cooperative working. Given that the most significant challenges of the last two years have centred on health-related matters, it is perhaps unsurprising this is the case. It is vital this continues throughout the entire panoply of resilience matters, going forward. Members are invited to note the contents of this report. It is recommended that a similar exercise is conducted in twelve months’ time to evaluate progress and ensure the appropriate support is being provided.
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1 REPORT Item No: 15 SUBJECT: Strategic Commissioning Plan 2023-26 TO: Integration Joint Board Lead Officer for Report: Head of Performance, Planning & Quality Assurance Author of Report: Senior Manager, Strategy & Performance DATE: 22 March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Board: For approval For endorsement To note 1.2 The purpose of the report is to provide the Board with the new Strategic Commissioning Plan 2023-26. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Senior Manager, Strategy & Performance Reviewed By: Endorsed By: 3. RECOMMENDATIONS 3.1 The Board is asked to: i) Approve the final version of the Strategic Commissioning Plan 2023-26 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 requires the Integration Joint Board to publish 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 and 2020, and a three-year plan covering the period 2020-23. The Strategic Commissioning Plans outline the key intentions to be delivered. Yes No N/A
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2 5.3 The Strategic Commissioning Plan sets out how the Health & Social Care Partnership plans and delivers services for North Lanarkshire over the medium term and how these arrangements are intended to achieve and contribute towards achieving the national health and wellbeing outcomes. 5.4 An engagement and consultation process has been undertaken to ensure a wide range of staff, people who use services, carers and partner organisations have had an opportunity to participate in shaping the next three-year commissioning plan which will run from 2023-2026. A number of events have taken place to facilitate discussion in localities as well as targeted groups, Community Board members, elected members, Integration Joint Board members, and the Strategic Planning Group. The programme of all engagement activities is detailed as an appendix to the final Strategic Commissioning Plan. 5.5 The Board approved the draft version of the Strategic Commissioning Plan at its meeting on 30 November 2022, subject to final consultation during the months of December, January, and February. The draft plan was published online in early December, alongside a survey questionnaire which allowed members of the public and any other interested parties to give their feedback on the draft plan. Feedback was generally positive and additional suggestions have been incorporated into the final draft. The feedback from the survey is published as an appendix to the final Strategic Commissioning Plan. 5.6 A programme of work is set out within the plan outlining the key work programmes that will be undertaken over the three-year period to meet the key priorities within the Strategic Commissioning Plan. Key deliverables and timescales will be further developed, with regular reports on progress to be made to the Board and its Committee. 5.7 The approach to the development of the plan and the completion of the process has been overseen by internal audit. 5.8 The final version of the plan, once approved, will be graphically designed, and published online. 6. CONCLUSIONS 6.1 Health and Social Care North Lanarkshire has held extensive engagement in the development of the Strategic Commissioning Plan 2020-23. 6.2 A first draft of the plan was published for consultation in February and feedback has been incorporated within the final draft version of the plan attached to this report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The Strategic Commissioning Plan is relevant to all national outcomes. 7.2 ASSOCIATED MEASURE(S) A performance plan setting out the strategic measures and associated trajectories for delivery that the North Lanarkshire IJB is required to deliver will be presented once the plan is finalised. 7.3 FINANCIAL The Strategic Commissioning Plan should be considered alongside the Medium-Term Financial Plan. 7.4 PEOPLE None
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3 7.5 INEQUALITIES EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix 1 Strategic Commissioning Plan 2023 - 26 Appendix 2 Strategic Needs Analysis Appendix 3 Survey Feedback Appendix 4 Equality Impact Assessment CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact Graeme Cowan on telephone number 07946702861.
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4 Appendix 1 Strategic Commissioning Plan 2023-26 Health & Social Care North Lanarkshire
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5 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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6 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 many 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 COVID-19 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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7 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. 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 Social Care (Self Directed Support) (Scotland) Act 2013 (and Framework of Standards) 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
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8 The strategic planning landscape is complex, as outlined above and 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. However, through our Strategic Commissioning Plan we are seeking to provide a clarity of direction for the Health & Social Care Partnership, while ensuring the appropriate linkages are made and due attention is given to our other planning commitments. 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’s and NHS Lanarkshire’s roles 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 Rowntree 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.” 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 nine 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.
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9 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. Members of the IJB have been involved in discussions and have been kept advised throughout the development of the plan. 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 in the preparation of this plan. 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, Voluntary Action North Lanarkshire (VANL, the Third Sector Interface for community and voluntary organisations in North Lanarkshire), and a range of other partner organisations. Consultation and engagement with the group took place via an online workshop and the group met in December 2022 to review the draft plan and met in March 2023 to agree the final plan and next steps engagement in the Programme of Work. 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.
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12 Community Boards – Strategic Engagement A Strategic Engagement event took place with members from each of the nine 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. Online Consultation During December 2022 – January 2023, HSCNL published an online questionnaire to gain feedback from the public and employees on the ambition statements that underpin the partnership’s new Strategic Commissioning Plan 2023- 2026. The survey was circulated and available for completion for a five-week period in December 2022 and January 2023. It was promoted to employees and the public through the social media channels of North Lanarkshire Council and NHS Lanarkshire. A total of 196 respondents completed the survey, consisting of 192 individuals and 4 organisations. Almost half of the respondents to the survey were unpaid carers and over 60% of respondents are currently receiving or have a received a service from Health & Social Care North Lanarkshire for themselves or a family member. The summary of feedback from the survey is included as an appendix of the plan.
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13 Timeline of Engagement & Consultation
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14 Strategic Needs Analysis A comprehensive needs analysis has been developed with expert support from the Local Intelligence Support Team (Public Health Scotland). The full document analysis is attached as appendix 2. 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 (-1.1%), while the overall Scottish population is projected to increase by 1.4%. It projected that by 2043, in North Lanarkshire: the number of people aged 0-15 to shrink by 11% those aged 75 and over to increase by 53.5% In relation to the forecasted increase in an older population, people will be living longer, and we recognise the positive contribution older people make to their communities and society in general. However, it is anticipated that with the significant change over time in the proportion of older people we will witness 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. 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. This is not a positive outcome at a personal level and could increase demand on health and care services for a longer period of time across the lifespan.
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15 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 social and economic circumstances such as poverty, housing, and education that together influence health throughout the life course. 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 – this highlights the fact that people who are on low incomes live across the whole of North Lanarkshire and not just the areas we usually understand to be the most economically deprived. 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.
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16 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). In North Lanarkshire the drug misuse death rate per 100,000 population was 23.4, compared to the Scottish rate of 22.9. 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 (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: Airdrie Bellshill Coatbridge Motherwell North Wishaw
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17 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 COVID-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 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 COVID-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 Recovery and Renewal 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 provides curriculum opportunities linked to the health and social care sector. These are targeted at young people in the senior phase of learning. 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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18 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 is being 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 COVID-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
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19 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. 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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20 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.
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21 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. 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 we will show ambition and be innovative to develop and try new ways of providing services. 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.
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22 Develop and support a workforce for the future The increase in the 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 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 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 Specialist mental health services All work must be underpinned by a collective effort to challenge mental health stigma and discrimination to ensure that those who require support are encouraged to access it.
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23 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; and 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. The Programme of Work is outlined in the two diagrams below and will evolve over time as we learn from practice what works and what doesn’t. Diagram 1 The Programme of Work outlined against the 5 key priorities Diagram 2 The Programme Management approach to the Programme of Work
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24 The programme of work consists of a range of evolving workstreams linked to each of the five strategic priorities. In the delivery and implementation of our programme, we will ensure appropriate governance arrangements are in place in relation to quality standards, staffing levels, financial management and outcome delivery. There are a range of supporting pillars in place which will support our programme, e.g. medium term financial plan, workforce plans, Engagement & Participation Strategy, which are described in more detail later in this plan.
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25 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 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.
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26 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. 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 A warm, accessible and affordable home is the foundation on which to build good health and wellbeing. By providing access to homes that are energy efficient, affordable, accessible and adaptable over the life course, North Lanarkshire’s housing sector is well placed to influence a number of key areas that improve health and wellbeing and reduce health inequalities. The sector also makes a vital contribution by boosting the local economy through the creation of employment, attracting investment and supporting sustainable economic growth, which has consequential positive impact on health outcomes. Shared outcomes have been identified which are aligned with both the LHS and this plan. 1. Reduce health inequalities experienced by people who face the most disadvantage in our communities 2. Reduce hospital admissions, length of stay, delayed discharge and readmission rates 3. Support people to live safely and well for longer in their own home through a range of home interventions and early prevention activities 4. Prevent and resolve homelessness effectively, providing wrap around support where necessary
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27 Housing is a key partner on North Lanarkshire’s Integration Joint Board and both local authority and registered social landlords are represented on the Strategic Planning Group. Key successes achieved include: Increased the number of affordable and accessible homes in North Lanarkshire helping to meet a broad range of needs, delivering 3,167 new build homes since 2010/11 and a further 611 homes through the Open Market and Empty Homes Purchase Scheme.1 Enhanced the design of new build homes to improve accessibility and ensure future sustainability. Improved the energy efficiency of our new and existing housing, employing low carbon technologies designed to reduce energy costs, helping keep carbon-emissions low and tackle fuel poverty. Implemented a revised allocations policy for sheltered housing which better meets the broad and changing needs of older households. Implemented a downsizing scheme to support older people to downsize to more suitable housing that better suits their needs. Developed and implemented new policies for tackling domestic abuse and improving tenancy sustainment, helping prevent homelessness and ensure timeous access to support. Delivered dedicated housing support, reducing the need for intensive support. Improved digital connectivity infrastructure installed in retirement complexes and in council new build homes, helping to support independence and promote social inclusion. Provided resource flats to help aid hospital discharge and key partner in established weekly discharge meetings to prevent housing-related hospital delays. Delivered income maximisation services and administered grant funding to those experiencing financial hardship who are at risk of homelessness, helping to combat the cost-of-living crisis and tackle fuel poverty. Implemented the Rapid Rehousing Transition Plan, providing settled accommodation first and foremost where possible, minimising time spent in temporary accommodation and providing flexible strength based support for those with complex and multiple support needs. The negative health consequences of homelessness are well documented. Those experiencing homelessness are at higher risk of morbidity, mortality as well as mental health and addictions issues. Our Rapid Rehousing Transition Plan (RRTP), which aims to provide settled housing options to those experiencing homelessness as quickly as possible to avoid lengthy stays in temporary accommodation, is now in its fourth year. We have made good progress. Our Housing First Team is well established, providing intensive support to those with the most complex needs. We have developed multi- disciplinary practice which continues to evolve. It is essential that we continue to strengthen this partnership approach to preventing and addressing homelessness, considering the wide-ranging impact on health and wellbeing. We are investing in our Town Centres, re-purposing and renovating buildings for residential use; helping to create sustainable mixed-use centres that are attractive and appealing. We are employing greener technologies, making our homes more energy efficient, reducing fuel poverty and boosting the local economy by creating employment opportunities. We are encouraging active transport links, providing 1 As at 20th Feb 2023, includes both Council and Registered Social Landlord new build homes.
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28 access to high quality, accessible open space and promoting the role that placemaking can have on generating positive health outcomes. Current Challenges: Homelessness is increasing across Scotland and is expected to increase in North Lanarkshire over the coming years due to the current cost-of-living crisis. This is particularly important since evidence suggests that homeless people also experience the worst health outcomes, including mental health issues, addictions and self-harm. Implementation of Prevention of Homelessness duty is expected at end of 2023 which will require considerable resource and collaboration. Our older population is increasing, particularly in the 75+ and 90+ age groups. This will present significant housing and support challenges and will increase the need for accessible and adaptable housing, and for equipment and adaptations. There is a shortage of wheelchair liveable homes and homes for older people across tenures with a need to increase provision particularly in the private sector. The cost-of-living crisis will exacerbate existing inequalities, forcing more residents into fuel poverty and rent/ mortgage arrears, and reduce capacity to fund repairs and maintenance. In recognition of these challenges, we have developed the following set of shared priorities to be addressed going forward, all of which will contribute towards meeting the priorities outlined in the SCP and achieving our shared outcomes. Our Shared Priorities: Implement the RRTP to effectively address homelessness, preventing people from becoming homeless in the first instance and where people do become homeless enable them to access permanent housing faster. Strengthen collaboration and joint care planning to effectively meet needs of homeless people with complex needs and reduce repeat homelessness. Identify and develop appropriate actions to deliver the Prevention of Homelessness duties when enacted. Work in partnership to identify earlier, effective interventions and responses to those experiencing domestic abuse. Provide an effective response to the housing and health needs of children and young people with a specific focus on those who are care experienced. Improve our understanding of the impact of inequality on specific protected groups. Increase the supply of accessible housing, including working with the private sector to increase awareness of the need for wheelchair housing and encourage development. Continue to adapt and install equipment and technology to help people live for longer in their own home. Ensure effective allocation of adapted properties to make best use of our housing stock in meeting the needs of people with disabilities. Enable swifter discharge from hospital and reduce delayed discharge. Provide person-centred support to help people develop the skills to live independently and thereby reduce the risk of a more acute crisis or intervention.
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29 Provide high quality, tailored housing options advice to meet the needs of individual households. These shared priorities although funded primarily by housing budgets, some will require pooled budgets/resourcing in the longer-term to ensure sustainability and continued progress towards improving outcomes for people, particularly those with complex, enduring or multiple needs, who have been involved with health, social care and housing services. This mainly relates to the actions and priorities set out in the RRTP. 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 seek to take a Human Learning Systems (HLS) approach to understand what makes a difference in people’s lives. We will seek to co-design integrated solutions based on people’s strengths and assets in the context of a whole system. Our workforce will be empowered to test new approaches and report what works. We will capture and use data and intelligence in a different way to support learning, bringing professionals and people together to reflect regularly and share learning. We will work creatively and continue to develop a realistic medicine approach. In developing a culture of empowering practitioners across our whole system to work differently to achieve desired outcomes, we will apply a trauma-informed lens to our services and undertake a self-
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30 assessment to recognise the current impacts of the last three years, in particular the impact of the pandemic. We will also apply this approach across our staff teams and ensure our staff health and wellbeing programmes provide the most appropriate support. 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 – quality and standards of care and support 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: Professional regulation, workload and workforce development; Information assurance; Service user experience and safety and quality of integrated service delivery and personal outcomes; Person-centred care; Management of clinical risks; and Learning from adverse event
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31 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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32 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 Integration Joint Board Liaison Session Online event, via MS Teams 30 November 2022 Integration Joint Board meeting Online meeting, via MS Teams 6 December 2022 Strategic Planning Group Online meeting, via MS Teams 16 December 2022 – 20 January 2023 Online Survey Online feedback questionnaire, hosted on NLC website 18 January 2023 Population Health & Primary and Community Services Governance Committee, NHS Lanarkshire Online meeting, via MS Teams 1 February 2023 North Lanarkshire Council Elected Members Briefing Session Online event, via MS Teams
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33 Appendix 2 Health & Social Care North Lanarkshire Strategic Needs Analysis February 2023
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34 Contents 1 Introduction ............................................................................................................................................................................................. 35 2 Demographics .......................................................................................................................................................................................... 37 3 Population Projections ............................................................................................................................................................................. 42 4 Life Expectancy ........................................................................................................................................................................................ 45 5 Care at Home ........................................................................................................................................................................................... 46 6 Care Home .............................................................................................................................................................................................. 55 7 Self-Directed Support (SDS) ..................................................................................................................................................................... 61 8 Unscheduled Care .................................................................................................................................................................................... 67 9 Delayed Discharges .................................................................................................................................................................................. 84 10 Long Term Conditions .............................................................................................................................................................................. 86 11 Children and Young People ...................................................................................................................................................................... 91 12 Mental Health .......................................................................................................................................................................................... 98 13 Last 6 months of life ................................................................................................................................................................................. 99 14 Outpatient Appointments ...................................................................................................................................................................... 100 15 Cancer .................................................................................................................................................................................................... 104 16 Births and Deaths ................................................................................................................................................................................... 105 17 Smoking.................................................................................................................................................................................................. 108 18 Primary Care .......................................................................................................................................................................................... 109 19 Health Inequalities ................................................................................................................................................................................. 110
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35 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 54%. 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. 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 compared to Scotland at the 13-15 month, 27-30 month and 4-5 years child health reviews North Lanarkshire has generally had a higher uptake percentage for child vaccinations compared with 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.
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36 North Lanarkshire has higher age/sex standardised rates for all deaths, deaths by suicide and deaths by alcohol, compared to Scotland North Lanarkshire has a lower number of GPs and GP practices per practice list size compared with Scotland, with North Lanarkshire having lowest number of GPs per practice list size of all HSCPs in Scotland North Lanarkshire populations in the most deprived SIMD quintiles have much higher rates per 1,000 population than those in least deprived quintiles for 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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37 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
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38 Source: National Records of Scotland population estimates 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
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39 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 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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40 Chart 5: Percentage of population who are income deprived, comparing SIMD 2016 and SIMD 2020 Source: Scottish Government (SIMD), via ScotPHO Online Profiles Tool Table 5: Percentage of population who are income deprived, comparing SIMD 2016 and SIMD 2020 Geography SIMD 2016 SIMD 2020 Airdrie 16% 16% Bellshill 16% 16% Coatbridge 17% 17% Motherwell 17% 17% North Lanarkshire North 12% 11% Wishaw 16% 16% North Lanarkshire 15% 15% Scotland 12% 12% Source: Scottish Government (SIMD), ScotPHO Online Profiles Tool North Lanarkshire have a higher percentage of the population who are income deprived compared with Scotland. All North Lanarkshire localities are above the Scotland percentage apart from North Lanarkshire North, with Coatbridge having the highest percentage of all the North Lanarkshire localities. Generally there has been a decrease for all areas when comparing SIMD 2016 (based on 2014 population) compared with SIMD 2020 (based on 2017 population). Note this data is from several years ago and does not reflect the current cost of living crisis.
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41 Chart 6: Percentage of working age population who are employment deprived, comparing SIMD 2016 and SIMD 2020 Source: Source: Scottish Government (SIMD), via ScotPHO Online Profiles Tool Table 6: Percentage of working age population who are employment deprived, comparing SIMD 2016 and SIMD 2020 Geography SIMD 2016 SIMD 2020 Airdrie 14% 12% Bellshill 14% 12% Coatbridge 15% 13% Motherwell 15% 13% North Lanarkshire North 10% 9% Wishaw 14% 12% North Lanarkshire 13% 11% Scotland 11% 9% Source: Source: Scottish Government (SIMD), ScotPHO Online Profiles Tool North Lanarkshire has a higher percentage of the working age population who are employment deprived compared with Scotland. All North Lanarkshire localities are above the Scotland percentage apart from North Lanarkshire North, with Motherwell having the highest percentage of all the North Lanarkshire localities. Generally there has been a decrease for all areas when comparing SIMD 2016 (based on 2014 population) compared with SIMD 2020 (based on 2017 population). Note this data is from several years ago and does not reflect the current cost of living crisis.
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42 Chart 7: 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 7: 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. Population Projections
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43 Chart 8: North Lanarkshire population projections for all ages for 2022-2043 Source: National Records of Scotland population projections Table 8: 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 9: North Lanarkshire population projection for 2022-2043 for 75+ age group
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44 Source: National Records of Scotland population projections Table 9: 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 27,439 in 2023 to 42,131 in 2043, which is an increase of around 54%. Chart 10: North Lanarkshire population projections by age group, comparing 2023 and 2026 Source: National Records of Scotland population projections Table 10: 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
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45 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. Chart 11: North Lanarkshire population projection, 2020-2040, with under/over 75 years age breakdown Source: National Records of Scotland population estimates and projections Table 11: 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. 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.
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46 Chart 12: Life expectancy by gender, comparing North Lanarkshire and Scotland Source: Public Health Scotland/National Records of Scotland (NRS), via ScotPHO Online Profiles Tool Table 12: 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 Scotland 2001-2003 71.9 73.5 77.4 78.8 2010-2012 74.9 76.5 79.1 80.7 2002-2004 72.4 73.8 77.4 79.0 2011-2013 75.1 76.8 79.4 80.9 2003-2005 72.8 74.2 77.6 79.2 2012-2014 75.4 77.1 79.7 81.1 2004-2006 73.1 74.6 78.2 79.5 2013-2015 75.3 77.1 79.6 81.1 2005-2007 72.8 74.8 78.4 79.7 2014-2016 75.4 77.1 79.6 81.1 2006-2008 73.3 75.0 78.4 79.8 2015-2017 75.3 77.0 79.4 81.1 2007-2009 73.9 75.3 78.5 80.0 2016-2018 75.2 77.1 79.6 81.1 2008-2010 74.5 75.8 78.8 80.3 2017-2019 75.2 77.2 79.6 81.1 2009-2011 74.8 76.2 79.0 80.6 2018-2020 74.5 76.8 79.2 81.0 Source: Public Health Scotland/National Records of Scotland (NRS), via ScotPHO Online Profiles Tool 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. 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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47 Chart 13: Number of North Lanarkshire care at home users by financial year Data Source: mySWIS, North Lanarkshire council Table 13: 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 14: Average annual number of care at home hours supplied per user by financial year for North Lanarkshire Data Source: mySWIS, North Lanarkshire council
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48 Table 14: 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 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 15: Average weekly care at home package of care (POC) hours as at 31st March for North Lanarkshire Data Source: mySWIS, North Lanarkshire council Table 15: 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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49 Chart 16: Number of North Lanarkshire care at home users by age group and financial year Data Source: mySWIS, North Lanarkshire council Table 16: 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 17: 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 17: 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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50 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 18: 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 18: 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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51 Chart 19: 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 19: 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 20: 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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52 Table 20: 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 21: Average annual number of care at home hours supplied per user by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 21: 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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53 Chart 22: 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 22: 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. Chart 23: A&E Attendances per 1,000 people all ages receiving home care, by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland
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54 North Lanarkshire have consistently had higher rates than Scotland over the period 2017/18 Q4 – 2020/21 Q4. Rates were highest in 2019/20 Q3 and then rates decreased due to the COVID-19 pandemic. Rates then increased close to pre-pandemic levels and they have been decreasing in the last few quarters. Chart 24: Emergency admissions rate per 1,000 people all ages receiving home care, by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland North Lanarkshire have consistently had higher rates than Scotland over the period 2017/18 Q4 – 2020/21 Q4. Rates for North Lanarkshire and Scotland have followed a similar pattern. There was slight fluctuations for North Lanarkshire in each quarter before COVID-19 pandemic where the rates decreased, this was followed by an increase in 2020/21 Q2 close to pre-pandemic levels, with a decrease in 2020/21 Q4. Chart 25: Emergency admissions bed days rate per 1,000 people all ages receiving home care, by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland North Lanarkshire have consistently had higher rates than Scotland over the period 2018/19 Q1 – 2020/21 Q4. Rates for North Lanarkshire and Scotland have followed a similar pattern. Rates had been decreasing between 2018/19 Q3 then increased in 2019/20 Q3, before a sharp decrease the next quarter due to the COVID-19 pandemic. Rates the increased to pre-pandemic levels, then have been decreasing in last 2 quarters.
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55 Care Home Chart 26: Number of North Lanarkshire care home admissions, discharges and placements at end of period by financial year Data Source: mySWIS, North Lanarkshire council Table 23: 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.
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56 Chart 27: North Lanarkshire care home admissions rate per 10,000 population by financial year and age group Data Source: mySWIS, North Lanarkshire council Table 24: 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. Chart 28: North Lanarkshire care home discharges rate per 10,000 population by financial year and age group Data Source: mySWIS, North Lanarkshire council Table 25: 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
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57 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 29: 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 Table 26: 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.
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58 Chart 30: North Lanarkshire care home admissions rate per 10,000 population by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 27: 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. Chart 31: North Lanarkshire care home discharges rate per 10,000 population by financial year and locality Data Source: mySWIS, North Lanarkshire council Table 28: 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
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59 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 32: 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 Table 29: 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.
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60 Chart 33: A&E Attendances per 1,000 Long Stay Care Home Residents by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland North Lanarkshire rates have consistently been higher than Scotland over the period 2017/18 Q4 – 2020/21 Q4. Rates had been fluctuating, with a sharp increase before the COVID-19 pandemic, followed by a sharp decrease until 2020/21 Q1, another sharp increase until 20/21 Q3, followed by another decrease. Chart 34: Emergency admissions rate per 1,000 Long Stay Care Home Residents by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland The North Lanarkshire rates have fluctuated over the 3 year period, the rates had a sharp decrease from 2019/20 Q3 to 2020/21 Q1, followed by a sharp increase and then another decrease. North Lanarkshire rates were higher than Scotland in the period 2018/19 Q3 – 2019/20 Q3, then lower than Scotland in the period 2019/20 Q4 – 2020/21 Q2, higher in 2020/21 Q3 then lower again in 2020/21 Q4.
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61 Chart 35: Emergency admissions bed days rate per 1,000 long stay care home residents by quarter Source: Insights in social care: statistics for Scotland - Support provided or funded by health and social care partnerships in Scotland 2019/20 - 2020/21 - Insights in social care: statistics for Scotland - Publications - Public Health Scotland The North Lanarkshire rate had generally been increasing up to 2019/20 Q1, decreased until 2019/20 Q3, relatively stable until 2020/21 Q1, increased until 2020/21 Q3 followed by a decease. The North Lanarkshire rate has been lower than Scotland for the period 2017/18 Q4 – 2020/21 Q2, higher in 2020/21 Q3 and then lower again in 2020/21 Q4. 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 36: Number of North Lanarkshire Self-Directed Support (SDS) users Data Source: mySWIS, North Lanarkshire council
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62 Table 30: 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 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 37: Average budget of North Lanarkshire Self-Directed Support (SDS) users Data Source: mySWIS, North Lanarkshire council Table 31: 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.
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63 Chart 38: North Lanarkshire Self-Directed Support (SDS) users rate per 1,000 population Data Source: mySWIS, North Lanarkshire council Table 32: North Lanarkshire Self-Directed Support (SDS) users rate per 1,000 population Financial Year Rate of SDS users per 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 39: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by age group Data Source: mySWIS, North Lanarkshire council Table 33: 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
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64 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. Chart 40: Rate per 1,000 population of North Lanarkshire Self-Directed Support (SDS) users by locality Data Source: mySWIS, North Lanarkshire council Table 34: 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 41: Percentage of North Lanarkshire Self-Directed Support (SDS) budget by SDS Type and financial year
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65 Data Source: mySWIS, North Lanarkshire council Table 35: 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% 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 42: Percentage of Self-Directed Support budget in 2021/22 by SDS Type, for all North Lanarkshire localities Data Source: mySWIS, North Lanarkshire council Table 36: 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 43: Percentage of Self-Directed Support budget in 2021/22 by SDS Type per age group
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66 Data Source: mySWIS, North Lanarkshire council Table 37: 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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67 Unscheduled Care Chart 44: Accident and Emergency attendances rate per 1,000 population by financial year Source: A&E Datamart, Public Health Scotland Table 38: 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 localities remain above the Scotland rate with Coatbridge currently the highest and North Lanarkshire North the lowest.
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68 Chart 45: 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 39a: 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 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.
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69 Chart 46: Accident and Emergency attendances rate per 1,000 populations by month Source: A&E Datamart, Public Health Scotland Table 40: Accident and Emergency attendances rate per 1,000 populations by month Month North Lanarkshire Scotland Month North Lanarkshire Scotland Month North Lanarkshire Scotland Apr-18 30.6 23.2 Oct-19 32.1 24.7 Apr-21 29.5 20.2 May-18 33.4 25.6 Nov-19 30.8 24.1 May-21 32.6 22.4 Jun-18 31.4 24.4 Dec-19 31.0 23.9 Jun-21 33.7 23.6 Jul-18 31.8 24.1 Jan-20 30.6 23.6 Jul-21 32.5 22.8 Aug-18 30.9 23.9 Feb-20 28.4 21.8 Aug-21 32.7 23.3 Sep-18 30.4 23.6 Mar-20 22.4 17.3 Sep-21 31.2 22.8 Oct-18 30.9 23.4 Apr-20 16.2 11.3 Oct-21 29.2 21.6 Nov-18 30.2 23.1 May-20 21.9 15.5 Nov-21 28.3 20.8 Dec-18 30.1 23.5 Jun-20 25.7 17.7 Dec-21 26.1 19.3 Jan-19 31.2 23.7 Jul-20 26.8 19.4 Jan-22 26.4 19.3 Feb-19 28.8 22.1 Aug-20 29.4 21.0 Feb-22 26.2 19.2 Mar-19 31.9 24.6 Sep-20 27.8 20.0 Mar-22 30.0 22.6 Apr-19 31.8 24.5 Oct-20 26.3 18.5 Apr-22 28.2 21.1 May-19 33.6 25.3 Nov-20 23.9 17.2 May-22 31.8 23.9 Jun-19 31.6 24.7 Dec-20 22.7 16.2 Jun-22 30.2 23.2 Jul-19 32.2 24.9 Jan-21 22.1 14.9 Jul-22 29.1 21.9 Aug-19 33.0 25.2 Feb-21 20.4 14.1 Aug-22 30.3 22.9 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.
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70 Chart 47: Percentage of A&E attendances resulting in a hospital admission by financial year Source: A&E Datamart, Public Health Scotland Table 41: 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% 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.
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71 Chart 48: Emergency Admissions average length of stay in days, by financial year Source: SMR01, Public Health Scotland Table 42: 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 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.
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72 Chart 49: Acute emergency hospital admissions rate per 1,000 population by financial year Source: SMR01, Public Health Scotland Table 43: 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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73 Chart 50: 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 44a: 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 44b: 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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74 Chart 51: Acute emergency hospital admissions rate per 1,000 populations by month Source: SMR01, Public Health Scotland Table 45: Acute emergency hospital admissions rate per 1,000 populations by month Month North Lanarkshire Scotland Month North Lanarkshire Scotland Month North Lanarkshire Scotland Apr-18 11.1 8.8 Aug-19 11.9 9.5 Dec-20 9.5 8.1 May-18 11.1 9.2 Sep-19 11.8 9.4 Jan-21 9.1 7.6 Jun-18 10.8 8.9 Oct-19 12.6 10.0 Feb-21 9.0 7.2 Jul-18 10.6 8.8 Nov-19 12.8 9.8 Mar-21 11.0 8.7 Aug-18 11.2 9.1 Dec-19 12.5 9.9 Apr-21 11.0 8.7 Sep-18 10.9 8.6 Jan-20 12.5 9.6 May-21 11.5 9.0 Oct-18 11.8 9.3 Feb-20 11.4 8.8 Jun-21 11.8 9.1 Nov-18 11.8 9.3 Mar-20 10.4 8.3 Jul-21 11.7 8.9 Dec-18 11.9 9.5 Apr-20 7.1 5.8 Aug-21 11.5 8.8 Jan-19 12.4 9.7 May-20 8.9 7.1 Sep-21 11.0 8.8 Feb-19 11.4 8.8 Jun-20 9.6 7.7 Oct-21 11.3 8.8 Mar-19 12.4 9.5 Jul-20 10.3 8.3 Nov-21 10.9 8.8 Apr-19 11.9 9.2 Aug-20 10.1 8.4 Dec-21 10.9 8.7 May-19 12.4 9.8 Sep-20 10.3 8.5 Jan-22 10.0 8.1 Jun-19 11.3 9.1 Oct-20 10.4 8.4 Feb-22 9.9 7.8 Jul-19 11.9 9.5 Nov-20 9.7 7.8 Mar-22 11.0 8.6 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.
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75 Chart 52: Acute emergency hospital admissions bed days rate per 1,000 populations by financial year Source: SMR01, Public Health Scotland Table 46: 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 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 53: Percentage of 2 plus emergency admissions (all ages) Source: SMR01, Public Health Scotland North Lanarkshire’s percentage of 2 plus emergency admissions has remained above the Scotland average for the last 5 years. Both had shown a slight continual increase before the pandemic and in 2021/22, is showing signs of
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76 returning back to pre pandemic levels. For the North Lanarkshire localities, North Lanarkshire North has consistently had the the lowest percentage over the 5 years, with Motherwell the highest in most recent years. Chart 54: Potentially preventable admissions rate per 1,000 population (all ages) Source: SMR01, Public Health Scotland North Lanarkshire’s potentially preventable admissions rate has remained above the Scotland average for the last 5 years. Both were relatively steady before the COVID-19 pandemic, with rates now increasing since 2020/21. For the North Lanarkshire localities, North Lanarkshire North has consistently had the lowest rate over the last 5 years, with Wishaw now being the highest in 2021/22.
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77 Chart 55: 7 day emergency readmissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 47: 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. For the North Lanarkshire localities, North Lanarkshire North has consistently had the lowest rate over the last 5 years, with Motherwell being the highest in most recent years.
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78 Chart 56: 28 day emergency readmissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 48: 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 in more recent years, with North Lanarkshire North the lowest.
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79 Chart 57: Alcohol related hospital admissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 49: 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 consistently has the highest rates of all the North Lanarkshire localities, with North Lanarkshire North consistently being the lowest.
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80 Chart 58: Drug related hospital admissions rate per 1,000 population, by financial year Source: SMR01, Public Health Scotland Table 50: 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 59: NHS24 calls - Rate per 1,000 population by financial year
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81 Source: Unscheduled Care Datamart, Public Health Scotland Table 51: 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 60: GP out of hours attendances rate per 1,000 population by financial year
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82 Source: Unscheduled Care Datamart, Public Health Scotland Table 52: 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 rate, with North Lanarkshire North being the lowest. Chart 61: Scottish Ambulance Service incidents rate per 1,000 population (all ages)
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83 Source: Unscheduled Care Datamart, Public Health Scotland The North Lanarkshire rate per 1,000 population of Scottish Ambulance Service incidents has been consistently lower than the Scotland rate. The rate was relatively steady up until 2020/21, and then there was an increase in 2021/22. Wishaw has the highest rate of the North Lanarkshire localities, with North Lanarkshire North having the lowest rates consistently over the 5 year period.
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84 Delayed Discharges Chart 62: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by financial year Source: Delayed Discharges, Public Health Scotland Table 53: 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 149.0 139.9 154.8 122.3 85.2 Bellshill 116.7 118.1 140.3 95.0 101.8 Coatbridge 135.4 148.1 163.9 119.5 95.8 Motherwell 138.4 134.4 191.7 126.9 134.5 North Lanarkshire North 116.0 100.4 130.3 99.0 147.2 Wishaw 136.7 141.5 139.5 108.9 105.3 North Lanarkshire 131.1 127.8 151.5 111.2 115.5 Scotland 109.6 116.5 120.6 78.3 113.0 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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85 Chart 63: Delayed Discharges bed days for 18+ age group – Rate per 1,000 population by month Source: Delayed Discharges, Public Health Scotland Table 54: 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 Scotland Apr-18 8.3 7.6 Oct-19 10.4 8.5 Apr-21 5.8 5.9 May-18 7.2 7.9 Nov-19 9.8 8.2 May-21 6.2 6.4 Jun-18 7.4 7.8 Dec-19 10.3 8.3 Jun-21 6.7 6.8 Jul-18 8.3 8.0 Jan-20 10.1 8.7 Jul-21 8.5 7.7 Aug-18 7.4 8.0 Feb-20 10.2 8.6 Aug-21 8.9 8.4 Sep-18 8.8 8.4 Mar-20 10.2 8.2 Sep-21 8.4 8.8 Oct-18 9.4 8.7 Apr-20 4.1 3.7 Oct-21 7.2 9.2 Nov-18 9.4 8.1 May-20 6.5 3.9 Nov-21 6.7 8.6 Dec-18 9.0 7.9 Jun-20 7.6 4.3 Dec-21 8.3 8.6 Jan-19 9.4 8.1 Jul-20 8.4 5.2 Jan-22 10.1 9.6 Feb-19 8.4 7.5 Aug-20 10.1 5.9 Feb-22 7.7 8.7 Mar-19 9.0 8.0 Sep-20 9.5 6.0 Mar-22 8.3 9.8 Apr-19 9.3 7.5 Oct-20 7.5 6.1 Apr-22 8.7 9.8 May-19 10.7 8.2 Nov-20 7.9 6.1 May-22 8.8 9.7 Jun-19 9.6 7.7 Dec-20 7.3 6.1 Jun-22 7.8 9.2 Jul-19 11.7 8.3 Jan-21 7.5 6.4 Jul-22 8.4 10.2 Aug-19 10.6 8.6 Feb-21 5.9 5.6 Aug-22 8.8 10.2 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.
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86 Long Term Conditions Chart 64: 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 55: 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 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) or community prescribing data from the Prescribing Information System (PIS), with some conditions using data linkage of the 2 datasets. 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.
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87 Chart 65: Prevalence of Anxiety/Depression Rate per 1,000 population by financial year Source: Prescribing Information System (PIS), Public Health Scotland Table 56: 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. Chart 66: Prevalence of COPD/Asthma rate per 1,000 population by financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland
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88 Table 57: Prevalence of COPD/Asthma rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 152.4 153.5 155.7 156.1 155.8 Bellshill 154.2 154.9 156.1 153.5 153.5 Coatbridge 146.3 148.9 152.9 153.0 155.5 Motherwell 144.4 145.8 147.6 146.5 148.7 North Lanarkshire North 144.0 144.6 146.7 146.1 147.4 Wishaw 153.9 155.8 158.1 160.4 162.6 North Lanarkshire 148.6 149.9 152.1 151.9 153.2 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Over the last 5 years, the rate for COPD/asthma has increased for North Lanarkshire and for all localities apart from Bellshill. The highest rates are in Wishaw, with the lowest being in North Lanarkshire North. Chart 67: Prevalence of Hypertension rate per 1,000 population by financial year Source: Prescribing Information System (PIS), Public Health Scotland Table 58: Prevalence of Hypertension rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 152.0 152.6 153.1 151.1 152.7 Bellshill 154.9 155.2 154.3 151.3 150.6 Coatbridge 141.3 142.7 143.2 141.2 141.9 Motherwell 132.1 133.1 132.7 130.1 131.4 North Lanarkshire North 150.2 150.5 150.6 147.1 145.7 Wishaw 149.2 151.6 154.6 154.9 158.4 North Lanarkshire 146.8 147.7 148.2 145.9 146.5 Source: Prescribing Information System (PIS), Public Health Scotland The prevalence rate of hypertension in North Lanarkshire had been increasing from 2017/18 to 2019/20, then decreased in 2020/21 likely as a result of the COVID-19 pandemic followed by an increase in 2021/22. Wishaw is the only North Lanarkshire locality where rates have continuously increased over the 5 year period and has been the locality with highest rates since 2019/20, with Motherwell consistently being the locality with the lowest rates.
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89 Chart 68: Prevalence of Chronic Pain rate per 1,000 population by financial year Source: Prescribing Information System (PIS), Public Health Scotland Table 59: Prevalence of Chronic Pain rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 92.9 92.7 92.0 90.3 89.1 Bellshill 98.5 98.4 96.0 92.0 89.7 Coatbridge 99.7 98.9 98.9 97.9 99.0 Motherwell 92.7 91.7 90.4 89.1 87.6 North Lanarkshire North 87.2 87.7 86.4 84.1 82.3 Wishaw 111.8 111.4 110.2 108.9 107.6 North Lanarkshire 96.0 95.8 94.6 92.7 91.4 Source: Prescribing Information System (PIS), Public Health Scotland The prevalence rate of chronic pain has slightly decreased over the last 5 years in North Lanarkshire. The rate has decreased in all North Lanarkshire localities, Wishaw has consistently had the highest rates, with North Lanarkshire North the lowest. Chart 69: Prevalence of Diabetes rate per 1,000 population by financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland
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90 Table 60: Prevalence of Diabetes rate per 1,000 population by financial year Financial Year Area of Residence 2017/18 2018/19 2019/20 2020/21 2021/22 Airdrie 58.5 59.9 62.4 63.8 65.9 Bellshill 60.8 62.7 64.8 66.5 69.2 Coatbridge 58.1 59.6 62.4 63.4 67.2 Motherwell 61.0 63.0 63.9 65.6 68.1 North Lanarkshire North 54.8 56.3 57.7 58.5 60.7 Wishaw 67.0 69.2 72.1 74.1 77.5 North Lanarkshire 59.5 61.2 63.2 64.6 67.2 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Over the last 5 years, the prevalence rate of Diabetes has increased year on year for North Lanarkshire and all 6 localities. Wishaw has consistently had the highest rates, with North Lanarkshire North the lowest. Chart 70: Percentage of the population with 3 or more long term conditions Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 61: 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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91 Children and Young People Chart 71: 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 62: 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. Chart 72: Child and Adolescent Mental Health Service (CAMHS) DNA’s percentage by financial year
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92 Source: Lanarkshire data: TrakCare, NHS Lanarkshire; Scotland data: CAMHS Waiting Times database, Public Health Scotland The percentage of North Lanarkshire’s CAMHS DNA’s has remained fairly steady at around 13%. In 2020/21 North Lanarkshire fell below the Scottish rate, however has crept above again in 2021/22 at just below 14%. In 2021/22, Coatbridge is the North Lanarkshire locality with the highest rate, with Bellshill being the lowest. Chart 73: Percentage of children with a concern in any domain at 13-15 month child health review, by financial year Source: CHSP Pre-School August 2022, Public Health Scotland
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93 The percentage of children with concern in any domain at 13-15 month review for North Lanarkshire as a whole has seen a slight decrease from 2018/19 to 2020/21, however has remained above the Scotland average for each year. For the North Lanarkshire localities, Motherwell have had the highest percentage in most recent years, with North Lanarkshire North the lowest. Chart 74: Percentage of children with a concern at 27-30 month child health review by financial year Source: CHSP Pre-School August 2022, Public Health Scotland Table 63: 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 August 2022, 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, and has largely remained steady at just under 18%. In 2020/21 Wishaw had the highest percentage of 19% and Bellshill with the lowest at 15%.
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94 Chart 75: Percentage of children with a concern in any domain at 4-5 year child health review, by financial year Source: CHSP Pre-School August 2022, Public Health Scotland The percentage of children with concern in any domain at 4-5 year child health review has been consistently higher than Scotland over the last 4 years. The North Lanarkshire rate has been relatively steady over the last 3 years, following a decrease between 2017/18 and 2018/19, compared to Scotland rate which had been increasing from 2017/18 to 2019/20 and then decreased slightly in 2020/21. For the North Lanarkshire localities in 2020/21, Bellshill has the highest rate with Motherwell the lowest. Chart 76: Unintentional injuries in under 5s, age/sex standardised rate per 100,000 (3 year aggregate) Source: SMR01, Public Health Scotland, via Online Profiles Tool - ScotPHO Unintentional injuries for under 5’s in North Lanarkshire has remained below the National figure from 2015 to 2018, however latest data for 2019 has shown this figure to have risen above the Scotland figure to just under 1085 per 100,000.
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95 Chart 77: Percentage uptake rate for child vaccinations at 12 months, by financial year Source: Scottish Immunisation and Recall System (SIRS) North Lanarkshire has consistently had a higher uptake percentage for all of the 12 month vaccinations over the last 5 years compared with Scotland. Similar patterns also observed for: 24 months – Hib/MenC, Men B booster, MMR1, PCVB, 6 in 1 5 years – 4 in 1, Hib/MenC, MMR1, MMR2, 6 in 1 6 years – 4 in 1, MMR1, MMR2 Where North Lanarkshire has generally had a higher uptake percentage compared with Scotland over the last 5 years compared with Scotland. % coverage of 12 month vaccination - MenB % coverage of 12 month vaccination - PCV % coverage of 12 month vaccination - Rotavirus % coverage of 12 month vaccination - 6 in 1
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96 Chart 78: Percentage of Primary 1 children receiving a letter 'C' (no obvious decay experience but should continue to see the family dentist on a regular basis) at basic inspection by school year Source: National Dental Inspection Programme Basic Inspection, Public Health Scotland; Online Profiles Tool - ScotPHO *Please note: Data for 2020/21 school year was unavailable due to COVID-19 pandemic. North Lanarkshire’s Primary 1 child dental health has been consistently slightly below the Scotland percentage over the last 5 years, with both showing a gradual increase over the last 5 years. Of the localities, North Lanarkshire North has had the highest percentage and Wishaw most recently being the lowest.
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97 Chart 79: Percentage of Primary 7 children receiving a letter 'C' (no obvious decay experience but should continue to see the family dentist on a regular basis) at basic inspection by school year Source: National Dental Inspection Programme Basic Inspection, Public Health Scotland; via Online Profiles Tool - ScotPHO Similarly with the Primary 1 dental health percentage, the Primary 7 dental health percentage in North Lanarkshire, has also seen a gradual increase year on year and in 2019/20, North Lanarkshire’s percentage has overtaken the Scotland rate for the first time in 5 years. For the North Lanarkshire localities in 2019/20, Motherwell had the highest rate with Coatbridge being the lowest.
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98 Mental Health Chart 80: Mental Health (psychiatric only) emergency admissions bed days rate per 1,000 population by financial year Source: SMR04, Public Health Scotland Table 64: 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 99.8 75.7 58.6 Bellshill 479.4 421.3 414.6 353.7 Coatbridge 155.8 184.2 150.8 130.8 Motherwell 264.7 282.1 284.0 240.8 North Lanarkshire North 135.2 125.4 102.9 79.4 Wishaw 126.7 120.8 102.2 81.6 North Lanarkshire 191.8 190.0 172.0 142.9 Scotland 224.6 219.6 209.6 186.9 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. Chart 81: Estimated number of people on drugs for anxiety, depression, psychosis rate per 1,000 population (all ages)
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99 Source: Prescribing Information System (PIS), Public Health Scotland The rate per 1,000 population of estimated number of people on drugs for anxiety, depression, psychosis in North Lanarkshire has been higher than the Scotland rate for the last 5 years and is showing a gradual increasing trend year on year. In 2021/22 the locality with the highest rate was Wishaw with 242 and North Lanarkshire North being the lowest at 209. Last 6 months of life Chart 82: Proportion of the last 6 months of life spent in the community for North Lanarkshire Source: Death records, NRS; SMR01 & SMR04, Public Health Scotland Table 65: 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%
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100 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. Outpatient Appointments Chart 83: Outpatient appointments attended rate per 1,000 population (all ages) Source: SMR00, Public Health Scotland The rate per 1,000 population of outpatient appointments in North Lanarkshire has been lower than the Scotland rate the last 3 years. North Lanarkshire and Scotland rates have followed a very similar pattern, at around 300 before the COVID-19 pandemic in 2020/21 where there was a decrease and then figures appear to returning back to pre pandemic levels in 2021/22. Chart 84: Outpatient appointments did not attend (DNA) rate per 1,000 population (all ages)
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101 Source: SMR00, Public Health Scotland The rate of outpatient appointment DNA’s for North Lanarkshire has consistently been slightly above the Scotland rate for the last 5 years. There was a decrease from 2017/18 to 2020/21, followed by an increase in 2021/22. For the North Lanarkshire localities, Coatbridge and Motherwell have had the highest rates, with North Lanarkshire having the lowest rate in 2021/22. Chart 85: Outpatient appointments attended in mental health specialties rate per 1,000 population (all ages)
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102 Source: SMR00, Public Health Scotland North Lanarkshire’s rate per 1,000 population for outpatient appointments in mental health specialties has remained below the Scotland rate for the last 5 years. For the North Lanarkshire localities in 2021/22, Motherwell has the highest rate with Airdrie being the lowest. Chart 86: Outpatient appointments did not attend (DNA) in mental health specialties rate per 1,000 population (all ages)
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103 Source: SMR00, Public Health Scotland North Lanarkshire’s rate per 1,000 population for outpatient appointments DNA’s in mental health specialties has consistently been slightly higher than the Scotland rate over the last 5 years. For the North Lanarkshire localities in 2021/22, Coatbridge has the highest rate and Wishaw the lowest.
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104 Cancer Chart 87: Percentage of bowel screening uptake by calendar year (3 year aggregate) Source: Scottish Bowel Screening Database (Public Health Scotland), Online Profiles Tool - ScotPHO North Lanarkshire’s bowel screening uptake rate has shown a continual increase from 2016, however remains below the Scotland percentage. For the North Lanarkshire localities, North Lanarkshire North has the highest uptake percentage, with Motherwell having the lowest. Add in more Cancer screening outputs when we receive IR from PHS Cancer team. Chart 88: Cancer registrations age/sex standardised rate per 100,000 population by calendar year (3 year aggregate) Source: SMR06, Public Health Scotland, via Online Profiles Tool - ScotPHO
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105 North Lanarkshire’s Cancer registrations age/sex standardised rate per 100,000 population has remained at a constant rate around 650; and is slightly higher than the Scotland rate. For the most recent 3 year aggregate calendar years, the North Lanarkshire locality with the highest rate is Airdrie, and Motherwell is the lowest. Births and Deaths Chart 89: Live births rate per 1,000 population by calendar year Source: ScotPHO Online Profiles Tool Online Profiles Tool - ScotPHO The rate of live births per 1,000 population has been slightly higher in North Lanarkshire compared to Scotland over the last 5 years, with both rates decreasing over the 5 year period. For the North Lanarkshire localities, Motherwell has the highest rate with Bellshill now being the lowest.
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106 Chart 90: Deaths (all ages) age/sex standardised rate per 100,000 population by calendar year (3 year aggregate) Source: National Records of Scotland (NRS), via Online Profiles Tool - ScotPHO The age/sex standardised death rate per 100,000 population has been consistently higher in North Lanarkshire compared to Scotland over the last 5 years, showing a gradual increase from 2018 to 2020. Year on year North Lanarkshire has had a higher rate in comparison to the national rate. Coatbridge has the highest rate of the North Lanarkshire localities, with North Lanarkshire North having the lowest. Chart 91: Deaths from suicide, age/sex standardised rate per 100,000 population by calendar year (5 year aggregate) Source: National Records of Scotland (NRS), via Online Profiles Tool - ScotPHO North Lanarkshire’s deaths from suicide rate has risen at a higher rate compared to Scotland in more recent years. For the North Lanarkshire localities, Wishaw has consistently had the highest rate, with North Lanarkshire North being the lowest most recently.
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107 Chart 92: Age/sex standardised rate per 100,000 population of alcohol specific deaths by calendar year (5 year aggregate) Source: National Records of Scotland (NRS), via Online Profiles Tool - ScotPHO North Lanarkshire’s age/sex standardised rate per 100,000 alcohol specific deaths has been consistently higher than the Scotland rate. All localities are above the Scotland rate with Coatbridge generally having the highest rate of the 6 localities, with North Lanarkshire North the lowest. Chart 93: Drug related deaths, age/sex standardised rate per 100,000 population by calendar year Source: National Records of Scotland (NRS) via Online Profiles Tool - ScotPHO The age/sex standardised rate per 100,000 population for drug related deaths in North Lanarkshire had been increasing from 2017 to 2019, steady until 2020 and then decreased in 2021 where it is now lower than the Scotland rate.
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108 Smoking Chart 94: Smoking quit rate percentage at 4 week follow up by financial year Source: NHS Smoking Cessation Database, Online Profiles Tool - ScotPHO The percentage of smoking quit rate in North Lanarkshire has remained steady at approximately 40% from 2015/16 to 2019/20 and remains above the Scotland rate. Chart 95: Smoking quit rate percentage at 12 week follow up by financial year Source: ScotPHO Online Profiles Tool Online Profiles Tool - ScotPHO The smoking quit rate percentage at 12 week follow up in North Lanarkshire has generally remained above the Scotland rate over the 5 year period, with 2018/19 being the only year where it fell below the Scotland rate. In 2019/20, the quit rate was just under 25%.
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109 Primary Care Chart 96: Number of GP practices per 100,000 practice list size, as at 1st January 2023 Source: National Primary Care Contractor Database (NPCCD), Public Health Scotland As at 1st January 2023, North Lanarkshire has a slightly lower number of GP practices per 100,000 practice list size compared with Scotland and ranks 17th highest of all HSCPs in Scotland. Wishaw is the North Lanarkshire locality with the highest rate, Airdrie has the lowest. Chart 97: Number of GPs per 100,000 practice list size, as at 1st January 2023 Source: National Primary Care Contractor Database (NPCCD), Public Health Scotland As at 1st January 2023, North Lanarkshire has a considerably lower number of GPs per 100,000 practice list size compared with Scotland and they rank the lowest of all HSCPs in Scotland. Motherwell is the North Lanarkshire locality with the highest rate, Airdrie has the lowest. Notes GPs contracted to work in Scottish General Practices contact details; as at 01/01/2023 Excludes GPs working only on a locum/sessional basis and those working only in Out of Hours service locations Also excludes NHS Board administration practices which have no registered GPs or registered patients.
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110 Health Inequalities Chart 98: 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 66: 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 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 99: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by SIMD Quintile and financial year
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111 Source: SMR01, Public Health Scotland Table 67: 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 100: Rate per 1,000 population of acute emergency admissions bed days for North Lanarkshire residents by SIMD Quintile and financial year Source: SMR01, Public Health Scotland Table 68: 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.
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112 Chart 101: 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 69: 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) 162.0 175.1 212.6 138.0 Q2 156.0 132.3 148.5 129.0 Q3 116.8 122.4 134.5 109.0 Q4 78.4 77.1 102.7 76.6 Q5 (Least Deprived) 63.7 50.2 66.0 38.2 Source: Delayed Discharges, Public Health Scotland The rate per 1,000 population of delayed discharge bed days for North Lanarkshire residents as generally higher for more deprived quintiles. From 2017/18 to 2019/20, this has been increasing, more notable for residents who live in the most deprived quintile. 2020/21 has seen a drop in Delayed discharge bed days, however this is will be due to the covid 19 pandemic. Chart 102: 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
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113 Table 70: 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 2017/18 2018/19 2019/20 2020/21 Q1 (most deprived) 167.2 195.2 171.5 120.8 Q2 166.5 151.8 156.7 137.8 Q3 392.5 363.7 312.6 290.5 Q4 211.9 196.8 163.8 141.0 Q5 (least deprived) 34.2 26.8 35.7 27.5 Source: SMR04, Public Health Scotland The rate of mental health emergency bed days has been steadily decreasing over the years across all SIMD quintiles. SIMD quintile 3 is consistently the quintile with the highest bed day rate, with quintile 5 being the lowest. Chart 103: 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 71: 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 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.
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114 Chart 104: 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 72: 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 105: 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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115 Table 73: 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 106: 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 74: 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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116 Chart 107: 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 75: 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 74 185.1 152.1 179.3 153.6 75 plus 972.5 1,002.2 1,084.4 798.6 Source: Delayed Discharges, Public Health Scotland The rate per 1,000 population of delayed discharge bed days is much higher for older age groups. With an overall increasing trend year on year before the COVID-19 pandemic in 2020/21. The 75 plus age group is approximately 20 times higher than that of the 45 to 64 year olds and was reaching past 1,000 beds on average before the pandemic. Chart 108: Rate per 1,000 population of acute emergency admissions for North Lanarkshire residents by age group and financial year
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117 Source: SMR01, Public Health Scotland Table 76: 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 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 109: 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 77: 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
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118 Chart 110: 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 78: Rate per 1,000 population of Mental Health emergency admission bed days for North Lanarkshire residents by age group and financial year Financial Year Age Group 2017/18 2018/19 2019/20 2020/21 0 to 17 15.3 14.9 8.1 5.1 18 to 44 112.9 145.0 132.6 102.9 45 to 64 166.9 149.1 150.3 124.2 65 to 74 549.3 522.4 397.3 364.7 75 plus 694.4 612.1 590.5 474.9 Source: SMR04, Public Health Scotland Overall, the rate of mental health emergency bed days for North Lanarkshire residents is higher as the age group increases. With the 65 to 74 and the 75 plus age bands being around 3 times higher than the 45 to 64 year olds. Chart 111: 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
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119 Table 79: 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 112: Percentage of North Lanarkshire population prevalent with 3 or more long term conditions by age group and financial year Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Table 80: 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.
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120 Chart 113: 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 81: 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% 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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121 Chart 114: Top 10 Long Term Conditions by financial year and age group
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122 Coronary Heart Disease Migraines Osteoarthritis Anxiety/Depression COPD/Asthma Hypertension Chronic Pain Diabetes Gastro-Oesphaegal Reflux Cancer 0% 5% 10% 15% 20% 25% 30% 35% 40% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 5% 10% 15% 20% 25% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 10% 20% 30% 40% 50% 60% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 5% 10% 15% 20% 25% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 2% 4% 6% 8% 10% 12% 14% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 5% 10% 15% 20% 25% 30% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 1% 2% 3% 4% 5% 6% 7% 8% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 2% 4% 6% 8% 10% 12% 14% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+ 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year 0-34 35-49 50-64 65-74 75+
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123 Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland
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124 Chart 115: Top 10 Long Term Conditions by financial year and SIMD quintile Source: SMR01 and Prescribing Information System (PIS), Public Health Scotland Coronary Heart Disease Migraines Osteoarthritis Cancer Anxiety/Depression COPD/Asthma Hypertension Chronic Pain Diabetes Gastro-Oesphaegal Reflux 0% 5% 10% 15% 20% 25% 30% 35% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 5% 10% 15% 20% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 2% 4% 6% 8% 10% 12% 14% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 4% 5% 6% 7% 8% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 4% 5% 6% 7% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 4% 5% 6% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 4% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived) 0% 1% 2% 3% 2017/18 2018/19 2019/20 2020/21 2021/22 Percentage of population Financial Year Q1 (most deprived) Q2 Q3 Q4 Q5 (least deprived)
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125 Chart 116: A selection of health indicators broken down by SIMD quintile comparing North Lanarkshire & Scotland for most recent available data
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126 % 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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127 Chart 117: A selection of health indicators broken down by SIMD quintile, comparing North Lanarkshire localities for most recent available data % of children with 6-8 week review recorded 2020/21 Outpatient appontments attended 2021/21 CAMHS Referrals 2021/22 Mental Health Emergency Bed Days 2020/21 A&E Attendances 2021/22 Acute Emergency Admissions 2021/22 7 Day Readmissions 2021/22 % coverage of 12 month vaccination - MenB 2021/22 Estimated patients prescribed anxiolytics, antipsychotics and/or antidepressants, 2021/22 % with a concern in any developmental domain (13-15 month review) 2020/21 0 50 100 150 200 250 300 350 400 450 500 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 20 40 60 80 100 120 140 160 180 200 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 5 10 15 20 25 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 50 100 150 200 250 300 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 5 10 15 20 25 30 35 40 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Percentage Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 50 100 150 200 250 300 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 10 20 30 40 50 60 70 80 90 100 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived) 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Rate per 1,000 population Q1 (Most Deprived) Q2 Q3 Q4 Q5 (Least Deprived)
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128 Chart 118: A selection of health indicators broken down by age group comparing North Lanarkshire & Scotland for most recent available data
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129 Delayed Discharges Bed Days (18+) 2021/22 Outpatient appontments attended 2021/22 Percentage population with 3 or more LTC's 2021/22 Mental Health Emergency Bed Days 2020/21 A&E Attendances 2021/22 Acute Emergency Admissions 2021/22 7 Day Readmissions 2021/22 Potentially Preventable Admissions 2021/22 Estimated patients prescribed anxiolytics, antipsychotics and/or antidepressants, 2021/22 Emergency admission average length of stay 2021/22
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130 Chart 119: A selection of health indicators broken down by age group, comparing North Lanarkshire localities for most recent available data Delayed Discharges Bed Days (18+) 2021/22 Outpatient appontments attended 2021/22 Percentage population with 3 or more LTC's 2021/22 Mental Health Emergency Bed Days 2020/21 A&E Attendances 2021/22 Acute Emergency Admissions 2021/22 7 Day Readmissions 2021/22 Potentially Preventable Admissions 2021/22 Estimated patients prescribed anxiolytics, antipsychotics and/or antidepressants, 2021/22 Emergency admission average length of stay 2021/22
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131 Appendix 3 Strategic Commissioning Plan 2023-2026 -Your Views and Opinion During December 2022 – January 2023, HSCNL published an online questionnaire to gain feedback from the public and employees on the ambition statements that underpin the partnership’s new Strategic Commissioning Plan 2023- 2026. The survey was circulated and available for completion for a five-week period in December 2022 and January 2023. It was promoted to employees and the public through the social media channels of North Lanarkshire Council and NHS Lanarkshire. Respondent Characteristics A total of 196 respondents completed the survey, consisting of 192 individuals and 4 organisations. The two organisations which gave their name were: Lilac Neighbourhood Watch for Abronhill and North Lanarkshire Recovery Community 49% of the respondents described themselves as a person who provides unpaid care. 34% of the respondents work within the health and social care sector 60% of the respondents are currently receiving or have received a service from health and social care for themselves or a family member. Ambition 1 - Do the right thing first time - ensure that when people make contact with our services the response is quick and effective - 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) - embedding this approach with a whole system focus remains a priority Ambition 1 Count % Strongly agree 115 59% Agree 52 27% Neutral 4 2% Disagree 14 7% Strongly disagree 9 5% Total 194 100% 86% of respondents agreed with the statements within this ambition 17% of employees responding disagreed with some of the statements compared to 9% of those who are not employees. There was no difference in the proportion of disagreement in the responses to this ambition between those who have and those who do not have a caring responsibility. The general themes emerging from the comments provided in response to this question are as follows: There needs to be clarity as to what the Strategic Commissioning Plan will achieve, and its aims need to be realistic Helping people to help themselves is important and it needs to be clear what this means in practice Effective and timeous access to and communication with services is essential. A selection of respondents’ comments have been highlighted below for illustrative purposes. “Helping people to help themselves first is good in theory but we deal with vulnerable services users who are unable to help themselves and they must be given every assistance to help them live in a safe and healthy environment” (unknown)
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132 “People need to be able to contact services in a variety of ways not just online as many disadvantaged groups do not have access to digital equipment.” (member of the public) “It is rare for anything to be actioned that the response is quick and effective. Everything needs to be followed up time and time again” (employee) Ambition 2 - 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. - 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 riskier 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. Ambition 2 Count % Strongly agree 93 48% Agree 60 31% Neutral 9 5% Disagree 16 8% Strongly disagree 14 7% Total 192 100% 79% of respondents agreed with the statements within this ambition 20% of those employed in social care or health disagreed with this ambition as opposed to 14% of the respondents who do not work in the sector. 19% of carers disagreed with this statement compared to 12% of those who do not have caring responsibilities The general themes emerging from the comments provided in response to this question are as follows: The role and potential of the 3rd sector needs to be recognised and supported A focus on prevention and early intervention is necessary Single sex spaces are important as is the language used in ensuring that women are effectively supported and included The right services and staff are essential with planning reflecting measurable and achievable outcomes Planning and implementation need to include a focus on addressing inequalities
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133 A selection of respondents’ comments have been highlighted below for illustrative purposes. “Who wouldn't? However, if underlying ambition is to withdraw services to vulnerable people, that will only serve to exacerbate inequalities.” (employee) “A lot of the time the 3rd sector gets oversubscribed and have to deal with more complex clients because there is not enough council workforce support, or the criteria for input from the council becomes so restrictive that at the end of the day those vulnerable people at most need get no support.” (employee) “It is easy to listen to needs and aspirations - another thing to act upon them, which is what we need urgently.” (employee) “This looks like an excuse to cut costs and reduce services” (current service user) “Effective support is ALWAYS best provided by healthcare professionals!” (current service user) Ambition 3 - Develop and support a workforce for the future - The ageing population of North Lanarkshire is broadly mirrored within the workforce of the health and social care sector; therefore it is important to recognise this and make sure we prepare 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 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 Ambition 3 Count % Strongly agree 100 52% Agree 59 31% Neutral 8 4% Disagree 15 8% Strongly disagree 10 5% Total 192 100% 83% of respondents agreed with the statements within this ambition. 15% of those providing unpaid care disagreed with the statements compared to 10% of those without caring responsibilities The general themes emerging from the comments provided in response to this question are as follows: Critical to invest in and value home care workers, in terms of competitive salaries, training, and support to retain experienced and talented employees Explore the barriers to young people entering the profession to ensure a new generation of employees are coming through
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134 Ensure robust processes in any outsourcing of home care, including satisfactory training and delivery of a quality service A selection of respondents’ comments have been highlighted below for illustrative purposes. “Without an environment where staff feel they are supported and valued the recruitment and retention of the workforce is going to be an issue.” (employee and previous service user) “Home care workers require much better pay and training. It is an expert job looking after elderly dementing clients, who are just, if not more vulnerable than children. Yet inexperienced, low paid staff are asked to do a job that is emotionally and physically challenging. That is why carers are leaving. (employee and current service user) “There is no point in recruiting a new generation of workers who only leave after a few months because of low pay, low job satisfaction because they are not given enough time to do a good job. And sourcing out homecare to private companies who don't seem to have robust processes in place to ensure staff are trained well enough is not a solution.” (employee and current service user) “Pay care staff better, give them more time to do their jobs and treat them like the valuable staff they are. Nurses in hospital get a lot of media coverage of how hard they work, yet carers are forgotten about.” (employee and current service user) “Front line carers need more communication avenues with office-based staff” (current service user) “As an elderly citizen myself now, I still find myself caring for an elderly family member due to shortages of care workers which is more stressful wand with little respite. Ambition 3 sounds perfect but I don’t think will be achievable in my lifetime, but I do think if the right calibre of workforce it may one day happen. Having experience of care services, I certainly think that emphasis on life experience and good training essential.” (previous service user) “This is needed but the jobs need to attractive and reflective of what is being asked of people.” (employee) Ambition 4 - 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 and 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 - Specialist mental health services Ambition 4 Count % Strongly agree 117 60% Agree 47 24% Neutral 6 3% Disagree 17 9% Strongly disagree 7 4% Total 194 100%
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135 84% of respondents agreed with the statements within this ambition. Agreement with this ambition was similar across those who worked for health and social care and carers and respondents in general. The general themes emerging from the comments provided in response to this question are as follows: This sector needs increased investment, staff resource, and continued support to the third sector who provide much of this service Keep the positive conversation around mental health going within our communities Improvements are needed in all mental health care and support services, particularly for young people Educate all generations on mental health to ensure positive and ongoing support in the home, school and communities A selection of respondents’ comments have been highlighted below for illustrative purposes. “Requires investment and other incentives to make this an attractive area to work in. Further consideration of societal issues is also necessary.” (employee) “There should be a focus on mental health outcomes for those most severely affected by poor mental health. Too much effort is spent on dealing with people who have minor temporary mental health issues that can be overcome. Teaching young people about poor mental health can often result in young people self-diagnosing mental health problems rather than using their own resilience to overcome personal issues.” (member of the public) “priority to be needs based and not strategic tick box use of resources and funding” (employee and service user) “It is difficult to access mental health wellbeing services without a clinical diagnosis therefore some focus should be on prevention and early intervention. Access to mental health services is very difficult long waiting lists and staff capacity stretched to limit.” (employee and previous service user) “The main help for mental health in NL is third sector and charitable organisations.” (employee and previous service user) Ambition 5 - 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.
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136 Ambition 5 Count % Strongly agree 107 55% Agree 58 30% Neutral 14 7% Disagree 4 2% Strongly disagree 11 6% Total 194 100% Overall, 85% of respondents agreed with the statements in this ambition. 17% of those who work within health and social care disagreed with this ambition compared to 11% of those who do not. Carers were slightly more in agreement with this ambition (86%) compared to those who do not have caring responsibilities (83%) The general themes emerging from the comments provided in response to this question are as follows: Carers should be at the centre of any conversations around proposed changes to service provision Young carers need to be supported and their burden lifted. They need the opportunity and time to achieve in their own lives Partnership links and whole family support approach is needed alongside individualised support and care provision It is essential to signpost carers to the help and resources available to them A selection of respondents’ comments have been highlighted below for illustrative purposes. “Ambition laudable - but if this means that families subsume additional unpaid responsibilities, that they're not able to fulfil, that will make life difficult for many.” (employee) “Patient are waiting years to be treated. What kind of support is that?” (employee) “The work of unpaid carers underpins the work of Health & Social Care. This foundation needs greater support and access to services especially as family members grow older and their grown-up children require help to cope. The lack of care staff within social care and the time it takes to put care packages in place is a major contribution to the lack of beds in hospitals and needs to be addressed quickly.” (service user) “This is an important part of the strategy often families feel let down and struggle to know where to turn.” (employee and service user) “This statement fails to take into consideration the increased responsibility that has already been put on families throughout the pandemic due to lack of appropriate services.” (service user) “From experience carers and their families are not even involved in these conversations and most definitely not at the heart of the approach” (employee and service user) General Comments Respondents were also given the opportunity to contribute general comments on the plan and its content. A selection of these comments are provided below which reflect some of the wider sentiments and responses from the respondents.
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137 “This is at best a very broad strategy with no outcomes, accountabilities or measures of success or failure. It is a nice wish list with no real proposals to achieve the aims. The apparent enthusiasm present in the strategy needs to translate into practice and continue to be supported and worked on. I worry that some areas of health and social care will see having a strategy as sufficient, regardless of how well it is implemented. Previous experience of mental health services, most help came from 3rd sector organisations who provided support when healthcare could not. There is a need for adequate funding, greater staffing levels and proper skill-based training Carers’ workload appears to be haphazard and ‘not joined up’ scheduling. The time given for carers to provide the service is not long enough Elevating social care to a profession would acknowledge the work and encourage recruitment and retention of staff.
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138 Appendix 4 Equality Impact Assessment Health and Social Care North Lanarkshire Strategic Commissioning Plan 2023-2026 Title of policy Health and Social Care North Lanarkshire Strategic Commissioning Plan 2023-2026 Responsible body Integration Joint Board – North Lanarkshire Council and NHS Lanarkshire Lead officer Ross McGuffie, Chief Officer, Health and Social Care Lanarkshire What is the purpose of the proposed policy or changes to established policy? This assessment relates to a statutory published plan summarising the purpose and intentions of the Integration Joint Board’s (IJB) Strategic Commissioning Plan (SCP) for Health & Social Care North Lanarkshire. The Public Bodies (Joint Working) (Scotland) Act 2014 puts in place arrangements for integrating health and social care to improve outcomes for patients, service users, carers and their families. The Act requires Health Boards and Local Authorities to work together effectively to agree a model of integration to deliver high quality, sustainable care services. The North Lanarkshire IJB is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of those functions through the directions issued by it under s25 of the Act. This Strategic Commissioning Plan covers the period 2023-26, the final phase of North Lanarkshire’s long term Strategic Plan 2016-2026. The SCP builds on the work established through the previous plan, 2020 - 2023. Following extensive engagement and collaboration with local people, service users, members of staff and other key stakeholders, the SCP sets out the IJB’s ambitions for improving the health and wellbeing of North Lanarkshire’s population over the next 3 years. Who is affected by the policy or who is intended to benefit from the proposed policy and how? All residents of North Lanarkshire including those who use services, carers and providers of health and social care services may benefit from and be affected by this policy. How have you or will you, put the policy into practice? Who will be responsible for delivering it? The IJB has overall responsibility for planning health and social care services within North Lanarkshire, however, the Health and Social Care Partnership has a key role in delivering on the strategic commissioning intentions within the SCP. The IJB’s continued commitment to working in partnership with statutory partners and the third and independent sectors is highlighted in the SCP. The continuation of work within community planning in North Lanarkshire is also acknowledged. The SCP seeks to ensure maximum impact across the whole health and care system. The impact of Covid recovery is given consideration within the plan alongside the need to build resilience in ensuring the priorities set out are met. High level outcomes and priorities that inform how community health, social care and social work functions delegated to the IJB by North Lanarkshire Council and NHS Lanarkshire are detailed within the SCP. A more detailed implementation plan to support the priorities of the IJB will be developed in the coming months. In terms of governance, in implementing the programme of work, further Equality Impact Assessments (EQUIAs) will provide reassurance of compliance with the Equality Act. EQIAs will be undertaken as part of each commissioned service’s delivery plans.
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139 The plan will be monitored on a quarterly and annual basis, as appropriate to the key management and partnership structures within IJB with further reporting on progress through an Annual Performance Report. In stage 1 screening you identified that the policy will impact on one or more of the protected characteristics. What information do you have that tell you how this policy might have an impact? Key Questions: What will the impact of the proposed policy/function be the same or different for each group identified? Is there any indication or evidence of higher or lower participation or uptake of services by different groups? Are there are any groups of people who are not taking up services? Protected Characteristic What evidence do you have that consultation has been undertaken Sex Pregnancy & maternity Disability Race Religion & belief Marriage & civil partnership Gender reassignment Sexual orientation Age A programme of consultation has taken place over the past year, both prior to the construction of a draft plan as well as in relation to the published draft SCP. To ensure that the plan reflects the needs and aspirations of residents of North Lanarkshire and other stakeholders, a comprehensive programme of communication and engagement has been facilitated. With the intention of reaching and involving as many people as possible, community consultation events have taken place alongside online interactive surveys to provide a range of opportunities for stakeholder involvement. This has enabled the IJB to ensure that its intentions are communicated widely and provide an opportunity for the perspectives of different groups to inform the plan. A Strategic Planning Group has met regularly to produce, monitor and review the SCP. The Group is chaired by the Chief Officer and has a wide-ranging membership. There is representation from senior leaders and managers within the partnership, service user and carer representatives, VANL, and a range of other partner organisations. North Lanarkshire’s North-East and North-West sectors brought their locality teams and local stakeholders together across two in-person engagement events. This allowed a large attendance from each of the six localities, with dedicated inputs and workshop sessions on the development of the SCP. 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. 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. In addition, there was also engagement with senior leaders and managers across our delivery areas, including: Adult Health Services
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140 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. What is the impact on the protected characteristics identified? Protected Characteristic Impact (High, Medium Low or Unknown) Description of impact L The principal purpose of the SCP is to set out how community health, social care and social work functions delegated to the IJB by North Lanarkshire Council and NHS Lanarkshire will be planned and delivered over the medium term. The plan itself does not intend to differentially impact on any specific protected characteristic. Data has been gathered in relation to all and a comprehensive needs analysis has been developed with expert support from the Local Intelligence Support Team (Public Health Scotland). The draft analysis is complete with final publication alongside the SCP in March 2023. The SCP covers all residents of North Lanarkshire and the impact on all protected characteristics will be monitored on an ongoing basis, with any required changes made to the implementation plan in consequence. Sex L See above Pregnancy and Maternity L See above Disability L See above Race L See above Religion and belief L See above Marriage and civil partnership L See above Gender reassignment L See above Sexual orientation L See above Age L See above Does the policy need to be changed?
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141 Are there any changes? Protected characteristics Description All No This is a high level plan which details the outcomes for the IJB over the next 3 years. An implementation plan will set out how these will be achieved with performance monitoring and review facilitated on an ongoing basis. Approved by: Name (Chair of partnership) Designation Date
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1 REPORT Item No: 16 SUBJECT: Launch of the new HSCP website TO: Integration Joint Board Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report Mark Dell Communications Manager DATE: 22nd March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement To note This paper outlines the progress made in developing a new website for Health and Social Care North Lanarkshire and celebrates the launch. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By the Strategic Leadership Team of the HSCP
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the launch of the new website (2) Request that further reports are brough on the performance and analysis of the use. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The HSCP North Lanarkshire is fully committed to promoting and facilitating the active involvement and engagement of the public, people who use services, carers, the community, voluntary and the independent sector, wider partners, staff and potential staff across all levels of the whole health and social care partnership. 5.2 A key strand of facilitating that active involvement and engagement is a great website. 5.3 The new website was launched at the end of February 2023 which brings together months of work from a wide range of staff and partners and catches up on time lost through the pandemic. Weblink to the new website 5.4 The website is at the vanguard of sites developed by NLC in terms of architecture and layout complying fully with all current accessibility requirements. 5.5 The website is now hosted and managed fully in-house now which means that changes, updates and additions can be made instantly, reinforcing the use of the website as the best first point of contact for both staff and the public. 5.6 The site is also easy to navigate, not only does it look good as you will see from the screenshots below, but it is instinctive and reactive to the choices and clicks you make. Regular monitoring will inform the development, changing frequently asked questions into additional information available to all with a preference always to offering out the right information in the right way rather than people needing to make specific requests. Yes No N/A
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3 5.7 The website brings together key information for the HSCP including information about services, locality profiles, who’s who in the structure and links to key partners. Creating a single source of information for key strategies and policy drivers will start with the key documents required by statute but will increasing be the repository for all supporting strategic drivers across the breadth and depth of the whole HSCP. 5.8 The structure of the website is built around 4 key strands: 5.9 The homepage outlines our main aim to improve the health and wellbeing of our residents and staff and our commitment to using our resources and staff expertise of our staff to make sure our patients and service users are at the centre of all we do. 5.10 About us: including who’s who, the outcomes we seek to achieve, services provided directly, through partners and hosted service arrangements, and key links. 5.11 Find a Service: which will help people access good quality information about services and supports available, information about localities and locality profiles as well as prominently display information about job opportunities and current vacancies adding to the range of work being done to recruit and retain excellent staff.
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4 5.12 News and Events: helping people stay up to date with the latest news and events from Health & Social Care North Lanarkshire. The website will also be a great way of showcasing the excellent work done across the HSCP on a day to day basis. 5.13 Get in Touch: making it easy to access information about helplines, how to make a media enquiry and how to make other enquiries. 5.14 Along with the launch of the new website, robust monitoring of the use of the site will ensure that enquiries are delt with quickly as well as future content increasing the relevance, targeting information and broadening the reach. 5.15 The website content will build over time reflecting the wide range of work that is done to analyse performance, reflect on the impact of services and use the data and analysis to drive improvements and change will increasingly be shared through the website increasing accountability to demonstrating the impact on the lives of people in North Lanarkshire. 6. CONCLUSIONS The launch of the new HSCP website represents an important step in making information easily available, that is easy to navigate and looks great. Demonstrating the richness, range and detail of the work done across the partnership will service to empowering and engagement all stakeholders and increase accountability for the work we do through a new openness and ease of access to information. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all 9 National outcomes 7.2 ASSOCIATED MEASURE(S) Regular monitoring of the use of the website will developed into a performance framework for the website. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE
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5 The launch and development of the website is relevant across a wide and increasing range of staff and partners who will be actively engaged in the monitoring and future use of the site. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY The development of the website seeks specifically to address inequality through increasing open and transparent access to information. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. Members seeking further information about any aspect of this report, please contact Mark Dell on telephone number 07795 602 664.
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1 REPORT Item No: 17 SUBJECT: Progress Update: Development and Delivery of Chryston Community Health Clinic TO: IJB Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Maggs Thomson, Head of Health DATE: 22nd February 2023 1. PURPOSE OF REPORT This paper is coming to the IJB to provide an update on the development and delivery of Chryston Community Health Clinic For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed Prepared by Maggs Thomson, Head of Health in consultation with both Chryston Community Health Clinic Mobilisation Group and the Northern Corridor Service Repatriation Group. 3. RECOMMENDATIONS The IJB is asked to: 1) Note the active and ongoing progress with the delivery of this capital programme. 2) Note the progress with the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and their associated Health and Social Care Partnerships (HSCP’s)
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2 3) Note the previously identified financial gap reported Feb 2022 and reflect on work to date to progress towards final conclusion. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. 5.1.2 This boundary change aimed to facilitate the development of integrated services across all areas of Scotland. The change resulted in the Northern Corridor (covering the areas of Moodiesburn, Muirhead, Chryston, Stepps, Gartcosh and Auchinloch) being transferred into the NHS Lanarkshire (NHSL) boundary. 5.1.3 This geographical area has one health facility located within Muirhead (Muirhead Clinic), which is small and at the time of transfer, dilapidated and not fit for function. The facility required backlog maintenance and asbestos work to be undertaken which was completed. 5.1.4 Despite the upgrade and refurbishment which improved compliance with healthcare standards, the facility could still not support the provision of all services for the local population. 5.1.5 Consideration was given to providing a new build facility on the existing site, however the footprint and parking limitations would not allow for the size of centre required to meet the clinical ask. 5.1.6 Due to the limited capacity of this facility, NHSL was unable to fully repatriate services from NHSGG&C, resulting in northern corridor residents having to travel significant distances across Glasgow to access some health services, with teams and clinics based in a range of areas including Shettleston, Kirkintilloch, Easterhouse and Bridgeton. 5.1.7 The services identified below continue to be delivered via a Service Level Agreement (SLA) with NHSGG&C and the associated HSCP’s. • Community Diabetic Service • Community Mental Health Teams • Dietetics • Physiotherapy Yes No N/A
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3 • Sexual and Reproductive Health Services • Substance Misuse 5.1.8 An opportunity emerged with the development of North Lanarkshire Council’s (NLC) ‘The Plan for North Lanarkshire’ which set out an ambitious estates strategy that looked to develop Community Hubs / Campuses. Further to consideration of this approach, NHSL working in partnership with NLC, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. 5.1.9 There was extensive engagement with all stakeholders including NLC and NHSL project teams which resulted in the optimum design being developed to the satisfaction of all the stakeholders. The agreed design went through wide- ranging routes of engagement with key stakeholders including NHSL staff, H&SCP staff, teachers, support staff and pupils at Chryston Primary School. This process also included joint engagement with representatives of the Parent Council and elected members, culminating in an online public consultation to inform residents of the design outcome. 5.1.10 The business case for the Development of Chryston Community Health Clinic was considered by the NHSL Board on December 2021 at a cost of £3.65M and signed off with all legal agreements completed in January 2022. 5.1.11 The build programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. 5.1.12 In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. 5.1.13 A Service Level Agreement (SLA) continues to be in place and as of February 2022 this exposed H&SCNL to a £392k financial gap if services where to be delivered with the known funded establishment and skill mix of the NHS Lanarkshire service model. 5.1.14 It was also recognised in February 2022 that to support the smooth transition, clinical safety and continuity of care there would be an expectation of double running costs for a period of 3 months, equating to an increased cost of £212k for that quarter. 5.1.15 All work has progressed on the basis of the funding being agreed in February 2022 calculation. 5.2 Chryston Community Health Clinic 5.2.1 The build programme is currently on schedule for completion August 2023 (see Appendix 1 for visual update).
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4 5.2.2 H&SCNL mobilisation group is progressing well with all work streams and is currently on track to have all systems in place for operational delivery in August 2023. At the point of writing, all planned milestones have been met. 5.2.3 The next three months will require development around the operational plan for the clinic, communication plan for all stakeholders, procurement, staff engagement, system education and mobilisation plan. All milestones have been identified and the new work plan for the next 3 months will be in place by the end of February 2023. 5.2.4 The work plan is now being progressed in tandem with the repatriation programme and the next iteration will show a confluence of milestones as recruitment will be a key work stream and this is in development. 5.3 Repatriation of Services 5.3.1 The timeline for repatriation and local delivery of services continues to move toward completion that will coincide with the operational delivery of the new health clinic in August 2023. There is the comfort of double running agreed for 3 months to support smooth and safe transition of care. 5.3.2 Discussion between H&SCNL and NHSGG&C (and associated H&SCP’s) is ongoing and progressing to achieve a smooth and clinically safe transfer of services. This is being managed via two discrete working groups focussing on mental health services and physical health services. 5.3.3 There is currently work ongoing with finance colleagues from both NHSL and NHSGG&C to conclude financial agreements to provide certainty to allow recruitment to progress. 6. CONCLUSIONS 6.1 In conclusion, this paper confirms that Chryston Community Health Centre has been commissioned by NHSL in partnership with NLC and is on track to be operationally available for service delivery from August 2023. 6.2 In tandem with the build programme, work is ongoing to repatriate the identified services, with work ongoing with both finance and operational teams. 6.3 The IJB has already approved additional fundng to support double running costs for one quarter, as well as additional recurring funding to support the roll out of the NHS Lanarkshire service models in the area. Work continues between the two finance departments around the financial transfers and further updates will come to the IJB once finalised.
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5 7. IMPLICATIONS Noted within the content of the paper 7.1 NATIONAL OUTCOMES The repatriation of services will support improvements in a range of service performance measures, particularly around mental health and substance misuse. 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL Yes No N/A At this time (2022 calculation), it is known that there is a revenue gap of £392k per annum and a non-recurring cost of £212k to support double running of service for a 3-month period, as previously approved by the IJB and built into the IJB’s Medium Term Financial Plan. Finance teams are reviewing our known position and will provide contemporary costs by the end of March 2023. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks around the repatriation of services, including the transfer of complex treatment packages, ongoing recruitment challenges and the funding gap already identified and will be built into the operational risk register. 7.5 PEOPLE A significant programme of engagement has taken place as part of the development of the business case. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A Developed as part of the business case. 8. BACKGROUND PAPERS NHS Lanarkshire Chryston Community Health Clinic Business Case
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6 https://www.nhslanarkshire.scot.nhs.uk/download/2021-december-20-board- papers/ 9. APPENDICES Appx 1 Artistic representation of Health Clinic and progress photograph date 22nd February 2023. . CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Maggs Thomson, maggs.thomson@lanarkshire.scot.nhs.uk
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7 Appendix 1 1: Artists Impression of main entrance with health clinic to the left of the picture 1: Work to date (22nd February) of health clinic
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REPORT SUBJECT: Improving the Cancer Journey TO: Integration Joint Board Lead Officer for Report: Chief Officer Author of Report: Head of Planning, Performance and Quality Assurance DATE: 22 March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 Following a paper being presented to the IJB on the 22 June 2021 endorsing the phase 1 application to Macmillan Cancer Support to access funding of £2m to improve the cancer journey across Lanarkshire, this paper seeks agreement to Phase 2 of the application. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: HSCP CORE team Endorsed By: Chief Officer 3. RECOMMENDATIONS 3.1 The Committee is asked to: 1) Endorse the application for funding from Macmillan Cancer Support to implement Phase 2 of the Improving Cancer Journey approach in order to develop the support for people with a cancer diagnosis and those affected by a diagnosis to improve the cancer journey for individuals, their carers, their families and friends. 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 Macmillan Cancer Support offered the Lanarkshire HSCPs funding totalling £2m to implement the Improving Cancer Journey approach. Of the £2m being provided by Macmillan Cancer Support, £1m is being provided directly by Macmillan Cancer Support and £1m is being match funded by the Scottish Government. All of the funding is being administered by Macmillan Cancer Support.
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4.2 In June 2021 the North Lanarkshire IJB endorsed Phase 1 of a two-part application to the fund to scope the local approach in partnership with VANL. 4.3 The application to the fund was seen as an opportunity to align the ICJ approach to the Community Solutions work led by VANL. Improving the journey for people with a cancer diagnosis and for those affected by a diagnosis aligns closely to Community Solutions health and social care investment programme focused on building communities where people can have full, independent lives. 4.4 A Programme Manager was jointly appointed by North Lanarkshire HSCP and the South Lanarkshire HSCP to lead on the implementation of the Improving Cancer Journey Programme across Lanarkshire. The total cost of this post was included in the South Lanarkshire HSCP application and is £0.382m over the five year period of the programme to 2026. 4.5 An ICJ Lanarkshire-strategy meeting is in place to support the vision: “Improving the cancer journey (ICJ) will work in the community- with the community, to ensure that those in Lanarkshire affected by cancer will receive information, support and care they need, efficiently, at the right time, in the right place and in the right way. It is our vision that by 2027, everyone in Lanarkshire affected by cancer is offered a personalised and supported conversation through a holistic needs assessment to identify and support their individual needs throughout their cancer journey.” 4.6 Phase 1 of the North Lanarkshire application led to the appointment of a 0.5 WTE Senior Programme Officer, to support and develop the implementation of the Improving Cancer Journey across North Lanarkshire, working closely with the Programme Manager to achieve the agreed outcomes and support the project evaluation. 4.7 It has been possible to recruit a full time Programme Manager by combining the ICJ funding and funds secured for a Social Prescribing lead. The post is held within the Community Solutions Programme through VANL. 4.8 The scoping work undertaken to support the phase 2 application includes: Extensive engagement to refresh the Community Solutions investment strategy Development of Improving Lives approach within the Community Solutions Programme including the proposals to appoint 6 community connectors funded through the HSCP Winter Planning and Enhances Social Care monies agreed through the IJB in February 2022 Learning from Support in the Right Direction connector role Learning from the First Point of Contact demonstrations work utilising the Three Conversations model Wider experience and evidence of community-based, CVS support in improving people’s health and wellbeing 4.9 It was intended that the second part of the bid be submitted to secure additional funding of £652,000 to invest in localities to further develop and expand services and support to improve the cancer journey. The second phase of the project being targeted to areas of greatest need and where maximum benefit will be secured. 4.10 The ICJ approach aligning to Community Solutions, Improving Lives will mobilise the community voice around cancer as well as wider long term conditions to complement the national approach to inclusion, promote successful engagement with more deprived communities and facilitate volunteering models.
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4.11 The Phase 2 Application outlines the resource provided by Macmillan, which is equivalent to employ 3.5 whole time equivalent staff, will be matched against the funding within the Improving Lives Initiative (ILI) of £412,800 to employ a team of 10 Community Connectors. The total funding available within ILI is just over £1million per year, with the remaining resource being used to build the local capacity of CVS supports and services across the six localities in North Lanarkshire. This will ensure everyone in North Lanarkshire diagnosed with cancer can easily access the support they need, when they need it to enable them to live as well and as independently as possible. 4.12 Macmillan are supportive of a two year application to match the timescales of the funding in place for the 6 Community Connectors given the integration of the approach. 4.13 The ICJ service will be made up of 3 WTE community connectors spread across 10 WTE staff who will support people diagnosed with cancer with their non-clinical needs utilising a holistic needs assessment discussing “what matters.” The service will be supported by a central point of administration which will triage and coordinate all referrals across the whole of Lanarkshire, thus creating a pan-Lanarkshire hub. 5. IMPLICATIONS 5.1 NATIONAL OUTCOMES This relates to all nine national outcomes 5.2 ASSOCIATED MEASURE(S) The key outputs and outcomes of the ICJ investment are detailed in the attached Macmillan Investment Application. 5.3 FINANCIAL The funding profile is detailed in the attached Application 5.4 RISK ASSESSMENT/RISK MANAGEMENT The investment opportunity is non-recurring for a fixed period of five years overall but a 2 year period in relation to Phase 2. It was therefore deemed essential that the funding opportunity enhances already embedded approaches which will be sustained into the future. 5.5 PEOPLE The impact on people affected by a cancer diagnosis and their carers will be monitored throughout the duration of the ICJ approach. 5.6 INEQUALITIES The Cancer Research UK Screening Inequalities Report Deprivation and Cancer Inequalities in Scotland was presented to the IJB PFA on the 14 February 2023 The report highlights the significant impact of deprivation on cancer incidence, diagnosis and outcomes. With NHS Lanarkshire identified as the third most deprived Health Board in Scotland, the findings of the report are highly concerning. Cancer incidence is 33% higher in the most deprived populations in Scotland in comparison to the least deprived areas. It is estimated there are around 4,900 extra cancer cases every year in Scotland attributable to deprivation, with lung cancer contributing nearly half of these. Further that cancer mortality is 74% higher in the most deprived population compared to the least deprived. This gap has narrowed slightly since the Covid-19 pandemic, which may relate to people from more deprived areas being more likely to die from Covid-19.
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The report notes that barriers to seeking help are more likely to exist for those living in more deprived communities. A range of difficulties such as getting access to an appointment, getting an appointment at a convenient time, being able to discuss health problems remotely, confidence to talk about symptoms or thinking symptoms were related to an existing condition are all significantly more prevalent in those from the most deprived communities (particularly around being able to access appointments with health professionals). This development and Phase 2 of the funding application seeks to improve access to help, advice and support across the localities of North Lanarkshire and target resources at those experiencing the highest inequality. EQIA Completed: Yes No N/A 6. BACKGROUND PAPERS None 7. APPENDICES Macmillan Investment Application (MIA) CHIEF OFFICER Members seeking further information about any aspect of this report, please contact Morag Dendy by emailing dendym@northlan.gov.uk
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. Macmillan Investment Application (MIA) Please provide the following information to allow your Investment Application for a Macmillan Intervention to be recorded and considered Investment Application is dated: 3 March 2023 Applicant (include all parties applying for the grant) Enter Partner name, address of registered head office North Lanarkshire Health and Social Care Partnership C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Registered Number if applicable – only required if partner is charity or company If more than one partner, please include details of all partners including registered number if applicable Enter Joint Working Organisation (JWO) name if any, address of registered office Registered Number if applicable – only required if JWO is charity or company Purpose of this document This document is a Macmillan Investment Application and any grant is subject always to written approval of Macmillan and the execution by all the relevant Parties of the relevant binding Grant Documents provided by Macmillan. It details the Intervention for which the Macmillan grant is being applied for. If the Grant is to be awarded you will be sent your Macmillan Special Conditions Schedule with the Macmillan Standard Grant Conditions and any relevant Annexes, which together will be the binding Grant Documents. To assist with understanding this application, terms used in this application (in capitals) shall have the meaning set out in the definition in the Macmillan Standard Grant conditions. It is important that you read the Macmillan Standard Grant Conditions when making this application to understand how it would work as all grants are subject to the Macmillan Standard Grant Conditions. By applying you are agreeing to the aforementioned framework. Please tick the box and enter name to indicate that you would be happy with the following: Commitment to provide Intervention as specified: Ross McGuffie ☐ date EITHER: Commitment to continue Intervention after funding period: Enter name ☐ date OR: Commitment to fully support the fixed term Intervention and take forward outcomes Ross McGuffie ☐ date
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. Macmillan Contact Information (Mandatory) Macmillan Intervention Lead and any successor that may be appointed by Macmillan and notified to the Partner, who is responsible for the wider relationship with the Partner Name Gordon McLean Title Strategic Partnership Manager Organisation Macmillan Cancer Support Address c/o Macmillan Cancer Support 2nd Floor Atrium Court 50 Waterloo Street Glasgow G2 6HQ Email GMcLean@macmillan.org.uk Tel No 07980 652 039 (Mandatory) Macmillan Partnership Quality Lead and any successor that may be appointed by Macmillan and notified to the Partner, who is responsible for the activity Name Joyce Dunlop Title Partnership Quality Lead Organisation Macmillan Cancer Support Address c/o Macmillan Cancer Support 2nd Floor Atrium Court 50 Waterloo Street Glasgow G2 6HQ Email JDunlop@macmillan.org.uk Tel No 07870468446 Partner Contact Information (Mandatory): Partner Intervention Lead and any successor that may be appointed by the Partner and notified to Macmillan, who is responsible for the wider relationship with Macmillan Name Morag Dendy Title Head of Planning, Performance and Quality Assurance Organisation North Lanarkshire Health and Social Care Partnership Address C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Email DendyM@northlan.gov.uk Phone No 07939284732 (Mandatory): Partner Senior Sponsor and any successor that may be appointed by the Partner and notified to Macmillan, who is responsible for the activity Name Ross McGuffie Title Chief Officer Organisation North Lanarkshire Health and Social Care Partnership Address C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Email Ross.McGuffie@lanarkshire.scot.nhs.uk Phone No 01698 752591 Ext. 402591 (Mandatory): Partner Operational Lead and any successor that may be appointed by the Partner and notified to Macmillan, who is responsible for the activity
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. Name Margaret Thomson Title Head of Health Organisation North Lanarkshire Health and Social Care Partnership Address C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Email maggs.thomson@lanarkshire.scot.nhs.uk Phone No 01698 752591 (Optional): Partner Communications Lead and any successor that may be appointed by the Partner and notified to Macmillan Name Mark Dell Title Communications Manager Organisation North Lanarkshire Health and Social Care Partnership Address C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Email Mark.Dell@lanarkshire.scot.nhs.uk Phone No 07795 602 664 (Mandatory) Partner Finance Contact and any successor that may be appointed by the Partner and notified to Macmillan. If same as above contact specify here name of contact to which this applies or re- enter below: (The Partner individual who will be sent all finance related communications. This is the person to whom the invoice for the Macmillan Licence Fee will be issued for completion and return.) Name Laura Ace Title Director of Finance Organisation NHS Lanarkshire Address NHS Lanarkshire Health Board Headquarters Kirklands Fallside Road Bothwell G71 8BB Email Laura.Ace@lanarkshire.scot.nhs.uk Phone No 01698 752 774 (Mandatory) Partner Contact for Formal Notices: and any successor that may be appointed by the Partner and notified to Macmillan. If same as above contact specify here name of contact to which this applies or re-enter below: (The Partner individual who will be sent all formal notices and other communications after the contract has been signed. He/she will also be sent the Grant Documents, therefore this person should have requisite authority/seniority and relevant levels of authorisation to sign the Grant Documents if the application is successful. This may be the same contact as the Partner Senior Sponsor) Name Ross McGuffie Title Chief Officer Organisation North Lanarkshire Health and Social Care Partnership Address C/O Michelle Merryfield’s Office Kirklands Hospital Fallside Road Bothwell G71 8BB Email Ross.McGuffie@lanarkshire.scot.nhs.uk Phone No 01698 752591 Ext. 402591
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. JWO Contact Information Please make additional copies of this box for each JWO detailed in the Applicant section JWO Contact for Formal Notices: and any successor that may be appointed by the Partner and notified to Macmillan. Name Title Organisation Address Email Phone No Cost Profile for Investment Application Application Details – Salary costs Intervention Title Band Hours WTE Post Title(s) Macmillan ICJ Community Connector Lanarkshire 4 1-40 3.5 Macmillan ICJ Project Support Officer Lanarkshire 3 1-40 0.8 Macmillan town/speciality/job 1-40 Year 1: Year 2: Year 3: Year 4: Year 5: Year 6: Macmillan’s contribution (%) 100% 100% 100% 100% Partner’s contribution (%) Matched against Improving Lives Initiative funding for Community Connectors Salary Total £314,637 - Years 1 and 2 = £273,344 - Years 3 and 4 = £41,293 Investment Period 24 months for Community Connectors and 48 Months for Project Support Officer Application Details – Non-salary costs Grant for item as specified: Year 1: Year 2: Year 3: Year 4: Year 5: Year 6: Set up costs: £7,350 N/A Description: Recruitment costs and IT Hardware Delivery costs: £19,250 £19,250 Description: Travel costs and staff support overheads Engagement costs: £8,750 £8,750 Description: Venue Costs including catering, training, support meetings and events Environment costs: Description: Non-salary Total £63,350 Investment Period 24 months Investment Application Total £377,987 - Years 1 and 2 = £336,694 - Years 3 and 4 = £41,293 Investment Period 48 months
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. PART ONE – NEED The establishment of the partnerships between Macmillan Cancer Support and Health & Social Care North Lanarkshire (HSC-NL) to implement the Improving Cancer Journey (ICJ) model will contribute to the delivery of the key objectives of the Scottish Cancer Plan and other Scottish Government strategies. The Scottish Government and Macmillan Cancer Support are also taking forward the new programme Transforming Cancer Care which will support the roll out of the ICJ model and other areas of redesign work to significantly improve the support provided to people affected by cancer. The cancer incidence rate in Lanarkshire is approximately 642 per 100,000, with the population in North Lanarkshire being 341,400 in 2021 it is estimated that there will be almost 2,200 people being diagnosed with cancer across North Lanarkshire annually. It is also estimated that 70% of people with cancer will also be experiencing at least one or more co-morbidity conditions, which is having a wider impact on informal carers, employers and the wider community. The Strategic Ambitions (Strategic Commissioning Plan 2020-23) of HSC-NL focus heavily on making sure that a whole system approach is taken and that links are strengthened between acute services, primary care and locality teams. The emphasis on designing and delivering services and supports around outcomes and what is important to individuals, families and communities will be delivered by getting the response right first time, focusing on home, ensuring that people are not in hospital any longer than is needed and of course promoting prevention and early intervention including effective screening programmes There is a strong and effective third sector interface across North Lanarkshire, Voluntary Action North Lanarkshire (VANL) which coordinates voluntary and community sector (CVS) services and support to best effect, helping people, carers and families connect with their local community and where appropriate to navigate the range of available services. With over 850 CVS organisations across North Lanarkshire, the Community Solutions Programme managed by VANL aligns its commissioning priorities with those of the Plan for North Lanarkshire and Health and Social Care North Lanarkshire and supports groups and organisations to deliver key services and supports including: befriending healthy eating physical activity transport for appointments hospital discharge support support for carers The foundation of the Community Solutions programme is the locality approach. Six well established and robust local organisations who are appointed as “locality hosts” (one per locality) who convene a group of local stakeholders: groups, organisations, statutory partners (a locality consortium). Each consortium distributes £30,000 through a Locality Activity Fund to build the capacity of the CVS organisations to provide targeted support. The Community Solutions programme also manages a number of custodian funds, which amounted to over £4million in 2022/23 to also build local capacity across North Lanarkshire. PART TWO – PURPOSE AND INTERVENTION DETAIL The funding being requested will contribute to recruiting a team of 10 Community Connectors to implement the improving lives initiative which will incorporate the ICJ model in North Lanarkshire. The service will offer people a holistic needs assessment using the Macmillan eHNA to discuss “what matters to them” at significant points of their cancer journey and will provide dedicated support to all people affected by cancer including families and carers. The resource provided by Macmillan, which is equivalent to employ 3.5 whole time equivalent staff, will be matched against the funding within the Improving Lives Initiative (ILI) of £412,800 to employ a team of 10 Community Connectors. The total funding available within ILI is just over £1million per year, with the remaining resource being used to build the local capacity of CVS supports and services across the six localities in North Lanarkshire. This will ensure everyone in North Lanarkshire
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. diagnosed with cancer can easily access the support they need, when they need it to enable them to live as well and as independently as possible. Key Outcomes of the Programme Contributing to the prevention of and early diagnosis of cancer Improved care and support for people who have a cancer diagnosis utilising the Macmillan Holistic Needs Assessment Increased support for carers/those in a caring role for people with a cancer diagnosis Tackling cancer poverty and contributing to welfare reform including accessing state benefits, grants, support with council tax and housing, assistance with fuel poverty, carer support and debt management. Improved knowledge and understanding for CVS groups and organisations about the cancer journey and the needs of individuals Increased awareness of CVS supports and services available Improve the cancer journey as part of the whole system approach Building on the Community Solutions Programme infrastructure across North Lanarkshire, including existing Macmillan Cancer support services Support data sharing agreements across partners and utilise robust research in order to evaluate outcomes to ensure longer term sustainability. Recognising the Macmillan Cancer Support findings nationally and locally to focus on the social care needs of people with cancer, this partnership is in a unique place to broker local solutions for people, their carers and communities. Creating a new normal for those affected by cancer is fraught with difficulties, as the consequences of the disease and treatment pathways not only impact on their physical condition, but also on their psychological, financial and social wellbeing. Early intervention will be promoted to reduce the stress associated with the cancer journey. Cancer services are delivered Lanarkshire wide. Clinical staff and social care staff will be key stakeholders during the consultation and engagement process. PART THREE – DELIVERY PLAN The programme will be delivered through the Community Solutions Programme, as part of the Improving Lives Initiative (ILI). The Community Solutions Programme has a robust triple-lock Governance Structure based on the involvement of local CVS organisations and statutory staff at a locality level with the engagement through local consortiums in each of the six localities across North Lanarkshire. Further scrutiny and support are provided by the Community Solutions Governance Sub-Group, which also includes statutory partners drawn from the H&SC Partnership, North Lanarkshire Council and NHS Lanarkshire. There is also representation from groups supporting service users and unpaid carers. The final level of scrutiny and support is by the Strategic Leadership Team (SLT) of HSC-NL, which is chaired by the Chief Officer of HSC-NL Ross McGuffie. Key elements of the delivery plan include the: Development of a robust and simple referral process for partners across Lanarkshire. Creation of clear pathways for people affected by cancer from diagnosis that are designed around the user and streamlined for convenience, efficiency & accessibility. Use of the Macmillan Holistic Needs Assessment, where transitions will be anticipated, planned, fully supported, coordinated and integrated from the point of a cancer diagnosis as part of the whole system approach. Establishment of access points for information and other support services that will provide advice on support, health & wellbeing and self-management. This will build on existing links in local communities and make the best use of available resources & partnerships. Access to financial and welfare benefits advice and support to help reduce poverty. Provision of support for mental health issues arising from peoples experience of cancer.
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. Help people to make lifestyle choices to aid survival and prevention of secondary occurrences. Support to assist people to return to and/or enabling independent living (including self-management) and maintaining wellbeing (including employment) or to access welfare benefits, end-of-life care and bereavement support. Development of effective data sharing agreements across partners and to utilise robust research and to evaluate outcomes to ensure longer term sustainability. Development of a new model of collaborative working within Lanarkshire which has partner and community involvement at the heart of the process. Establishment of an agreed set of outcomes and targets across the services which deliver on strategic objectives. Development of a range of training and support options to build capacity to support delivery staff. Ensure staff have access to the Macmillan Professional Knowledge & Development portal to enhance skills in supporting people with a cancer diagnosis. Identification of key partners across all sectors to support the delivery of the model. The ICJ service will be made up of 3.5 WTE community connectors spread across 10 staff who will support people diagnosed with cancer with their non-clinical needs. The service will be supported by a central point of administration which will triage and coordinate all referrals across the whole of Lanarkshire, thus creating a pan-Lanarkshire hub. The North Lanarkshire Disability Forum have already been identified as a host for 2 of the 10 Community Connectors. The six Locality Host Organisations have also been successfully selected following the recommissioning exercise and they are: West Sector Diamonds in the Community Airdrie Glenboig Development Trust Coatbridge Cornerstone House Centre The North (includes Cumbernauld, Kilsyth and The Northern Corridor) East Sector UTHEO Ltd - Orbiston Neighbourhood Centre Bellshill The Health & Wellness Hub Motherwell Getting Better Together Shotts Wishaw (includes Shotts) One for each sector will be chosen to employ 4 Community Connectors each to operate across the whole sector. The final decision on the 2 successful organisations will be made by the end of March 2023, Macmillan will be advised regarding the outcome.' PART FOUR – PROGRESS AND MEASUREMENT The Community Solutions programme has a robust monitoring and evaluation framework in place which has been developed over many years and commended by the Improvement Service (2019). The framework has recently been reviewed and revised in response to stakeholder feedback and will be applied to this work. Progress will be monitored through the Community Solutions Triple-Lock Governance System, with progress being collated and reported at a local level involving the locality consortiums in all six localities. Bi-annual progress and monitoring reports will be reviewed by the Community Solutions Governance Sub-Group and reported more formally to the Strategic Leadership Team of HSC-NL, with an annual report presented to the full North Lanarkshire Integrated Joint Board (IJB). A six-monthly update report will also be provided to the IJB Performance, Finance & Audit Committee on the implementation of the ICJ approach being delivered through the Improving Lives Initiative.
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Private and Confidential Subject to Contract and Written Approval of Macmillan Cancer Support Limited and Macmillan Cancer Support Trading Limited Macmillan Investment Application v6 20200310 Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. We will evaluate the following outcomes: 1. Improved quality of life including person-led post-treatment rehabilitation and ability to self-manage. 2. Improved outcomes for service users, carers and families. 3. Increased financial gains, reduced poverty, reduced inequality and dynamic response to housing issues. 4. Focus on preventative health. 5. Improved job satisfaction and morale within clinical staff by taking care of the non-clinical issues presented by people affected by cancer, further developing the skills and knowledge of the workforce in respect of cancer and releasing time to care. 6. Support realistic medicine. 7. Compliance with each IJB’s Strategic Commissioning Plans in particular the 9 National Health and Wellbeing Outcomes. 8. Positive Local Cancer Impact Assessments evidencing equity of provision and seamless referral systems. 9. Increased joint decision-making between key stakeholders and local communities, enhancing service integration and care co-ordination Working closely with the Macmillan Programme Manager (Improving the Cancer Journey in Lanarkshire), Donna Bruce, we will report to the Improving Cancer Journey (ICJ) Strategy Group and the ICJ Lanarkshire Operational steering group. Both groups are currently pan-Lanarkshire, but the Operational Group may align more closely to each H&SC Partnership. Qualitative information on the number of referrals received the number of Holistic Needs Assessments completed and the number of care and support plans produced will be provided by the central administrative hub, with information compared with the Engagement, Participation and Involvement (EPI) Database, which is being used by both North and South ICJ services. This will be complemented with qualitative information based on feedback from people referred to the service, clinicians referring to the service and CVS organisations providing non-clinical supports. The ICJ approach will mobilise the community voice around cancer, complement the national approach to inclusion, promote successful engagement with more deprived communities and facilitate volunteering models. The investment in the ICJ model across Lanarkshire will build on previous Macmillan investments. Over the last few years, Macmillan has invested over £2m in Lanarkshire across a number of different services including clinical, welfare benefits and Move More. Office use box Approved in principle: Yes-☐ No-☐ Date: MIL Comments:
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1 REPORT Item No: 19 SUBJECT: Annual Report of the Chief Social Work Officer 2021/22 TO: Integrated Joint Board Lead Officer for Report: Alison Gordon Chief Social Work Officer (Education, Families, Justice and Integrated Practice) Author(s) of Report Alison Gordon Chief Social Work Officer (Education, Families, Justice and Integrated Practice) DATE: 22nd March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed In line with guidance this report is approved through the Council and this approval is exercised both through the Adult Care and Social Work Committee and the Education, Children and Families Committee. The Adult Care and Social Work Committee approved the report on 21st February 2023 and the Education, Children and Families Committee will consider the report on 28th February 2023.
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2 3. RECOMMENDATIONS 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 The Chief Social Work Officer (CSWO) of each local authority is required to provide an annual report and a standard template for this purpose is issued by the office of the Chief Social Work Advisor to the Scottish Government. The North Lanarkshire CSWO Report 2021/22, which is attached as an appendix to this report, provides information on the delivery of statutory functions, performance and improvement activity across the range of social work services over the last year. In addition, information is provided on the wider governance and planning of social work provision in North Lanarkshire, including its key role in local partnerships, and on both the national and local challenges impacting on the delivery of social work services These challenges include rising demand and complexity of need, reflecting and overlaid by the lasting impact on our communities of the Covid 19 pandemic and the subsequent cost of living crisis The report also reflects social work’s contribution to the Programme of Work underpinning the Plan for North Lanarkshire and Delivering for Communities. 5.1.2 The requirement that each local authority appoint a professionally qualified Chief Social Work Officer is contained in Section 45 of the Local government (Scotland) Act 1994. Statutory Guidance on the role of the Chief Social Work Officer was updated in 2016, in particular to reflect the impact of Health and Social Care integration, extending the responsibilities of the role to provide advice to the Integration Joint Board (IJB). In addition to providing advice both to the Local Authority and IJB in relation to the discharge of statutory social work functions the role continues to carry key responsibilities for professional leadership, values, and standards both for directly provided and commissioned services. 5.1.3 Within North Lanarkshire social work services are now delivered and governed through both the Health and Social Care Partnership (Adult Social Work Services) and the Education and Families Services (Children, Families and Justice Social Work) with the Chief Social Work Officer’s responsibilities for practice and staff governance covering social work functions across both areas. The Chief Social Work Officer role in North Lanarkshire sits within the Education and Families Service with the operational head of Children, Families and It is recommended that the Integrated Joint Board: (1) Endorse this report (2) Note the approval route through Council committees. Yes No N/A
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3 Justice Social Work. However, whilst the CSWO role requires to be undertaken by one designated individual, delegation of responsibilities is permitted where required by the scale of business. In North Lanarkshire this means that the Chief Officer Adult Social Work Services, routinely exercises delegated responsibilities for decision-making and professional standards within adult services as well as providing support and cover with respect to the wider functions of the CSWO role. 5.1.4 As noted above the Annual Chief Social Work Report is intended to provide a key overview of social work service delivery and uses a core template provided by the Scottish Government. The Office of the Chief Social Work Advisor (OCSWA) also produces a national report each year which draws on key themes and messages from CSWO reports across Scotland. 5.2 Report 5.2.1 The report provides an update on the governance and partnership arrangements which provide a framework for the delivery of social work services in North Lanarkshire. There have been limited changes to these within 2021/22 although the incorporation of additional services within Education and Families and within the remit of the Chief Social Work Officer has further strengthened opportunities for joint-working and supported the integration of service delivery and support to individuals and families in key areas such as tackling poverty, employability, and community connection. Similarly social work services remain fully engaged with the continued embedding of the communities structures associated with Delivering for Communities including the delivery of local outcome and improvement plans (LOIPs) through the Community Boards. Continued coherence of planning and delivery across all areas of social work is supported both by the core council operating model and specific cross-cutting arrangements within social work such as the social work leadership and workforce meetings. This close alignment has been particularly important to ensuring a responsive and effective approach to some of the challenges experienced during this period where both the direct the impacts of the pandemic and the related changes in the needs of our communities have required adjustments in service delivery and flexibility in deployment of resources. 5.2.2 A key strength with respect to social work service delivery in North Lanarkshire remains a strong balance of care which has been sustained despite the challenges in service delivery during the pandemic and recovery period. We continue to benchmark well nationally with respect to the proportion of adults and children, including those with complex needs, who continue to receive support, including intensive support, within their own homes and communities. Work across all social work care groups also continues to deliver improvement with respect to effective early support, for example, through the testing of the three conversation model in adult services, enhancements in family support and family group decision making for children and families and a continuing focus on diversion in both adult and youth justice,
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4 5.2.3 Performance in some areas of the service has however been impacted by the significant demand and workforce pressures outlined within the report and this has at times impacted on responsiveness and our ability to consistently deliver the level of high-quality individualised support which is our aim for all those whom we support. This has meant, for example, some people assessed as having less immediate or critical needs having to wait longer for some aspects of service. Pressures have been particularly acute with respect to the delivery of home support services but are a feature across many areas of the service. In response, and as reflected more fully within the report, a range of actions are ongoing to redesign and enhance services, maximise the benefits of integrated working and to support the recruitment and retention of staff, 5.2.4 Looking forward the report reflects on the opportunities for improvement in outcomes for people arising both from national policy commitments such as the Promise and the facilitative local context but also notes the risks to delivery of both improvement and key functions arising from key demand, financial and workforce pressures including the level of change capacity required. This is particularly relevant to the uncertainties introduced with respect to proposals for root and branch structural reform through the implementation of a National Care Service (NCS). The recently agreed establishment of a Member Officer Group within the Council will support focus on this issue whilst other issues highlighted within this report will also continue to be reflected through established reporting structures in the year ahead. 6. CONCLUSIONS As set out above this report is presented to the Integrated Joint Board in order to provide an overview of social work activity and performance for the period 2021/22 in addition to providing context relevant to service delivery with respect to governance, resources, workforce, challenges and opportunities. A number of areas covered within the report will already have been the subject of more detailed reporting to the Board over this period however this overview is intended to facilitate the Board’s oversight, scrutiny and future planning with respect to social work services. 7. IMPLICATIONS As above – no direct implications, 7.1 NATIONAL OUTCOMES The service delivery and improvement activity reflected in the report supports a range of national outcomes. 7.2 ASSOCIATED MEASURE(S) As reflected within the report and in more detailed reporting to the Board.
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5 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Financial information within the report has been drawn from and verified by Adult Social Work and Education and Families finance teams 7.4 RISK ASSESSMENT/RISK MANAGEMENT None specific to the report – risk context and management measures are referenced within the body of the report 7.5 PEOPLE None specific to report. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix 1 - Annual Report of the Chief Social Work Officer 2021/22 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Alison Gordon, Chief Social Work Officer (Education, Families, Justice and Integrated Practice)
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6 ANNUAL REPORT BY CHIEF SOCIAL WORK OFFICER: NORTH LANARKSHIRE 2021/22 The Chief Social Work Officer Function The requirement that each local authority appoint a professionally qualified Chief Social Work Officer (CSWO) is contained in Section 46 of the Local Government (Scotland) Act 1994. The CSWO provides professional governance, leadership, and accountability in respect of the delivery of social work and social care services, including commissioned Services. A key aspect of the role is to provide the local authority Chief Executive, Elected Members and the Integrated Joint Board with advice on social work service delivery and on cross-cutting issues and in parallel to promote understanding of the complexities involved in delivering the linked statutory responsibilities which require consideration of need and the management of risk and liberties. The then Scottish Office explicitly recognised that the need for the CSWO role was driven by “the particular responsibilities which fall on social services in that they affect personal lives, individual rights and liberties to an extent that other local authority services do not.” (Circular: SWSG2/1995 May 1995). The CSWO also has a direct remit for decisions on a number of statutory matters including in relation to secure accommodation, adoption and welfare guardianship as illustrated below. An additional aspect of the CSWO role is to inform the delivery of wider services which support or impact on social welfare. This is of particular importance in the current period of post-pandemic recovery and the cost of living crisis, both of which have impacted disproportionately on those within our communities who already face a range of adversities. In North Lanarkshire the CSWO role is held by Head of Children, Families and Justice Services closely supported by the Head of Adult Social Work Services who holds delegated responsibilities with respect to adult social work and social care, deputises in other areas as required and works alongside the CSWO in relation to the other functions of the role.
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7 Annual Report The CSWO is required to provide an annual report in accordance with Scottish Government guidance. The format of this report was abridged during the pandemic to reflect a smaller number of priority areas and in the light of associated demands and this approach has been maintained for this reporting period. This report therefore seeks to provide an overview of social work service delivery in North Lanarkshire for the period April 2021 to March 2022 and addresses the following areas: Governance and accountability arrangements, including partnership working Service Quality and Performance, including key service developments Resources Workforce Future Priorities The continuing impact of the Covid 19 Pandemic and emerging Cost of Living Crisis have clearly been significant to the landscape of social work service delivery over this period and this is reflected across the report. In this context and that of significant demand and staffing pressures, staff across the service have showed remarkable resilience and a continued commitment to achieving the best possible outcomes to those we support. In presenting this report I would like to thank and pay tribute to all staff involved in the delivery of social work services in North Lanarkshire for their vital work over the past year and the persistence and flexibility shown in the face of a particularly challenging environment. I would also like to thank all internal and external partners, carers, families and communities who have supported us in our work. Alison Gordon Chief Social Work Officer
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8 1. GOVERANCE AND ACCOUNTABILTY ARRANGEMETS Social Work Services in North Lanarkshire continue to play a critical role in supporting and safeguarding our communities. Adult Social Work and Social Care Services are delivered though North Lanarkshire’s Health and Social Care Partnership (HSCNL) whilst Children, Family and Justice Services are delivered through the Council’s Education and Families Service, both arrangements support integration in service delivery with other key services. A range of mechanisms, as reflected below, also ensures strong alignment is maintained across social work in planning, delivery and professional support arrangements. The Social Work Service in North Lanarkshire directly employs around 2,800 staff and in collaboration with commissioned services and partners are involved in providing support to approximately 30, 000 individuals and families at any one time in addition to contributing to wider partnership and community activity. Following previous structural changes, 2021-22 has been a year of relative stability with respect to governance arrangements for social work therefore the core arrangements described below will largely be familiar from previous CSWO reports. I have however highlighted both changes made corporately to continue to strengthen capacity to deliver the wider Plan for North Lanarkshire as to well as to oversight arrangements as services begin to move beyond initial emergency and resilience arrangements put in place during the early period of the pandemic and referenced in my previous report. Moving forward it is clear that proposals for a National Care Service as reflected in the consultation in autumn 2021 and the Bill published in June 2022 are likely to involve radical change in the future governance of social work services. During 2021-22 the Council and HSCP responded to the NCS consultation whilst retaining a focus on continuous improvement within current arrangements, a balance which will is likely to continue to be necessary over the next period. Partnership working at local level remains fundamental to social work and a key aspect of the role of the CSWO involves developing and sustaining effective partnership working and relationships across a range of organisations and structures. In addition to the specific responsibilities of the CSWO to the Council and HSCNL the CSWO holds a key leadership role within a number of local partnerships as well as contributing to the wider national social work community
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9 1.1 North Lanarkshire Council and North Lanarkshire Partnership The Plan for North Lanarkshire continues to set the direction for the council and partners. Its purpose is to communicate the shared priorities and provide a focus for activities and resources around place making with a long-term vision where North Lanarkshire is the place to Live, Learn, Work, Invest, and Visit and of inclusive growth and prosperity. It's a Plan with a shared ambition that aims to ensure the benefits that this brings reach all our communities, and that there is a much fairer distribution of wealth. https://www.northlanarkshire.gov.uk/index.aspx?articleid=1240 It is centred on: improving economic opportunities and outcomes supporting all children and young people to realise their full potential improving the health and wellbeing of communities enhancing participation, capacity and empowerment across our communities and improving North Lanarkshire’s resource base The Plan is supported by 25 high level ambition statements and in turn by a Programme of Work: https://mars.northlanarkshire.gov.uk/egenda/images/att90076.pdf att95824.pdf (northlanarkshire.gov.uk) The CSWO, Head of Adult Social Work and Head of Planning, Performance and Quality Assurance have lead responsibility for key areas of this programme but also a role in ensuring connections are made across the wider range of corporate programmes of work, which impact on areas which are important to those who use social work services, for example, employability services. Phased changes in the council’s management structure have been implemented to support the delivery of the Plan and from spring 2022, the CSWO/Head of Children, Family and Justice Services has also had operational responsibility for Tackling Poverty and for Community Learning and Development and Resettlement functions, creating further opportunity for integrated working in areas which have close links with social work. The Programme of Work is shaped and overseen by the Corporate Management Team and through the council committee structure with the Adult Health and Social Care Committee and Education and Families Committee having oversight of the delivery of social work. The overarching framework for partnership working in North Lanarkshire continues to be provided by North Lanarkshire Partnership (NLP) which brings together the major public sector agencies in the area along with Voluntary Action North Lanarkshire (VANL) the third sector interface in the area. The priorities for delivery across the partnership are now included in The Plan for North Lanarkshire.
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10 The Children’s Services Partnership (CSP) continues to provide multi-agency governance and strategic planning and direction for children’s services in North Lanarkshire. Children’s Service Partnership Board membership includes Elected Members and HSCP/NHS Board representation to enhance the coherence of children’s services planning across key governance structures. There is also direct representation of young people on the Board though the Youth Council, Promise Development Team and Champion’s Board links. Our most recent Children’s Services Plan https://www.northlanarkshire.gov.uk/sites/default/files/2021- 08/North%20Lanarkshire%20Childrens%20Services%20Plan%202021-2023.pdf was published in spring 2021 and is framed around the foundations of the Promise and UNCRC. Young people themselves were integral to the development of the plan with the Promise Development team leading on the development of the vision and the Youth Council undertaking a survey focussing on awareness of rights and leading on identification of actions within the plan to promote and embed these rights. The task groups supporting the delivery of the plan have been reconfigured in line with the updated priorities with new groups focusing on Voice and Family Support, the Corporate Parenting Task Group evolving into the Promise Partnership Care and a refreshed Mental, Health, Wellbeing and Resilience Task Group co-ordinating work including the establishment of new supports as part of the Community Mental Health and Wellbeing Framework. Social Work places a key role in each of these strands with Senior Social Work Managers co-chairing 3 of the 4 task groups and the Partnership’s Continuous Improvement Group. The CSWO is lead officer for the CSP and chairs the Improving Children’s Services Group which has oversight of the work of task groups together with the ‘Scaffolding’ and ‘People’ elements of the Children’s Services Plan. The North Lanarkshire Community Justice Partnership (NLCJP) currently also chaired by the CSWO has responsibility for the oversight of Community Justice in North Lanarkshire. The partnership has benefited from the strong participation of partners and published the North Lanarkshire Community Justice Outcome and Improvement Plan (NLCJOIP) in March 2017. https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=20573&p=0. Due firstly to the pandemic and subsequently to ongoing work at national level on a new Community Justice Strategy and revised Outcome Performance and Improvement Framework, this plan initially published as a three-year plan, has since been extended and supplemented by annual action plans to March 2023. Interim planning has been informed by an ongoing process of Strategic Needs and Strengths Assessment. The Community Justice Annual Report 2021/22 NLCJP 2021-22 Annual Report_0.pdf (northlanarkshire.gov.uk) provides an overview of key activity during this period.
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11 During 2020/21 arrangements for the North Lanarkshire Partnership’s Strategic Leadership Board (NLSLB) were revised and new arrangements were agreed for the Community Justice Partnership and Children’s Services Partnership Board to present on an annual basis to enhance visibility and oversight. This has now been implemented leading also to a wider partnership focus on The Promise and commitment to further work to ‘Build a Promise Community’. A similar arrangement is now in place to present the CSWO Annual Report to the NLSLB, with the intention of supporting increased visibility and ownership across the partnership of public protection work (whose multi -agency governance is through the Chief Officer Public Protection Group) as well as the wider work of social work and social care. A key development in North Lanarkshire over the past two years has been the establishment and embedding of nine Community Boards to support community leadership, involvement and capacity building with each area focussing activity through a local outcome and improvement plan (LOIP). Social work services play a part in these supporting local partnership structures with the CSWO undertaking the role of Community Co-ordinator for one of the local boards and the Head of Adult Social Work and Head of Planning Performance and Quality Assurance providing a link to the Health and Social Care Partnership and its strategic commissioning activity across all Community Boards. Senior Social Work Managers also participate in area-based teams and the sub-groups which support the delivery of the LOIPs. 1.2 Health and Social Care North Lanarkshire The Integrated Joint Board and its Performance, Audit and Finance Sub Committee provide the overarching governance structure for the partnership. Both the Head of Children Families and Justice Social Work Services/CSWO and the Head of Adult Services provide professional social work advice to the Board. The Mental Health, Learning Disability and Addictions Partnership Board (chaired by the Head of Adult Social Work Services) and the Frailty and Long Term Conditions Partnership Board (chaired by the Head of Health) have the role of informing and implementing strategic direction on behalf of HSCNL across their respective areas and maximising the opportunities provided by the integration of Health & Social Care to promote best practice and guide the access for individuals to the right support. The Partnership Boards have been in place for a number of years and are currently under review as part of the refresh of the Integration Joint Board’s new Strategic Commissioning Plan 2023-26. The current Strategic Commissioning Plan for the HSCP was published in March 2020 following an extensive engagement process with a wide range of service users, carers and staff the covers the period to 2023: https://www.hscnorthlan.scot/wp- content/uploads/2020/07/Strategic-Comm-Plan-20-23-FINAL.pdf
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12 The Plan identifies three key priorities: 1. People should be in control of the care they receive, and it should meet their needs 2. People are supported to maintain their independence and manage their care needs 3. People are supported and helped to avoid preventable conditions These are also supported by a set of Ambition Statements which guides the work of the partnership going forward: Do the right thing first time Provide a range of community support services 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. The plan is supported by a programme of work which interfaces with the wider Plan for North Lanarkshire and the wider council programme of work Strategic-Comm-Plan-20-23-FINAL.pdf (hscnorthlan.scot) North Lanarkshire Alcohol and Drug Partnership is hosted within HSCNL and has been considerably strengthened over the last two years, co-developing its 2021-2024 strategy around the themes of rights/respect/recovery through engagement with a broad range of stakeholders : https://mars.northlanarkshire.gov.uk/egenda/images/att99221.pdf Five ADP sub-groups have been established to develop actions covering: Prevention, Early Intervention and Education; Treatment Care and Recovery; Whole Family Approach; Public Health Approach in Justice and Reducing Alcohol Harms. In line with the cross-cutting elements within these key areas the interface between the ADP, CSP and CJP has also been strengthened and whilst the lead senior officer for the ADP is the Head of Planning, Performance and Quality Assurance both the CSWO and Head of Adult Social Work Services have a role in the wider ADP structure. 1.3 Support, care, practice and staff governance arrangements The Health and Social Care Partnership’s Support Care and Clinical Governance Committee (SCCGC) continues to meet on a quarterly basis and is chaired on a rotational basis by the CSWO, Medical Director, AHP Director and Nursing Director. The terms of reference for the SCCGC were updated in 2021 to reflect the organisational changes within the partnership and Adult Social Work Services now report via two sector focussed groups. In view of the need to maintain coherence in practice and staff governance across social work functions and care groups the local framework for professional social is supported both by Social Work Leadership meetings, whose frequency was increased to six-weekly in 2022, and by quarterly Social Work Workforce meetings. A brief fortnightly ‘Social Work
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13 Solutions’ meeting also provides a forum for social work Heads of Service, Senior Managers and Business Partners to address cross-cutting business issues. As reported in my previous report, a cross care group working group was established in 2021 involving senior and frontline managers, frontline staff and union representatives to address the challenges presented by new ways of working and organisational changes, initiated or escalated during the pandemic, and in particular the impact of more disparate and remote working on social work practice and on practitioner support needs. This group focussed on how to maintain and enhance the delivery of high-quality services and support staff wellbeing within the context of pandemic and in planning for recovery. Notably it took a trauma informed approach focussing on areas of safety, trust, choice, collaboration and empowerment considered what was working well organisationally and in practice and areas for development. An initial action plan to address identified issues was developed in conjunction with the social work leadership team and whilst the group has met less regularly over recent months its work has informed priorities within wider strategic workforce plans and has fed into planning for the new hubs and the linked operating model within North Lanarkshire. A range of other processes are in place to support assurance around practice and service delivery in social work services. The Quality Assurance and Commissioning Team, hosted in Adult Social Work Services, operates across social work and over 2021/22 its capacity has been strengthened, particularly, to support the CSWO and service responsibilities for the monitoring of the delivery of commissioned services. The team which reports to the Head of Planning ,Performance and Quality Assurance also lead on a range of other functions critical to the duties of the Chief Social Work Officer including with respect to regulatory activity, complaints management and overview, risk management and procurement and provider sustainability as reflected in their annual report for 2021/22: https://mars.northlanarkshire.gov.uk/egenda/images/att99223.pdf Additional arrangements for multi-professional oversight of Care Homes and Care at Home established during the pandemic have also been maintained although the frequency of meetings has been reduced as the year has progressed and pandemic pressures have reduced. In addition, a Home Care Board continues to oversee the wider redesign of the service. In addition to the role of the Quality Assurance Team all Senior Managers within social work undertake regular performance reviews with their teams and support additional audit, development and review activity to support practice standards, agreeing priorities with the CSWO and Head of Adult Social Work Services. With respect to staff governance the CSWO and Head of Adult Social Work also maintain an overview of referrals to, and investigations by, Scottish Social Services Council supported by HR Business Partners. With respect to less formal engagement with staff, whilst there has been a return to more site-based working, and alongside this more direct team interactions over the course of the year, Senior Social Work Leaders have been conscious that their visibility as leaders and the
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14 opportunity for less formal but direct face-to-face dialogue with staff has been impacted by pandemic. This has begun to be addressed through visits by the CSWO and other key managers to teams planned over the summer of 2022 and this will remain a priority going forward. 1.4 Public Protection Leadership in the field of Public Protection remains a key responsibility of the CSWO and the Head of Adult Social Work Services who collectively provide support to the Chief Executive of the Council in his role as chair of the Chief Officers’ Public Protection Group (COPPG) to which the MAPPA Strategic Oversight Group (MAPPA SOG), Violence Against Women Strategic Group (VAWSG), Adult Protection Committee (APC) and Child Protection Committee (CPC) report on a quarterly basis. The CSWO chairs the Lead Officers Public Protection Group and is currently vice chair of the CPC and chair of the Violence Against Women Strategic Group whilst the Head of Adult Social Work Services is a key member of the Adult Protection Committee. The MAPPA Strategic Oversight Group operates on a pan Lanarkshire basis with the chair rotating between the Police Scotland Public Protection Superintendent and the CSWOs of North and South Lanarkshire. The prioritisation of public protection remained a key focus both nationally and locally during the pandemic period and recovery period and over the past two years both public awareness raising, and monitoring have given close attention to areas in which the pandemic may have increased vulnerabilities or impeded access to support. Whilst ongoing self-evaluation activity has continued, the pandemic resulted in the temporary suspension of external inspection programmes relating to Adult Protection, Children’s and Justice Services however these were again stood up during 2021/22. Although no external inspection of public protection functions took place during this period notification of a Joint Inspection of Adult Support and Protection has since been announced with related activity scheduled for summer/autumn 2022. By its nature Public Protection is an area of high residual risk and this is reflected on the local authority risk register. It was therefore, as previously reported, included in the Council’s internal audit programme for 2020/21 with a focus on quality assurance mechanisms. The audit report to Audit and Scrutiny Panel in September 2021 concluded that assurance arrangements were generally satisfactory offering ‘reasonable assurance’ to the council and noted the prioritisation of public protection during the pandemic period. Recommendations were made in three areas and included progression of further planned self-evaluation of the Chief Officers Group and the strengthening of multi-agency action plans including through use of SMARTer measures. Action in these areas has been progressed along with a small number of additional actions identified as a result of the subsequent self-evaluation undertaken by the COPPG. In addition, it is proposed to amend the terms of reference for Chief Officers Group to incorporate reporting and oversight responsibilities relating to Drug Deaths and Suicide and associated preventative activity reflecting both the broader focus of public protection taken during the pandemic period and
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15 the additional ask of Chief Officer Groups linked to new national action plans for these areas. The COPPG regularly considers the resourcing of multi-agency public protection activity and following recommendations from the Lead Officers Group agreed in early 2022 also to enhance capacity, for a 12-month period in the first instance, to support the enhancement of MARAC arrangements locally as well as to create additional training and development capacity to support the implementation of new national guidance in child and adult protection. 1.5 Engagement with the people who use support services and the Community and Voluntary Sector Ultimate accountability for social work services is to those who use them, their families and the communities of North Lanarkshire and Social Work Services and the CSWO play a key role in ensuring that the voices of people who use and have experience of social work services are heard, not only in individual planning, but that they inform the design and delivery of the service. This approach is in line with the overall vision for the Council expressed in Delivering for Communities and the importance placed on the role of Community Boards as outlined in section 1.1 above. HSCNL also operates within the framework of its Engagement and Participation Strategy 2021-2024 which is designed to ensure the right systems and supports are in place to enable effective engagement with stakeholders: https://mars.northlanarkshire.gov.uk/egenda/images/att95292.pdf The strategy builds on the strong foundations established to facilitate the involvement and engagement of people who use services, carers, the community and voluntary sector, and the independent sector and its operationalisation is supported by a Stakeholder Engagement and Participation Strategy, Framework and Working Group Care Opinion also continues to be promoted with increased use of the platform to add to the learning possible through complaints analysis. Care Opinion is an independent web- based service where people can share their experience of services which has widened its focus from health to health and social care. Partnership for Change, our local umbrella forum for service user and carer involvement has supported this roll out and monitors and presents on postings to relevant forums to illustrate issues of concern as well as positive stories. Within Children’s Social Work we have continued to develop the use the Mind of My Own App (MOMO) which helps young people communicate their views for meetings, raise concerns or share good news in way that suits them. With Children’s Services partners and colleagues from the Council’s corporate communication team, the service has also supported the innovative Make It Right project, a campaign co-designed with young people and launched in January 2022 to raise awareness of children’s rights and a key stepping- stone to embed these in practice in North Lanarkshire. With respect to Children’s Services
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16 the Partnership Agreement between the CSP and Young People was established in 2018: https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=21857&p=0 and continues to form the basis for engagement with young people who are now represented directly on the Board but with partners also making a parallel commitment through a range of other links with the Youth Council and to the Champion’s Board which has over this period been successful in significantly extending engagement and participation with younger children experiencing care. The Promise Development Team, which has at its heart Development Workers and Assistant Support Workers with lived experience of care, was established in early 2021 and has also been key to ensuring children, families and carers are central to service planning and development both within social work and within wider services. While awareness raising remains part of their remit equally important has been their role in promoting the wider engagement of children and families and direct contribution to practice and system change. Building on this model and previous engagement with those with lived experience, Justice Social Work Services have now also progressed the recruitment of two workers with lived experience to support service development and provide peer support. Engagement with carers in North Lanarkshire remains equally critical to service delivery and development and is undertaken through the framework of the Carers Strategy 2019-24 http://www.carerstogether.org/wp-content/uploads/2020/10/NL-Carers-Strategy.pdf which was developed in partnership with carers with a vision ‘to ensure, in partnership, that North Lanarkshire adult carers and young carers are supported, represented and enabled to build resilience, carry out their caring role and to live healthy independent and fulfilled lives’. North Lanarkshire Carers Together continues to provide an information and advice service but also a network for carers to represent individual and collective issues and to contribute to policy development, service provision and evaluation both locally and nationally, a role which has been particularly valuable and important in ensuring carers voices are heard and challenges understood during the pandemic period. Voluntary Action North Lanarkshire (VANL) continues to provide the key local interface with the community and voluntary sector in North Lanarkshire and participates as equal partners in the partnership structures described above and in a wide range of linked improvement activity. This has included membership of the Children’s Services Partnership Board and the ongoing involvement and facilitation of endorsed third sector networks linked to the Community Justice Partnership. Within Health and Social Care, VANL have also continued to play a central role in developing voluntary and community sector involvement through community capacity and carers support work as reflected within the Community Solutions Strategy and delivery programme, Softening the Lines 2018-23: http://www.voluntaryactionnorthlanarkshire.org/sites/default/files/cs_strategy_2018- 23_softening_the_lines-converted.pdf
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17 Using 9 thematic leads to guide best practice and 6 locality host organisations to ensure a truly community led approach a devolved budget of over 1m is directly invested in organisations and community groups. A supporting commissioning plan and the programme approach have ensured a focus on key outcomes with the budget also supporting the leverage of additional funding and in-kind contributions. The overarching aims of the programme are to prevent isolation and loneliness and to address inequalities using innovative approaches to support people to be more active and to reconnect to their communities. The use of the Community Solutions model has also provided a vehicle within Children’s Services to test out new models of support to address distress and promote positive mental health with a significant portion of new Scottish Government funding targeted at early intervention and community support through the Children and Young People’s Mental Health and Wellbeing Framework allocated to organisations through VANL to develop new supports in partnership with school clusters, children, young people and their families. Of key importance in social work across all care groups however remains the principle that engagement, inclusion and empowerment are not seen as episodic events but also embedded in day-to-day practice with a focus on good conversations and strength-based approaches. 2. SERVICE DEVELOPMENT, QUALITY AND PERFORMANCE 2.1 Support to Unpaid Carers As referenced in my previous report the ongoing impacts of the COVID-19 pandemic on unpaid carers have been significant. Many carers had to provide more care than usual during the pandemic, and this has continued for some people with staffing and demand pressures across the social care, social work and health sectors, both locally and nationally, further exacerbating the issues faced by unpaid carers. This has resulted in a detrimental impact on overall well-being of many carers in terms of stress and anxiety levels and the need to continue providing care for longer. Despite this, unpaid carers continue to provide support for those who otherwise may require support from social work and health services and are the main source of support for many people. In order to support an increase understanding of carer experience both nationally and locally including where we are making a positive difference, North Lanarkshire noted an interest in participation as a site for more in-depth activity linked to the the Care Inspectorate’s national ‘Inquiry into carer’s experiences of social work and social care service delivery’, with subsequent confirmation that linked survey and focus group activity would take place over the period March to June 2022. In the interim priority has continued to be given to how support to carers can be enhanced: A range of supports and services are commissioned to provide Carer support, inclusive of the following key strands:
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18 Lanarkshire Carers – Direct Support for Adult Carers Action for Children Young Carers Service – Young Carers Support Services North Lanarkshire Carers Together (NLCT) – Campaigning, information and representation services VANL – Community Solutions Programme There are also a range of funded organisations who play a part in supporting unpaid carers, including the Disability Forum and other condition specific and\or age-related support organisations. We work in partnership with both commissioned services and funded organisations, all of whom offer a range of supports to Adult Carers and Young Carers. Overall, approximately 11,000 carers are known to the carer support organisations in North Lanarkshire and are in receipt of some form of support. During 2021/22 1040 Adult Carer Support Plans have been progressed by Lanarkshire Carers where assessed need was deemed to be low or moderate. In situations where carer need has been identified as being significant or critical and unable to be met through the range of carer support options described above and below, approximately 50 individual Carer budgets have been agreed. In many instances individual budgets to supported people are also scoped to reflect individual carer circumstances, such as complex care related needs, caring responsibility for more than one person, or the carer’s own health related needs. In addition, over 1,000 carers benefited from small grants distributed through Lanarkshire Carers. Young Carers have been supported through Young Carer Statements, a wide range of carer support and activity groups, training opportunities, resilience aid and support, respite breaks, creative short breaks, carer awareness training and legal advice. A pan Lanarkshire Steering Group focussing on the needs of Young Adult Carers was also established last year. A key ambition is to ensure the needs of carers are integral to wider service planning, an example being that following the success of a Community Link Worker initiative which focussed on support, advice, guidance, and signposting to families whose child may have a neuro-developmental condition, there are plans to extend this in 2022/23. This has been funded through Community Mental Health and Wellbeing Framework budget for children and young people and is now hosted through North Lanarkshire Carers Together and in line with our wider approach focusses on early, whole family support and community connections. There is a well-established short break service, operated by Lanarkshire Carers and this continues to play an important role in supporting unpaid carers in enjoying a break from their caring role. Feedback from carers however has also pointed to the need for more regular, flexible ‘time out’ accessible within their local community. This has informed a range of new initiatives including a ‘Carer Breather’ programme, facilitated through NLCT and delivered by a range of local organisations and the piloting of a ‘Sitter Service’. These initiatives offer unpaid carers regular and flexible breaks from caring. Positive feedback from
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19 unpaid carers regarding this approach will result in an expanded programme in the coming year. Work is also ongoing to meet the requirements of the Carers Act to ensure that unpaid carers are as involved as they want to be in hospital discharge arrangements. This includes involvement in decision making, as well as support at the point of discharge and beyond. Whilst this approach has been welcomed, we are aware through feedback from Carer Support Organisations, Advocacy, and individual carers that further work is required in this area, to ensure that no involved unpaid carers are missed from discharge planning as a result of pressures to work at pace in this area. We remain aware also of the diversity and fluidity of the carer population and that despite our efforts some carers remain less visible to services and supports. We continue to innovate and use a range of methods to ensure information and support is accessible, from the more traditional information packs to the launch of a new podcast for carers and support for digital inclusion. 2.2 Justice Social Work Services During this period criminal justice service activity has continued to be delivered as per our legislative responsibilities, and during periods of restrictions related to the Covid-19 pandemic in accordance with emergency legislation, health and safety, and social distancing measures. In common with all social work disciplines the most significant challenge for Justice Social Work Services throughout the reporting period was the impact of the restrictions and the challenges associated with fulfilling statutory obligations, managing risk, and supporting our most vulnerable service users and their families including those with unstable or chaotic lifestyles. To assist with this a Red/Amber/Green (RAG) risk management system was implemented to ensure that those most in need or at the highest risk were prioritised, and appropriately supported. This was reviewed on a weekly basis by both front line and senior managers ensuring that throughcare licences, drug testing and treatment orders and community payback orders were managed and supervised through a combination of regular home visits and contact via virtual platforms and telephone calls. Community Payback Orders (CPOs) Covid-19 pandemic restrictions necessitated the closure of unpaid work across North Lanarkshire for two periods during 2020/21 and 2021/22. As these restrictions began to ease recovery planning was crucial to support the transition from a partial, to a fully operational service and in the initial stages of recovery service users were able to attend unpaid work in a limited way and in fewer numbers. Part of the approach to recovery has continued to involve increasing the opportunities for unpaid work to be undertaken at home supported by the completion of appropriate risk and health and safety assessments. This approach has permitted some orders to be completed without the need to submit requests for extensions to an already burdened Court Service.
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20 The continuation of this hybrid working model, alongside traditional unpaid work, together with successful partnerships with the third sector has supported the delivery of 53,464 unpaid work hours during 2021/22. This figure is close to twice the 27,600 hours completed in 2020/21 but still substantially less than 85,116 hours delivered pre-pandemic in 2018/19. The number of outstanding unpaid work hours, an area of national concern, has also fluctuated, dropping initially from circa 54k in February 2021 to circa 34k in April 2021 due to one-off commutation of some hours on some CPOs facilitated through emergency legislation and new approaches in service delivery but standing at circa 47k as of May 2022 with the impact of an escalation in orders made as court activity increased counter- balancing innovations in practice to enhance capacity. In recognition of the longer- term impacts of the pandemic on the whole justice system, temporary funding was provided to justice social work by Scottish Government to enhance capacity for both core and commissioned services in 2021/22. This will be continued in 2022/23 although the temporary year on year nature of the funding has created a number of challenges in service planning and recruitment. A fuller report on the delivery of Community Payback Orders over this period is available: att99332.pdf (northlanarkshire.gov.uk) The following examples however illustrate the range of unpaid work opportunities that were made available across North Lanarkshire during this reporting period: Over 203 bicycles were distributed to North Lanarkshire residents though the Restorative Justice bike workshop at no cost. A by-product of this was the assistance and support it gave to individuals in terms of the potential to maximise their health and wellbeing. In addition, the service has given help to local communities by offering bike maintenance and repairs. This project has particularly assisted those children, young people, and families who are unable to afford the cost of bikes or their repair. Bikes have also been given to victims of bike theft. The Wood Workshop has enabled the creation of useful items for various community groups, such as outdoor classrooms and activity equipment for schools, and planters for sheltered housing complexes. The Laundry workshop has helped to ensure that donated clothing such as school uniforms could be repaired, cleaned and ironed prior to distribution to families and individuals in need. Within our craft activity groups items were made and donated to local organisations or sold at fayres with the money raised being donated to local charities. Squad placements assisted with the completion of projects in local communities such as landscaping. Several private placements were maintained in various settings including local churches, allotments, sheltered housing complexes and charity shops As previously noted, unpaid work home working for appropriate service users was employed throughout the pandemic. These arrangements benefitted community partners including the Police Scotland Dog Unit, SSPCA, NHS, Wildlife Trust, Housing
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21 and Leisure and Recreation colleagues, and the wider community. This resulted in 5,650 hours of home working being completed during this reporting period. Whilst group work to support the ‘other activity’ element of orders was restricted over this period, the additional funding provided by the Scottish Government for recovery purposes permitted the continuation of the delivery of ‘other activity’ from third sector providers through both digital platforms and more limited face-to-face delivery: 1. The Wise Group delivered a group-based programme designed to provide information and awareness on topics such as managing mental health, dealing with negative thoughts and emotions, dietary and physical health benefits, financial inclusion and budgeting, building positive networks, dealing with conflict, support with employment and training possibilities, and alcohol and drug education. 2. Love Learning worked with service users on an individual basis to address literacy, and social isolation difficulties. 3. Street Cones designed a group work activity to support individuals through the maximisation of their skills and potential by involvement in the creative arts. Participants wrote a script which they subsequently performed. The quality of North Lanarkshire Council’s Community Payback Order delivery is continually assessed, and the perspective of service users and community projects supported is regularly sought as reflected in our annual CPO report (link above) Diversion from Prosecution In line with the Vision for Justice in Scotland the service continues to prioritise the promotion of Diversion from Prosecution. To ensure consistency of practice in this area multi agency briefing events have continued to take place with relevant social work staff, police colleagues and the voluntary sector. Diversion from Prosecution referrals in North Lanarkshire continue to be above the Scottish Average, and the numbers have been consistently high throughout the pandemic. Diversion 2021/22 Male Female Total Number of Referrals 255 98 353 Number of Assessments Undertaken 240 93 333 Number of Cases Commenced 134 61 195 Number of Individuals for whom cases commenced 123 61 184 Number of cases successfully completed 117 57 174 Offence focused interventions People subject to supervision by justice social work are supported to recognise and address wide ranging and often complex personal and family issues as well as undertaking offence
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22 related work. Developing a strong professional relationship is a key element of the supervision experience and is fundamental to effective engagement and positive outcomes. Staff utilise Risk Management Authority approved risk assessment tools to assess risk and need and to implement appropriate responses to addressing criminogenic needs. The Justice Outcome Star has been developed over several years to support more meaningful engagement and to contribute to the measurement of both individual outcomes and the impact of interventions at service level within Justice Social Work Services. The aggregated information from this tool is used both to support Strategic Needs Assessment and service planning. Offence focused Interventions take place both on a one-to-one basis and within groupwork settings, although due to pandemic restrictions, the capacity to safely deliver groupwork was severely compromised over this period placing more reliance on 1-1 delivery. The approach is based on “Good Lives” principles and includes general offence focussed work, for example, managing strong feelings, handling conflict, dealing with relationships, anger awareness, managing impulsive behaviour, goal setting and planning. More intensive and targeted interventions encompass MFMC (Moving Forward Making Changes) and our UP2U domestic abuse programme. More detail on these programmes is provided below. UP2U Domestic Abuse Groupwork Programme UP2U ‘Creating Healthy Relationships’ is now fully operational across the Justice service and can be accessed by individuals who are subject to statutory supervision because of their involvement in domestic abuse offences. The programme is delivered by justice social workers in a case management setting on a 1:1 or a 2:1 basis. The service also has a centralised UP2U team to support locality teams with the delivery of the programme to high-risk individuals who are screened using our new UP2U screening panel process. The programme can also be delivered in a group work setting, however, capacity for this has been limited over the pandemic period. Justice Services also utilised a proportion of covid recovery monies during the reporting period to purchase a training programme for 56 staff across children and families. This allowed for the implementation of the ‘UP2U Family Practice’ intervention for non-court mandated individuals. This version of UP2U is designed specifically for child and family practice scenarios where unhealthy domestic abuse relationship behaviours exist. This approach provides a vehicle to respond to the need for domestic abuse behavioural change work across both children, families, and justice services. Moving Forward Making Changes As part of revised and newly implemented Criminal Justice Social Work structure a dedicated Moving Forward Making Changes (MFMC) Team was established in August 2021. Following the easing of Covid-19 health and safety restrictions a steady resumption of face- to-face MFMC programme delivery during the period 01.04.21 to 31.03.22 has been possible. Other Justice Services:
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23 The Women’s Community Justice Service has continued to work holistically to address the specific needs and issues of women within the justice system over this period enhancing the provision of practical support where required including the use of technology to facilitate participation. Justice Throughcare provision has also remained a priority to ensure those leaving custody receive appropriate levels of support to address their risk and facilitate their reintegration from prison to the community. The linked Community Bridges Project was maintained throughout the pandemic period and continued to support people who have difficulties with substance use and who are being released following a short-term prison sentence. The Drug Treatment and Testing Order team maintained its focus on intensive support services to 35 individuals in total during the reporting period. The specific challenge in this area of work was associated with the withdrawal of drug testing provision during the period of Covid restrictions, and its limited reintroduction thereafter. It is anticipated that this service will be fully restored during the coming year. Finally, the Prison Social Work Team based at HMP Shotts has maintained site-based provision, continuing to work closely with SPS colleagues to assess and support prisoners and their families. In addition to statutory work the team delivered child protection awareness sessions to SPS staff resulting in an increase in child welfare referrals. Tackling Poverty and Exclusion In addition to a focus on the above work the team have continued to integrate actions to address poverty and exclusion within day-to-day practice recognising the corrosive impact of both on both those involved with the service and our communities. This has included: Income maximisation, generating £58k in monies for over one hundred adults and families Working with the Connecting Scotland Scheme to address digital exclusion and secure devices/solutions for a number of service users Prioritising recovery of access to the Keep Well nursing service to support address the health inequalities and poor mental and physical health often experienced by justice service users, and with respect to community support: Staff and service users supported foodbanks in Coatbridge and Airdrie by collecting food and distributing food parcels 2 to 3 times per week. 491 gifts for younger children and 343 gifts for older children were given out over the festive season. Christmas and New Year meals were also provided for vulnerable adults and families by local restaurants, and Restorative Justice staff distributed these. Working in partnership with local charities the service has laundered donated school uniforms and assisted in their distribution to the families that required them. 2.3 Children and Families Social Work Services Keeping The Promise
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24 Following publication of The Promise by the Independent Care Review in February 2020, cross-party commitment to support delivery was made by North Lanarkshire Council in August 2020, thereafter with the intent of working across council services and with the Scottish Government, partners and care providers to deliver the necessary changes. Children and Families Social Work has a key leadership role in this and is uniquely placed to drive and connect the key strands of work required to support the ambitions of the Promise and the required transformation of systems, outcomes and experience for children and families. This is due to the key statutory role social work plays in supporting children and young people and their families both for ‘children in need’ and those experiencing or who have experienced care and the underpinning values of inclusion and empowerment alongside a culture of partnership working. Social work therefore has a key role to play in transforming both family support and care. Following a reduction in demand in 2019/20, primarily in the initial stages of the pandemic referrals to children and families social work services have grown over the past two years and in 2021/22 were 15% higher than in 2018/19. This appears to reflect increased need for support from children and families within our community. Although further work is needed to fully understand the picture which sits behind this, the change is perhaps unsurprising given the evidence that the pandemic impacted disproportionately on those who already faced the greatest adversities, including on children’s early development and wider wellbeing, and that families are now also adversely affected by the emerging cost of living crisis. Year Number of Referrals 2021/22 10858 2020/21 10253 2019/20 9077 2018/19 9519 2017/18 9654 Balance of Care Placement Type 31 March 2019 31 March 2020 31 March 2021 31 March 2022 Foster care (NLC) 119 100 112 94 Foster care (Independent) 47 67 61 53 Home Supervision 294 298 227 188 Formal Kinship Care 296 355 321 307 Informal Kinship Care 150 153 170 183 Residential (NLC) 27 28 27 33 Residential (Independent) 12 13 11 11 Secure* 4 0 2 1 Continuing Care 39 45 53 73 Overall, the above table shows that the number of children and young people experiencing formal care has fallen over the past year. A focus on family support, strengths-based
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25 practice and integrated working has enabled North Lanarkshire to continue to achieve fewer children looked after per head of population than the national average. We also used residential care proportionality less than the national average. Despite this, there was an increase in young people in our children’s houses for three main reasons: our commitment to providing support to unaccompanied children seeking asylum in a nurturing and safe environment, our openness to taking older young people back into care when they need and ask for it and the growth in continuing care. Following a drop of a third in numbers of children and young people supported in external residential placements over 2018-21 the number has plateauedespite a longer-term commitment to providing support Close to Home. This is due to a number of factors relating both to demand, complexity of need and the long-term nature and supporting relationships associated with some of these placements. Nonetheless it remains a key priority of the education and families service to ensure increased capacity to support young people with complex needs within the North Lanarkshire community. This also drives efforts to recruit more ‘in-house’ foster carers. While there were slightly fewer in children in foster care, our focus on supporting and encouraging young people remain with their carers for as long as they need meant a continued and sustained increase in the use of continuing care with the effect that some of our foster and kinship carers are now ‘continuing carers’. The COVID-19 pandemic coincided with a significant decrease in the number of children looked after at home and this trend has continued. The reasons for this continue to be monitored as it is not yet clear if this is the result of preventative support and early help or a continued disruption to processes following the pandemic. Involving Young People A key development led by Today Not Tomorrow (part of our Champions Board Structure) has been the production of an online resource to support managers and practitioners on how to improve record keeping with a focus on the impact of language. Awareness raising sessions by the Promise Development Workers took place with some managers and practitioners, with further role out planned. Several young people were also involved in scoping and framing the key qualities required of mental health support for Care Experienced Young People, work they had the opportunity to showcase at a national event, Tending the Light, which formed part of the festival of care in February 2022. This work led on to young people codesigning and taking part in the council procurement process for a new bespoke service. A helpful by-product of this, is our corporate commissioning and corporate staff asking for specific training on The Promise so they can support meet the ambitions of the council and our children and young people. Our Promise Development Workers were also involved shaping the development of our services in response to young people in conflict with the law and contextual safeguarding. A Good Childhood Achieving a loving and caring home: Children and young people experiencing care
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26 The positive role children’s houses play in providing care and love to children and young people continued to develop over the year as the culture changes associated with keeping The Promise became more established. In particular, the service facilitated 3 young people returning to the houses as younger adults, because of trauma and crisis in their lives, in line with the aspirations of young people’s right to ‘return to care’ if necessary. The Promise Plan 21-24 sets out clear expectations in reducing the use the use of the restraint and our children’s houses were and the serviced participated in a pilot project funded via the Promise Partnership Fund, on partnership with Aberlour and Kibble, to help us achieve this ambition. A core group of 8 staff were identified to take the work forward and the first step in the project plan is to remove the use of the Prone hold by the 31st of January 2023. A significant development over the year has been the introduction of the National Transfer Scheme requiring all local authorities to accept transfers of children into their care, providing crucial placements to unaccompanied asylum-seeking children. To this end our children’s houses played a critical role in providing care to 14 unaccompanied children to ensure that their individual support needs were more fully assessed, and they received wrap around support whilst they settled in Scotland, starting their recovery from trauma. Another 4 young people went straight into supported care placements with 3 progressing from children’s houses to supported care placements. While this has placed increased demand on our children’s houses and supported care, the service has taken the view that this has been a child centred approach to supporting children who have come to the UK unaccompanied. We also appointed a social worker to specialise in working with and supporting this group of young people. Achieving a loving and caring home: Support to family-based carers The Children’s Carers’ Service provides support to kinship carers, supported carers of young adults, as well as to adopters and foster carers to achieve permanent loving homes for children and young people into adulthood. Over the course of the year the team received 120 initial enquiries about fostering or adopting and of these, 63 progressed to initial interview. 21 enquirers progressed to preparatory groups and of these 14 went on to submit an application to foster or adopt. This represents a 38% decrease on previous years, reflecting national trends. To meet this challenge the team established a new and creative recruitment strategy. This has a particular focus on new and changing needs, including the council’s commitment to find homes for unaccompanied asylum-seeking young people, and young people with complex needs to allow them to remain in North Lanarkshire. The team also worked with North Lanarkshire’s resettlement team to undertake initial assessments and support for Ukrainian host families. The engagement and participation of care experienced young people continued to be highly valued in the delivery of the service and young people supported and actively contributed to the recruitment and preparation groups for prospective adopters and foster carers. Brothers and Sisters
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27 Development in this area is not without challenge and over the year 65% of children in care were separated from at least one brother and sister. In response to this analysis, the team developed a new strategy, co-led by the Promise Development workers and involving carers, to support brothers and sisters stay together when they need to be cared for away from home. This comprised specific support to carers as well as a focus on recruiting carers with the capacity to look after brothers and sisters together. In addition, a revised framework for assessing family time was implemented, with the voice of children and parents central to more creative approaches to family time, while keeping children safe. Adoption This service provided a range of support and advice to 60 adoptive families. This comprised individually tailored post adoption support as well as support groups and training specific to adoption. The team experienced an increase in demand for post adoption support services, leading to a planned review of the whole service that has now commenced to ensure it meets all needs and offers timely support to avoid families reaching crises, providing the scaffolding required as outlined in the key messages of The Promise. This review will include consideration of an apparent increase in the small but significant number of adopted teenagers required to move to alternative arrangements over the past year, often residential care. As part of the team’s commitment to learning and development, the service participated in national research including researching the impact of Dyadic Developmental Psychotherapy (therapeutic support to adoptive and permanent fostering families) led by Oxford and Glasgow Universities. Permanence Planning The service continued to play an active role in leading developments in permanence planning for children to avoid drift in care planning. A number of new initiatives were started or refreshed including: Senior practitioners within the Children’s Carers team supporting locality social workers to increase capacity and progress permanence planning. New Permanence Planning Training was developed and launched to reflect new legislation and research and as part of North Lanarkshire’s commitment to relational practice in line with The Promise. Kinship Team In response to growing need, the kinship care team continued to expand to comprise 1 senior social worker, 3 social workers, 1 support worker and 1 support work assistant. The team had a busy and successful year with 106 new kinship carers approved, and ongoing dedicated emotional and practical support provided to 170 kinship carers. In addition, the team co-facilitated 7 kinship carer groups across North Lanarkshire in partnership with Nurture Scotland and CLD.
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28 Whole Family Support Family Group Decision Making & Lifelong Links Family Group Decision Making (FGDM) is a strength-based way of working which takes a structured approach to involving wider family and support network in decision making and planning for children and families. It is rights-based and aligned with the principles of UNCRC. Research in Scotland has found very good outcomes associated with this approach in reducing the risk of accommodation (Mitchell et al, 2018). As such FGDM is a key component of North Lanarkshire’s commitment to keep The Promise by supporting and nurturing relationships within families and preventing the accommodation of children wherever possible. Over the year April 2021 to end of March 2022, the FGDM service made considerable progress in successfully supporting children remain within, or return to, their families. Over period the service had two full time FGDM Co-ordinators. Family meetings achieved the following outcomes: Based on referral dates for the year April 2021 to March 2022, 23 meeting were held and family plans were made for 32 young people, involving their family networks of support. All 32 young people were supported to reduce the risk of them being accommodated, part of a rehabilitation plan, support new babies stay at home with their family or to support kinship placements. 12 children referred as at risk of coming into residential or foster care, 11 have successfully remained living with parents or family members. One child was supported with family and friends but unfortunately this wasn’t sustainable and is now supported in a children’s house with family support. 6 babies whose names were placed on the Child Protection Register pre-birth as at potential risk of significant harm, 5 have been supported to remain safely in the care of their parents post birth and one in a kinship placement. Family meetings avoided significant placement costs to the service but most importantly family meetings have enabled children to benefit from loving and safe relationships within their families. In January 2022, the service was successful in securing funds for two additional coordinators from the Promise Partnership fund to implement and approach to family group decision making called ‘Lifelong Links’. Lifelong Links seeks to create life-long social networks for children and young people in care and aftercare, providing them with practical and emotional support. Lifelong Links uses tools and techniques to identify family members and other adults, such as former foster carers or teachers, who care about the child or young person. These individuals can then be brought together in a lifelong links meeting to develop a life-long support plan for the young person. This outcomes of this will be presented in next year’s report. Intensive Services
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29 Intensive family support that is available to families when they need it, including out of hours and at weekends, is provided by our intensive service. The primary objective of the service is to ensure that children and young people are able to remain in or move to family where they feel they belong and are safe. During this year work in the team was concluded with 202 children and young people, of which this objective was achieved for 153 children and partially for 20 children and young people. There were 18 children and young people where this outcome was not a focus of intervention and 11 children and young people where this outcome was not achieved. To promote the involvement of the children, young people and their families in the development of the service, some young people coproduced a set of service standards with staff so that families are clear what can expect and have a right to from the service. With the easing of COVID restrictions, intensive services also stood back up group work and other activities to promote the wellbeing and resilience of children and young people. For example, through the provision of intensive support some young people achieved their Duke of Edinburgh Bronze Award and are now able to progress their DofE awards through North Lanarkshire’s universal offer. Some young people were involved in singing coaching and playing instruments and others produced their own DJ set whilst learning the skills to use the associated technology. The service also delivered parenting support delivered on a 1-1 and groupwork basis and learn to cook family participation sessions. During school holiday periods the team has assisted families with access to activities in the local community and further afield to ensure positive experiences for children and young people. This included a sports day, walking group, swimming group and supported family outings. Young People in Conflict with the law Support from custody As part of our Intensive Service, the Youth Bridges team supported 58 young people under the age of 21 who had experienced custody. 21 were new admissions to Polmont within this period. This is consistent with the downward trend in admissions to Polmont from North Lanarkshire although may have also been affected by Court restrictions through Covid. Youth Bridges staff ensured that 72-hour reviews were held within the prison to discuss vulnerabilities and support for these young people. Five (24%) young people were care experienced, a significant reduction from the past two years (56% in 2019/20 and 50% in 2020/21). Youth Bridges uses the Outcome Star to identify areas requiring support and to measure outcomes. Over the year ten domains of the Outcome Star showed improved outcomes of at least 65% for the young people closed to the service, with reduced offending for 88% and reduction in drug / alcohol use for 69%. As part of the commitment to meet the requirements of The Promise Plan 21-24, the service reviewed its approach to young people in conflict with the law. We found that 182 children were referred to the Reporter on offence grounds - a higher rate than the national average. However, SCRA only referred 7 of these children to a Hearing on offence grounds, reflecting the strong partnership commitment to the welfare principles of Kilbrandon. We still have
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30 work to do, however, to maximise the use of the Children’s Hearings and diversion rather than the court: In 2021/22 only 4 young people (under the age of 18) were remitted to the Hearing by the Sheriff court for a disposal, 5 young people were remanded or sentenced to custody and 7 were made subject to a Community Payback Order. This resulted in the development of a small team to work in partnership SCRA to use hearings more effectively to support relational working and robust alternatives to custody, remand and court disposals. Moving on: Supporting Care Experienced young people who have left care In response to our recognition of our need to provide more intensive and integrated support to care experience young people, the newly established team of three support workers and two social workers within intensive services has proactively reached out to young people and responded to young people returning for support to provide the care they need. As at March 2022, 141 young people were receiving support representing an increase of more than a third since the start of the pandemic. 66 care experienced young people were supported directly from Intensive Services, many of whom have reconnected with the service over the past year. A key area of improvement has focused on a ‘hub’ approach delivered from the Intensive Services building to ensure awareness of the rights and entitlements of care leavers and promote a ‘no wrong door’ approach across the multi-agency partnership. The building is used by many care leavers to receive support from the service or other agencies. A new protocol with housing was also agreed to ensure housing support was arranged around the needs of young people. Each locality in North Lanarkshire now has a housing champion advocating for care experienced young people. Tackling poverty has been a key priority and the council did not reduce payments to care experienced young people in line with the UK Government’s decision to end the temporary uplift to Universal Credit. A Right to Education: The Virtual School North Lanarkshire has continued to strengthen its commitment to care experienced children and young people to access education and close the attainment gap through the Virtual School. The Virtual School is a small multi-professional team, which supports the improvements in capacity and responses across the education system as well as co- ordinating and providing direct bespoke support for children and young people. The Virtual School maintains an overview of education planning and support for all care experienced learners. The Virtual School works in an integrated way and has formed productive relationships with community learning and development, local businesses and many other relevant partners in addition to strong connections with schools and other education and social work services. During the 2021/2022 school session, the Virtual School received 89 new requests for direct support and worked with 242 learners. The Virtual School supports young people through a wide range of activities including well-being programmes – improving physical and mental health, vocational learning opportunities, outdoor learning, literacy and numeracy
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31 programmes including direct support for SQA qualifications, volunteering/mentoring opportunities, individual learning engagement projects, transition supports and access to specialised resources e.g., counselling. Support interventions are delivered in a setting specific to the needs of the young people involved with intensive staffing provided to increase confidence levels and ensure any barriers to engagement are addressed. The Virtual School seeks to accredit young people for their learning undertaken during these activities through wider achievement awards including for example, John Muir, Young STEM Leader and Saltire or additional qualifications such as Forest and Outdoor Learning Award (SCQF 2 and 3), Cosmetology (SCQF Level 4) and City & Guilds Introduction to Automotive Engineering (Level 1). In session 2021-22, 108 such awards were achieved. Through Virtual School, teachers also deliver 1-1 or small group teaching sessions, with a specific focus on S4 pupils at risk of leaving education without any formal qualifications and learners at significant risk of disengagement with education. The direct impact of the former being the achievement of 81 SQA national 3 or 4 qualifications achieved by 32 young people. The Virtual School coordinates an intensive support offer for a number of vulnerable families across school holidays. Over summer 2021, the intensive offer was aimed at care experienced families including kinship groups and other targeted groups. Offers made were wide-ranging and included a variety of activities for young people and their families to enjoy, for example, leisure passes, access to summer activity camps, family days out (including cinema and bowling trips), Cooking Together sessions and bespoke health and wellbeing interventions. In total, 1339 individual offers at the intensive level were accepted by 402 children and young people. In addition, 74 families were supported with a direct payment to facilitate a bespoke package of support in circumstances of particular need. Removing exclusions of care experienced learners from school, aligning with the ambition of the Promise Plan 2021-24 is a target for Virtual School. Staff work in collaboration with schools and wider services to support the development of trauma informed practice and to seek alternatives to exclusion. For care experienced learners over three sessions (August 2019 to June 2022), data gathered demonstrates a 48% reduction in exclusion episodes, a 59% reduction in school days lost due to exclusion, and a 39% reduction in the number of care experienced learners excluded from school. Education within Intensive Services Within the intensive services base in Coatbridge, bespoke education was provided to 18 young people in need of enhanced support. Four were school leavers and achieved various qualifications in National 3 and 4s. The young people in the school were supported by intensive services support assistants to engage in their education programme and with some practical skills and activities. As part of our intensive service offer, we have an operational garage, The 7 Day Centre, that offers experiential learning in automotives and mechanics. Over the year the centre offered 9 young people vocational placements. One young person was supported to access a college course for mechanics, and this commenced in August 22. One young person evidenced the skills and ability to pursue mechanic but was not ready to undertake other available routes to further their training or employment. The
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32 young person has been supported to maintain their placement at the 7 Day Centre through NL Roots: Opportunity for Growth programme, which is placement and learning programme for young people who are or have experienced care. The young person is being supported to continue their learning in automotives and mechanic whilst increasing skills, options and readiness to pursue further careers options. To ensure the young people within these settings benefit from more robust pathways and the full range of educational opportunities, the 7 Day Centre and intensive service education base are being integrated into the We Aspire Academy. 2.4 Adult Social Work Services In common with other social work care groups there have been a number of challenges to the delivery of Adult Social Work Services over the year due to the impact of the pandemic and both associated and underlying demand pressures as well as recruitment challenges in key areas. Significant work has been undertaken, both to reinstate support services that had been reduced due to the pandemic and to continue to redesign services. This report therefore reflects the challenges experienced in maintaining high-quality care in line with statutory and regulatory requirements as well as ongoing work to redesign and improve services to support improved outcomes for individuals. Investment in Adult Social Work and Social Care through the Winter Planning and Enhanced Support funding stream from the Scottish Government was introduced during the course of 2021/22 to increase capacity in direct provision as well as to improve assessment capacity, nonetheless the volume and complexity of demand profile alongside workforce challenges have resulted in significant operational and capacity pressures across the whole of health and social care provision and we have seen this in particular with respect to Support at Home, Mental Health Officer activity and also in adult protection where the resourcing of large scale investigations has been required against a background of existing high demand. The narrative below provides further detail on service activity, performance, innovation and improvement as well as areas of challenge. Early and preventative interventions – Right Support, Right Time First Point of Contact A major focus for the Health and Social Care Partnership is to ensure that when people contact health or social work services the response is rapid and appropriate. There should be a focus on assisting people to be independent and getting things right first time. The core of which is a strength-based approach, transferring the balance of care to prevention, early intervention and self-management. In order to explore a whole system change a pilot project was undertaken in Motherwell in 2021 using the Three Conversation Model. Partners 4 Change who led on the delivery of the model have experience of working with 75 council areas in the UK in relation to reform, redesign, financial sustainability, and personalisation. Of the 75 councils, 35 councils were judged to have used this to support whole system change.
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33 Here the evaluation of the Motherwell innovation site in 2022 deemed it to be a success with much learning. The aim was to build a whole system, multi-disciplinary team approach embodying coordination, collaboration focusing on communities and person-centred practice. The new way of working was found to have reduced barriers and with simplified recording sufficient to meet legislative needs. It was found that early links with the community and voluntary sector was important for quality outcomes and supporting people with better lives. The quality of engagement with people was strong and there was reduced need to access services for longer term supports. Ongoing development work through the First Point of Contact Group is considering how to scale the learning from the innovation site and addressing how to bridge the gap between the voluntary and statutory services, creating trusted pathways. Making Life Easier Making Life Easier (MLE) is an online resource offering information, professional advice and direct access to support and services for all residents of North Lanarkshire. Making Life Easier gives people the tools to look after their own health and wellbeing. It allows earlier interventions for people and prevents deterioration. The system has reduced waiting lists for Occupational Therapy services with the consequent increase in capacity allowing for services to be directed to the people that need them most. Making Life Easier supports the national policy shift in Scotland to give people the tools to help them to stay well, live independently, promote their social engagement, live active and healthy lives and can, where possible, self-manage. In the year 2021/2022 8,089 people in North Lanarkshire used MLE, a 24.9 % increase on the previous year and an increase of 63% increase on the 2019 usage. Of these users, 86.7% were new visitors and 1,102 people completed a self-assessment. Figures show through the Covid 19 pandemic, Making Life Easier remained a reliable source of information, advice, and support for the people of North Lanarkshire with users increasing year on year. Technology in Health and Social Care We continue to invest in the implementation of technology enable care and have established a dedicated Technology Team within Health and Social Care which provides support and guidance on the implementation of technology, through the development of standards, processes and training. A key focus is on embedding technology into the assessment, planning and implementation of care to provide service users further choice in how care can be provided. The ‘tech flat’ within North Lanarkshire has been set up to demonstrate technology in situ to professionals as well as those who use services and their carers’. Having closed during
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34 2020/21 due to pandemic restrictions it has now reopened and continues to be a well-used resource with around 60 visitors per month. The flat supports consideration of the use of technology within support plans for individuals and continues to be upgraded with new and innovative technology, something that the team will be looking to further evolve. We also continue to be involved in shaping the NHS Lanarkshire Digital Strategy to ensure a person-centred focus is maintained is this fast-developing area of practice. Work has been carried out alongside our NHS partners in developing guidance around the use of technology within rehabilitation. The team has also had involvement in shaping national policy and learning around TEC, telecare and the analogue to digital transition through partnerships with the Digital Office for Local Government, NSS TEC and the Scottish Government. The analogue to digital telecare transition is a major change project with considerable associated challenges for our Community Alarm Service through the transition. This continues to be progressed through the technology team with the aim to conclude with a fully digital community alarm and telecare service by the end of 2025. Locality Support Services The Locality Support Services (LSS), registered with the Care Inspectorate, offer self-directed support to adults with disabilities and /or long-term health conditions. Support is flexible over seven days and evenings connecting people with their local communities and interests. The service takes a human-rights and asset-based approach, promoting independence and personal responsibility, supporting people to consider their natural connections, friendships and paid support where it is required to achieve positive individual outcomes and better lives. The locality support service adapted its delivery model throughout the pandemic and into recovery, offering a blended service of direct support and online/distant support to the people and their families and where required making use of a temp variation to registration to offer support and care in and from people’s homes. Some service users have opted to continue having support on-line and benefit from our broader portfolio of communication methods. Some young people have been particularly enthusiastic about using technology to communicate including a preference for using this for reviews rather than traditional building-based meetings although limits on organisational access to social media platforms can be an issue. The pandemic has also necessitated a more place-based approach changing the needs profile of people being referred into locality support services, with more people requiring support who have mental ill health, self-neglect and addictions as their main issue. This has highlighted new training needs with steps taken to source development opportunities for workers. The service is also very conscious of the wider health inequalities which often impact on those with disabilities and long-term conditions and continue as core practice to support people to identify at least one health outcome and to promote general healthy lives. This is underpinned by an approach which places value on developing a progressive assessment
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35 process, communicating well and working with partners will improve access to health and other services. Integrated Day Services Integrated Day Services for Older Adults have continued to work with an aim to support people with complex support needs to continue to live in their own homes safely, often preventing admissions to hospital. During the initial period of the pandemic the service changed its delivery model in line with restrictions to work on an outreach basis however the have now returned to working as a building-based service implementing a recovery plan whilst adapting to the increased pressures across health and social care services. This has temporarily reduced the availability of some on-site interventions from health professionals however operational arrangements will continued be reviewed as full recovery of the service is progressed. Support at Home North Lanarkshire has, for many years, had a positive balance of care, which means that the considerable investment in community-based supports over time has resulted in a high proportion of people with long-term and complex needs being able to continue to live in their own homes. The metric used for benchmarking across Scottish Health & Social Care Partnerships and reported in the Annual Performance Reports (APRs) reflects very positively the long-term efforts in North Lanarkshire to create and sustain the range of supports which minimise long term residential, nursing or hospital care. In Adult Services, support at home is offered through internal home support, independent sector provision and direct payment. Home Assessment Team To complement existing measures around Planned Date of Discharge (PDD), Discharge to Assess (D2A) and Discharge without Delay (DwD) a multi-disciplinary Home Assessment Team has been established with the aim of supporting people to be cared for at home (or as close to home as possible), preventing avoidable admissions to hospital and, where hospital admission is necessary, supporting timely discharge. During 1st April 2021 and 31 March 2022 the referral rates demonstrate the pressure on Home Support with 73.1% of referrals coming from the hospital. The Home Assessment Team (HAT) soft launch took place in Wishaw in late April taking referrals from University Hospital Wishaw/ Monklands and in August the Cumbernauld soft launch was implemented taking referrals from UH Monklands/Wishaw with plans now underway to accelerate full implementation at UHW.
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36 HAT work collaboratively with hospital discharge hubs and clinical teams to support timely discharge from hospital to enable an assessment of each person’s immediate and longer- term needs in their own home. This can include anything from signposting to support from a statutory service and community care assessment. The Home Assessment Team has a multi-disciplinary approach to person centred care and consists of Home Support staff, AHP’s, Clinical Responders and Social Work staff facilitating ‘Home First’ principles enabling people to be supported to return home for a period of assessment. This also reduces the pressures associated with having to make life-changing decisions around longer-term care from a hospital setting. The initial implementation stage has demonstrated multiple benefits in supporting early intervention, reducing deconditioning, supporting and maintaining independence though better tailored support, reducing also the ‘over-prescribing’ of support and levels of ongoing care required from the home support service. Home Support Service The Home Support Services supports up to 3,000 people at home in any one day (over 5,500 people over the year), providing over 22.5k hours of support each week. 74% of home support service is provided by in house services, the remainder provided by the independent sector. However, maintaining responsive, high-quality support at home for those who require this has presented as substantial challenge over the past year due to significant workforce and demand pressures within the sector, a pattern which has been common across the country. An underlying increase in the level of need and national and local drive to relieve pressure on acute health services are significant factors and within home support resource has been drawn to the high level of referrals from hospitals impacting also on the responsiveness to emerging need within the community, As reflected above the HSCP have continued to focus on early intervention and prevention and the delivery of person-centred care through self- directed support with the introduction of the HAT team, described above, designed to improve the experience and outcomes for individuals, in particular on their pathway from hospital, as well as improving allocation of home support resource to those who need ongoing support. As noted in previous CSWO reports immediately prior to the pandemic plans were put in place for a redesign of the service with the centralisation management and support functions and new roles to maximise the capacity and quality of the service, to embed reablement and to support a move away from a time and task model to more personalised self-directed support for those with more stable longer-term needs. The pandemic, wider demand and system changes have required these plans to be adapted. There has since been considerable work to implement a new structure within Home Support Service to ensure that assessment and planning through reablement is re-introduced and that the wider options for independent living can be developed. A Home Support Redesign programme has been established to progress the implementation to improve pathways and service user experience, and address workforce challenges to maximise capacity and
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37 responsiveness. Additional resource has been invested in the service supported through partnership and new Scottish Government funding, with additional management and administrative support put in place, alongside the additional recruitment of 140 frontline home support workers based in Home Assessment Team and Home Support Service. The service now employs approximately 950 FTE Home Support Workers. A reassessment of the implementation to inform further redesign is taking place to allow the service to reflect and review changes to meet current and new priorities. This includes our Out of Hours Service to address call waiting times for both staff and service users. To ensure the delivery of a safe and high-quality service to support positive outcomes, consultation with staff, service users and their carers and stakeholders will inform the continued redesign of the service. The key areas that will be addressed to include; 1. Recruitment and retention of Home Support Workers, administration and Management 2. Training, to ensure staff are competent and confident across all aspects of Home Support provision 3. Roles: evaluating the hard-to-recruit posts 4. Quality of care and support being providd 5. Efficiency/ scheduling 6. Increased demand needs to be managed through efficient pathways Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. In addition to Home Support Worker roles, Support Officer and Service Delivery Coordinators are difficult to recruit and retain. These new roles were introduced just prior to the pandemic, and it was not possible to establish them fully due to changes in working arrangements and the difficulties of delivering training during this period, contributing to staff feedback suggesting the posts are too challenging. The tasks and skill sets required for a number of posts, including administration and management roles which are critical to supporting our staff will therefore be reviewed as part of our planned work. In the interim the rolling recruitment of Home Support Workers continues in order to meet demand, with plans now in place to ensure all learning and development requirements are informed by a fully inclusive development plan and robust curriculum to support key priorities. A further key element of the planned redesign of Home Support was the development and implementation of a dynamic scheduling tool both to benefit home support workforce in the field and for those who schedule and plan work. Initial development work has been undertaken but identified a number of design complexities however this will be taken forward as a priority given its criticality to service efficiency and improvement. In response to the challenges outlined the service has been working closely with colleagues from the Care Inspectorate, both strategically in relation to service improvement as well as operationally at local level. Promoting choice through Self-Directed Support Transformational SDS Agenda
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38 Our transformational SDS agenda has an emphasis on building greater community capacity to support earlier preventative approaches and proactive planning alongside the continued use of individual budgets for those with substantial and ongoing need. Two new temporary Service Manager posts have been created to further develop and shape our strategy around Self Directed Support across the Partnership supported by two resource worker posts. These posts are part funded through Scottish Government monies to enhance SDS. Key priorities include enhancing partnership working across the spectrum of community solutions, universal services, third and voluntary sectors and statutory sector, linking also with the Tec team on assistive technology so that people can be supported at home as independently as possible, for as long as is appropriate, whilst minimising risk and reducing reliance on statutory services. SDS Budgets The number of people receiving an individual budget within the 21/22 year was 1520. The graph below shows the number of individual budgets per locality. This numbers reflect all people receiving funding via an SDS budget across children, adults, and carers. There are currently 148 individuals who have an individual budget to provide 24-hour support. Part of the transformational work going forward will be around robust reviews of these support arrangements considering the potential use of technology enabled care solutions where these are appropriate to support better lives and increased independence.
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39 In the year 21/22 year we had a total of 317 Direct Payments (Option 1) and as with SDS budgets overall these figures include all children, adults and carers. To support the increase in people choosing a Direct Payment arrangement, and the anticipated need going forward a new DP support service was specified and procured. As of October 2021, Take Control North Lanarkshire commenced work in North Lanarkshire replacing SPAEN. Take Control NL are part of the well-established user led organisation Glasgow Centre for Inclusive Living (GCIL). GCIL have a track record of effectively meeting the needs of people wishing to employ their own support staff using a DP. 23 21 18 39 17 30 0 5 10 15 20 25 30 35 40 45 Individuals receiving 24/7 Support per Locality
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40 Community Living Change Fund/Coming Home Report In line with Scottish Government recommendations made within the Coming Home Implementation Report, and more recently the allocation to North Lanarkshire Health and Social Care Partnership of £1,298,332 from the Community Living Change fund, over a three-year period (2021-2024), a programme of work is being undertaken to support the strategic objectives of: Reducing delayed discharges of people with complex needs. Repatriating those people inappropriately placed outside of Scotland. Redesigning the way services are provided for people with complex needs. This initiative will build on the work already well established in North Lanarkshire and evidenced through our balance of care data. A significant amount of work has been undertaken to ensure people are supported at home in their local community. North Lanarkshire has the highest proportion of people aged 18 and over with long term needs who receive personal care at home in mainland Scotland and has the lowest placement rate for all adults aged over 18 in Scotland, which is over 30% lower than the Scottish average The addition investment will provide an opportunity to review the current situation post- pandemic and compliment the national work being undertaken to develop a dynamic discharge register. A multi-agency team lead by Health and Social Care Partnership was proposed to be established and will identify individuals with Complex Care Needs who are out of area or whose discharge is delayed and review and develop protocols to address this. This will include robust planning arrangements across a widen number of agencies to reduce the length of time people need to wait to be discharged. A key outcome is to establish a new register of individuals affected and the introduction of an appropriate assessment tool which will facilitate review of all cases. From this individual outcome plans will be developed to assist each person back home addressing and resolving the key obstacles faced such as housing, funding, care equipment etc. For those individuals identified as being repatriated and following appropriate assessment including risk assessments, planning will facilitate appropriate interventions to ensure individuals can come home safely. Additional protocols will be developed to support interactions with other authorities which may be involved in such areas. Statutory Interventions Mental Health Officers Service and Adults with Incapacity Act (Scotland) 2000 Mental Health Officers (MHO) are social workers with a minimum of two years post qualifying experience who have gained Mental Health Officer Award (MHO award) which is a postgraduate certificate at SCQF level 11. Statutory duties for MHO’s are set out in the Adults with Incapacity (Scotland) Act, 2000; the Mental Health (Care and Treatment) (Scotland) Act, 2003 [MHCTA]; the Criminal Justice (Scotland) Act, 1995; Criminal Justice (Scotland) Act 2016 and the Adult Support and Protection (Scotland) Act, 2007. The implications of emergent court judgements emphasising the significance of both the
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41 European Convention of Human Rights and the United Nations Convention on the Rights of Persons with Disabilities in statutory decision making, combine to place heavy demands on the current resource. Additionally, new duties for mental health officers were introduced in the implementation of the Mental Health (Scotland) Act, 2015. The Chief Social Work Officer holds overall statutory responsibility for the governance and the management of welfare guardianship orders that have been granted to the local authority, and for overseeing the supervision of private guardians in their role and function as welfare guardians. The day-to-day management of these statutory responsibilities are delegated to Mental Health Officers and Social Workers and overseen by managers within adult social work. Adults with Incapacity Act (Scotland) 2000 The above chart shows the monthly running total of private and local authority welfare/financial guardianship orders held for individuals in North Lanarkshire over the period April 2021 until March 2022. The total number of guardianship orders in place in the North Lanarkshire Council area at the end of March 2022 was 986. This is a 1.6 % decrease from the period 2020-21. On 31 March 2022, the number of individuals on a guardianship order in Scotland overall was 17,101. The North Lanarkshire total figure constitutes 5.8 % of the national total. The local authority has a statutory responsibility to provide supervision and support to all Private Guardians and undertake reviews of how the powers are being used on a regular basis, unless it is formally agreed that this is not required. In relation to local authority welfare guardianship powers, these are also reviewed regularly either by a Designated Mental Health Officer or Social Worker.
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42 Within North Lanarkshire Council there are several private residential and nursing care homes which offer accommodation for adults with complex care requirements. Local Authorities, from across Scotland, place Adults in these establishments. number of these Adults require the use of Mental Health, Adults with Incapacity and/or Adult Support and Protection legislation to ensure lawful decision making and protection of human rights. The statutory responsibility for undertaking statutory duties as relevant to individual residents is carried out by North Lanarkshire Council staff. During this period, as noted in section 2.5 below two Large Scale Investigations were undertaken under Adult Protection processes with respect to this type of establishment. The co-ordination of these investigations and associated statutory activity, in liaison with home local authorities, to ensure individuals rights were safeguarded and needs appropriately supported placed substantial additional demands on North Lanarkshire MHO and social work resources. Over the period April 2021 to March 2022, 135 requests were received for Mental Health Officer reports to accompany new guardianship applications. In comparison with the previous year this shows a 5.5 Increase. Of these applications 77 were for renewals of welfare guardianship orders, which is a 157 % Increase in renewal applications since the previous year. It should be noted that the ‘stop the clock’ put in force by the Coronavirus (Scotland) Act 2020 ended on 30th September 2021, therefore the increase in renewals this year would be expected as a direct consequence of demand effectively being held over from the previous year.
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43 Younger Adults with intellectual disabilities and/or neurodevelopmental causes and older Adults with cognitive impairment remain the main categories of diagnosis in respect of guardianship applications granted between April 2021 and March 2022. Mental Health (Care and Treatment) Act 2003 and Mental Health (Scotland Act 2015 Statutory interventions to safeguard and support individuals through mental health legislation is noted in the table below. National trends for civil detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 have continued to rise. In North Lanarkshire there has been a reduction in the number of Emergency Detention Certificates (down 10%) and Short-Term Detention Certificates (7.9%), whilst the number of Compulsory Treatment Orders has increased (22%) since the previous year. The total number of supervised Forensic orders continues to increase in North Lanarkshire Council. We continue to maintain a higher than the national average rate of consent to Emergency Detention Certificates. This year, MHO’s have however refused consent to 38 Short Term Detentions, which is 25 more than the previous year. Quality Assurance, Continuous Improvement and involving Lived Experience North Lanarkshire Council recognise that, MHO involvement in the social work and care management role of adults with complex needs in relation to decision making capacity and/or experience severe and enduring mental health difficulties, can offers much better outcomes for individuals as a result of the knowledge and skill base MHOs retain whilst ensuing human rights are central to intervention.
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44 Our plan is to promote quality assurance by gathering feedback from people with lived experience who are involved in the service, in addition to continuing to work collaboratively with partnership colleagues and other stakeholders. We are developing our links with Integrated Addiction Services in recognition that many individuals we work with experience mental health and addiction issues which require a whole systems approach. We are also introducing self-evaluation and auditing processes for statutory MHO reports and have undertaken a trauma informed walk through of the service to ensure best practice and continuous improvement. Service Recovery As discussed in last year’s report, the impact of the pandemic, required rapid development of remote working and centralising processes across the MHO service. Whilst there has been a return to face-to-face assessments, meetings and MHO forums we have also continued to benefit from the flexibility remote ways of working can offer service users and staff alike with MS TEAMS and ‘Near Me’ service. The centralisation of key functions has created many benefits to managing pressures across the service in relation to staffing, workload and sharing knowledge and experience. A centralised priority allocation process is now in place as a way of addressing the pressures across the service. Appropriate Adults Services In January 2020, Appropriate Adults (AA) Services across Scotland became a statutory function via part implementation of the Criminal Justice (Scotland) Act 2016. This now means that a statutory duty is placed upon Police Scotland to request an Appropriate Adult, while the Council have a statutory duty to provide Appropriate Adult Services, and the training of AA’s. The Care Inspectorate have the duty to assess the quality of AA Services. During 2021-22, national developments have continued to take place to assist with the ongoing implementation of the national statutory framework e.g. Scottish Government AA Oversight Group, national training group, and the requirement to complete a service-based questionnaire on North Lanarkshire AA Services, for the Care Inspectorate. The Council is currently working in partnership with the Care Inspectorate and other partners to design a self-evaluation model for ongoing quality assurance purposes for AA Services. Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with 12 employees trained to perform AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In line with statutory guidance produced by Scottish Government, work is underway to develop a local Appropriate Adult Oversight Group. This multi-agency group will have responsibilities for policy and practice development in this area eg. recruitment, training, confidentiality, health and safety and service complaints. Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year, in line with other local authority areas who have also experienced reductions in referral rates. This is being monitored by a National Oversight Group, Scottish Appropriate Adult
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45 Network and Police Scotland. While there was a decrease, there were increases in the number of times AA’s are being asked to attend police stations (for the same offence) and are spending an increased amount of time supporting vulnerable adults whilst there. As Council employees perform the AA role in addition to professional social work roles, this continues to contribute to resource pressures however an Appropriate Adult Development Officer post has been agreed and funded through new monies following statutory implementation and it is hoped to recruit to this shortly. 2.5 Public Protection Whilst all public protection activity is undertaken in partnership, the social work service has a lead role and associated statutory responsibilities, particularly with respect to adult and child protection and the management of high-risk offenders. The information below provides an overview and analysis of that activity. Child Protection The number of children whose names were placed on the child protection register decreased by 20% from 2020 to 2021, consistent with an emerging national trend during the initial period of the pandemic. Historically, proportionately fewer children’s names have been placed on the children protection register in North Lanarkshire than the Scottish average and this remains the case, although the gap is narrowing as illustrated below. Despite this decrease, 2021/22 saw a continuing trend of increased child protection activity overall. The table below illustrates an increase of 66% in child protection referrals over the past 5 years but proportionality fewer children (a 33% decrease) being referred to a Child Protection Case Conference. This indicates that more children were referred into the child protection system than was perhaps necessary. The development in North Lanarkshire of planning for the wellbeing of children through our Empowering Clusters, is designed, in part, to address this, with local supports and services in place to respond to need at an early stage. These trends will be monitored.
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46 Year Number of Child Protection Referrals Number of referrals that proceeded to Case Conference Percentage of Investigations Proceeding to Case Conference Percentage of Conferences resulting in Registration 2021/22 1714 229 30% 73% 2020/21 1482 261 31% 76% 2019/20 1617 339 42% 74% 2018/19 1150 329 51% 76% 2017/18 1030 340 49% 74% Adult Support and Protection During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. Police Scotland remain one of the highest referring agencies, submitting 16% (380) of all ASP referrals received; this is a 39% decrease from last year (from 598 to 380). In addition to the 380 ASP referrals made by Police Scotland, there were a total of 4,004 Police ‘Adult Concern’ Reports received. Since the same reporting period last year there has been a 13% increase in police ‘Adult Concern’ reports (from 3,552 to 4,004). This is the third year running when significant increases have occurred; this work continues to generate significant resource pressures. For the fourth year running, there was an increase in the number of referrals received from NHS L personnel (from 426 to 473, up 11%). Referrals from Social Work Services staff decreased by 10% (from 411 to 371). For this period, ASP referrals from Care Homes demonstrated a 9% increase (from 416 to 455). Information from inquiry and Investigation processes suggest possible causes of this include, the increasing complexity of people placed in care homes, many of whom have significant levels of cognitive impairment and/or dementia, and behaviour which requires intensive support. Monitoring and support in this area is provided by colleagues in Quality Assurance and, in line with the increased focus on Care Homes during the pandemic this area of activity has also been monitored through regular review of ASP referrals for care homes and multi- professional Care Home Oversight arrangements. Adults with mental health issues were represented in 35% (858) of the total ASP referrals received, being the main primary user group referred. Referrals for this group have decreased since the same time last year but remain high in overall percentage terms (from 939 to 858). This only reinforces the importance of key service developments such as Distress Brief Intervention (DBI) and social work investment in delivering ASP training for those organisations who deliver services at home to our most vulnerable service users.
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47 ASP Investigations /Case Conferences and Statutory Orders/Functions During 2021-22 there were 434 ASP Investigations carried out, a 18% conversion rate from inquiry to investigation and a 16% increase from the previous year. There were 111 ASP Initial Case Conferences held; this measures a 29% decrease from last year. Anecdotal information from localities suggest that some cases have moved from investigation to case conference sooner in the process. For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire also sought and implemented thirteen ASP Protection orders, broken down as; six Removal Orders, three Banning Orders and four temporary Banning Orders, all with power of arrest. During the period from April 2021 to March 2022, two Large Scale Investigations (LSI) under Adult Support and Protection (Scotland) Act 2007 (ASPA) were carried out at care homes. Both investigations highlighted a lack of legal safeguarding for many adults in relation to welfare and financial decision-making with necessary actions progressed to address this in conjunction with the Care Inspectorate, placing authorities, providers, individuals and families. The nature of these investigations required dedicated staff teams to be set up for a period to progress this and whilst this was critical in ensuring the effectiveness of investigations and supporting actions, this did have an impact on staff resource for other activity. MAPPA (Multi-Agency Public Protection Arrangements) In addition to their in public protection though the management of offenders, as described in 2.2 above, justice social work services have a key role in respect to MAPPA arrangements as lead agency for offenders subject to statutory supervision. As such the service works closely with the council’s housing service and other responsible authorities including, Police Scotland, NHS and the Scottish Prison Service to assess and manage the risk posed by sexual, violent and other risk of serious harm offenders. As noted in 1.4 above whilst activity is operationally managed within relevant agencies. multi-agency oversight and co-ordination is supported by a small pan-Lanarkshire team and Strategic Oversight Group (SOG). An annual MAPPA report provides information on the ongoing local implementation of MAPPA arrangements, key priorities and activity statistics: MAPPA Annual Report 2022 | North Lanarkshire Council Of the 699 individuals in custody or in the community in Lanarkshire subject to MAPPA as of 31/3/22, 56% (394) were the responsibility of North Lanarkshire authorities. Overall, the number of individuals managed under MAPPA have grown significantly since arrangements were established 15 years ago however this increase has slowed in recent years. In both North Lanarkshire and pan-Lanarkshire there was again a small increase between 20/21 and 21/22 however as in other areas of the justice system it difficult to clearly separate underlying trends from the impact of the pandemic on the justice system. MAPPA related activity is however a key aspect of justice social work workloads. Whilst the statutory activity above is categorised in distinct strands there is a clear interface across the different areas of public protection requiring joint-working across both social work
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48 care groups and partnership arrangements. There is for example an increasing number of older individuals and those with substantial care needs who are managed under MAPPA requiring close working between adult and justice services and there is also a strong interface with child protection whilst domestic abuse and violence against women may also link strongly to wider public protection processes. All social work staff are therefore expected and trained to have core knowledge of of the range protection procedures and responsibilities. Statutory public protection interventions and processes are also part of a wider continuum of safeguarding and community safety activity in which social workers are involved, some of which are reflected in earlier sections of this report. Additional examples of key priority areas for social work and partners where practice is evolving and innovating to strengthen the protection and wellbeing of our communities are set out below: Contextual Safeguarding and Missing Young People Contextual Safeguarding is an approach to protecting young people who are at risk of extra familial abuse (harm outside of the home), such as criminal or sexual abuse or violence within peer groups. North Lanarkshire is one of the first local authorities in Scotland to adopt this approach and a multiagency steering group was established in 2021 and an audit of practice comprising a review of processes and consultation with staff was completed. In addition, the Promise Development Team with the support of Who Cares Scotland provision in North Lanarkshire, held consultations and engagement with young people in relation to their experience of service responses to risk of harm outside the family. To ensure interventions and resources are put in place to reduce risks in contexts, a Young Person’s Safeguarding Panel was established in November 2021. It has representation from across council services (CLD, education, community safety, housing) as well as from partners to ensure a holistic response. The panel considers young people at significant risk of harm outside the home and is co-chaired by Police Scotland and Social Work and with each panel there has been a complex mix of risks. Risks are discussed alongside strengths, and there is a clear focus on the young person/people’s wellbeing. The panel adds value to case planning with young people by agreeing actions to address risks in locations or contexts for young people. There continued to be a weekly Missing Persons’ meeting that discussed all young people who were reported to the Police as being missing from the community or a residential home. The missing person meeting notes any risks to the child or young person when they were missing for further action and support and monitors the outcome of this. A comparison of those young people reported as missing in 2021/22 with the previous year shows a decrease in the number of total missing episodes (603 as opposed to 663) but an increase in the number of individual young people reported as missing (287 as opposed to 185). As a result of ongoing work with children’s house staff in their approach to nurturing and supporting young people, there was a significant reduction in young people reported missing from North Lanarkshire’s children’s houses as illustrated below. In 2020/21 nearly half the missing episodes related to care experienced young people missing from children’s houses whereas this reduced to a quarter in 2021/22. However, it also reflects an increase in young people missing from their own families, 65% of whom were not known to the social work service at the point of being reported missing.
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49 20/21 21/22 All young people reported as missing continued to be offered a Return Discussion from a contracted service through Barnardo’s Scotland. This enabled young people to raise any issue that may be affecting them with an independent person rather than a parent, police officer, teacher or social worker. This led to a number of young people being referred onto additional supports and the disclosure of harm that would not necessarily have occurred if this independent service had not been available. All young people reported as missing continued to be offered a Return Discussion from a contracted service through Barnardo’s Scotland. This enabled young people to raise any issue that may be affecting them with an independent person rather than a parent, police officer, teacher or social worker. This led to a number of young people being referred onto additional supports and the disclosure of harm that would not necessarily have occurred if this independent service had not been available. Suicide Prevention The Suicide Prevention Partnership Group is a collective of multi-agency staff which aims to collaborate in the promotion of the national and local suicide prevention strategies. This takes place via a range of activities including awareness raising and training across services and local communities. The process of gathering data on suicide locally has developed since the winter of 2019. More comprehensive information is now available from Police Scotland; which includes more contextual information about the deceased person’s life, employment and relationships. This information support the targeting of prevention activity. As noted in the table below from 2018 until 31st December 2021, North Lanarkshire has lost 171 people to completed suicides. There continues to be an increase in deaths of younger people under the age of 39: these have mostly been young males. Suicide rates did not significantly vary throughout the lockdown period (2020/2021) however as we continue to recover from the emotional and fiscal effects of the pandemic there is a
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50 concern that the cost-of-living crisis may impact an increasing number of individuals mental health and wellbeing with an associated risk of a rise in suicide rates. In this context continuing to review and enhance the local action plan is clearly essential (taken from National Records of Scotland suicide data for North Lanarkshire on an annual basis from 2018 until 2021) YEAR Completed number of suicides in NLC 2018 58 2019 57 2020 62 2021 52 Up to 31 March 2022 13 The local action plan delivered by the Suicide Prevention Partnership Group is framed around the following aims: 1. Reducing the risk of suicide in high-risk groups. 2. Tailoring approaches to improve mental and physical health in specific groups. 3. Reducing access to means of suicide, including identified Locations of Concern 4. Learning from investigations and reviews into unexpected deaths. 5. Providing better information and support to those bereaved or affected by suicide. 6. Supporting research, data collection and monitoring. 7. Building community capacity to help reduce the stigma and taboo associated with suicide. There is extensive peer support available across the authority with suicide awareness and prevention training being delivered across health, education, third sector and voluntary organisations. The partnership now embedded participation, initially as a pilot area in rolling out Distress Brief Intervention is also supportive of this work. A Senior Officer Adult Service Leads on the Suicide Prevention work. A proposal is being progressed to recruit a Suicide review Officer pan Lanarkshire, initially on a temporary basis, to continue to take forward this important work. Drug Related Deaths North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 94 people dying from drug-related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire.
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51 Measures associated with targeting drug related deaths locally and nationally have been implemented via MAT Standards, Drug related Death task force workstreams and ADP funded projects. Actions will be centred on improving quality, offering choice and creating more of the connections to keep people safe, well and thriving. Realising a North Lanarkshire where: 1. Fewer people develop problem drug and alcohol use 2. People access and benefit from effective, integrated person-centred support to achieve their own type of recovery 3. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. 4. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. 5. Less harm is caused by alcohol. 3. RESOURCES For financial year 2021/22 North Lanarkshire Council had gross annual social work budget, inclusive of Covid & winter planning funding, in excess of £266m. This was allocated as £220m for Adult Social Care and £46m for Children, Families & Justice. The equivalent funding for the previous financial year was £252m. The ongoing impact of Covid-19 resulted in spend in excess of £8M which included the costs of PPE, the provision of additional home support hours and partner sustainability payments. This expenditure was fully funded by the Scottish Government. New recurring investment of £300m was announced by the Scottish Government at the end of 2021 to protect health and social care services over the winter period and to provide longer term improvement in service capacity across health and social care systems. North Lanarkshire’s share of this funding was £6.4m and a full business case was approved on how this would be utilised over the forthcoming 12-month period: https://mars.northlanarkshire.gov.uk/egenda/images/att97950.pdf
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52 There are however ongoing difficulties across the sector in recruiting for the required posts delaying spend against these funds. In aggregate Social Work had a savings target of £1.768M, 78% of which was achieved during the year. Plans are in place to fully achieve the savings in future years. Whilst the totality of Social Work activity during 2021/22 was undertaken within the overall budget resource and resulted in an underspend position this outturn underspend is projected to be on a non-recurring basis and therefore financial pressures are expected in specific areas as follows: - a. Home Support b. Independent Care Homes c. Self-Directed Services d. Integrated Equipment and Adaptation Service e. Family Placements f. Children’s Houses The underspend in Children’s Services Social Work was mainly due to savings in employee costs, which were largely as a result of recruitment issues and savings in external payments both to individuals and external agencies. There remain however significant ongoing cost pressures particularly in relation to placements costs which were alleviated by temporary additional funding allocated by the council which ended in 2021/22. Pressures relate primarily to growth in placements and costs within kinship care and external fostering. There are also ongoing cost pressures in relation to the management of internal Children’s Houses and the rise in costs for external residential placements, although as noted previously there has been a reduction in the use of external residential resource over recent years. Previous pressures with respect to continuing care costs have been mitigated by the additional recurring local investment in this area of service. Within the Justice budget the Scottish Government allocated additional funds to all 32 authorities to support the Justice recovery from the pandemic. North Lanarkshire received £0.943m of which £0.164m was earmarked specifically for the Third Sector. NLC were able to utilise £0.632 in year which included the full utilisation of the Third Sector monies. The main obstacle to fully spending the additional funds was in relation to recruiting to temporary posts. This was exacerbated by the relatively late confirmation of this funding which meant an automatic lag in recruitment as a direct consequence. In view of demand pressures and the criticality of frontline social work provision to both the delivery of statutory responsibilities and wider national and local policy ambitions the council and HSCP have taken no savings from main grade social worker posts over this period or recent years however wider savings have impacted within the service and the overall financial climate clearly remains challenging. Additional national funding for adult health and social care, of which local spend is reflected in the business case link above, has supported address some pressure points in Adult Services, however as noted elsewhere in this report recruitment challenges remain. Further
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53 recurring national investment in Adult Social Work from 2022/23, equating to 1.278m for North Lanarkshire announced in early 2022 is also welcome. Additional funding for Justice Social Work Services to support address the pandemic related backlog in demand will also continue into 2022/23 however the position beyond this is unclear. In contrast there has been no earmarked national investment in Children’s Social Work Services beyond the short- term winter support plan monies allocated at the end of 2020 with the impact that a number of the developments reflected in section 2.3 above have been supported by a range of short-term or non-recurring partnership funding and are therefore vulnerable to any changes within this. Financial Modelling for Service Delivery Financial Planning and monitoring continue to be a key responsibility for the management team. The Council’s financial strategy includes Service input to four key processes. These are: a. Preparation of detailed single year budget b. In–year budget monitoring and projections c. Preparation of rolling 3-year budgets d. Preparation of a Medium-Term Financial Plan Alongside these the Council Finance Team work closely with the IJB Chief Finance Officer to prepare a medium-term financial plan for the Health and Social Care Partnership. In terms of financial modelling the Management Team increasingly take a whole systems approach to delivering new and more efficient operating models which often requires joint working with other Council services and key external partners. The Management Team have also had to undertake significant work to prepare projections, plans and models which estimate the operational and cost impact of Covid on service delivery. This information is shared with officers in the Council, IJB key external partners and with the Scottish Government. In addition to the wider financial modelling described above work has also been undertaken to support the business plan for Adult Health and Social Care. With respect to Children’s Services the council and local partnership is one of three areas who have committed to working with the Promise team nationally on ‘Human and Economic Cost Modelling’, work which is intended to support longer term change both nationally and locally by identifying how money is currently spent and the system changes required to move the balance of spend toward early intervention and family support in line with the aspirations of Christie. 4. WORKFORCE 4.1 Workforce Planning
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54 Workforce planning within social work is integrated thought the social workforce group but informed by the Council’s corporate ‘Workforce for the Future Strategy’, https://mars.northlanarkshire.gov.uk/egenda/images/att96241.pdf which was updated and approved in June 2021 and interfaces also with the wider HSCP workplan. As reflected in other parts of this report the direct and indirect impacts of the pandemic and cost of living crisis along with underlying demand pressures have significantly impacted on the ask of the social work workforce over this period. Changes in the labour market as the country moves into the recovery phase have also impacted on recruitment and retention of staff and have together exposed some of the underlying vulnerabilities with respect to the capacity, valuing and development of the social work and social care workforce. North Lanarkshire is not immune to these challenges and whilst many of these also require action at national level, there is substantial work ongoing locally to address key issues and support workforce resilience. Social Worker Recruitment and Retention The service has previously adopted a mixed model with respect to social worker recruitment bur in response to financial constraints the services’ internal social worker trainee programme was paused in 2018/19 and since this time social worker recruitment has been predominantly external. Whilst staff turnover in many areas was supressed during the initial stages of the pandemic this has increased over the last 18 months. This is in part due to more internal movement to promoted, developmental and specialist posts within all care groups, including those created through service redesign and temporary funding streams, with such opportunities also supporting positive career pathways and staff retention. There has also been movement across care groups due to the creation of additional posts in justice and adult services with some ‘churn’ emerging particularly in children and families alongside an emerging increase in movement to other local authorities, in particular Glasgow where pay rates for main grade social work staff are higher. This is in a context of national recruitment challenges for social work with no overarching-system of bursaries/employment whilst training as well as increased demand for staff and the disruptive impact of the pandemic on social worker qualifying training. Whilst North Lanarkshire continues to successfully recruit including attracting students who have has positive placement experiences with the authority, this has also impacted on experience levels and stability at the frontline, for example in Children, Families and Justice alone 36 external appointments were made to the role of social worker over this period, 29 of whom were newly qualified. Whilst these staff bring skills, creativity and commitment to the service, the impact of the pandemic on pre-qualifying opportunities has impacted on learning needs and the changing balance between newly qualified and more experienced workers, alongside an increasing complexity in the demand profile, has created clear pressures with respect to the allocation of work within localities with a requirement to provide more support across teams. Frontline managers continue to monitor caseloads and assist their workers in the prioritisation of their statutory responsibilities. In Justice Social Work a revised structure has allowed for a more flexible approach to the deployment of staff across the authority to
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55 support the teams who are dealing with the most urgent and pressing demands and authority wide teams continue to support localities across all care groups. Whilst not favoured as a core element of our ongoing workforce strategy, where necessary limited use of agency social workers has also been employed under the auspices of Covid-19 recovery monies in Adult and Justice services. There is a productive partnership approach between the service and our HR colleagues in terms of ongoing recruitment strategies. Advertising frequency and dates have been reviewed to streamline the process and quicken the employee onboarding experience to and the service also maximises opportunities to recruit on a permanent basis (temp location) against temporary vacancies on the basis that normal levels of turnover mitigate any associated. financial risk. As outlined in 4.2 below, a commitment to capacity to support Practice Learning, the new Supported Year in Practice and to both Continuous Professional Development and Health and Wellbeing Support are all critical to longer-term recruitment and retention strategies but in the current context and it is likely that supporting actions will need to continue to be updated and reviewed. Our Senior Practitioner Scheme continues to contribute to retention and the building of a skilled workforce. It allows social workers and occupational therapists to progress to an enhanced salary scale on completion of relevant post qualifying training and commitment to undertake additional responsibilities and remains a key component of our model, with over 60 practitioners within the service carrying the status alongside tailored work plans identifying their additional contribution to the service. The Senior Practitioner qualification has been extended to include the Diploma in Autism and the National Joint Investigative Programme Training and new social workers who meet the criteria have immediate access to temporary Senior Practitioner status, pending a process to confirm status. Our strong commitment to the provision of Practice Learning as part of Learning Network West has been maintained and despite some of the challenges involved in providing quality learning experiences in the context of hybrid working, we have by the end of 2021/22 been able to restore placement provision to pre-pandemic levels. The service has benefitted significantly from the input of the students and as noted above this also supports recruitment. Following a ‘test of change’ in autumn 2021 provision of opportunities through traditional dispersed placements has been supplemented by the development of two student hubs base in the north and south of the authority. Each hub has the capacity to support around 9 students with a co-located practice teacher and with all placement opportunities overseen by a dedicated Senior Officer in our Training and Organisational Development team. Our experience to date suggests this model is highly valued by students whilst also providing flexibility of deployment to support service needs. Recruitment and retention of Mental Health Officers
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56 North Lanarkshire Council remain committed to training social workers to become MHO’s and since 2018 have successfully supported nine individuals through their MHO award. An MHO Traineeship Scheme was introduced during the pandemic, ensuring the MHO Trainees are located within the MHO Service during the course. We received positive feedback from the Trainees that being based within the service, provided quality learning and practice opportunities, despite a significant reduction in face-to-face contact with colleagues and service users. The scheme will continue, and a self-evaluation process is currently being undertaken. Colleagues across Education and Families and Social Work Emergency Services have shown an interest in being considered for the Award. Mental Health Officer forums continue every 6 weeks, offering discussion on practice issues, case studies, national reports/guidance and providing feedback to Scottish Mental Health Law Review. North Lanarkshire continue to offer MHO’s the opportunity to obtain, and maintain, Senior Practitioner status and to share their knowledge and experience with MHO and social work colleagues in relation to various aspects of AWI and MH legislation as well as Self Directed Support. We recognise the breadth of knowledge, experience, and skill across the MHO service and plan to restart consultation sessions regarding human rights, AWI and MH Act as well as establishing MHO champions who have areas of practice interest, in relation to neurodiversity, forensic work, and complex trauma. Remote external training and development opportunities continue to be available to MHO’s, for example via the Scottish Forensic Network, Mental Welfare Commission and MHO community of practice (SASW). Despite these measures in common with other local authorities, North Lanarkshire continues to be under-resourced in this area and this poses a considerable challenge for responding to statutory duties and timelines. Recruitment, retention and succession planning for MHOs are high level priorities and are under constant review. The service has recently been augmented by three newly qualified Mental Health Officers and an experienced MHO from another social work team. We also continue to have a core group of sessional MHOs who are involved in supporting AWI processes to support adults assessed as lacking capacity for making decisions with respect to hospital discharge processes this is proven to be beneficial and will continue to be funded. Grant aided funding from the Scottish Government to support Mental Health Officer training, is supporting the recruitment of a stand-alone Practice Assessor with we anticipate the post be filled by September 2022. We are also in the process of recruiting social worker posts to be based in the Mental Health Officer Service and an additional Mental Health Officer post for complex discharge planning is also currently under development. Social Care
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57 As reflected in Section 2.4 above there remain significant recruitment, retention and capacity challenges with respect to the home support workforce and whilst recruitment planning for the in-house service has always had to be balanced to avoid a simple transfer of capacity from the local independent sector the need to retain critical service delivery has necessitated an upscaling of recruitment to our in-house service over the last year. Challenges in recruitment and retention in this sector are not confined to the roles of home support workers providing direct care but also to management and support functions, as reflected earlier in this report, requiring further review of roles, the creation of additional posts and ongoing consideration of support arrangements to aid retention. Other areas in which there are recruitment challenges include locality support services and some roles within residential childcare, significant factors being wider labour market changes and comparative pay. In addition to wider strategic actions, service areas are themselves active in seeking solutions, for example, locality support services have continued to build links with education, encourage apprenticeship schemes and promote the idea to young people that a career in social care is rewarding and full of possibilities for promotion, further education and development. A group has been set up with a focus on promoting succession planning and preparedness of workers interested in promotion, staff development and the introduction of the principles of creating a working environment that is trauma informed Administration/Business Support Administrative and support staff within social work play an invaluable role in supporting service delivery and increasing challenges with respect to recruitment and retention in respect of key administrative and support roles have over the past year also impacted significantly on the service with high vacancy and turnover rates particularly in main grade roles with loss of staff to other services in the local authority, the health service and private sector an issue, again with comparative pay issues a significant factor. A wider review of administrative support across the wider education and families and social work service is planned with an ambition that a redesigned business support model will support efficiency and offer roles which both reflect the specific needs of the current service and which are more attractive and offer improved career pathways for staff. Care Academy A important vehicle to support workforce planning in social work and a key element of Workforce for the Future is the Health & Social Care Academy a much long-standing piece of work, with mature partnership model and based on a key joint venture with NHS Lanarkshire. Recently, existing work has been deepened by establishing 3 priority sub- groups focused on 1) the young workforce, with further development of the in school vocational offering for Health and Social Care; 2) adult recruitment and employability, with a focus on both short- and longer-term workforce demands in the sector, 3) building capacity and resilience by supporting wellbeing, training, and development across the existing workforce. A clear plan of action has been developed for each of the subgroups who will take forward this work in the next 6 to 12 months with regular reporting to the Workforce for the Future Steering Group. Work will also be taken forward in the next phase to develop a framework of outcome measures which can be used to track the overall progress of the programme and its impact.
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58 4.2 Workforce Development and Staff Support There are a wide range of learning and development opportunities open to staff supported and planned both corporately and at service, team and individual levels with a focus on alignment to service and corporate ambitions and redesign but also on more specific team and individual development needs the latter through our PRD processes. Prior to the pandemic the council invested in LearnNL a cloud-based learning management system designed to support a more inclusive and accessible approach to learning whilst improving digital literacy, and this was a key support in sustaining training and development during the pandemic period during which more training was adapted for online delivery however as the year has progressed there have been some opportunities to re-stablish face- to-face team development, with the hope that wider opportunities will be available over the coming year. A summary of key activity over the period with respect to Learn NL, Assessment Centre and training activity to supporting registration and the social care workforce and Post-qualifying Awards is noted below: LearnNL Total number of activities undertaken on LearnNL including mandatory learning – 10,718 Leadership Development – 87 activities Fundamental Leadership – 2 Influential Leadership – 9 Assessment Centre and Registration The Assessment Centre continues to support SVQ, and PDA qualifications required to meet registration, role and CPD requirements. This is achieved through both in house assessment and access to SVQs through external providers. The North Lanarkshire Assessment Centre was subject to an external verification visit in August 2022. A number of activities were undertaken in this visit to ensure we continue to meet the requirements set out by SQA. All areas sampled in the visit were rated green (High Confidence) by the external verifier, an excellent achievement, sustaining high standards of delivery throughout challenging times. Awards completed (2021 – present) SCQF Level 6 (SVQ2) – 8 SCQF Level 7 (SVQ3) – 5 SCQF Level 9 (SVQ4) – 2 PDA Level 9 – 4 Active Candidates – External Programmes (2021 – present) New College Lanarkshire – 17
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59 West Lothian College – 4 A tender has recently been issued for the provision of SVQ Level 2 in Social Services in Health Care which will provide up to 30 places over the next two years Active Candidates – Internal Programmes (2021 – present) SCQF Level 7 (SVQ3) – 4 SCQF Level 9 (SVQ4) – 5 PDA Leadership and Care (SCQF Level 9) – 3 Post Graduate Opportunities Advanced Practice skills – 1 completed 2022 Postgraduate in Child Welfare and Protection @ Stirling University – 4 started in 2021 and completed June 2022. A further 5 will commence September 2022 due to finish June 2023. Postgraduate in Adult Support and Protection – 2 Postgraduate in Contemporary Drug and Alcohol Studies – 2 Part funding of final year of PHD qualification – 1 Postgraduate in Management and Leadership – 1 Exploring the Theory and Practice of Psychological Trauma – 1 MSc In Leading People Centred Care – 1 Children in Conflict with the law – 2 places funded for 2022 with a further 4 places funded for 2023 Professional development award in practice learning (PDA PL) Four social workers qualified as practice teachers this year with a further two due to finish by December 2022. This is supported by a practice learning pathway for social workers to become link workers and practice teachers. Over the past 4 years we have promoted practice learning and successfully built a strong cohort of competent and confident link workers and currently have waiting list to become a practice teacher. Social Worker Training Whilst our secondee scheme is currently suspended as noted above we continue to have staff studying on their own time with the Open University which they self-fund. We have 6 support workers who are all at a stage they now only require to be sponsored by NLC for their 2 practice placements to qualify as social workers. We have committed to this funding and all 6 will start their first assessed placement February 2023 and will qualify September 2024. Newly Qualified Social Workers (NQSWs), Supported Year in Practice In view of the workforce profile describe in 4.1 above, the service has been delighted to receive funding support for a Practice Learning Officer as and early implementer of a supported year for NQSW’s. Knowing that North Lanarkshire Council (NLC) is a part of the early implementation has also been a key factor for NQSW applying for posts in the local authority.
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60 There are currently 21 NQSW who are registered with SSSC as part of the supported year with others sue to join this group shortly whilst 4 NQSW who were employed by NLC prior to the supported year starting are receiving support through Early Professional Development Programme, training and development opportunities being shared and 1:1 support as required. An initial face-to-face inductions day for NQSWs has taken place with others to be scheduled as further staff join backed with a 12-session programme to runover the year and engagement with line managers. The CSWO and Head of Adult Social Work met with NQSWs as part of their initial induction programme, and it is planned that further ‘touch in’ contact will take place in future induction days and later in the programme. Other key training and development: A broad range of other core training and development activity has continued including with respect to Public Protection using online and blended models. For example, ASP Council Officer Training (Day2) and investigative Interview Training (Day3) were reviewed and redesigned to support remote delivery and were delivered to 30 staff during April and May 2021. The Getting it Right in Child Protection blended course has run throughout the pandemic ensuring that multi-agency staff are knowledgeable and confident within child protection practice. A range of service specific and partnership training has supported key areas of organisational, service and practice development described elsewhere in this report in a number of instances using a ‘train the trainer’ model which is supporting the expansion in the use of the Outcome Star as a tool from justice services across education and families and plans to embed Safe and Together within Children’s Services Team based learning is also common across the service. One example being locality support services who developed an on-line platform using Yammer to share good practise and develop a quality assurance space insuring services across the six localities were learning from one another and providing quality services. Six weekly ‘best practice’ meetings have been established locally to recognise and celebrate good stories, meeting one of the needs expressed by workers in one of our feedback exercises. Trauma Informed Practice A key priority across the social work service is the embedding of trauma informed approaches across both organisational systems and service delivery and to ensure an appropriately skilled workforce in line with the National Trauma Training Plan. Trauma Informed Practice is already embedded in areas of training and service delivery, for example, as integral to the Scottish Child Interview Model which forms the basis for the pan- lanarkshire Joint Investigative Interviewing Team. One of our childcare teams was involved in the national piloting of social work specific training and trauma informed systems and practice are also integral to our work on contextual safeguarding and the subject of a research partnership with the Innovate national research project as well as to the work of the services’ health and wellbeing group. Senior Social Work Managers are Trauma
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61 Champions for the Council and HSCP respectively along with our Principal Educational Psychologist, developing the local steering group and associated plan. Lived Experience As reflected elsewhere in this report the service has benefited significantly from the increased involvement of those with lived experience in training and development activity and from the opportunities created for targeted employment of those with lived experience. Further work is planned to ensure appropriate pathways are available both to this type of role and others within the service and to ensure appropriate support is available for staff with respect to these roles and future career development. a number of Reflective Learning: The Scottish Child Abuse Inquiry/Historical Abuse Reflective learning remains central to continuous professional development and service quality within social work and social care whether through 1-1 supervision or sharing learning from case audits and reviews. One area of focus over the past year has been local learning from work undertaken with respect to the Scottish Abuse Inquiry which has also dovetailed with work around the Promise. Lead officers involved in supporting the inquiry have prepared presentations around key learning which have been delivered to the social work management team and to a range of children and families staff with further inputs planned to adult services and the child protection committee. This is also influencing service improvement in areas as diverse as the planned review of our foster care handbook and management of access to records requests. Support for Staff Wellbeing As reflected across this report demands on staff remain significant and whilst there has been huge resilience within the workforce the level of demand alongside a significant change agenda and the residual impacts of the pandemic are still impacting on the wellbeing of many staff. A range of specific supports have been made available but there is also increasingly within the service a clear need to focus on the support staff need within day-to-day practice and working arrangements to manage and thrive and this clearly links with work around a trauma informed organisation. 5.1 Looking Forward - Priorities for 2022/23 and beyond It is clear from the reflection on delivery of social work and social care contained in this report that the context is likely to remain both complex and challenging over the coming year as both the service and the communities we support continue to be impacted by the legacy of the pandemic and the increasingly significant cost of living crisis. There are clear indications in the demand on all areas of the social work service during 2021/22 of a significant increase in both the volume and complexity of need, which will not be simply transitional, but will carry forward into 2022/23 and beyond, and that challenges in other parts of the public sector, particularly with respect to acute health services, will also continue to impact hugely.
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62 In this context it is sometimes difficult to focus on the strong starting position within North Lanarkshire with respect to our balance of care and the embedding of integrated working across Health and Social Care, the Education and Families Service and the wider Council and Partnership. Whilst this position is likely to be tested by immediate demand pressures it is important that these do not draw focus from a whole system approach and the opportunities to further strengthen this, for example, through the embedding of the Empowering Cluster’s model within Education and Families and of the 3 Conversations Model in Adult Services. Equally, whilst income maximisation and tackling poverty actions have always been a feature of the delivery of social work and social care in North Lanarkshire, it will be more important than ever that these are both broader and fully integrated into day-to-day practice and service delivery given the challenges faced by those we support and the close association between poverty, health inequalities and statutory interventions across all social work care groups and the disproportionate experience of poverty also impacting on unpaid carers. Workforce pressures and issues in social work and social care will require serious and continued attention at both national and local level, both to reduce the risk to the delivery of key statutory responsibilities and the quality of care and support, and to ensure capacity for the continuous improvement and service redesign necessary to improve outcomes. Whilst digital developments will continue to be essential, and create opportunities for wider engagement, as reflected at the start of this report, the visibility of senior managers and opportunities for more informal engagement with staff have been compromised over the last two years and a range of visits and events are planned for early 22/23 which will also provide an important vehicle for staff to come together. A continued focus on working to build trauma informed systems and organisation as well as to strengthen practice in this area will also be fundamental to creating a healthy service which supports staff to deliver well for our communities In addition to the continued opportunities presented by digital and tech solutions within service redesign and improvement, it is anticipated that the conclusion of a tender for a new social work case management system will be completed early in 2022/23. Whilst the transition to this will be complex, take some time and require the support of a robust implementation plan, a new system will be a key support to staff as well as improving service user experience and the measurement of performance/impact. Equally important, for the home support service in particular, will be work to finally secure a strong dynamic scheduling system. External scrutiny, specifically with respect to public protection is likely to feature for the service in the coming year with some inspection programmes previously paused during the pandemic. An adult support and protection inspection is scheduled during the first part of the year and there is the possibility also of an inspection of services to children and young people at risk of harm in the relatively near future. Whilst welcome this will require to be factored into planning given the associated stretch on organisational resource requirements. Similarly, 2022/23 will be a year when significant work will be required around strategic needs assessment and other preparatory work to support the the renewal of key statutory plans due in 2023 including the HSCP’s Strategic Commissioning Plan and
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63 the Children’s Services and Community Justice Plan whilst the Council will also refresh its Programme of Work. Undoubtedly the financial context for service delivery, as for the wider public sector, will also remain challenging and its impact is exacerbated by the growth in demand across all social work care groups. Whilst, as reflected in the resources section of this report, there is considerable focus on financial planning, there remain specific challenges around the short- term nature of additional funding specifically in justice and children’s services and in realising a route to support the aspiration to move a higher proportion of resource upstream. We will however continue to engage in work on this. The context for the delivery of social work services will also clearly continue to be impacted by key national policy drivers including the Promise, the yet to be finalised incorporation of UNRC into Scots Law, the Vision and Strategic Priorities for Justice, and perhaps most significantly by the planning and legislative process for the proposed National Care Service alongside a raft of additional national policy drivers and planned changes in guidance and legislation. Additionally wider and emerging demands on social work services include the now mandatory National Transfer Scheme for Unaccompanied Asylum-Seeking Children and, with the resettlement support needs arising from the tragic war in Ukraine. The overall the scale of change, some of it potentially significantly disruptive, alongside the demand and workforce pressures likely for social work will undoubtedly continue to challenge capacity and in moving forward there will be a need to maintain the benefits of local best practice and partnership working whilst progressing the system transformation required to address longstanding problems and to support better outcomes. Continued strong leadership will be required to avoid staff being overwhelmed and to balance immediate pressures with respect to core service delivery, and the associated risk to those we support, with the change and improvement capacity required for the scale of envisaged over the coming years. As noted in my report last year, and equally true a year on, ‘Social work has the potential to play a key role in shaping system transformation nationally and locally and in ensuring a focus on rights, inclusion and social justice however it is also important that the complexities inherent in the social work task are recognised and that context supports best practice’
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Mr Martin Hill Chair of Lanarkshire Health Board 31st March 2023 Dear Mr Hill, As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct NHS Lanarkshire to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2023/2024 is therefore set out in annexes 1, 2 and 3. NHS Lanarkshire is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (a) The Integration Delivery Principles (b) The Integration Scheme (c) The Strategic Commissioning Plan 2023 - 2026 and Programme of Work (d) The National Health and Wellbeing Outcomes (e) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan at Annex 2. The 2023 – 2026 Strategic Commissioning Plan is the culmination of a significant engagement programme, taking views of patients, service users, carers, staff and Elected Members. was originally developed in 2022/2023 and will continue to be implemented over the course of 2023/2024. The budget allocation for the delegated functions is outlined in annex 4 and reflects the financial planning principles agreed at the IJB on 22 March 2023. The detailed budget setting process for the financial year 2023/2024 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2023. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. 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 Term Financial Plan has been updated and approved at the 22nd March 2023 IJB, providing context in respect of the ongoing financial challenges for both partners and supporting future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019. For completeness, the Health Board are advised that the directions to North Lanarkshire Council continue to correspond to the revised responsibilities delegated to the IJB by North Lanarkshire Council.
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In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high-level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank NHS Lanarkshire for the continued support. We will continue to ensure that Health Board Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ayeshah Khan, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Jann Gardner, Chief Executive, Lanarkshire Health Board. Des Murray, Chief Executive, North Lanarkshire Council;
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DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: LANARKSHIRE HEALTH BOARD 31 MARCH 2023 1. The North Lanarkshire Integration Joint Board is required to give direction1 to Lanarkshire Health Board on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1st April 2019. 2. The North Lanarkshire Integration Joint Board is required to set out in writing2 how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used3. 3. Lanarkshire Health Board must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions4. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs Lanarkshire Health Board: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and commissioning summary as set out in Annex 2; c. that the carrying out of all functions will be delegated to Lanarkshire Health Board on the express understanding that Lanarkshire Health Board will delegate those functions to Officers of the Health Board in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them. Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2023 1 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 2 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 3 Section 27(1)(a),(b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 4 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function Column B Limitation The National Health Service (Scotland) Act 1978 All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB( (Functions of Health Boards outside Scotland); section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal medical or dental services); section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 (care of mothers and young children); section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation); section 55 (hospital accommodation on part payment); section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses); section 75B (reimbursement of the cost of services provided in another EEA state);
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section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114; The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135; The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183;
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The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. Except functions conferred by— section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co- operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital); section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer); section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall); section 281 (Correspondence of certain persons detained in hospital);
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and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions). Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36.
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Part 2 Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004; and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine; (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided outwith a hospital in relation to an addiction or dependence on any substance. 10. Services provided by allied health professionals in an outpatient department, clinic, or outwith a hospital. 11. The public dental service.
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12. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C(2) of the National Health Service (Scotland) Act 1978. 13. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 14. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 15. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 16. Services providing primary medical services to patients during the out-of-hours period. 17. Services provided outwith a hospital in relation to geriatric medicine. 18. Palliative care services provided outwith a hospital. 19. Community learning disability services. 20. Mental health services provided outwith a hospital. 21. Continence services provided outwith a hospital. 22. Kidney dialysis services provided outwith a hospital. 23. Services provided by health professionals that aim to promote public health.
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NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 and the Programme of Work are both available on the following web-site: Insert link following 22nd March IJB 2023 meeting
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SCHEME OF DELEGATIONS ANNEX 3 That the carrying out of integrated functions that relate to the services set out in 1 and 2 below will be delegated to Officers of Lanarkshire Health Board by the Chief Executive of Lanarkshire Health Board at his discretion, in accordance with all applicable legal requirements; 1. Accident and emergency services provided in a hospital; 2. Inpatient hospital services relating to the following branches of medicine: General medicine; Geriatric medicine; Rehabilitation medicine; Respiratory medicine; Palliative care services provided in a hospital; That the carrying out of integrated functions that relate to the services set out in 3 to 29 below will be delegated to Officers of Lanarkshire Health Board by the Chief Officer for the Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 3. Inpatient hospital services relating to the following branches of medicine: Paediatrics; Psychiatry of learning disability; Inpatient hospital services provided by general medical practitioners; Services provided in a hospital in relation to an addiction or dependence on any substance; Mental health services provided in a hospital except regionally or nationally organised forensic mental health services. 4. District nursing services; 5. Health Visiting; 6. Allied health professionals in an outpatient department, clinic, or out with a hospital; 7. Public dental services; 8. Primary medical services; 9. General dental services; 10. Ophthalmic services; 11. Pharmaceutical services; 12. Primary care out-of-hours; 13. Geriatric medicine; 14. Palliative care; 15. Community learning disability services; 16. Kidney dialysis services provided out with a hospital; 17. Services provided by health professionals that aim to promote public health; 18. Care Home Liaison; 19. Community Children’s Services; 20. Dietetics; 21. Psychology; 22. Sexual and Reproductive health and Blood Borne Viruses; 23. Speech and Language Therapy;
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24. Prisoner Health Care; 25. Podiatry; 26. Mental Health and Learning Disability services; 27. Community Paediatrics; 28. Continence Services; 29. Addiction Services. That the carrying out of integrated functions that relate to the services set out in 30 to 38 below will be delegated to Officers of Lanarkshire Health Board by the Chief Officer for the South Lanarkshire Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 30. Community Dental Services; 31. Diabetes Services; 32. Health & Homelessness; 33. Primary Care Administration; 34. Palliative Care; 35. Physiotherapy; 36. GP Out of Hours; 37. Traumatic Brain injury; 38. Occupational Therapy.
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BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to NHS Lanarkshire (NHSL) for the financial year 2023/2024 are as follows: 1. The NHSL recurring budget allocations for in-scope health care services including hosted services. For 2023/2024, based on the budget as at January 2023, the total allocation for directly managed services, including hosted services, is £549.671m. This also includes the notional set-aside budget which was increased in 2022/2023 by budget adjustments of £1.694m from £65.164m to £66.858m. The notional set-aside budget is updated at paragraph 2. It also includes non-recurring funding as at January 2023. The financial allocation will also be subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets will be confirmed following the detailed budget setting process for 2023/2024. Non-recurring budgets will be adjusted as appropriate as part of this exercise. 2. In respect of the Acute Hospital Services delegated to the IJB, the notional set-aside budget will increase by additional adjustments in 2022/2023 of £2.224m and the 2% inflation uplift for 2023/2024 of £1.382m to £70.464m. 3. Excluding the uplift on the resource transfer, social care fund, delayed discharge fund and integrated fund (£1.062m) allocated to NLC, the uplift to NHSL Acute Services in respect of the notional set-aside services (£1.382m), funding of approximately £4.771m will be allocated to NHSL in 2023/2024 to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the implementation of the Primary Care Improvement Plan, the Mental Health Services Strategy Action 15 and the Alcohol and Drug Partnership initiatives. 4. NHSL will implement as appropriate agreed efficiency savings plans in 2023/2024. 5. Additional non-recurring funding received in-year from NHSL which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 6. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2023/2024 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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Councillor Jim Logue Leader of North Lanarkshire Council 31st March 2023 Dear Councillor Logue As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct North Lanarkshire Council to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2023/2024 is therefore set out in annexes 1, 2 and 3. North Lanarkshire Council is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (a) The Integration Delivery Principles (b) The Integration Scheme (c) The Strategic Commissioning Plan 2023 - 2026 and Programme of Work (d) The National Health and Wellbeing Outcomes (e) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan at Annex 2. The 2023 – 2026 Strategic Commissioning Plan is the culmination of a significant engagement programme, taking views of patients, service users, carers, staff and Elected Members, was originally developed in 2022/2023 and will continue to be implemented over the course of 2023/2024. The budget allocation for the delegated functions is outlined in annex 4 and reflects the financial planning principles agreed at the IJB on 22 March 2023. The detailed budget setting process for the financial year 2023/2024 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2023. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. 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 Term Financial Plan has been updated and approved at the 22nd March 2023 IJB, providing context in respect of the ongoing financial challenges for both partners and supporting future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019. The directions correspond to the revised responsibilities delegated to the IJB which exclude Children and Family Services and Justice Services.
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In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high-level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank North Lanarkshire Council for the continued support. We will continue to ensure that Elected Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ayeshah Khan, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Des Murray, Chief Executive, North Lanarkshire Council; Jann Gardner, Chief Executive, Lanarkshire Health Board.
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DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: NORTH LANARKSHIRE COUNCIL 31 MARCH 2023 1. The North Lanarkshire Integration Joint Board is required to give direction1 to North Lanarkshire Council on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1 April 2019. 2. The North Lanarkshire Integration Joint Board is required to set out in writing2 how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used3. 3. North Lanarkshire Council must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions4. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs North Lanarkshire Council: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and programme of work as set out in Annex 2; c. that the carrying out of all functions will be delegated to North Lanarkshire Council on the express understanding that North Lanarkshire Council will delegate those functions to Officers of the Council in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them. Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2023 1 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 2 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 3 Section 27(1)(a),(b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 4 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Column A Enactment conferring function Column B Limitation National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45 (Recovery in cases of misrepresentation or non-disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 (Powers of Secretary of State.) So far as it is exercisable in relation to another integration function. Section 8 (Research.) So far as it is exercisable in relation to another integration function. Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function.
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Column A Enactment conferring function Column B Limitation Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.)
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Column A Enactment conferring function Column B Limitation Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) Section 80 (Enforcement of duty to make contributions.) Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) So far as it is exercisable in relation to another integration function. The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.)
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Column A Enactment conferring function Column B Limitation Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions. The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Section 12 (Investigations.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.) Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions
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Column A Enactment conferring function Column B Limitation The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation outwith Scotland.) Section 6 Deferred payment of accommodation costs.) Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co-operation.)
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Column A Enactment conferring function Column B Limitation Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.) Section 259 (Advocacy.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.) Section 6 (Duty to consider importance of providing advocacy and other.) Section 7 (Visits) Section 8 (Interviews) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk) Section 18 (Protection of moved persons property.) Section 22 (Right to apply for a banning order.)
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Column A Enactment conferring function Column B Limitation Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.) Section 43 (Membership.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.) Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013 . Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self-directed support.) Carers (Scotland) Act 2016 (b)
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Column A Enactment conferring function Column B Limitation Section 6 (Duty to provide Adult carer support plan) Section 21 (Duty to set local eligibility criteria) Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers) Section 35 (short breaks services statements) Part 2 Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services; h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services;
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q) Re-ablement services; R) Smart technology, equipment and telecare.
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NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2023 – 2026 and the Programme of Work are both available on the following web-site: Insert link following 22nd March IJB 2023 meeting
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SCHEME OF DELEGATION TO OFFICERS OF NORTH LANARKSHIRE COUNCIL ANNEX 3 This is the Appendix 1 referred to in the foregoing Authorisation of the Chief Officer to Officers of North Lanarkshire Council Column A Enactment conferring function Column B Limitation Column C National Assistance Act 1948 Section 48 (Duty of Councils to provide temporary protection for property of persons admitted to hospitals etc). Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Provisions relating to performance of functions by local authorities.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Research.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 Except in so far as it is exercisable in relation to Chief Social Work Officer Chief Officer
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Column A Enactment conferring function Column B Limitation Column C (General social welfare services of local authorities.) the provision of housing support services. Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AZA (Assessments under Section 12A – assistance) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AA (Assessment of ability to provide care.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AB (Duty of local authority to provide information to carer.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13A (Residential accommodation with nursing.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13B Chief Social Work Officer Chief Officer
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Column A Enactment conferring function Column B Limitation Column C (Provision of care or aftercare.) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Home help and laundry facilities.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Chief Social Work Officer Chief Officer Head of Housing Property Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 3 Chief Social Work Officer Chief Officer
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Column A Enactment conferring function Column B Limitation Column C (Assessment by local authorities of needs of disabled persons.) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of Section 16 and which have been delegated. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in Section 16 of that Act) which are integration functions. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Investigations.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 41 Only in relation to residents of Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Duties and functions of managers of authorised establishment.) establishments which are managed under integration functions. Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered social landlord for housing purposes.) Only in so far as it relates to an aid or adaptation. Head of Housing Services Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 5 (Local authority arrangements for of residential accommodation outwith Scotland.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Payments by local authorities towards expenditure by NHS Chief Social Work Officer Chief Officer
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Column A Enactment conferring function Column B Limitation Column C bodies on prescribed functions.) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 33 (Duty to inquire.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 34 (Inquiries under Section 33: Co-operation.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 228 (Request for assessment of needs: duty on local authorities and Health Boards Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 259 (Advocacy.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Head of Housing Services The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Co-operation.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Duty to consider importance of providing advocacy and other.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Assessment Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Removal Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 18 (Protection of moved persons property.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Right to apply for a Banning Order.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Urgent cases.) Chief Social Work Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 42 (Adult Protection Committees.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 43 (Membership.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Choice of options: Adults.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Choice of options under Section 5: assistances.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Choice of options: Adult Carers.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Provision of information about self-directed support.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Local authority functions.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Section 12 (Eligibility for direct payment: review.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under Section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Misuse of direct payment: recovery.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Promotion of options for self- directed support.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services National Assistance Act 1948 Section 45 (Recovery in cases of misrepresentation or non- disclosure) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Matrimonial Proceedings (Children) Act 1958 Section 11 (Reports as to arrangements for future care and upbringing of children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 5 (Powers of Secretary of State) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6B (Local authority inquiries into matters affecting children). Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 78A (Recovery of contributions) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Enforcement of duty to make contributions) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 81 (Provisions as to decrees for ailment) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 83 (Variation of trusts) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 86 (Adjustment between authority providing accommodation etc. and authority of area of residence) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children Act 1975 Section 34 (Access and maintenance) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Reports by local authorities and probation officers) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Notice of application to be given to local authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 50 (Payments towards maintenance of children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Health and Social Services and Social Security Adjudications Act 1983 Section 21 (Recovery of sums due to local authority where persons in residential accommodation have disposed of assets) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Section 22 (Arrears of contributions charged on interest in land in England and Wales) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Arrears of contributions secured over interest in land in Scotland) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Foster Children (Scotland) Act 1984 Section 3 (Local authorities to ensure well being of and to visit foster children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Notification by persons maintaining or proposing to maintain foster children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Notification by persons ceasing to maintain foster children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Power to inspect premises) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Power to impose requirements as to the keeping of foster children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Power to prohibit the keeping of foster children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services The Children (Scotland) Act 1995 Section 17 (Duty of local authority to child looked after by them) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Local authority plans for services for children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 20 (Publication of information about services for children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 21 (Co-operation between authorities) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Promotion of welfare of children in need) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Children affected by disability) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24 (Assessment of ability of carers to provide care for disabled children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Section 24A (Duty of local authority to provide information to carer of disabled child) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 (Provision of accommodation for children etc.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Manner of provision of accommodation to child looked after by local authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26A (Provision of continuing care: looked after children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Daycare for pre-school and other children) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Aftercare) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 30 (Financial assistance towards expenses of education or training and removal of power to guarantee indentures etc.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 31 (Review of case of child looked after by local authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Section 32 (Removal of child from residential establishment) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 36 (Welfare of certain children in hospitals and nursing homes etc.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 38 (Short term refuges for children at risk of harm) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 76 (Exclusion orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Criminal Procedure (Scotland) Act 1995 Section 51 (Remand and committal of children and young persons) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 203 (Reports) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 234B (Drug treatment and testing order) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 245A (Restriction of liberty orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services The Adults with Incapacity (Scotland) Act 2000 Section 40 (Supervisory bodies) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 (Accommodation more expensive than usually provided) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Deferred payment of accommodation costs) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Management of Offenders etc. (Scotland) Act 2005 Sections 10 (Arrangements for assessing and managing risks posed by certain offenders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Review of arrangements) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Adoption and Children (Scotland) Act 2007 Section 1 (Duty of local authority to provide adoption service) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Local authority plan) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 5 (Guidance) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Assistance in carrying out functions under sections 1 and 4) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Assessment of needs for adoption support services) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of services) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Urgent provision) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Power to provide payment to person entitled to adoption support service) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Notice under Section 18 local authorities duties) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Looked after children - adoption is not proceeding) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 45 (Adoption support plans) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 47 (Family member’s right to require review of plan) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Other cases where authority under duty to review plan) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Re-assessment of needs for adoption support services) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 51 (Guidance) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 71 (Adoption allowance schemes) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Permanence Orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 90 (Precedence of certain other orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 99 (Duty of local authority to apply for variation or revocation) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 101 (Local authority to give notice of certain matters) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 105 (Notification of proposed application for order) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adult Support and Protection (Scotland) Act 2007 Section 7 (Visits) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Interviews) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Medical examination) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Examination of records etc.) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Right to remove adult at risk) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Children’s Hearings (Scotland) Act 2011 Section 35 (Child assessment orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Child protection orders) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Parental responsibilities and rights directions) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Obligations of local authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Application for variation or termination) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Notice of an application for variation or termination) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 60 (Local authorities duty to provide information to Principal Reporter) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 131 (Duty of implementation authority to require review) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 144 (Implementation of a compulsory supervision order: general duties of implementation authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 145 (Duty where order requires child to reside in a certain place) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 153 (Secure accommodation regulations) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 166 (Review of requirement imposed on local authority) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 167 (Appeal to Sheriff Principal: section 166) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 180 (Sharing of information: panel members) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 183 (Mutual Assistance) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 184 (Enforcement of obligations of health board under section 183) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 8 (Choice of options: children and family members) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of information: children under 16) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002) Chief Social Work Officer Chief Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to North Lanarkshire Council (NLC) for the financial year 2023/2024 are as follows: 1. The NLC recurring budget allocations for in-scope social care services and housing services. For 2022/2023, the total allocation is £188.180 million based on the net budget as at January 2023. This budget will be uplifted as appropriate to reflect the 2023/2024 additional funding of £6.107 million, subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets, including agreed budget realignments, will be confirmed following the detailed budget setting process for 2023/2024. 2. The additional funding highlighted at paragraph 1 includes the uplift on the resource transfer, social care fund, delayed discharge fund and integrated fund totalling £1.062m. The additional funding allocated to NLC in 2023/2024 is to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the uplift of the free personal care rate and the contribution to the payment of the Scottish Living Wage. 3. NLC will implement as appropriate any agreed efficiency savings plans, budget realignments and management actions for 2023/2024 as detailed in the IJB Financial Plan 2023/2024. 4. Additional funding received in-year by the NLC and NHSL partners which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 5. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2023/2024 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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REPORT Item No: 20 SUBJECT: IJB Directions 2023/2024 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Financial Officer DATE: 22nd March 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) for: For approval For endorsement To note 1.2 This report:- (1) Seeks the approval of the IJB for the issue of the directions to each partner for 2023/2024 in line with the new Strategic Commissioning Plan 2023-26 and the IJB Financial Plan 2023/2024. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Approve the issue of the directions to North Lanarkshire Council for the financial year 2023/2024 attached at appendix 1; and (2) Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2023/2024 attached at appendix 2. 4. VARIATIONS TO DIRECTIONS The directions to each partner for 2023/2024 are attached as appendices to this report. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board is required to issue a direction to Lanarkshire NHS Health Board and North Lanarkshire Council in respect of the delivery of integrated functions and how resources are to be allocated for the resultant services. Yes No N/A
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6. CONCLUSIONS 6.1 The letters of direction are attached at appendices 1 and 2 and, following the approval of the IJB, will be issued to North Lanarkshire Council and Lanarkshire Health Board by 31st March 2023. 6.2 The focus for the year ahead will be on implementation of the year 1 programme of work of the IJB’s new Strategic Commissioning Plan, 2023-26. 6.3 The financial resources available are detailed in annex 4 of each direction. The budget for 2023/24 is indicative at this stage. A range of estimates have been agreed the Director of Finance of NHSL and the Head of Financial Solutions of NLC in respect of the preparation of the IJB Financial Plan 2023/2024 which will be updated during the course of 2023/2024 when costs and additional funding, as appropriate, are confirmed. As part of the detailed budget setting process, the financial allocations to each partner will therefore be finalised by the IJB Chief Financial Officer, in consultation with the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions for North Lanarkshire Council. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A comprehensive performance framework is established across the health and social care partnership to monitor progress in respect of the achievement of agreed outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Budget monitoring reports will be submitted to the Performance, Finance and Audit Committee and the IJB in accordance with the Financial Regulations. 7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks are detailed in the IJB Risk Register and are reported separately to the IJB. 7.5 PEOPLE None. 7.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the issue of IJB Directions in line with the IJB Financial Plan. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS None.
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9. APPENDICES Letter of Direction – North Lanarkshire Council Appendix 1 Letter of Direction – Lanarkshire Health Board Appendix 2 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 858 143.
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Appendix 1 Councillor Jim Logue Leader of North Lanarkshire Council 31st March 2023 Dear Councillor Logue As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct North Lanarkshire Council to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2023/2024 is therefore set out in annexes 1, 2 and 3. North Lanarkshire Council is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (a) The Integration Delivery Principles (b) The Integration Scheme (c) The Strategic Commissioning Plan 2023 - 2026 (d) The National Health and Wellbeing Outcomes (e) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2023/2024. The budget allocation for the delegated functions is outlined in annex 4 and reflects the financial planning principles agreed at the IJB on 22 March 2023. The detailed budget setting process for the financial year 2023/2024 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2023. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. 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 will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019. The directions correspond to the revised responsibilities delegated to the IJB which exclude Children and Family Services and Justice Services.
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In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high-level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead. On behalf of the officers across the partnership, I would like to thank North Lanarkshire Council for the continued support during this period of significant change. We will continue to ensure that Elected Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ayeshah Khan, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Des Murray, Chief Executive, North Lanarkshire Council; Jann Gardner, Chief Executive, Lanarkshire Health Board.
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DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: NORTH LANARKSHIRE COUNCIL 31 MARCH 2023 1. The North Lanarkshire Integration Joint Board is required to give direction1 to North Lanarkshire Council on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1 April 2019. 2. The North Lanarkshire Integration Joint Board is required to set out in writing2 how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used3. 3. North Lanarkshire Council must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions4. 4. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs North Lanarkshire Council: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and programme of work as set out in Annex 2; c. that the carrying out of all functions will be delegated to North Lanarkshire Council on the express understanding that North Lanarkshire Council will delegate those functions to Officers of the Council in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 5. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them. Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2023 1 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 2 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 3 Section 27(1)(a),(b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 4 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Column A Enactment conferring function Column B Limitation National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45 (Recovery in cases of misrepresentation or non-disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 (Powers of Secretary of State.) So far as it is exercisable in relation to another integration function. Section 8 (Research.) So far as it is exercisable in relation to another integration function. Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services.
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Column A Enactment conferring function Column B Limitation Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) So far as it is exercisable in relation to another integration function.
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Column A Enactment conferring function Column B Limitation Section 80 (Enforcement of duty to make contributions.) Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions.
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Column A Enactment conferring function Column B Limitation The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Section 12 (Investigations.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.) Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002
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Column A Enactment conferring function Column B Limitation Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation outwith Scotland.) Section 6 Deferred payment of accommodation costs.) Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co-operation.) Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.) Section 259 (Advocacy.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007
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Column A Enactment conferring function Column B Limitation Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.) Section 6 (Duty to consider importance of providing advocacy and other.) Section 7 (Visits) Section 8 (Interviews) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk) Section 18 (Protection of moved persons property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.) Section 43 (Membership.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.)
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Column A Enactment conferring function Column B Limitation Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013 . Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self-directed support.) Carers (Scotland) Act 2016 (b) Section 6 (Duty to provide Adult carer support plan) Section 21 (Duty to set local eligibility criteria) Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers)
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Column A Enactment conferring function Column B Limitation Section 35 (short breaks services statements) Part 2 Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services; h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services; q) Re-ablement services; R) Smart technology, equipment and telecare.
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NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2020 – 2023 and the Programme of Work are both available on the following web-site: https://mars.northlanarkshire.gov.uk/egenda/public/kab71.pl?cmte=HJI The relevant meeting is Tuesday 24 March 2020 and the agenda item number is 3 entitled Strategic Commissioning Plan 2020 – 2023 and Programme of Work. The progress report on the Remobilisation Plan and the update in respect of the Programme of Work for the North Lanarkshire Health and Social Care Partnership is available on the following web-site: att95922.pdf (northlanarkshire.gov.uk) The relevant meeting is Tuesday 23 March 2021 and the agenda item number is 9 entitled Remobilisation Plan 2021-22 and SCP Programme of Work 2020-23. The report outlining the Winter Planning and Enhanced Supports – Business Case For North Lanarkshire Health and Social Care Partnership is available on the following web-site: att97950.pdf (northlanarkshire.gov.uk) The relevant meeting is Wednesday 16 February 2022 and the agenda item number is 5 entitled Winter Planning and Enhanced Supports – Business Case For North Lanarkshire.
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SCHEME OF DELEGATION TO OFFICERS OF NORTH LANARKSHIRE COUNCIL ANNEX 3 This is the Appendix 1 referred to in the foregoing Authorisation of the Chief Officer to Officers of North Lanarkshire Council Column A Enactment conferring function Column B Limitation Column C National Assistance Act 1948 Section 48 (Duty of Councils to provide temporary protection for property of persons admitted to hospitals etc). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Provisions relating to performance of functions by local authorities.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Research.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AZA (Assessments under Section 12A – assistance) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AA (Assessment of ability to provide care.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12AB (Duty of local authority to provide information to carer.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13A (Residential accommodation with nursing.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13B (Provision of care or aftercare.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Home help and laundry facilities.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) So far as it is exercisable in relation to another integration function. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.) Chief Social Work Officer Chief Accountable Officer Head of Housing Property Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 3 (Assessment by local authorities of needs of disabled persons.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C welfare enactments within the meaning of Section 16 and which have been delegated. Head of Adult Social Work Services Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in Section 16 of that Act) which are integration functions. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adults with Incapacity (Scotland) Act 2000 Section 10 (Functions of local authorities.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Investigations.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Section 43 (Statement of resident’s affairs.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered social landlord for housing purposes.) Only in so far as it relates to an aid or adaptation. Head of Housing Services Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 5 (Local authority arrangements for of residential accommodation outwith Scotland.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 Except in so far as it is exercisable in relation to Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Care and support services etc.) the provision of housing support services. Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Services designed to promote well-being and social development.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 33 (Duty to inquire.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 34 (Inquiries under Section 33: Co- operation.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 228 (Request for assessment of needs: duty on local authorities and Health Boards Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 259 (Advocacy.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Head of Housing Services The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Co-operation.) Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Duty to consider importance of providing advocacy and other.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Assessment Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 14 (Removal Orders.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 18 (Protection of moved persons property.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Right to apply for a Banning Order.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Urgent cases.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 (Adult Protection Committees.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 43 (Membership.) Chief Social Work Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Choice of options: Adults.) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Choice of options under Section 5: assistances.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 7 (Choice of options: Adult Carers.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Provision of information about self-directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Local authority functions.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Eligibility for direct payment: review.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under Section 5 or 7 of the Social Care (Self-directed Support) (Scotland) Act 2013. Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Misuse of direct payment: recovery.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Promotion of options for self- directed support.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services National Assistance Act 1948 Section 45 (Recovery in cases of misrepresentation or non- disclosure) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Matrimonial Proceedings (Children) Act 1958 Section 11 (Reports as to arrangements for future care and upbringing of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Social Work (Scotland) Act 1968 Section 5 (Powers of Secretary of State) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6B (Local authority inquiries into matters affecting children). Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Supervision and care of persons put on probation or released from prisons etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 78A Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Recovery of contributions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Enforcement of duty to make contributions) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 81 (Provisions as to decrees for ailment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 83 (Variation of trusts) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 86 (Adjustment between authority providing accommodation etc. and authority of area of residence) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children Act 1975 Section 34 (Access and maintenance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 39 (Reports by local authorities and probation officers) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 40 (Notice of application to be given to local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 50 (Payments towards maintenance of children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Health and Social Services and Social Security Adjudications Act 1983 Section 21 (Recovery of sums due to local authority where persons in residential accommodation have disposed of assets) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Arrears of contributions charged on interest in land in England and Wales) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Arrears of contributions secured over interest in land in Scotland) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Foster Children (Scotland) Act 1984 Section 3 (Local authorities to ensure well being of and to visit foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Notification by persons maintaining or proposing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Notification by persons ceasing to maintain foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Power to inspect premises) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Power to impose requirements as to the keeping of foster children) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Power to prohibit the keeping of foster children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Children (Scotland) Act 1995 Section 17 (Duty of local authority to child looked after by them) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Local authority plans for services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 20 (Publication of information about services for children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 21 (Co-operation between authorities) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 22 (Promotion of welfare of children in need) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 23 (Children affected by disability) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24 Chief Social Work Officer Chief Accountable Officer
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Column A Enactment conferring function Column B Limitation Column C (Assessment of ability of carers to provide care for disabled children) Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 24A (Duty of local authority to provide information to carer of disabled child) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 25 (Provision of accommodation for children etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Manner of provision of accommodation to child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26A (Provision of continuing care: looked after children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 27 (Daycare for pre-school and other children) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 29 (Aftercare) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 30 (Financial assistance towards expenses of education or training and removal of power to guarantee indentures etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 31 (Review of case of child looked after by local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 32 (Removal of child from residential establishment) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 36 (Welfare of certain children in hospitals and nursing homes etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 38 (Short term refuges for children at risk of harm) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 76 (Exclusion orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Criminal Procedure (Scotland) Act 1995 Section 51 (Remand and committal of children and young persons) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 203 (Reports) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 234B (Drug treatment and testing order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 245A (Restriction of liberty orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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Column A Enactment conferring function Column B Limitation Column C The Adults with Incapacity (Scotland) Act 2000 Section 40 (Supervisory bodies) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Community Care and Health (Scotland) Act 2002 Section 4 (Accommodation more expensive than usually provided) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 6 (Deferred payment of accommodation costs) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Management of Offenders etc. (Scotland) Act 2005 Sections 10 (Arrangements for assessing and managing risks posed by certain offenders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Review of arrangements) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Adoption and Children (Scotland) Act 2007 Section 1 (Duty of local authority to provide adoption service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (Local authority plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 5 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 6 (Assistance in carrying out functions under sections 1 and 4) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 11 (Urgent provision) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 12 (Power to provide payment to person entitled to adoption support service) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 19 (Notice under Section 18 local authorities duties) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 26 (Looked after children - adoption is not proceeding) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 45 (Adoption support plans) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 47 Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Family member’s right to require review of plan) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Other cases where authority under duty to review plan) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Re-assessment of needs for adoption support services) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 51 (Guidance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 71 (Adoption allowance schemes) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 80 (Permanence Orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 90 (Precedence of certain other orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 99 (Duty of local authority to apply for variation or revocation) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 101 (Local authority to give notice of certain matters) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 105 (Notification of proposed application for order) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services The Adult Support and Protection (Scotland) Act 2007 Section 7 (Visits) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 8 (Interviews) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 9 (Medical examination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Examination of records etc.) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 16 (Right to remove adult at risk) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Children’s Hearings (Scotland) Act 2011 Section 35 (Child assessment orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 37 (Child protection orders) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 42 Chief Social Work Officer
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Column A Enactment conferring function Column B Limitation Column C (Parental responsibilities and rights directions) Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 44 (Obligations of local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 48 (Application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 49 (Notice of an application for variation or termination) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 60 (Local authorities duty to provide information to Principal Reporter) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 131 (Duty of implementation authority to require review) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 144 (Implementation of a compulsory supervision order: general duties of implementation authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 145 (Duty where order requires child to reside in a certain place) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 153 (Secure accommodation regulations) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services
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Column A Enactment conferring function Column B Limitation Column C Head of Adult Social Work Services Section 166 (Review of requirement imposed on local authority) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 167 (Appeal to Sheriff Principal: section 166) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 180 (Sharing of information: panel members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 183 (Mutual Assistance) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 184 (Enforcement of obligations of health board under section 183) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Social Care (Self-directed Support) (Scotland) Act 2013 Section 8 (Choice of options: children and family members) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 10 (Provision of information: children under 16) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services Section 4 (The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002) Chief Social Work Officer Chief Accountable Officer Head of Children Families and Justice Social Work Services Head of Adult Social Work Services
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BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to North Lanarkshire Council (NLC) for the financial year 2023/2024 are as follows: 1. The NLC recurring budget allocations for in-scope social care services and housing services. For 2022/2023, the total allocation is £188.180 million based on the net budget as at January 2023. This budget will be uplifted as appropriate to reflect the 2023/2024 additional funding of £6.107 million, subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets, including agreed budget realignments, will be confirmed following the detailed budget setting process for 2023/2024. 2. The additional funding highlighted at paragraph 1 includes the uplift on the resource transfer, social care fund, delayed discharge fund and integrated fund totalling £1.062m. The additional funding allocated to NLC in 2023/2024 is to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the uplift of the free personal care rate and the contribution to the payment of the Scottish Living Wage. 3. NLC will implement as appropriate any agreed efficiency savings plans, budget realignments and management actions for 2023/2024 as detailed in the IJB Financial Plan 2023/2024. 4. Additional funding received in-year by the NLC and NHSL partners which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 5. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2023/2024 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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Appendix 2 Mr Martin Hill Chair of Lanarkshire Health Board 31st March 2023 Dear Mr Hill, As part of the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board (IJB) is required to continue to direct NHS Lanarkshire to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year. The direction from the IJB for the financial year 2022/2023 is therefore set out in annexes 1, 2 and 3. NHS Lanarkshire is directed to continue to carry out the delegated functions and deliver services in a way which complies with and achieves the following: (f) The Integration Delivery Principles (g) The Integration Scheme (h) The Strategic Commissioning Plan 2020 - 2023 and Programme of Work (i) The National Health and Wellbeing Outcomes (j) All legal and regulatory requirements This direction will remain in force until it is varied, revoked or superseded by a later direction in respect of the same function. A summary of our commissioning intentions are outlined in our Strategic Commissioning Plan and Programme of Work at Annex 2. This was originally developed in 2022/2023 and will continue to be implemented over the course of 2023/2024. The budget allocation for the delegated functions is outlined in annex 4 and reflects the financial planning principles agreed at the IJB on 22 March 2023. The detailed budget setting process for the financial year 2023/2024 is being finalised. Once this work has been completed, the IJB will issue a further direction confirming the final budget. This should be concluded by no later than 30 June 2023. The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. 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 will be updated to provide context in respect of the ongoing financial challenges for both partners and to support future shared priorities. The Integration Scheme was revised and approved effective from 1 April 2019. For completeness, the Health Board are advised that the directions to North Lanarkshire Council continue to correspond to the revised responsibilities delegated to the IJB by North Lanarkshire Council. In order to monitor the progress of integration, a comprehensive performance framework has been established. This framework reports on the nine national high-level outcomes, the twenty-three associated indicators, the six Measuring Performance Under Integration indicators and the set of locally developed performance measures. This framework will continue to embed a positive performance culture across the partnership. Performance reports will continue to be available to the IJB in the year ahead.
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On behalf of the officers across the partnership, I would like to thank NHS Lanarkshire for the continued support during this period of significant change. We will continue to ensure that Health Board Members, officials and stakeholders are fully involved over the forthcoming year in the implementation of our commissioning intentions to improve the health and wellbeing outcomes for the people of North Lanarkshire. Yours sincerely Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Cc. Cllr Ayeshah Khan, Chair, North Lanarkshire Integration Joint Board; Martin Hill, Chair, Lanarkshire Health Board; Jann Gardner, Chief Executive, Lanarkshire Health Board. Des Murray, Chief Executive, North Lanarkshire Council;
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DIRECTIONS UNDER SECTION 26 OF THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 TO: LANARKSHIRE HEALTH BOARD 31 MARCH 2023 6. The North Lanarkshire Integration Joint Board is required to give direction5 to Lanarkshire Health Board on the carrying out of the functions delegated to it through the North Lanarkshire Integration Scheme as approved by the Scottish Ministers effective from 1st April 2019. 7. The North Lanarkshire Integration Joint Board is required to set out in writing6 how these functions are to be carried out and detail the financial resources that are available for carrying out the functions that are subject to these directions, including the allocated budget and how that budget is to be used7. 8. Lanarkshire Health Board must comply with the directions that are issued by the North Lanarkshire Integration Joint Board in respect of integrated functions8. 9. Pursuant to the powers under Section 26 of the 2014 Act, the North Lanarkshire Integration Joint Board directs Lanarkshire Health Board: a. that these directions relate to the functions and resultant services as set out in Annex 1; b. to carry out all integrated functions in line with the North Lanarkshire Integration Joint Board strategic plan and commissioning summary as set out in Annex 2; c. that the carrying out of all functions will be delegated to Lanarkshire Health Board on the express understanding that Lanarkshire Health Board will delegate those functions to Officers of the Health Board in accordance with the scheme of delegations set out in Annex 3 of this direction; d. that resources will be allocated to services as set out in Annex 4. 10. These directions shall remain in force until such time as the North Lanarkshire Integration Joint Board considers it appropriate to amend, revoke or supersede them. Signed on behalf of the North Lanarkshire Integration Joint Board Ross McGuffie Chief Officer North Lanarkshire Integration Joint Board Date: 31 March 2023 5 Section 26(1); Public Bodies (Joint Working) (Scotland) Act 2014. 6 Section 27(5)(b); Public Bodies (Joint Working) (Scotland) Act 2014. 7 Section 27(1)(a),(b) & (c); Public Bodies (Joint Working) (Scotland) Act 2014. 8 Section 27(4); Public Bodies (Joint Working) (Scotland) Act 2014.
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FUNCTIONS AND SERVICES ANNEX 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function Column B Limitation The National Health Service (Scotland) Act 1978 All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB( (Functions of Health Boards outside Scotland); section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal medical or dental services); section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 (care of mothers and young children); section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation); section 55 (hospital accommodation on part payment); section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses); section 75B (reimbursement of the cost of services provided in another EEA state); section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013);
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section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114; The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135; The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183; The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986
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Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. Except functions conferred by— section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co- operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital); section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer); section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall); section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and
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The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions). Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36.
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Part 2 Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004; and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine; (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided outwith a hospital in relation to an addiction or dependence on any substance. 10. Services provided by allied health professionals in an outpatient department, clinic, or outwith a hospital. 11. The public dental service.
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12. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C(2) of the National Health Service (Scotland) Act 1978. 13. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 14. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 15. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 16. Services providing primary medical services to patients during the out-of-hours period. 17. Services provided outwith a hospital in relation to geriatric medicine. 18. Palliative care services provided outwith a hospital. 19. Community learning disability services. 20. Mental health services provided outwith a hospital. 21. Continence services provided outwith a hospital. 22. Kidney dialysis services provided outwith a hospital. 23. Services provided by health professionals that aim to promote public health.
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NORTH LANARKSHIRE IJB STRATEGIC COMMISSIONING PLAN AND PROGRAMME OF WORK ANNEX 2 The North Lanarkshire IJB Strategic Commissioning Plan 2020 – 2023 is available on the following web-site: https://mars.northlanarkshire.gov.uk/egenda/public/kab71.pl?cmte=HJI The relevant meeting is Tuesday 22 March 2023 and the agenda item entitled Strategic Commissioning Plan 2023 – 2026.
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SCHEME OF DELEGATIONS ANNEX 3 That the carrying out of integrated functions that relate to the services set out in 1 and 2 below will be delegated to Officers of Lanarkshire Health Board by the Chief Executive of Lanarkshire Health Board at his discretion, in accordance with all applicable legal requirements; 1. Accident and emergency services provided in a hospital; 2. Inpatient hospital services relating to the following branches of medicine: General medicine; Geriatric medicine; Rehabilitation medicine; Respiratory medicine; Palliative care services provided in a hospital; That the carrying out of integrated functions that relate to the services set out in 3 to 29 below will be delegated to Officers of Lanarkshire Health Board by the Chief Accountable Officer for the Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 3. Inpatient hospital services relating to the following branches of medicine: Paediatrics; Psychiatry of learning disability; Inpatient hospital services provided by general medical practitioners; Services provided in a hospital in relation to an addiction or dependence on any substance; Mental health services provided in a hospital except regionally or nationally organised forensic mental health services. 4. District nursing services; 5. Health Visiting; 6. Allied health professionals in an outpatient department, clinic, or out with a hospital; 7. Public dental services; 8. Primary medical services; 9. General dental services; 10. Ophthalmic services; 11. Pharmaceutical services; 12. Primary care out-of-hours; 13. Geriatric medicine; 14. Palliative care; 15. Community learning disability services; 16. Kidney dialysis services provided out with a hospital; 17. Services provided by health professionals that aim to promote public health; 18. Care Home Liaison; 19. Community Children’s Services; 20. Dietetics; 21. Psychology; 22. Sexual and Reproductive health and Blood Borne Viruses; 23. Speech and Language Therapy; 24. Prisoner Health Care; 25. Podiatry; 26. Mental Health and Learning Disability services;
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27. Community Paediatrics; 28. Continence Services; 29. Addiction Services. That the carrying out of integrated functions that relate to the services set out in 30 to 38 below will be delegated to Officers of Lanarkshire Health Board by the Chief Accountable Officer for the South Lanarkshire Integration Joint Board at her discretion, in accordance with all applicable legal requirements; 30. Community Dental Services; 31. Diabetes Services; 32. Health & Homelessness; 33. Primary Care Administration; 34. Palliative Care; 35. Physiotherapy; 36. GP Out of Hours; 37. Traumatic Brain injury; 38. Occupational Therapy.
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BUDGET ALLOCATION FOR THE DELEGATED FUNCTIONS ANNEX 4 The financial resources which will be delegated by the IJB to NHS Lanarkshire (NHSL) for the financial year 2023/2024 are as follows: 1. The NHSL recurring budget allocations for in-scope health care services including hosted services. For 2023/2024, based on the budget as at January 2023, the total allocation for directly managed services, including hosted services, is £549.671m. This also includes the notional set-aside budget which was increased in 2022/2023 by budget adjustments of £1.694m from £65.164m to £66.858m. The notional set-aside budget is updated at paragraph 2. It also includes non- recurring funding as at January 2023. The financial allocation will also be subject to confirmation of the financial planning assumptions including the pay inflation estimates. The final budgets will be confirmed following the detailed budget setting process for 2023/2024. Non-recurring budgets will be adjusted as appropriate as part of this exercise. 2. In respect of the Acute Hospital Services delegated to the IJB, the notional set-aside budget will increase by additional adjustments in 2022/2023 of £2.224m and the 2% inflation uplift for 2023/2024 of £1.382m to £70.464m. 3. Excluding the uplift on the resource transfer, social care fund, delayed discharge fund and integrated fund (£1.062m) allocated to NLC, the uplift to NHSL Acute Services in respect of the notional set-aside services (£1.382m), funding of approximately £4.771m will be allocated to NHSL in 2023/2024 to support the strategic commissioning intentions and contribute to the agreed Scottish Government priorities which include the implementation of the Primary Care Improvement Plan, the Mental Health Services Strategy Action 15 and the Alcohol and Drug Partnership initiatives. 4. NHSL will implement as appropriate agreed efficiency savings plans in 2023/2024. 5. Additional non-recurring funding received in-year from NHSL which is ring fenced for areas covered by the IJB will be delegated to the partner responsible for service delivery. These in-year allocations will be agreed with each partner as appropriate. 6. Notwithstanding the above allocations, the IJB is asked to note that it may be necessary for the IJB Chief Financial Officer to vary the 2023/2024 allocations to reflect the detailed budget setting process undertaken by each partner. Any such accounting adjustment to assist with budget monitoring arrangements will be undertaken in consultation with the Director of Finance of NHSL and the Head of Financial Solutions for NLC.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 Item No: 21 North Lanarkshire Draft Volunteering Strategy 2023 – 2026 Approved by North Lanarkshire Partnership Board Feb. 2023 Referred to March 2023 IJB for consideration and approval. To be referred to North Lanarkshire Council Communities Committee for consideration and approval. Once approved, this document will be designed prior to publication.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 Contents 1. Background and Introduction 2. Vision and Mission 3. Principles 4. Strategic Objectives 5. Implementation Appendices Appendix One: North Lanarkshire Local Context Appendix Two: National Context
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 1. Background and Introduction 1.1. Volunteering 1.1.1. Volunteering is a freely given, unpaid contribution by individuals to support others directly and/or their community or society more generally. Volunteering can be informal – such as people helping an elderly neighbour on an occasional basis, or formal volunteering, where a person is appointed to a volunteer role offered by an organisation. Volunteers are also diverse and include people of all ages and backgrounds, although the majority of volunteers are young people and people of working age. 1.1.2. Formal volunteer roles may involve a few hours a month, week or day. It is estimated that over 1.2 million people volunteer in Scotland and that 24% of adults in North Lanarkshire, an estimated 66,257 people, volunteer formally through an organisation or group. Whilst this is very welcome and a high figure, it is below the national average in 2018 of 26% (source: Volunteer Scotland). 1.1.3. Formal volunteer roles are diverse and include a wide range of activities that make a vital contribution to society, complementing public services. For example: befriending or mentoring contributing to a local church or faith group driving someone to a vital appointment litter picking environmental improvements such as planting trees providing mental health support providing money advice through a Citizen’s Advice Bureau running a mother and toddler’s group, a children’s uniformed group (such as brownies) or youth group charity trusteeship 1.1.4. Volunteering supports volunteers’ physical and mental health and is linked to well-evidenced benefits of volunteering such as: strengthening volunteers’ social connections and sense of belonging improving volunteers’ self-regard related to helping others and contributing positively to society and strengthening skills improved employment opportunities for volunteers 1.1.5. Volunteering also supports “active citizenship” by enabling people to help others and participate in their communities. 1.1.6. Volunteering also makes a significant, positive contribution to the health and wellbeing of the people and communities supported by volunteers.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 1.1.7. Whilst volunteers give their time for free and is a very cost-effective way of helping people, volunteering needs adequate resources to support volunteer recruitment, training and retention, as well as travel and other activity costs such as venue hire and equipment. 1.1.8. Volunteering in North Lanarkshire is actively supported by the Community and Voluntary Sector (CVS) – including Voluntary Action North Lanarkshire (VANL); public sector and local businesses (see Appendix One.) However, there are opportunities to build on and strengthen volunteering across North Lanarkshire to benefit both volunteers and our communities – including: provision of health and social care support – for example advocacy; befriending; community transport; community sport, exercise and walking groups support for people on low income – for example money and welfare advice; charity shops; community food support. climate and green action – for example conservation; community gardens; green energy support - “green wellbeing” charity governance – all registered charities must be governed by volunteer trustees. 1.1.9. Volunteering plays a key role in supporting delivery of our Community Plan – The Plan for North Lanarkshire and nine Local Outcome Improvement Plans, as well as linked strategies and initiatives including: Health and Social Care NL’s Commissioning Plan and Community Solutions Programme Towards a Fairer North Lanarkshire Tackling Poverty Strategy Action on Climate Together NL initiative 1.2. Strategy 1.2.1. The purpose of this strategy is to set out partnership goals and activities to strengthen volunteering across North Lanarkshire, building on the significant progress that has already been achieved locally and contributing to achievement of the national Volunteering Framework and outcomes (see Appendix Two). 1.2.2. This partnership strategy has been co-produced by the following North Lanarkshire (community planning) Partnership (NLP) and Health and Social Care North Lanarkshire (HSCNL) partner organisations through the North Lanarkshire Volunteering Partnership. Voluntary Action North Lanarkshire and representatives from the wider North Lanarkshire Community and Voluntary Sector NHS Lanarkshire North Lanarkshire Council Lanarkshire division, Police Scotland Scottish Fire and Rescue Service, Lanarkshire
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 2. Vision and Mission 2.1. Vision All citizens in North Lanarkshire, regardless of their background, experience or support needs, are able to volunteer to support their own wellbeing and contribute to the wellbeing of their community. Volunteers and the vital contribution of volunteering to society, are valued, celebrated and supported effectively in North Lanarkshire - by the public; all sectors; and volunteering-involving organisations. 2.2. Mission To promote, engage and support North Lanarkshire residents from all ages, backgrounds and abilities in accessing and sustaining fulfilling volunteering opportunities. To continue to build the capacity of volunteer-involving organisations to contribute to the shaping and delivery of quality, inclusive and diverse volunteering opportunities in North Lanarkshire that support the wellbeing of volunteers and the people and communities they support and assist their host organisation in achieving their goals. 3. Principles 3.1. This strategy and its implementation and evaluation are guided by the following principles. Volunteering roles are designed to benefit the volunteer and the people / community receiving support. Volunteering is a respected and valued aspect of active citizenship, with resources provided to support the volunteer and their volunteering role effectively. Volunteering is open to all and supports inclusion and equality. Volunteering is a freely chosen activity. Volunteers receive support and training by their host organisation to enable volunteers to fulfil their volunteer role to the best of their ability. Volunteer-involving organisations protect the health, safety and wellbeing of volunteers. Volunteering is not done for financial gain. Volunteering may support volunteers’ employment prospects but is not a substitute for a paid role.
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Volunteer and paid staff in volunteer-involving organistions can contribute to volunteering policy and procedures. These principles align with the Scottish Volunteering Charter agreed between Volunteering Scotland and the STUC (see Appendix Two.)
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 4. Strategic Objectives Objective 1: Volunteering and the benefits of volunteering are actively promoted to support recruitment and placement of volunteers across North Lanarkshire in suitable roles – ensuring equal opportunities to participation for all groups. Objective 2: Volunteering-involving organisations are supported to provide high-quality and inclusive volunteering opportunities in North Lanarkshire, which provide the following. Volunteering opportunities for all equality groups including: o disabled people, people living with long term conditions, and challenges relating to their health o LGBTQi and community o people from black, Asian and minority ethnic groups o young people and older adults Volunteering roles which support our people and communities on key issues such as: o physical and mental health and wellbeing – through for example, exercise; crisis and recovery support o social inclusion, support and care – through for example, befriending; digital inclusion skills o action to tackle poverty – such as money and welfare advice; community food support; employability support o action to help tackle the climate emergency, including community conservation and greening initiatives. Public safeguarding by ensuring prospective volunteers pass appropriate Protection of Vulnerable Group checks. Volunteers are matched and supported well in appropriate roles. Objective 3: Volunteers have a positive volunteering experience with recognition and, where appropriate, accreditation for their participation and skills gained through volunteering. Objective 4: Employers in all sectors – business, public and CVS – increase their support for Employer-Supported volunteering as part of their Corporate Social Responsibility contribution and to support their workforces’ development and retention. Objective 5: Volunteer-involving organisations are supported to evaluate and report on their volunteering activities, including reach and benefits for volunteers, people receiving support, wider community and their own organisation.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 5. Implementation 5.1. VANL will facilitate effective joint working between members of The North Lanarkshire Volunteering Partnership to support resourcing and delivery of this Strategy including: preparation of a rolling annual, Implementation Plan undertaking an Equality Impact Assessment securing additional resources to support delivery of the strategy where possible agreeing performance measures to support monitoring, evaluation and progress reporting, with reference to the national volunteering outcomes.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 Appendix One: North Lanarkshire Local Context 1. Support for Volunteering 1.1. The Community and Voluntary Sector (CVS) is the major sector for providing volunteer opportunities in North Lanarkshire. Smaller CVS groups are often entirely run by volunteers – for example mother and toddler groups; community lunch clubs; volunteer driver schemes. Most medium to larger CVS organisations also involve volunteers – these are usually registered charities or social enterprises, including trustees/directors to support governance and volunteers to support delivery of activities and services. 2. Public Bodies 2.1. The major public bodies serving North Lanarkshire support volunteering directly and through participation in the Volunteering Partnership. 2.2. North Lanarkshire Council supports volunteering through schools and youth work including the Duke of Edinburgh and Saltire Award schemes. 2.3. NHS Lanarkshire supports volunteering within the NHS to help people gain pre- qualification experience in the health care sector and also roles that complement paid-staff roles, for example greeting and signposting at hospitals and volunteer driving. 2.4. Both Police Scotland and the Scottish Fire and Rescue Service involve volunteers in various community-supporting roles. Police Scotland – volunteers have actively supported policing in Scotland for over 100 years. Police Scotland’s Special Constables are volunteers who undergo extensive training and deploy with regular officers to enhance community safety across Scotland. The Police Scotland Youth Volunteer Programme was established in 2014 and comprises over 1000 young people aged 13-18. The programme gives young people of all backgrounds a positive means of engagement with the police service. Through regular training and participation in community safety initiatives, youth volunteers are given opportunities to overcome barriers and discover their talents while making a positive contribution to their communities. Scottish Fire and Rescue Service – SFRS’s Youth Volunteer Scheme (YVS) is a national youth initiative that creates opportunities for young people aged 12-18 to work together for a Safer Scotland.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 3. Business Organisations 3.1. Some businesses based in and/or serving North Lanarkshire, support their employees to volunteer as part of staff development and their contribution to local communities. There are significant opportunities to expand this through more structured approaches and wider support for “employer-supported volunteering”. 4. Voluntary Action North Lanarkshire (VANL) 4.1. VANL plays a major role in supporting volunteering across North Lanarkshire by: promoting volunteering for all ages and groups. supporting recruitment of volunteers, including matching supporting volunteer-involving organisations, including Volunteer-Friendly accreditation supporting Saltire (volunteering) Awards for young people supporting strategic development of volunteering through the Community Solutions Programme; Action on Climate Together North Lanarkshire; and Green Health Partnership. convening and supporting the North Lanarkshire Volunteering Partnership. 4.2. VANL receives some dedicated, recurrent annual funding to support delivery of the above volunteering work through Health and Social Care NL and is currently negotiating an increase in this amount from April 2023. VANL also receives some one-off, small grants to supplement its volunteering work and is seeking additional grant funding. 5. North Lanarkshire Volunteering Partnership 5.1. This partnership was established by VANL in February 2020 to support improved, strategic and operational collaboration on volunteering between VANL, CVS, public bodies and business sector. 5.2. This strategy was developed with members of the Partnership, who will co- ordinate and support implementation, review and reporting as set out above with reference to the Scottish Government Volunteering Framework.
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North Lanarkshire Draft Volunteering Strategy 2023 to 2026 Appendix Two: National Context 1. Volunteering for All: National Framework 1.1. In April 2019 the Scottish Government launched its Volunteering For All National Framework. The Framework was developed by the Scottish Government with partners from the Voluntary and Community Sector, local government, NHS, academics and social researchers and with volunteers. 1.2. The Framework: Sets out a coherent and compelling narrative for volunteering. Defines the desired outcomes for volunteering in Scotland over the next ten years. Identifies the key data and evidence that will inform, indicate and drive performance at a national and local level. Enables informed debate and decision about the optimal combination of volunteering programmes, investments and interventions. 1.3. The Framework has the following five outcomes. Volunteering participation is valued, supported and enabled from the earliest possible age and throughout life. Volunteering in all its forms is integrated and recognised in our lives through national and local policy. There is an environment and culture which celebrates volunteers and volunteering and all of its benefits. The places and spaces where we volunteer are developed, supported and sustained. There are diverse, quality and inclusive opportunities for everyone to get involved and stay involved. 1.4. The Scottish Government launched Scotland's Volunteering Action Plan in June 2022 to support delivery of the framework.
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2. Volunteer Charter Volunteer Scotland and STUC developed a Volunteer Charter to which sets out the ten principles below, to support a good volunteer experience and help ensure that volunteer-involving groups and organisations respect the spirit and values of volunteering and support good volunteer practice. 1. Any volunteer activity is a freely made choice of the individual. If there is any compulsion, threat of sanctions or force, then any such activity is not volunteering. 2. Volunteers should receive no financial reward for their time however out of pocket expenses should be covered; no one should be prevented from volunteering due to their income. 3. Effective structures should be put in place to support, train and develop volunteers and their collaboration with paid workers. 4. Volunteers and paid workers should be able to carry out their duties in safe, secure and healthy environments that are free from harassment, intimidation, bullying, violence and discrimination. 5. Volunteers should not carry out duties formerly carried out by paid workers nor should they be used to disguise the effects of non-filled vacancies or cuts in services. 6. Volunteers should not be used instead of paid workers or undercut their pay and conditions of service nor undertake the work of paid workers during industrial disputes. 7. Volunteers should not be used to reduce contract costs nor be a replacement for paid workers in competitive tenders or procurement processes. 8. Volunteers should not be used to bypass minimum wage legislation nor generate profit for owners. 9. Volunteers and paid workers should be given the opportunity to contribute to the development and monitoring of volunteering policies and procedures, including the need for policies that resolve any issues or conflicts that may arise. 10. Volunteer roles should be designed and negotiated around the needs and interests of volunteers, involving organisations and wider stakeholders. Finding legitimacy and avoiding exploitation through consensus depends on mutual trust and respect [document ends]