Agenda Pack
North Lanarkshire Council · 17 May 2023
Back to Health and Social Care Integration Joint Board — 17 May 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 A meeting of the Integration Joint Board Committee will be held on Wednesday 17th May at 9.30am-12pm via Microsoft Teams 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. AGENDA CHAIR: Cllr Ayeshah Khan No Time Item Action Attachment Reporting 1. Welcome and Apologies A Khan 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes IJB -22nd March 2023 For Approval Attachment A Khan 4. Matters Arising - Action Log For Approval Attachment R McGuffie GOVERNANCE 5. IJB Risk Register For Approval Attachment R McGuffie 6. Governance Report For Approval Attachment S Anderson PERFORMANCE 7. Resilience Update For Noting Attachment R McGuffie 8. Delayed Discharge and Site Occupancy Plans For Noting Attachment R McGuffie 9. Winter Plan Business Case Progress Report For Noting Attachment G Cowan 10. Fairer Scotland Duty For Noting Attachment K Todd 11. Implementation of National Trauma Framework For Endorsement Attachment A Gordon 12. Our Health Together For Noting Attachment R McGuffie
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2 13. 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 A Khan 14. Date of Next Meeting: 21st June 2023 10.30am-12pm
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 22nd March 2023 at 2pm-4.20pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Gerry Brennan North Lanarkshire Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Philip Couser NHS Lanarkshire Nominated Non Exec Director 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 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 Anderson Support Services Project Manager 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 Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Fiona Owens Audit Scotland Dr Tyra Smyth General Practitioner (GP) Maggs Thomson Head of Health North HSCP
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2 APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner James Muir NHS Lanarkshire Nominated Non Exec Director ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of IJB (30th November 2022) 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. He drew attention to the below updates: Item 8 Mental Health Continuing Care Contracted Beds – Ross McGuffie confirmed there are on-going discussion with providers and families to plan move of beds. Item 11 Provision of smoke alarms- Ross McGuffie advised update will be provided as part of the broader technology team once all work is completed. 5. IJB Reserve Strategy 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. 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.
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3 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. 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. Some reserves where set aside for project which were no longer required and there has also been new reserves identified which require funding so this has led to the review of the strategy. It was proposed to move £900k to education services for school counselling service appointments to support the CAMHS services. This was support by the committee. John Watson queried is it within the IJB guidelines that the committee can hold reserves, Ross McGuffie confirmed this has been the case since the IJB was established. Brian Moore asked will further updates come back to the committee and would it be possible to show what is aligned to SCP. Amanda Kilburn confirm she will provide the committee with further updates in due course and can demonstrate what is aligned to the strategic commissioning plan. The IJB agreed 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. 6. Medium Term Financial Plan 2023 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.
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4 Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 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: 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. The plan will be updated when more information is provided. Phillip Couser queried what do we do around recurring savings. Ross McGuffie acknowledged the relationships with partner organisations has helped the financial situation. The aim of the SCP is to link with savings plans to build for the next financial year. Maddy Halliday asked for the underspend, is there any scope to look at different provision for the funding if there continues to be a challenge to recruit to certain areas. Ross McGuffie acknowledge this has been the case in the past so services will have a look at different skill mixes for services models in future. The IJB: (1) Note the assumptions and context of the financial plan; and (2) Approve the Medium-Term Financial Plan 2023 - 2026. 7. Financial Monitoring The report tabled 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. 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. 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. 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:
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5 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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6 Brian Moore asked is there any scope to move away from using agency staff, is there other options we can consider to reduce this cost. Trudi Marshall noted undertaking work in Nursing, Midwifery & Allied Health Professionals (NMAHP) to reduce agency costs at a national and local level. Have agreed to move back to national framework which means the costs will reduce and starting to look at introduction of other types of roles within departments. Lucy Munro added will be looking a medical locum spend also. The IJB agreed the following recommendations: Note the contents of the report; and Note the financial position is a year-to-date underspend of £13.75m 8. Delegated Health & Social Care Budget 2023/2024 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. 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. 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. 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. The IJB agreed the following recommendations: Agree to accept the delegated social care budget for 2023/24 in section 9.4; 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
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7 - any further funding allocated by the Scottish Government. Approve a drawdown of reserves, if required, in order to fund any shortfall in funding for 2023/24 and 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. 9. Annual Audit Plan Fiona Owen attended the committee to present the external audit plan. 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. This is a presumed risk contained within every audit. The Annual Audit is planned to be signed off at the September IJB committee. Maddy Halliday welcomed point 26 “The Auditor General and Accounts Commission are developing a programme of work on climate change. In the third sector support for community climate is being considered; this was noted. The committee noted the report. 10. Resilience Update 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. 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. 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. 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:
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8 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. 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. Councillor Gerry Brennan queried was the firebreak labour intensive and could this be continued in future. Ross McGuffie confirmed it was labour intensive with overtime and weekend working in place to support the work. Will consider ways that this work can be used in future to support winter planning. Ally Boyle asked how will space be built in for learning from the work undertaken. Ross McGuffie advised the aim of the firebreak was to get stability across the whole system. Which was evident in being able to moved down from Black status. Really improved relationship and understanding across different services also. The IJB: (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
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9 (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 11. Amendment to Terms of Reference 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. 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. The IJB is asked to approve a further extension to the PFA Terms of Reference which is detailed at section 6. 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. The financial information reported in the IJB Annual Accounts has been reported to both the IJB and PFA throughout the financial year. 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. Harry Robertson queried the membership of the group. Ross McGuffie confirmed at the start performance, finance and audit includes 3rd sector representations. The IJB approved the revised Terms of Reference for the PFA noting the changes outlined in section 6.3 of the report. 12. Risk Register 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:
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10 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 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 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 It is planned to use a future IJB liaison session for a risk management session to look at risks in greater detail. Maddy Halliday would welcome review of risks to identify interdependencies which require further review for links to the 3rd sector. Ross McGuffie acknowledged the risks noted are for the broader HSCP workforce inclusive of the 3rd sector. Brian Moore acknowledged the work which has gone into updating the risk register and inclusion of mitigations; this was noted. 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. 13. Risk Management Strategy This initial Risk Strategy was put in place for December 2015, and was since updated and approved at the IJB in January 2018.
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11 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. 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 Ross McGuffie wanted to acknowledge special thanks to corporate risk managers and their assistance in the process; this was noted. Ally Boyle noted the paper says for any risk that are high or very high they are above tolerance will this be the case going forward. Ross McGuffie noted this has always been the case, there has been an increase in risk profiles aim to maintain a score of 10 or below going forward. Future reports will be more focused on the risk scoring and what actions will assist in lowering the scores. Maddy Halliday would be keen to explore risk appetite and innovation to learn and approve particularly with new projects. Ross McGuffie confirmed this can be covered as part of risk session. The IJB approved the new IJB Risk Management Strategy. 14. Category One Responders 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. 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. 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. 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.
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12 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. 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. The IJB: 1. Note the progress made in confirming identified resilience leads; 2. Note that local resilience plans will be updated once further guidance is received. 15. Strategic Commissioning Plan 2023-2026 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. 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. The approach to the development of the plan and the completion of the process has been overseen by internal audit. The final version of the plan, once approved, will be graphically designed, and published online. 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. The next steps will be to develop the programme of work alongside the plan, it will include a project management approach to key areas. Harry Robertson asked how can we analyse usage by Northern corridor patients going to other Health Board services. Morag Dendy noted using local intelligence to help explore data.
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13 Phillip Couser expressed an interest in accessibility of the document to the general public in a summarised format. Morag Dendy advised will make use of the new HSCP website to draw attention to key elements of the overall plan. Brian Moore asked how do we use this information through the IJB to get an oversight of data collected particularly around future resource use. Morag Dendy confirmed it will be part of locality planning groups to inform future discussions required. Maddy Halliday asked if there is any other feedback from other stakeholders and she asked if wording can be changed to be more inclusive for 3rd sectors. Morag Dendy was happy to accommodate in anyway possible. Ally Boyle noted the plan was taken to population health committee and it was well received. The needs analysis within the report provides a strong insight and should be used as a ’predictive needs assessment’; this was noted. The committee approved the final version of the SCP. 16. HSCP Website Update 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. A key strand of facilitating that active involvement and engagement is a great website. 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. Mark Dell advised use tools to scan website to identify any accessibility issues and it is now managed in house so changes can be made easier. The IJB: (1) Note the launch of the new website (2) Request that further reports are brought on the performance and analysis of the use. 17. Chryston Community Health Clinic Update 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.
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14 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. 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. 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. 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. In conclusion, the report 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. In tandem with the build programme, work is ongoing to repatriate the identified services, with work ongoing with both finance and operational teams. The IJB has already approved additional funding 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. The IJB: 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) 18. Improving Cancer Journey 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, the paper today seeks agreement to Phase 2 of the application.
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15 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. 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. 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. 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. Ally Boyle noted his endorsement for the service provision provided and links to other work within Lanarkshire. The Committee: 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. 19. Chief Social Work Officer Annual Report 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. The 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
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16 intended to facilitate the Board’s oversight, scrutiny and future planning with respect to social work services. Ally Boyle is there consideration for staff being able to access funding to qualify as a social worker as some are self-funded. Alison Gordon advised this a professional where there is not a national bursary process, previously Lanarkshire did have an internal programme but it was suspended. Funds have been set aside to re-open this to improve staff pathways into the profession. John Watson asked has there been any progress for social work recruitment and he noted there are difficulties with recruitment and foster carers. Alison Gordon advised for recruitment looking at what can be done within the current context but this is a national issue and we are supporting years in practice for newly qualified social workers. Seeking new ideas on how to recruit foster carers within local communities. There is a dedicated team for kinship carers who link with other teams to provide support. Brian Moore noted one of Lanarkshire risks was around public protection and failure to identified harm, are there gaps around responsibilities of staff. Alison Gordon noted we need to pay attention to emerging risks and ensure all staff have a basic awareness of their responsibilities. Phillip Courser asked does technology issues within social care hold back the services. Alison Gordon noted do rely on qualitative stories and experiences to back up information collated. Have commissioned a new database for social work to get an opportunity to pull and manipulate information. The IJB agreed the following recommendations: (1) Endorse this report (2) Note the approval route through Council committees. 20. IJB Directions Report 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. The letters of direction are attached at appendices 1 and 2 within the report and, following the approval of the IJB, will be issued to North Lanarkshire Council and Lanarkshire Health Board by 31st March 2023.
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17 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. 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. Ross McGuffie advised work is on-going to change templates to be more inclusive of directions and to update the committee more often; an update of this work will be brought to a future committee. The committee agreed: (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. 21. Volunteering Strategy Report 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. The committee approved the report which will be designed prior to publication. 22. Risk There were no new risk identified by the committee. 23. Date of Next Meeting 17th May 2023 9.30am-12pm
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1 North Lanarkshire Integration Joint Board 2023-24 ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 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. Strategic Commission Plan Approved by IJB Feb 2023. 2. 31.8.22 Item 6 IJB Self-Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Ongoing – future Liaison session topic 3. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in- depth discussion Discuss wider thematic work with Brian Moore and Cllr Ayeshah Khan 4. 14.2.23 Item 5 Risk Management Strategy R McGuffie A review of the IJB Risk Management process following the introduction of the new Risk Management Strategy May 2023
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REPORT Item No: 5 SUBJECT: Risk Management: IJB Risk Register TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer NHSCP Author(s) of Report Stacey Anderson, Support Services / Project Manager DATE: 17th May 2023 1. PURPOSE OF REPORT This paper is coming to the Integration Joint Board; 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 INTEGRATION JOINT 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 1
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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 19th April 2023. The register was also reviewed at the IJB on 22nd March 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 19th April 2023, the risk register has been updated and additional controls/actions added to: IJB 01/21 – Financial Challenges IJB 04/21 – Set Aside IJB 06/21 – Prescribing IJB 11/21 – Performance IJB 13/21 – Care Homes IJB 14/22 – CAMHS IJB 17/22 – Unscheduled Care 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. 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 Very High NHSL Corporate 2
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transfer' to care homes, those requiring care at home, exacerbated by rising cases of Covid and high demand 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 3
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NLC RIA0000446 Unable to deliver services due to funding issues Very High NLC - Social Care/Social Work NLC RIA0000448 Availability of workforce to deliver services within legislative and regulatory compliance requirements. High NLC – Social Care/Social Work NLC RIA0000449 Information & Data Protection – non-compliance with information governance legislation, standards and processes and data security and inability to retrieve relevant data with deadlines High NLC – Social Care/Social Work NLC RIA0000450 Health & Safety of staff in SW & partnership companies – failure to ensure the health safety and welfare at work of the service, employees, partners and provider agencies High NLC – Social Care/Social Work NLC RIA0000453 Supplier failure or services not provided to required standard. Insufficient number of providers. High NLC – Social Care/Social Work NLC RIA0000457 Inadequate supervision, governance and monitoring across professional workforce High NLC – Social Work/Social care NLC RIA0000458 IT system not fit for purpose High NLC – Social Work/Social care NLC RIA0000459 Integration – there is a risk that services and not integrated effectively thus impacting on improving the outcomes for individuals receiving care and support High NLC – Social Work/Social care 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 4
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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) 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 5
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9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Stacey Anderson on telephone number 07976801913. 6
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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 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 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 HIGHIJB.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 2023/2024 has been agreed and is being reviewed regularly. 7. IJB medium term financial plan 2023‐25 and reserves strategy 2023‐24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. 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. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget Report Prepared by Stacey Anderson on behalf of the Chief Officer 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 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. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and potential carry forward from 22/23 budget 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 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. ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 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. Report Prepared by Stacey Anderson on behalf of the Chief Officer 8
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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 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. 2. Face to face Q3 performance reviews taking place throughout May 23 with sectors/units low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 31.12.23 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. 5. Development day on 12th May 23 to agree structures and approach for year ahead medium medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 31.12.21 Report Prepared by Stacey Anderson on behalf of the Chief Officer 9
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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 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 1vetted 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 75% of gap by end of May 2023 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model 2. CAPA appointments begin on 1st May 2023 3. Refurbishment of North Lanarkshire facilities commences early summer 2023 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 5. SW Committee approval sought for cost of living contract increases in May 2023 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 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 5. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges 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. 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) Very High M edium Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB 28.02.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer 10
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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 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 McGuffie Ross McGuffie SLT, IJB PFA, IJB 31.05.23 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 Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer 11
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1 REPORT Item No: 6 SUBJECT: North Lanarkshire IJB Governance Document Update 2023 TO: IJB Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Stacey Anderson Support Services, Project Manager Stacey Connor Governance Support Manager DATE: 17 May 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 By: Stacey Anderson and Stacey Connor, NL H&SCP Governance Team ☒ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB review the updated IJB Governance documents and approve the documents and associated templates for IJB use during the 2023-24 period. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The report provides an overview of the recently reviewed/updated governance documents in regards to reporting for the North Lanarkshire Integration Joint Board. It is a requirement of the Integration Joint Board to ensure that they are compliant with The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014). A continuous review of the IJB governance documents/policy will commence across the financial year with updates regularly being provided to the IJB. The report focuses on the governance surrounding the IJB Programme of Reports, EQIA Process, Code of Conduct and Declaration of Interest, Directions, IJB Risk Reporting Process and Risk Reporting Template. 6. CONCLUSIONS Yes ☐ No ☐ N/A ☒
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3 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. Yes ☐ No ☒ N/A ☐
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4 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒
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5 EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Governance Report CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Stacey Anderson 07976801913. Yes / Date added ☐ No ☐ N/A ☒
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6 ABSTRACT
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7 Contents 1. Introduction ................................................................................................................................ 8 2. IJB Programme of Reports ..................................................................................................... 8 3. EQIA Process ........................................................................................................................... 8 4. Code of Conduct and Declaration of Interest ....................................................................... 9 5. Directions ................................................................................................................................... 9 6. IJB Risk Register Process Quarterly Report ...................................................................... 10 7. IJB Reporting Template ......................................................................................................... 10
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8 1. Introduction This report provides an overview of the recently reviewed/updated governance documents in regards to reporting for the North Lanarkshire Integration Joint Board. It is a requirement of the Integration Joint Board to ensure that they are compliant with The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014). A continuous review of the IJB governance documents/policy will commence across the financial year with updates regularly being provided to the IJB. 2. IJB Programme of Reports Following approval of revised terms of references of the Integrated Joint Board Performance Finance and Audit Committee a review of what papers/ reports are presented to which group was undertaken and a draft programme of reports has been developed to help provide both groups an overview of what papers will be presented to which group and when. In summary any update or governance reporting in regards to financial or service/project performance will be presented to the IJB PFA and any new developments/ projects, overview reports and overall IJB Governance will be presented at the IJB. A link to the minutes of the IJB PFA will be added to the agenda of the IJB for any further member discussion. The draft programme of reports will be circulated around the membership group at the start of each financial year. As this will be a fluid document with regular changes and developments, a copy of the programme of reports will be added to the end of the agendas for the IJB PFA and IJB to provide clarity to the board and show any changes to the reporting schedule. Appendix 1 Programme of Reports 1 3. EQIA Process As per the Equality Act 2010, EQIAs should be carried out when developing or reviewing current policies, strategies, services and functions to ensure that the policy, project or scheme does not unlawfully discriminate against any protected characteristics. Integration Joint Boards are required to: use equality evidence to assess the impact of health and social care services of different people’s lives For all protected groups, consider if and how the service will be non- discriminatory, advance equality of opportunity and foster good relations
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9 Take the results of the assessment into account when developing and agreeing what the service will look like Publish the results. In order to ensure that the IJB comply with the equality’s act, the North Lanarkshire Integrated Joint Board EQIA Process has been developed. The process details what the process that those presenting documents to the IJB / IJB PFA should follow in terms of EQIA, the governance process that the IJB / IJB PFA should follow to ensure that EQIAs are being considered and reviewed and details how the IJB / IJB PFA will publish the EQIAs on the IJB website North Lanarkshire Health and Social Care Partnership (hscnl.org.uk). Appendix 2 EQIA 4. Code of Conduct and Declaration of Interest As part of the risk measure for risk associated with fraud a review of the IJB Code of Conduct has taken place with the main change to the code of conduct being around how declarations of interest are submitted to the IJB. The proposed change is that all members are asked to submit an annual IJB declarations of interest form, with the form having a clearer focus on the nine categories that are listed within the Code of Conduct. The completed declarations of interest forms will then be uploaded to the IJB website North Lanarkshire Health and Social Care Partnership (hscnl.org.uk) and a register of interests including gifts and hospitality received by members will be held by the IJB administration team. Appendix 3 Code of Conduct 5. Directions In January 2020, the Scottish Government issued Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. The North Lanarkshire Joint Board must issue a direction in respect of every function that has been delegated to it by NHS Lanarkshire and North Lanarkshire Council which must provide relevant budget information. Directions are the means by which the IJB informs the Health Board and the Local Authority what is to be delivered using the integrated budget and for the IJB to
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10 improve the quality and sustainability of care, as outlined in its strategic commissioning plan. Directions are also the legal basis on which the Health Board and Local Authority deliver services that are under the control of the IJB. To help ensure that the North Lanarkshire Integration Joint Board implements the Statutory Guidance on Directions, a North Lanarkshire Integration Joint Board Directions Policy has been created. The policy details what directions are, how and when directions should be issued and how directions should be implemented and monitored. The policy also provides a Directions template for the IJB to use and add to each paper when directions are issued. Appendix 4 IJB Directions Policy 6. IJB Risk Register Process Quarterly Report The IJB Risk Register strategy was approved by the IJB at the March 2023 meeting. In order to ensure that the IJB Risk Register is following the strategy and also mirroring the risk reporting process utilised by NHS Lanarkshire, a new IJB Risk Register report template has been developed. The report template helps provide an overview of the risk register in a more user friendly graphic format with the aim of clearly showcasing the risk data, highlighting the risks held within the council, NHS and IJB and ensuring that risks are continuously reviewed and updated. Appendix 5 Risk Register 7. IJB Reporting Template To help support authors submitting items to the IJB, a new IJB Reporting Template has been developed. The report template for the IJB now has a greater focus on EQIAs, Risk, Participation and Engagement, National Outcomes and Directions. The aim of this template is for the author to ensure that they have considered all relevant elements before submitting items to the IJB and to provide the IJB committee assurance that these key elements have been considered during publication of the paper/ service review etc. In order to support authors completing the reporting template, the IJB Reporting Template Guidance has also been developed. Appendix 6 IJb Reports Template Appendix 7 IJb Report Template Guidance
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11 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Reporting Cycle Title Description Category Progress Priority Start date Due date Assigned to Notes Item Type Path IJB Quarterly Financial monitoring report Quarterly financial monitoring report Planning Not started Quarterly Item sites/IJB280/L ists/Progress tracker list IJB Quarterly Quarterly Risk Register Update Not started Quarterly Item sites/IJB280/L ists/Progress tracker list IJB March Website Update Report Not started IJB March Delivering for communities‐ engagement and participation ‐ Update Not started IJB March Chryston Community Health Clinic Update Not started IJB March Ethical Commissioning Report Not started IJB March Chief Social Work Officer (CSWO) Annual Report Not started IJB March IJB Directions Report Not started IJB March Category 1 Responders ‐ Update Not started IJB March Update on mental health and wellbeing strategy Not started IJB May Winter Plan ‐ Draft Not started IJB May National Care Services Bill ‐ Update Not started IJB May Tackling Poverty Not started IJB May Sustainability Plan Not started IJB May IJB Self Assessment Report IJB May Fairer Scotland duty update report IJB May Our Lives IJB September Investment in IT Infrastructure to support care delivery‐ Update Not started IJB September Action for Children ‐ North Lanarkshire Young Careers Review Not started IJB September Climate Change Report 2023 Not started IJB September Winter Plan Update Not started IJB September Internal Audit Annual Report Not started IJB September Lanarkshire Primary Care Out of Hours Service ‐ Review/Update Not started IJB September CAMHS Report Not started IJB September North Lanarkshire ADP Self‐ Assessment Not started IJB September Annual Whistleblowing Report IJB September Quality Assurance Update / Annual Report Not started IJB November External Auditor Annual Report Not started IJB November Annual Accounts Audited Not started IJB November Evaluation of Strategic Plan Not started Potential Reports Communications Strategy potential report Not started potential reports Potential Reports Falls Strategy Not started potential reports Potential Reports Workforce Plan Not started potential reports Potential Reports Business Continuity Assurance Not started potential reports Potential Reports Adult Protection Not started potential reports Potential Reports Home Support Not started potential reports Potential Reports Cost of living helpline review Not started potential reports Potential Reports mental health hospital based clinical complex care Not started potential reports Potential Reports supporting unpaid careers Not started potential reports Potential Reports Inpatient Mental Health Service Annual Review Potential Reports Psychological Services Annual Review Potential Reports Paediatrics Annual Review Potential Reports Dietetics Annual Review Potential Reports HMP Shotts Annual Review Potential Reports Custody HealthCare Potential Reports MAT Standards Update Potential Reports Financial Regulations IJB PFA Quarterly Financial monitoring report Quarterly financial monitoring report Planning Not started Quarterly IJB PFA Quarterly Quarterly Risk Register Update Not started Quarterly IJB PFA Quarterly PFA Risk Register Not started Quarterly IJB PFA Quarterly Resilience Update Quarterly IJB PFA Quarterly Performance Update IJB PFA February Maintaining a Positive Balance of Care Update IJB PFA February Financial Regulations IJB PFA February Annual Performance Report IJB PFA February MAT standards update IJB PFA February NSS Screening IJB PFA February Cancer Inequalities IJB PFA April Mental Health Strategy Update Potential a forum session IJB PFA April IJB self‐ assessment report IJB PFA April Whole system performance for North Lanarkshire ‐ Update IJB PFA April Speech and Language Therapy Update IJB PFA April OT Pads Update IJB PFA April Digital Alarms IJB PFA June Specialist Children's Health Service Annual Update IJB PFA June Adult Health Service Annual Update IJB PFA June Adult Social Work Annual Update IJB PFA June Infection Control Annual Update IJB PFA June Public Protection Annual Update IJB PFA June Health Technologies Annual Update IJB PFA June HMP Shotts Annual Update IJB PFA June Prescribing Annual Update Appendix 1 12
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IJB PFA June Equality Outcomes and Mainstreaming Report update Bi‐Annually IJB PFA October Analogue to digital telecare transition update IJB PFA October Primary Care improvement plan update IJB PFA October Integration Review IJB PFA October ADP Self‐ Assessment IJB PFA October Service Recovery/ Winter Planning and supporting the health and social care system 13
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North Lanarkshire Integrated Joint Board: Process for Equality Impact Assessments (EQIAs). Version No: Prepared By: Effective From: Next Review Date: Lead Reviewer: Dissemination Arrangements: Appendix 2 14
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2 Content 1.0 Purpose ........................................................................................................... 3 2.0 Scope ............................................................................................................... 3 3.0 Procedure ........................................................................................................ 3 3.2 Useful Information: ........................................ Error! Bookmark not defined. 15
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3 1.0 Purpose The aim of the document is to detail the process followed by the North Lanarkshire Integrated Joint Board (IJB) or the IJB Performance, Finance and Audit Committee (PIJB PFA) in regards to Equality Impact Assessments (EQIA). 2.0 Scope As per the Equality Act 2010, EQIAs should be carried out when developing or reviewing current policies, strategies, services and functions to ensure that the policy, project or scheme does not unlawfully discriminate against any protected characteristics. Integrated Joint Boards are required to: use equality evidence to assess the impact of health and social care services of different people’s lives For all protected groups, consider if and how the service will be non- discriminatory, advance equality of opportunity and foster good relations Take the results of the assessment into account when developing and agreeing what the service will look like Publish the results. 3.0 Procedure 3.1 When a paper/report is submitted to the IJB or IJB PFA, the author must ensure that the IJB reporting template has been used. 3.2 The author of the paper/ report must complete section 7.6 INEQUALITIES AND FAIRER SCOTLAND DUTY of the IJB reporting template, detailing if they have completed an EQIA, attached a copy of the EQIA to the paper/ report and if the EQIA has already been published on the IJB website. 3.3 If section 7.6 of the reporting template is not completed and/or if a copy of the EQIA has not been attached to the report, the North Lanarkshire Health and Social Care Partnership (NL H&SCP) Governance Team will highlight this to the author of the paper/ report and if not received in time for the IJB, the governance team will notify the Chair of the IJB / IJB PFA and a decision will be made by the chair as to whether or not the paper/report will be presented without the EQIA. 3.4 The IJB/ IJB PFA should review the EQIAs and issue any associated directions relating to the EQIA as per the IJB Directions Policy. All directions will be recorded on the IJB Directions Tracker as per policy. 3.5 Once the paper/report and associated EQIA has been approved by the IJB/ IJB PFA, the NL H&SCP Governance Team will follow the relevant procedures to ensure that the relevant documents are added to the website (if this has not already been completed by the author). 3.6 The NL H&SCP will also record on the IJB/ IJB PFA paper tracker the date that the paper/report and EQIA was approved by the IJB/ IJB PFA and the date in which the EQIA was added to the website for audit purposes. 16
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17 Appendix 3 Code of Conduct for Members of: NORTH LANARKSHIRE INTEGRATION JOINT BOARD Version Control Date Summary of Changes 1 2022 2 2023
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18 CONTENTS Section 1: Introduction to the Code of Conduct My Responsibilities Enforcement Section 2: Key Principles of the Code of Conduct Section 3: General Conduct Respect and Courtesy Remuneration, Allowances and Expenses Gifts and Hospitality Confidentiality Use of Public Body Resources Dealing with my Public Body and Preferential Treatment Appointments to Outside Organisations Section 4: Registration of Interests Category One: Remuneration Category Two: Other Roles Category Three: Contracts Category Four: Election Expenses Category Five: Houses, Land and Buildings Category Six: Interest in Shares and Securities Category Seven: Gifts and Hospitality Category Eight: Non–Financial Interests Category Nine: Close Family Members Section 5: Declaration of Interests Stage 1: Connection Stage 2: Interest Stage 3: Participation Section 6: Lobbying and Access ANNEXES Annex A Breaches of the Code Annex B Definitions
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19 APPENDIX Appendix 1 Register of Interest Form
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20 SECTION 1: INTRODUCTION TO THE CODE OF CONDUCT 1.1 This Code has been issued by the Scottish Ministers, with the approval of the Scottish Parliament, as required by the Ethical Standards in Public Life etc. (Scotland) Act 2000 (the “Act”). 1.2 The purpose of the Code is to set out the conduct expected of those who serve on the boards of public bodies in Scotland. 1.3 The Code has been developed in line with the nine key principles of public life in Scotland. The principles are listed in Section 2 and set out how the provisions of the Code should be interpreted and applied in practice. My Responsibilities 1.4 I understand that the public has a high expectation of those who serve on the boards of public bodies and the way in which they should conduct themselves in undertaking their duties. I will always seek to meet those expectations by ensuring that I conduct myself in accordance with the Code. 1.5 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all situations and at all times where I am acting as a board member of my public body, have referred to myself as a board member or could objectively be considered to be acting as a board member. 1.6 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all my dealings with the public, employees and fellow board members, whether formal or informal. 1.7 I understand that it is my personal responsibility to be familiar with the provisions of this Code and that I must also comply with the law and my public body’s rules, standing orders and regulations. I will also ensure that I am familiar with any guidance or advice notes issued by the Standards Commission for Scotland (“Standards Commission”) and my public body, and endeavour to take part in any training offered on the Code. 1.8 I will not, at any time, advocate or encourage any action contrary to this Code. 1.9 I understand that no written information, whether in the Code itself or the associated Guidance or Advice Notes issued by the Standards Commission, can provide for all circumstances. If I am uncertain about how the Code applies, I will seek advice from the Standards Officer of my public body, failing whom the Chair or Chief Officer of my public body. I note that I may also choose to seek external legal advice on how to interpret the provisions of the Code. Enforcement 1.10 Part 2 of the Act sets out the provisions for dealing with alleged breaches of the Code, including the sanctions that can be applied if the Standards Commission finds that there has been a breach of the Code. More information on how complaints are dealt with and the sanctions available can be found at Annex A.
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21 SECTION 2: KEY PRINCIPLES OF THE MODEL CODE OF CONDUCT 2.1 The Code has been based on the following key principles of public life. I will behave in accordance with these principles and understand that they should be used for guidance and interpreting the provisions in the Code. 2.2 I note that a breach of one or more of the key principles does not in itself amount to a breach of the Code. I note that, for a breach of the Code to be found, there must also be a contravention of one or more of the provisions in sections 3 to 6 inclusive of the Code. The key principles are: Duty I have a duty to uphold the law and act in accordance with the law and the public trust placed in me. I have a duty to act in the interests of the public body of which I am a member and in accordance with the core functions and duties of that body. Selflessness I have a duty to take decisions solely in terms of public interest. I must not act in order to gain financial or other material benefit for myself, family or friends. Integrity I must not place myself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence me in the performance of my duties. Objectivity I must make decisions solely on merit and in a way that is consistent with the functions of my public body when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits. Accountability and Stewardship I am accountable to the public for my decisions and actions. I have a duty to consider issues on their merits, taking account of the views of others and I must ensure that my public body uses its resources prudently and in accordance with the law. Openness I have a duty to be as open as possible about my decisions and actions, giving reasons for my decisions and restricting information only when the wider public interest clearly demands. Honesty I have a duty to act honestly. I must declare any private interests relating to my public duties and take steps to resolve any conflicts arising in a way that protects the public interest. Leadership I have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of my public body and its members in conducting public business.
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22 Respect I must respect all other board members and all employees of my public body and the role they play, treating them with courtesy at all times. Similarly, I must respect members of the public when performing my duties as a board member.
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23 SECTION 3: GENERAL CONDUCT Respect and Courtesy 3.1 I will treat everyone with courtesy and respect. This includes in person, in writing, at meetings, when I am online and when I am using social media. 3.2 I will not discriminate unlawfully on the basis of race, age, sex, sexual orientation, gender reassignment, disability, religion or belief, marital status or pregnancy/maternity; I will advance equality of opportunity and seek to foster good relations between different people. 3.3 I will not engage in any conduct that could amount to bullying or harassment (which includes sexual harassment). I accept that such conduct is completely unacceptable and will be considered to be a breach of this Code. 3.4 I accept that disrespect, bullying and harassment can be: a) a one-off incident, b) part of a cumulative course of conduct; or c) a pattern of behaviour. 3.5 I understand that how, and in what context, I exhibit certain behaviours can be as important as what I communicate, given that disrespect, bullying and harassment can be physical, verbal and non-verbal conduct. 3.6 I accept that it is my responsibility to understand what constitutes bullying and harassment and I will utilise resources, including the Standards Commission’s guidance and advice notes, my public body’s policies and training material (where appropriate) to ensure that my knowledge and understanding is up to date. 3.7 Except where it is written into my role as Board member, and / or at the invitation of the Chief Officer, I will not become involved in operational management of my public body. I acknowledge and understand that operational management is the responsibility of the Chief Officer and Management Team. 3.8 I will not undermine any individual employee or group of employees, or raise concerns about their performance, conduct or capability in public. I will raise any concerns I have on such matters in private with senior management as appropriate. 3.9 I will not take, or seek to take, unfair advantage of my position in my dealings with employees of my public body or bring any undue influence to bear on employees to take a certain action. I will not ask or direct employees to do something which I know, or should reasonably know, could compromise them or prevent them from undertaking their duties properly and appropriately. 3.10 I will respect and comply with rulings from the Chair during meetings of: a) my public body, its committees; and b) any outside organisations that I have been appointed or nominated to by my public body or on which I represent my public body. IJBs can opt out of this paragraph when adopting their Code.
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24 3.11 I will respect the principle of collective decision-making and corporate responsibility. This means that once the Board has made a decision, I will support that decision, even if I did not agree with it or vote for it. Remuneration, Allowances and Expenses 3.12 I will comply with the rules, and the policies of my public body, on the payment of remuneration, allowances and expenses. Gifts and Hospitality 3.13 I understand that I may be offered gifts (including money raised via crowdfunding or sponsorship), hospitality, material benefits or services (“gift or hospitality”) that may be reasonably regarded by a member of the public with knowledge of the relevant facts as placing me under an improper obligation or being capable of influencing my judgement. 3.14 I will never ask for or seek any gift or hospitality. 3.15 I will refuse any gift or hospitality, unless it is: a) a minor item or token of modest intrinsic value offered on an infrequent basis; b) a gift being offered to my public body; c) hospitality which would reasonably be associated with my duties as a board member; or d) hospitality which has been approved in advance by my public body. 3.16 I will consider whether there could be a reasonable perception that any gift or hospitality received by a person or body connected to me could or would influence my judgement. 3.17 I will not allow the promise of money or other financial advantage to induce me to act improperly in my role as a board member. I accept that the money or advantage (including any gift or hospitality) does not have to be given to me directly. The offer of monies or advantages to others, including community groups, may amount to bribery, if the intention is to induce me to improperly perform a function. 3.18 I will never accept any gift or hospitality from any individual or applicant who is awaiting a decision from, or seeking to do business with, my public body. 3.19 If I consider that declining an offer of a gift would cause offence, I will accept it and hand it over to my public body at the earliest possible opportunity and ask for it to be registered. 3.20 I will promptly advise my public body’s Standards Officer if I am offered (but refuse) any gift or hospitality of any significant value and / or if I am offered any gift or hospitality from the same source on a repeated basis, so that my public body can monitor this. 3.21 I will familiarise myself with the terms of the Bribery Act 2010, which provides for offences of bribing another person and offences relating to being bribed.
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25 Confidentiality 3.22 I will not disclose confidential information or information which should reasonably be regarded as being of a confidential or private nature, without the express consent of a person or body authorised to give such consent, or unless required to do so by law. I note that if I cannot obtain such express consent, I should assume it is not given. 3.23 I accept that confidential information can include discussions, documents, and information which is not yet public or never intended to be public, and information deemed confidential by statute. 3.24 I will only use confidential information to undertake my duties as a board member. I will not use it in any way for personal advantage or to discredit my public body (even if my personal view is that the information should be publicly available). 3.25 I note that these confidentiality requirements do not apply to protected whistleblowing disclosures made to the prescribed persons and bodies as identified in statute. Use of Public Body Resources 3.26 I will only use my public body’s resources, including employee assistance, facilities, stationery and IT equipment, for carrying out duties on behalf of the public body, in accordance with its relevant policies. 3.27 I will not use, or in any way enable others to use, my public body’s resources: a) imprudently (without thinking about the implications or consequences); b) unlawfully; c) for any political activities or matters relating to these; or d) improperly. Dealing with my Public Body and Preferential Treatment 3.28 I will not use, or attempt to use, my position or influence as a board member to: a) improperly confer on or secure for myself, or others, an advantage; b) avoid a disadvantage for myself, or create a disadvantage for others or c) improperly seek preferential treatment or access for myself or others. 3.29 I will avoid any action which could lead members of the public to believe that preferential treatment or access is being sought. 3.30 I will advise employees of any connection, as defined at Section 5, I may have to a matter, when seeking information or advice or responding to a request for information or advice from them.
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26 Appointments to Outside Organisations 3.31 If I am appointed, or nominated by my public body, as a member of another body or organisation, I will abide by the rules of conduct and will act in the best interests of that body or organisation while acting as a member of it. I will also continue to observe the rules of this Code when carrying out the duties of that body or organisation. 3.32 I accept that if I am a director or trustee (or equivalent) of a company or a charity, I will be responsible for identifying, and taking advice on, any conflicts of interest that may arise between the company or charity and my public body.
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27 SECTION 4: REGISTRATION OF INTERESTS 4.1 The following paragraphs set out what I have to register when I am appointed and whenever my circumstances change. The register covers my current term of appointment. 4.2 I understand that regulations made by the Scottish Ministers describe the detail and timescale for registering interests; including a requirement that a board member must register their registrable interests within one month of becoming a board member, and register any changes to those interests within one month of those changes having occurred. A copy of the registering of interest form is detailed within Appendix 1. 4.3 The interests which I am required to register are those set out in the following paragraphs. Other than as required by paragraph 4.23, I understand it is not necessary to register the interests of my spouse or cohabitee. Category One: Remuneration 4.4 I will register any work for which I receive, or expect to receive, payment. I have a registrable interest where I receive remuneration by virtue of being: a) employed; b) self-employed; c) the holder of an office; d) a director of an undertaking; e) a partner in a firm; f) appointed or nominated by my public body to another body; or g) engaged in a trade, profession or vocation or any other work. 4.5 I understand that in relation to 4.4 above, the amount of remuneration does not require to be registered. I understand that any remuneration received as a board member of this specific public body does not have to be registered. 4.6 I understand that if a position is not remunerated it does not need to be registered under this category. However, unremunerated directorships may need to be registered under Category Two, “Other Roles”. 4.7 I must register any allowances I receive in relation to membership of any organisation under Category One. 4.8 When registering employment as an employee, I must give the full name of the employer, the nature of its business, and the nature of the post I hold in the organisation. 4.9 When registering remuneration from the categories listed in paragraph 4.4 (b) to (g) above, I must provide the full name and give details of the nature of the business, organisation, undertaking, partnership or other body, as appropriate. I recognise that some other employments may be incompatible with my role as board member of my public body in terms of paragraph 6.7 of this Code.
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28 4.10 Where I otherwise undertake a trade, profession or vocation, or any other work, the detail to be given is the nature of the work and how often it is undertaken. 4.11 When registering a directorship, it is necessary to provide the registered name and registered number of the undertaking in which the directorship is held and provide information about the nature of its business. 4.12 I understand that registration of a pension is not required as this falls outside the scope of the category. Category Two: Other Roles 4.13 I will register any unremunerated directorships where the body in question is a subsidiary or parent company of an undertaking in which I hold a remunerated directorship. 4.14 I will register the registered name and registered number of the subsidiary or parent company or other undertaking and the nature of its business, and its relationship to the company or other undertaking in which I am a director and from which I receive remuneration. Category Three: Contracts 4.15 I have a registerable interest where I (or a firm in which I am a partner, or an undertaking in which I am a director or in which I have shares of a value as described in paragraph 4.19 below) have made a contract with my public body: a) under which goods or services are to be provided, or works are to be executed; and b) which has not been fully discharged. 4.16 I will register a description of the contract, including its duration, but excluding the value. Category Four: Election Expenses 4.17 If I have been elected to my public body, then I will register a description of, and statement of, any assistance towards election expenses relating to election to my public body. Category Five: Houses, Land and Buildings 4.18 I have a registrable interest where I own or have any other right or interest in houses, land and buildings, which may be significant to, of relevance to, or bear upon, the work and operation of my public body.
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29 4.19 I accept that, when deciding whether or not I need to register any interest I have in houses, land or buildings, the test to be applied is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as being so significant that it could potentially affect my responsibilities to my public body and to the public, or could influence my actions, speeches or decision- making. Category Six: Interest in Shares and Securities 4.20 I have a registerable interest where: a) I own or have an interest in more than 1% of the issued share capital of the company or other body; or b) Where, at the relevant date, the market value of any shares and securities (in any one specific company or body) that I own or have an interest in is greater than £25,000. Category Seven: Gifts and Hospitality 4.21 I understand the requirements of paragraphs 3.13 to 3.21 regarding gifts and hospitality. As I will not accept any gifts or hospitality, other than under the limited circumstances allowed, I understand there is no longer the need to register any. Category Eight: Non–Financial Interests 4.22 I may also have other interests and I understand it is equally important that relevant interests such as membership or holding office in other public bodies, companies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. In this context, I understand non- financial interests are those which members of the public with knowledge of the relevant facts might reasonably think could influence my actions, speeches, votes or decision-making in my public body (this includes its Committees and memberships of other organisations to which I have been appointed or nominated by my public body). Category Nine: Close Family Members 4.23 I will register the interests of any close family member who has transactions with my public body or is likely to have transactions or do business with it.
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30 SECTION 5: DECLARATION OF INTERESTS Stage 1: Connection 5.1 For each particular matter I am involved in as a board member, I will first consider whether I have a connection to that matter. 5.2 I understand that a connection is any link between the matter being considered and me, or a person or body I am associated with. This could be a family relationship or a social or professional contact. 5.3 A connection includes anything that I have registered as an interest. 5.4 A connection does not include being a member of a body to which I have been appointed or nominated by my public body as a representative of my public body, unless: a) The matter being considered by my public body is quasi-judicial or regulatory; or b) I have a personal conflict by reason of my actions, my connections or my legal obligations. Stage 2: Interest 5.5 I understand my connection is an interest that requires to be declared where the objective test is met – that is where a member of the public with knowledge of the relevant facts would reasonably regard my connection to a particular matter as being so significant that it would be considered as being likely to influence the discussion or decision-making. Stage 3: Participation 5.6 I will declare my interest as early as possible in meetings. I will not remain in the meeting nor participate in any way in those parts of meetings where I have declared an interest. 5.7 I will consider whether it is appropriate for transparency reasons to state publicly where I have a connection, which I do not consider amounts to an interest. 5.8 I note that I can apply to the Standards Commission and ask it to grant a dispensation to allow me to take part in the discussion and decision-making on a matter where I would otherwise have to declare an interest and withdraw (as a result of having a connection to the matter that would fall within the objective test). I note that such an application must be made in advance of any meetings where the dispensation is sought and that I cannot take part in any discussion or decision- making on the matter in question unless, and until, the application is granted. 5.9 I note that public confidence in a public body is damaged by the perception that decisions taken by that body are substantially influenced by factors other than the public interest. I will not accept a role or appointment if doing so means I will have to declare interests frequently at meetings in respect of my role as a board member. Similarly, if any appointment or nomination to another body would give rise to objective concern because of my existing personal involvement or affiliations, I will not accept the appointment or nomination.
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31 SECTION 6: LOBBYING AND ACCESS 6.1 I understand that a wide range of people will seek access to me as a board member and will try to lobby me, including individuals, organisations and companies. I must distinguish between: a) any role I have in dealing with enquiries from the public; b) any community engagement where I am working with individuals and organisations to encourage their participation and involvement, and; c) lobbying, which is where I am approached by any individual or organisation who is seeking to influence me for financial gain or advantage, particularly those who are seeking to do business with my public body (for example contracts/procurement). 6.2 In deciding whether, and if so how, to respond to such lobbying, I will always have regard to the objective test, which is whether a member of the public, with knowledge of the relevant facts, would reasonably regard my conduct as being likely to influence my, or my public body’s, decision-making role. 6.3 I will not, in relation to contact with any person or organisation that lobbies, do anything which contravenes this Code or any other relevant rule of my public body or any statutory provision. 6.4 I will not, in relation to contact with any person or organisation that lobbies, act in any way which could bring discredit upon my public body. 6.5 If I have concerns about the approach or methods used by any person or organisation in their contacts with me, I will seek the guidance of the Chair, Chief Officer or Standards Officer of my public body. 6.6 The public must be assured that no person or organisation will gain better access to, or treatment by, me as a result of employing a company or individual to lobby on a fee basis on their behalf. I will not, therefore, offer or accord any preferential access or treatment to those lobbying on a fee basis on behalf of clients compared with that which I accord any other person or organisation who lobbies or approaches me. I will ensure that those lobbying on a fee basis on behalf of clients are not given to understand that preferential access or treatment, compared to that accorded to any other person or organisation, might be forthcoming. 6.7 Before taking any action as a result of being lobbied, I will seek to satisfy myself about the identity of the person or organisation that is lobbying and the motive for lobbying. I understand I may choose to act in response to a person or organisation lobbying on a fee basis on behalf of clients but it is important that I understand the basis on which I am being lobbied in order to ensure that any action taken in connection with the lobbyist complies with the standards set out in this Code and the Lobbying (Scotland) Act 2016.
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32 6.8 I will not accept any paid work: a) which would involve me lobbying on behalf of any person or organisation or any clients of a person or organisation. b) to provide services as a strategist, adviser or consultant, for example, advising on how to influence my public body and its members. This does not prohibit me from being remunerated for activity which may arise because of, or relate to, membership of my public body, such as journalism or broadcasting, or involvement in representative or presentational work, such as participation in delegations, conferences or other events.
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33 ANNEX A: BREACHES OF THE CODE Introduction 1. The Ethical Standards in Public Life etc. (Scotland) Act 2000 (“the Act”) provided for a framework to encourage and, where necessary, enforce high ethical standards in public life. 2. The Act provided for the introduction of new codes of conduct for local authority councillors and members of relevant public bodies, imposing on councils and relevant public bodies a duty to help their members comply with the relevant code. 3. The Act and the subsequent Scottish Parliamentary Commissions and Commissioners etc. Act 2010 established the Standards Commission for Scotland (“Standards Commission”) and the post of Commissioner for Ethical Standards in Public Life in Scotland (“ESC”). 4. The Standards Commission and ESC are separate and independent, each with distinct functions. Complaints of breaches of a public body’s Code of Conduct are investigated by the ESC and adjudicated upon by the Standards Commission. 5. The first Model Code of Conduct came into force in 2002. The Code has since been reviewed and re-issued in 2014. The 2021 Code has been issued by the Scottish Ministers following consultation, and with the approval of the Scottish Parliament, as required by the Act. Investigation of Complaints 6. The ESC is responsible for investigating complaints about members of devolved public bodies. It is not, however, mandatory to report a complaint about a potential breach of the Code to the ESC. It may be more appropriate in some circumstances for attempts to be made to resolve the matter informally at a local level. 7. On conclusion of the investigation, the ESC will send a report to the Standards Commission. Hearings 8. On receipt of a report from the ESC, the Standards Commission can choose to: Do nothing; Direct the ESC to carry out further investigations; or Hold a Hearing. 9. Hearings are held (usually in public) to determine whether the member concerned has breached their public body’s Code of Conduct. The Hearing Panel comprises of three members of the Standards Commission. The ESC will present evidence and/or make submissions at the Hearing about the investigation and any conclusions as to whether the member has contravened the Code. The member is entitled to attend or be represented at the Hearing and can also present evidence and make submissions. Both parties can call witnesses. Once it has heard all the evidence and submissions, the Hearing Panel will make a determination about whether or not it is satisfied, on the balance of probabilities, that there has been a contravention of
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34 the Code by the member. If the Hearing Panel decides that a member has breached their public body’s Code, it is obliged to impose a sanction. Sanctions 10. The sanctions that can be imposed following a finding of a breach of the Code are as follows: Censure: A censure is a formal record of the Standards Commission’s severe and public disapproval of the member concerned. Suspension: This can be a full or partial suspension (for up to one year). A full suspension means that the member is suspended from attending all meetings of the public body. Partial suspension means that the member is suspended from attending some of the meetings of the public body. The Commission can direct that any remuneration or allowance the member receives as a result of their membership of the public body be reduced or not paid during a period of suspension. Disqualification: Disqualification means that the member is removed from membership of the body and disqualified (for a period not exceeding five years), from membership of the body. Where a member is also a member of another devolved public body (as defined in the Act), the Commission may also remove or disqualify that person in respect of that membership. Full details of the sanctions are set out in section 19 of the Act. Interim Suspensions 11. Section 21 of the Act provides the Standards Commission with the power to impose an interim suspension on a member on receipt of an interim report from the ESC about an ongoing investigation. In making a decision about whether or not to impose an interim suspension, a Panel comprising of three Members of the Standards Commission will review the interim report and any representations received from the member and will consider whether it is satisfied: That the further conduct of the ESC’s investigation is likely to be prejudiced if such an action is not taken (for example if there are concerns that the member may try to interfere with evidence or witnesses); or That it is otherwise in the public interest to take such a measure. A policy outlining how the Standards Commission makes any decision under Section 21 and the procedures it will follow in doing so, should any such a report be received from the ESC can be found here. 12. The decision to impose an interim suspension is not, and should not be seen as, a finding on the merits of any complaint or the validity of any allegations against a member of a devolved public body, nor should it be viewed as a disciplinary measure.
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35 ANNEX B: DEFINITIONS “Bullying” is inappropriate and unwelcome behaviour which is offensive and intimidating, and which makes an individual or group feel undermined, humiliated or insulted. "Chair" includes Board Convener or any other individual discharging a similar function to that of a Chair or Convener under alternative decision-making structures. “Code” is the code of conduct for members of your devolved public body, which is based on the Model Code of Conduct for members of devolved public bodies in Scotland. "Cohabitee" includes any person who is living with you in a relationship similar to that of a partner, civil partner, or spouse. “Confidential Information” includes: • any information passed on to the public body by a Government department (even if it is not clearly marked as confidential) which does not allow the disclosure of that information to the public; • information of which the law prohibits disclosure (under statute or by the order of a Court); • any legal advice provided to the public body; or • any other information which would reasonably be considered a breach of confidence should it be made public. "Election expenses" means expenses incurred, whether before, during or after the election, on account of, or in respect of, the conduct or management of the election. “Employee” includes individuals employed: • directly by the public body; • as contractors by the public body, or • by a contractor to work on the public body’s premises. “Gifts” a gift can include any item or service received free of charge, or which may be offered or promised at a discounted rate or on terms not available to the general public. Gifts include benefits such as relief from indebtedness, loan concessions, or provision of property, services or facilities at a cost below that generally charged to members of the public. It can also include gifts received directly or gifts received by any company in which the recipient holds a controlling interest in, or by a partnership of which the recipient is a partner. “Harassment” is any unwelcome behaviour or conduct which makes someone feel offended, humiliated, intimidated, frightened and / or uncomfortable. Harassment can be experienced directly or indirectly and can occur as an isolated incident or as a course of persistent behaviour.
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OFFICIAL “Hospitality” includes the offer or promise of food, drink, accommodation, entertainment or the opportunity to attend any cultural or sporting event on terms not available to the general public. “Relevant Date” Where a board member had an interest in shares at the date on which the member was appointed as a member, the relevant date is – (a) that date; and (b) the 5th April immediately following that date and in each succeeding year, where the interest is retained on that 5th April. “Public body” means a devolved public body listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, as amended. “Remuneration" includes any salary, wage, share of profits, fee, other monetary benefit or benefit in kind. “Securities” a security is a certificate or other financial instrument that has monetary value and can be traded. Securities includes equity and debt securities, such as stocks bonds and debentures. “Undertaking” means: a) a body corporate or partnership; or b) an unincorporated association carrying on a trade or business, with or without a view to a profit. 36
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OFFICIAL Appendix 1 – Register of Interests Form Received Date Entered Code of Conduct for Members of the North Lanarkshire Integrated Joint Board Register of Interests Note: If you have no interest in a category, please state “None”. The descriptions provided below are in summary form. For full details refer to the Code of Conduct. Board members must register their registrable interests within one month of becoming a board member and register any changes to those interests within one month of those changes having occurred. Name: Position on Board: Category One: Remuneration Remuneration from Employment Name (Registered name if different) of Employer and Post Held Nature of Business and regularity of remunerated work Additional Comments Details of Employment held Additional Employment held 37
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OFFICIAL Remuneration from Self-employment Name of Business Nature of Business and regularity of remunerated work Additional comments Details of Self- employment held Additional Self- employment held Remuneration as Holder of an Office Nature of Office held Organisation and any allowances received Additional comments e.g. Frequency Details of Office Held Additional details of Offices Held Additional details of Offices Held 38
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OFFICIAL Remuneration as a Director of an Undertaking Name of Undertaking Nature of Business and any allowance received Additional comments Details of first Directorship held Details of second Directorship held Details of third Directorship held Remuneration as a Partner in a Firm Name of Partnership Nature of Business and any allowance received Additional comments Details of first Partnership held Details of second Partnership held Details of third Partnership held 39
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OFFICIAL Remuneration from appointment or nomination by North Lanarkshire Integration Joint Board to another body Name of Body Nature of Business and any allowance received Additional comments Details of first appointment held Details of second appointment held Details of third appointment held Remuneration from a trade, profession vocation or any other work Nature of work For whom undertaken and Frequency Additional comments Details of remuneration from trade, profession or other work Additional instances of remuneration from trade, profession or other work 40
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OFFICIAL Category Two: Other Roles This applies to any unremunerated directorships where the body in question is a subsidiary or parent company of an undertaking in which the member holds a remunerated directorship. Name and registered number of subsidiary, parent or other organisation Nature of business and relationship to company or other undertaking where remunerated directorship under Category One Additional Comments Details of non- remunerated directorship Additional instances of non- remunerated directorship 41
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OFFICIAL Category Three: Contracts Applies to a registerable interest where the member (or a firm in which they are a partner, or an undertaking in which they are a director or in which they have shares of a value as described in paragraph 4.20 of the Code) have made a contract with North Lanarkshire Integration Joint Board: a) under which goods or services are to be provided, or works are to be executed; and b) which has not been fully discharged. Description of Contract (excluding value) Duration of Contract Additional comments Details of contracts entered into None Additional instances of contracts entered into Additional instances of contracts entered into Category Four: Election Expenses If a member has been elected to North Lanarkshire Integration Joint Board, then they will register a description of, and statement of, any assistance towards election expenses relating to election to North Lanarkshire Integration Joint Board. Source of Assistance towards Election Expenses Description of any Allowance received Additional comments Details of election expenses Additional instances of election expenses 42
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OFFICIAL Category Five: Houses, Land and Buildings Requirement to declare land/housing ownership or any other right or interest in houses which may be significant to, or of relevance to, or bear upon, the work of North Lanarkshire Integration Joint Board Description of interest Description of approximate location Additional comments Details of interests in houses, land and buildings Additional instances of interests in houses, land and buildings Additional instances of interests in houses, land and buildings Category Six: Shares and Securities A description of the shares is required if (a) a member owns or has an interest in more than 1% of the issued share capital of the company or other body; or (b) where, at the relevant date, the market value of any shares and securities (in any one specific company or body) that they own or have an interest in is greater than £25,000. Description of undertaking Description of nature of holding (value need not be disclosed) Additional comments Details of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB 43
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OFFICIAL Additional instances of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of interests in shares and securities which may be significant to, or relevant to, or bear upon the work of the IJB Category Seven: Gifts and Hospitality Members should understand the requirements of paragraphs 3.12 to 3.20 regarding gifts and hospitality. As members will not accept any gifts or hospitality, other than under the limited circumstances allowed, they understand there is no longer the need to register any. Date Description of Gift Received from 44
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OFFICIAL Category Eight: Non-Financial Interests Members may also have other interests and they understand it is equally important that relevant interests such as membership or holding office in other public bodies, companies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. In this context, they understand non- financial interests are those which members of the public with knowledge of the relevant facts might reasonably think could influence their actions, speeches, votes or decision-making in North Lanarkshire Integration Joint Board (this includes its Committees and memberships of other organisations to which they have been appointed or nominated by North Lanarkshire Integration Joint Board). Description of interest Additional comments Details of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB Additional instances of non- financial interests which may be significant to, or relevant to, or bear upon the work of the IJB 45
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OFFICIAL Category Nine: Close Family Members Members will register the interests of any close family member who has transactions with North Lanarkshire Integration Joint Board or is likely to have transactions or do business with it. Relationship Nature of transaction Additional comments Details of interest Additional instances of interest Additional instances of interest Date of Preparation: Number of Continuation Sheets: Signed: 46
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Version Control Date Summary of Changes 1 20/03/2023 North Lanarkshire Integration Joint Board DIRECTIONS POLICY Appendix 4 47
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Contents 1. Purpose and Scope .......................................................................................................................... 1 2. Policy Aims ...................................................................................................................................... 1 3. Legislative/Policy Framework ......................................................................................................... 1 4. Definition and Purpose of Directions .............................................................................................. 2 5. Policy Implementation .................................................................................................................... 2 6. Monitoring and Review ................................................................................................................... 3 Appendix 1: Directions Procedure .......................................................................................................... 4 Appendix 2 :Process for Issuing Directions ............................................................................................. 5 48
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1. Purpose and Scope This policy sets out the process for formulating, approving, issuing and reviewing directions from North Lanarkshire Integration Joint to NHS Lanarkshire and North Lanarkshire Council. This policy has been developed in line with the Public Bodies (Joint Working) (Scotland) Act 2014 and Scottish Governments Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on Integration Authorities (IJBs) to develop a strategic commissioning plan, for integrated functions and budgets under their control. An Integration Authority requires a mechanism to action their strategic commissioning plan, this mechanism takes the form of binding directions from the Integration Authority to one or both of NHS Lanarkshire and North Lanarkshire Council. Directions are also the means by which a record is maintained of which body decided what and with what advice, which body is responsible for what, ad which body should be audited for what, whether in financial or decision making terms. In January 2020, the Scottish Government issued Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities. The North Lanarkshire Joint Board must issue a direction in respect of every function that has been delegated to it by NHS Lanarkshire and North Lanarkshire Council which must provide relevant budget information. Directions are the means by which the IJB informs the Health Board and the Local Authority what is to be delivered using the integrated budget and for the IJB to improve the quality and sustainability of care, as outlined in its strategic commissioning plan. Directions are also the legal basis on which the Health Board and Local Authority deliver services that are under the control of the IJB. 2. Policy Aims This policy seeks to enhance governance, transparency and accountability between the IJB, NHS Lanarkshire and North Lanarkshire Council by clarifying responsibilities. This policy has been developed to ensure compliance with the Scottish Governments Directions from Integration Authorities to health boards and local authorities: statutory guidance. 3. Legislative/Policy Framework The Public Bodies (Joint Working) (Scotland) Act 2014 states that an Integration Joint Board must give a direction to constituent authority to carry out each function delegated to Integration Authority. Revised statutory guidance on directions was issued by Scottish Government in January 2020. This statutory guidance has informed the development of this policy, to ensure that the IJB can meet the key requirement of the guidance to improve governance, transparency and accountability between all partner organisations. 49
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4. Definition and Purpose of Directions It is essential that directions are understood to be the end point of a process of decision making by the IJB. Directions should not contain surprising or completely unknown information about service change or redesign and should follow a period of wider engagement on the function(s) that are the subject of the direction. This should normally be part of the service planning and design phase of strategic commissioning. Directions are legally binding, which is why they come at the end point of a process of planning and decision making. The delivery partners are required to comply with all directions received from the IJB, and the law is clear that they may not amend, ignore, appeal or veto any direction. Neither NHS Lanarkshire nor North Lanarkshire Council may use resources allocated via the Integration Joint Board in pursuit of a direction for any other purpose than that intended. The content of Directions should be sufficiently detailed to ensure the intention of the IJB is adequately captured. Directions should include information on the required delivery of the function and the financial resources that are available for carrying out the function. Directions may specify what the Health Board, Local Authority or both are to do in relation to carrying out a particular function. Lack of detail in a direction may cause difficulties in performance monitoring and hamper the effective delivery of the function. To assist with monitoring and reviewing directions issued, the IJB may seek information from either the Health Board or Local Authority or both about the delivery 5 of a function that is the subject of a direction, including when issues are identified in implementation and delivery of a direction. Specific directions can be given to NHS Lanarkshire, North Lanarkshire Council, or both (Health and Social Care Partnership (H&SCP)) depending on the services to be provided. However, directions should not be issued unnecessarily and should be proportionate. A direction will remain in place until it is revoked, varied or superseded by a later direction in respect of the same function. In summary, the purpose of directions is to set a clear framework for the operational delivery of the functions that have been delegated to the IJB. All directions must be in writing. Functions may be described in terms of delivery of services, achievement of outcomes and/or the priorities set out in the strategic commissioning plan. 5. Policy Implementation This Policy has been developed in line with the Public Bodies (Joint Working) (Scotland) Act 2014, Scottish Governments Statutory Guidance on Directions from Integration Authorities to Health Boards and Local Authorities as published in January 2020. This Policy defines what a direction is and is underpinned by the Directions Procedure (Appendix 1) which supports the development of new and revised directions. Directions are informed by a number of factors, including but not limited to: Content of the IJB Strategic Commissioning Plan Specific service redesign or transformation programmes 50
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Financial changes or developments A change in local circumstances A fundamental change to practice or operations. 6. Monitoring and Review Directions: The IJB has agreed that Directions will be monitored on a quarterly basis via the IJB Committee structure. This will ensure that the relevant Committee will assume responsibility for maintaining an overview of progress with the implementation of directions, via detailed reports, and escalating any issues to the IJB. A full set of directions, will be presented to the IJB at the start of the financial year following confirmation of budget setting arrangements, however, other directions will be brought forward throughout the year to reflect strategic developments and service transformation. Policy: This policy will be reviewed every two years by the IJB, or earlier if Scottish Government release further guidance. 51
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Appendix 1: Directions Procedure This procedure sets out the process for formulating, approving, issuing and reviewing directions for the North Lanarkshire Integration Joint Board to NHS Lanarkshire, North Lanarkshire Council or both constituent authorities. A process map is attached at Appendix 2 of this document. 1. Directions Directions are the mechanism by which the IJB delivers its Strategic Commissioning Plan. When a Direction is presented to the IJB, the report author must ensure that the content of the Direction include details of the function to which it is the subject of, budget information which has been delegated to deliver it, the impact on workforce, any legal or risk implications, impact on IJB outcomes, priorities or policy, details of consultation and an Equalities Impact Assessment if required. The final page of the report template (attached at Appendix 3) provides a standard format for outlining the requirements for each direction to be issued; all sections of this must be completed. Following approval at the IJB a Direction will then be issued on behalf of the Chief Officer to the Chief Executive of NHS Lanarkshire, the Chief Executive of North Lanarkshire Council, or both. This will take the form of a letter together with the IJB report, including Direction template. Directions will be copied to the Chair and Vice Chair of the NHS Board and the Leader and Deputy Leader of the Local Authority. Directions should be issued within 7 days of IJB approval where possible. The details of each Direction issued by the IJB are entered into the IJB Register of Directions. An update on Directions will be provided quarterly to the IJB. A Direction will remain in place until it is varied, revoked or superseded by a later direction in respect of the same functions. 2. Implementation and Monitoring of Directions NHS Lanarkshire and North Lanarkshire Council are responsible for complying with and implementing all directions issued by the IJB. As the issuing of directions is a legally binding process any issues with this should be brought to the attention of the Chief Officer. An annual report on all current Directions will be presented to the IJB. 52
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Appendix 2: Process for Issuing Directions If any of the following cicrumstances are detailed within the report being submitted to the IJB, then a direction should be issued as per process detailed below.. o Specific service redesign or transformation o Financial changes or developments o Strategic Commissioning Plan o Changes in local circumstances o Fundamental changes to practice or operations When issuing a direction consideration must be given to: Scope and scale of function Finance involved Scale and nature of change Timescale for delivery Those impacted by the change ‐ Patients ‐ Service users Paper presented to IJB/IJB PFA for discussion IJB agree the directions required based on paper Directions issued to relevant partner(s) to carry out the functions relating to the directions Assurance provded via the IJB on the delivery of the function to which the Direction related to on a quartly basis 53
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‐ Carers ‐ Local communities ‐ Staff ‐ Others 54
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Appendix 3 ‐Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number This will be provided by IJB Administration Support Team 2 Report Title Title of Report 3 Date direction issued by IJB Date of IJB meeting that direction was issued 4 Date from which direction takes effect Date of when the direction should begin to be implemented or date direction issued by IJB 5 Direction to: This can be either: ‐ NHS Lanarkshire ‐ North Lanarkshire Council ‐ H&SCP 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) This can be provided by IJB Administration Support Team 7 Functions covered by direction List all the functions to which the direction related e.g. Occupational Therapy, Mental Health. 8 Full text of direction Detail what the authorities are being asked to carry out. 9 Budget allocated by Integration Joint Board to carry out direction Detail if any funding has been allocated by IJB to carry out direction. 10 Performance Management / Governance arrangements Directions will be reported to the relevant IJB committee quarterly and an annual report of all current directions presented to IJB. Detail if any other groups etc will be involved in the performance management of the direction e.g. Core/ SLT. 55
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11 Date direction will be reviewed Date at which the next review of the direction is due (e.g. at next IJB meeting). 56
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NORTH LANARKSHIRE IJB RISK REGISTER OVERVIEW [Document subtitle] Anderson, Stacey [Email address] Abstract [Draw your reader in with an engaging abstract. It is typically a short summary of the document. When you’re ready to add your content, just click here and start typing.] Appendix 5 57
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North Lanarkshire IJB Risks – Dashboard Executive Summary Following an agreement of the IJB Risk Strategy at the IJB held on xxxxxx, a full review of the IJB risk register was undertaken Any emerging or new risks are discussed at the IJB PFA and presented for information at IJB All risks on the IJB Risk Register are consistently reported to relevant assurance committees to provide oversight and assurance Highest Scoring Risks IJB Risk Score Trend NL Council Risk Score Trend Risk movement since last report No Change Risk Level Increase Risk Level Decrease New Risks Closed Risks Risks with Action Updates Risk Registers Number of Risks IJB NL Council NHS Lanarkshire 58
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NHS Lanarkshire Risk Score Trend 59
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Details of IJB Risk Movement/ Update of Actions Risk (Reference and Title) Date Risk Added to Register Current Score Trend Target Score Commentary SMART Actions for the risk 60
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61 REPORT Item No: SUBJECT: TO: Lead Officer for Report: Author(s) of Report DATE: 16 February 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 By: ☐ Reviewed By: ☐ Endorsed By: ☐ Appendix 6
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62 3. RECOMMENDATIONS 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 6. CONCLUSIONS 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ Yes ☐ No ☐ N/A ☐
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63 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Yes ☐ No ☐ N/A ☐
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64 ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐ Members seeking further information about any aspect of this report, please contact the following;
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65 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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66 REPORT Item No: SUBJECT: This will match the name on the agenda. Please do not use ALL CAPITAL LETTERS when typing this. TO: This will be the name of the committee either –Integration Joint Board or Integration Joint Board Performance, Finance & Audit. Lead Officer for Report: This should include full name and job title and should be completed before being submitted to IJB administration support. Author(s) of Report This should include full name and job title of any report contributors and should be completed before being submitted to IJB administration support. DATE: 16 February 2023 Show the actual date of the meeting being presented at; to do this select the correct date from drop down box. Please do not enter date when the report is written. 1. PURPOSE OF REPORT Identify by using the correct check box is report is for approval, endorsement or noting. Please make at least one selection in this section. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☐ 2. ROUTE TO THE BOARD Where possible outline who has prepared the report, who has reviewed report prior to submission and who has endorsed the report (such as another group). This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☐ Appendix 7
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67 3. RECOMMENDATIONS Recommendations must be written in line with the following example: It is recommended that the IJB/IJB PFA Committee: (1) (2) (3) etc. Each individual recommendation should have a separate number and each recommendation should ask something of the audience, e.g. approve, consider, endorse, acknowledge, recognise, review, etc. Use of the word Note in recommendations should be avoided, alternative words could be consider, endorse, acknowledge, recognise, review, etc. It should be noted that many committees are required to receive reports for information in line with the terms of reference for that committee or because there is a statutory requirement to do so. If this is the case, please state this in the recommendations, e.g. consider abc in line with xyz. Recommendations listed in this section should be articulated in the body of the report (i.e. the rationale for any recommendation should be set out clearly in the body of the report), similarly any recommendation narrated in the body of the report should be listed in the recommendations section. A recommendation for a report to be remitted to another Committee / Sub- Committee should only be included if that Committee / Sub-Committee requires to take a decision - remits for Noting are discouraged. Please don’t forget to number the recommendations using a simple 1, 2, 3, 4, etc format (not roman numerals or using a b, c, d).
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68 4. VARIATIONS TO DIRECTIONS? Directions are the means by which the IJB tells the Health Board and the Council what is to be delivered using the integrated budget. A direction must be given in respect of every function that has been delegated to the IJB. Directions are a legal mechanism, the use of directions is not optional for IJBs, Health Boards or Local Authorities, it is obligatory. This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required Detail if Health Board, Local Authority or Both. 5. BACKGROUND/SUMMARY OF KEY ISSUES The Background should set the context for your report and contain information that covers, for example, what has led to the purpose of the report (e.g. legislative or transformational change), summarising relevant information previously reported and previous decisions approved. It should provide sufficient information so that the reader understands the context within which the report is being presented. The body of the report should be as succinct as possible and the text should flow logically. It should inform readers of the work carried out to date and explain future work plans. Generally, it should provide new information that requires further consideration and/or approval. Long sentences or paragraphs of text should be avoided; short sentences and short paragraphs are much easier to read. Please don’t forget to check the paragraph numbering runs in sequence, the text is formatted correctly, and the paragraph numbering is formatted and indented correctly. Headers are Arial, font size 12, bold with single line spacing. Body of the report is Arial, font size 12 with single line spacing. Yes ☐ No ☐ N/A ☐
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69 6. CONCLUSIONS This section should draw the committee’s attention back to the key reasons and arguments in favour of the recommendations made within the report. Conclusions can also inspire fresh concepts to address a problem highlighted within the report or presenting fresh perspectives on a subject. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Please check the relevant boxes from the 9 national outcomes. Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) This should refer to other associated work/governance arrangements in place. 7.3 FINANCIAL Where there is a financial impact highlighted within your report, please summarise this impact. In doing so please ensure that all financial impacts have been discussed and agreed with Finance. Where there is a financial impact that requires to be discussed and agreed with Finance, please ensure you have ticked the box to confirm that this has been done.
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70 This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT State details of which Risk Register the topic is listed on (if any), the current risk level and the risk owner. Where appropriate outline any mitigations in place. Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICIPATION State how engagement and participation links to this piece of work, providing further details where appropriate on what engagement and participation was undertaken. Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of
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71 expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY As per Equality Act 2010, please ensure that the policy, project or scheme does not unlawfully discriminate against any protected characteristics. EQIAs should be carried out: when developing new or reviewing current policies, strategies, services and functions. Please see Equality Impact Assessment Guidance and Forms (available on first port) for further guidance. . EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS Outline any other relevant papers or websites. 9. APPENDICES Please include a glossary of terms if not already included. If the report has one or more Appendices, please use this section to list the Appendices (examples below). These can be files attached to the report or hyperlinks to external sources, e.g. a website.
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72 For example: - Appendix 1 - name of document attached to report - Appendix 2 - title on web page and url hyperlink for an item on the council’s website or to an external webpage. Please ensure any url links will work for all audiences. Please do not embed Excel / Word / PowerPoint / PDF files into your report - they are not always able to be retrieved by the reader when turned into a pdf; so do not always enable the reader to review the complete information. Any information from embedded files must be extracted and added as an appendix. Please do not insert any other text under the name and title of the signatory for the report. . CHIEF ACCOUNTABLE OFFICER (or Depute) For governance purposes the accountable officer should be a chief officer (Heads of Service are classed as chief officers). This should be an electronic signature and not typed. Note: All reports must have a signature. Members seeking further information about any aspect of this report, please contact the following; It is useful to provide the details of the contact person (name, e-mail address, and telephone) who can respond to enquiries on the subject matter of the report, so the E-mail address can show either show the Chief Officer or the author of the repor
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1 REPORT Item No: 7 SUBJECT: Resilience Response TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 17 May 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 being taken in response to current whole system service pressures. 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 PFA 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 The IJB received an update on Operation Flow at its meeting on 22nd March 2023 and again at the PFA meeting on 19th April 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 5.2.2 Following two further face to face planning sessions that brought together leaders from across the whole system, a Task and Finish structure has now been developed to take forward the key actions agreed for Operation Flow 2 (see appendix 1). 5.2.3 Five Task and Finish groups commenced on week beginning 24th April, with the aim to have the second stage of Operation Flow fully implemented by September 2023. 5.3 Delayed Discharge 5.3.1 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. 5.3.2 Performance in North Lanarkshire has been on an improving trajectory since February, though the Easter fortnight did present some challenges as demonstrated in figure 1, though performance has returned back to the mid-70s by the end of April. Figure 1 North Lanarkshire Delayed Discharges 5.3.3 Figure 2 shows that bed days were out with routine variation in January but have returned within the control limits in February. This contrasts with the Scotland position where delayed discharge bed days for standard delays are at pre Covid
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3 levels with special cause variation September – February 2023 (fig. 3). Since the operation flow ‘firebreak’ in late February/early March, delayed discharge performance has been on a positive trajectory. Figure 2 HSCP NL SPC Standard Bed Days Figure 3 NHS Scotland Standard Delays bed days 5.3.4 Performance at the 10th April 2023 Public Health Scotland data release (figure 4) showed North Lanarkshire continued below the Scottish average in terms of rates of delay for the overall adult population and in a similar position for 75+ delays.
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4 Figure 4 Patients in standard delay, rate per 100,000 for all HSCPs 5.3.5 The number of patients discharged with no delay dropped from 96% to 95% (target 98%) over the Easter fortnight (figure 5). Figure 5 All inpatient discharges 5.3.6 Whole system work continues on the Discharge Without Delay process, current performance (figure 6) shows the overall increase in patients aged 65+ who have a PDD set and remains consistently around 60% though this has dipped moving into April. Figure 7 shows a decrease in unplanned referrals to their lowest point in six months in the middle of March but these have increased again in recent weeks. Figure 6 Current Inpatients (at time of census) with a Planned Date of Discharge
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5 Figure 7 Current Inpatients (at time of census) with a SW referral that is unplanned 5.3.6 Factors affecting performance over Easter: Higher annual leave across the whole system Increase in sickness absence, including Covid Significant pressures on acute sites, with added complication of a peak of Covid inpatients hitting highest number in a significant number of months of over 130 Due to site pressures, referrals for supported discharge on the date of clinical readiness increased and planned dates of discharge dipped. It is important to note, however, that both Lanarkshire partnerships have not seen the deterioration in performance around Delayed Discharge as seen elsewhere in Scotland since the pandemic due to the significant improvements in use of planned dates of discharge and reducing numbers of unplanned referrals (though admittedly starting from a poor baseline) Demand for supported discharge remains very high, with over 130 referrals per week being received in recent weeks. To put this into context, during the peak winter pressures of 2019/20, North Lanarkshire had the highest rate of referrals for supported discharge in Scotland, averaging 77 referrals per week. 5.3.7 Current developments: New Home Assessment Teams are now live in 2 Localities and rolling out across the remaining 4. These teams provide wrap around care and assessment for 2wks in people’s own homes. This allows us to provide early supported discharge and assessments in the patient’s own home, rather than in an acute environment. To date, we have received 608 referrals from hospital, with 62% requiring no ongoing Home Support after the 2wks of support. The aim is to provide this service from community as well in future to prevent unnecessary admissions Additional Clinical Support Worker posts have been created in the District Nursing Teams to focus on those identified for Care Management (highest risk of admission) to support more proactive support of high risk patients in the community New choice protocol developed to more proactively manage Care Home related delays Lanarkshire is a demonstrator site for Discharge Without Delay. The graphs above highlight the improved understanding of our system and whole-system focus on improvement
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6 Home Support programme board in place to review the current service model and implement new ways of working 5.3.8 With a number of upcoming long weekends in May, the partnership will have a full presence on the acute sites over the long weekends, including our Home Assessment Teams, while Planned Dates of Discharge will continue to be set for over the long weekends with the aim of ensuring flow is maintained. 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 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 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.
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7 9. APPENDICES Appendix 1: Operation Flow 2 structure ............................................................................. 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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8 Appendix 1: Operation Flow 2 structure
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1 REPORT Item No: 8 SUBJECT: Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 17th May 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 Scottish Government’s action plan to improve delayed discharge and hospital occupancy. 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 the Scottish Government action plan on delayed discharge and hospital occupancy; (2) Note that the actions contained within are being built into the phase 1 action plan for Operation Flow, to ensure a whole system approach is fully embedded in Lanarkshire; (3) Request sight of the Operation Flow phase 1 action plan and associated task and finish groups once finalised. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Winter 2022/23 was an incredibly challenging period for health and social care systems across Scotland, managing a number of complex factors including increased seasonal demand for unscheduled care and critical care due to the combined incidence of flu, Covid-19 and other respiratory infections. 5.1.2 Throughout this period, local systems have tried to manage through these competing demands with whole system actions such as Discharge Events and substantial developments such as Operation Flow within Lanarkshire. 5.1.3 This has led to a greater understanding of the issues being faced and what works, with the greatest challenge facing all systems being how to turn this into plans that can create a sustainable difference. 5.1.4 The action plan brings together 12 whole system actions across the areas of Good Practice, Data Management and Workforce, that are essential in reducing pressure on staff and the system and in ensuring people receive the right care in the right place at the right time. The Action Plan is attached in appendix 1. 5.2 Delayed Discharge and Hospital Occupancy Action Plan 5.2.1 The Action Plan places significant emphasis on ‘getting the basics right’ through consistent implementation of models such as the Discharge Without Delay programme, of which NHS Lanarkshire is a demonstrator site. This includes: Use of admission avoidance approaches such as Hospital at Home, multi-agency input at the front door, Locality rapid wrap-around models and early whole-system input within the first 48hrs of admission for those who do require acute care. The social care needs of patients are considered in every ward with social work input to wards with high frailty, providing expert advice and input to discharge planning Discharge Without Delay principles should be utilised to set jointly agreed Planned Dates of Discharge, reviewed daily and used to plan and prepare discharges Use of multi-agency teams to support senior decision making, with whole system visibility of plans and senior oversight and escalation to resolve any delay-causing issues Structured ward rounds or white board reviews 7 days per week to ensure there are priorities, plans and tasks set for the day and the parameters for criteria led discharge agreed to support early discharge Utilise Planned Dates of Discharge to commission/organise care Identify complex discharges early in their inpatient journey, including those with high frailty scores, to allow coordinated multi-agency management Ensure early engagement with families and carers to manage expectations Implement discharge to assess and intermediate care models to support discharge home and allow assessments for ongoing care to be undertaken in people’s own homes. Utilise community rehabilitation as the preferred place of recovery and intermediate care. 5.2.2 These ‘getting the basics right’ actions are included in NHS Lanarkshire’s Flow Foundation Bundle developed through Operation Flow.
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3 5.2.3 The twelve actions identified within the plan are noted below: 1 All systems to review and implement learning from their discharge event to embed improvements in an ongoing, ‘business as usual’ way Boards and IJBs to confirm this has been actioned by end March 2023 2 Put systems in place to provide the assurance necessary to confirm the measures set out in ‘Getting the Basics Right’ are consistently being applied Boards and IJBs to confirm this has been actioned by end April 2023 3 SG will continue work with NES to develop a toolkit of support and training materials to support discharge Toolkit and materials to be available by end April 2023 4 Boards and IJBs to assess their systems and processes in terms of acute discharge planning and apply the DwD toolkit in every inpatient area, community hospitals and other off-site beds Boards and IJBs to confirm this has been actioned by end April 2023 5 SG to provide a tactical social care dashboarding solution to support HSCPs and HBs to have access to a core set of indicators, predicated on existing and robust management information to enable consistent and comparable data to be available at different levels of geography Dashboard to be available by end April 2023 6 SG to provide modelling of potential future demand to support more effective local planning Modelling to be available by end April 2023 7 SG to support partners to develop forum to drive work towards more consistent and comprehensive data Forum to be established by end March 2023 8 SG/PHS/NSS to provide a strategic solution for the delivery of MI data for insights across health and social care using NSS’s Seer2 platform Solution to be agreed by end May 2023 9 SG to support local partners through NES to utilise international recruitment Ongoing 10 Continue to pursue national recruitment campaign Ongoing 11 Continue to pursue recruitment activity with DWP for Ukrainian displaced people and UK residents that are economically inactive Ongoing 12 Increase in pay to £10.90 per hour in 23/24 for adult social care sector in commissioned services. Looking at improvements to terms and conditions for adult social care in 2023/24 April 2023 and ongoing 5.2.4 A number of face to face whole-system development sessions have been held to support learning from the Operation Flow firebreak, with a weekly whole-system Operation Flow Programme in Board to develop the next stages of the local action plan. 5.2.5 Five task and finish groups have been developed to implement the local action plan, which picks up actions 1, 2 and 4 in the table above. This will conclude the first phase of Operation Flow, with the aim of having sustainable implementation of these initial actions by summer. Phase two will then commence with a view to preparing for winter, with the third phase then being the wider transformation of services in the longer-term. 5.2.6 The North Lanarkshire HSCP has been involved in the previous exercises to build a social care dashboard outlined in action 5, with work ongoing to develop this through the new
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4 national Whole System Oversight and Planning Group, of which the North Lanarkshire Chief Officer is a member. 5.2.7 The Lanarkshire system continues to engage with the Scottish Government and NES around international recruitment, with some recent success through this approach. 6. CONCLUSIONS 6.1 Through Operation Flow, the Lanarkshire system has undertaken a large-scale programme of change, which has picked up the vast majority of the actions outlined within the new national action plan. 6.2 The Operation Flow phase 1 action plan and associated task and finish groups is currently being finalised and will be shared with the NHS Board and IJBs in due course, for full implementation over the coming 3-4 months. 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 17/22 sets out the impact of unscheduled care challenges in the Lanarkshire system. 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 Appendix 1 Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan
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5 ............................................................................. 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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6 Appendix 1 Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan March 2023
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7 Contents Foreword 1. Context ............................................................................................................. 10 2. Delayed Discharge .......................................................................................... 11 2.1 Defining a delayed discharge ...................................................................... 11 2.2 January 2023 Discharge Events .................................................................. 11 3. Delivery Action ................................................................................................ 11 3.1 Good practice ............................................................................................ 12 3.1.1 Reduce length of stay and ensure people are discharged when they are clinically fit. ........................................................................................................ 12 3.1.2 Getting the basics right ......................................................................... 12 3.1.3 Support already provided ...................................................................... 14 3.1.4 Actions for Best Practice ....................................................................... 15 3.2 Data and Managing Variation ................................................................... 15 3.2.1 Analysis for future planning ................................................................... 15 3.2.2 Using data-driven insights to manage variation .................................... 15 3.2.3 Actions for Data and Managing Variation .............................................. 16 3.3 Workforce ................................................................................................... 16 3.3.1 Labour Shortages ................................................................................. 16 3.3.2 Actions for Workforce ............................................................................ 17 4. Sustaining Change .......................................................................................... 17 4.1 Transparency ............................................................................................... 17 4.2 Measuring Progress .................................................................................... 17 5. Conclusion and Next Steps ............................................................................ 18 ANNEX A – Context ......................................................................................... 19 Short-term pressures on the NHS ..................................................................... 19 Persistent Demand ............................................................................................ 19 Admissions into Acute ....................................................................................... 20 Ageing Population ............................................................................................. 21 Frailty and Deconditioning ................................................................................. 21 Social care vacancy levels .................................................................................... 21 ANNEX B – Delayed Discharge ...................................................................... 23 Reasons for delayed discharge ............................................................................. 23 Trends in delayed discharge ................................................................................. 24 Flow through delayed discharge ........................................................................... 25 ANNEX C – Definition of Discharge Event ........................................................ 26 ANNEX D - Improving Urgent and Unscheduled Care ..................................... 28 Increasing capacity outwith hospitals .................................................................... 28 Foreword
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8 Winter is challenging for the NHS every year, but winter 2022/23 was considerably more so for a variety of factors, not least the substantial increase in short-term seasonal demand for unscheduled and critical care due to the combined high incidence of flu, Covid-19 and other respiratory infections. This has placed exceptional pressure on an already strained system that was working hard to rebuild following the pandemic and striving to address the ‘backlog’ and meet high levels of demand for elective procedures. Additionally we have been responding to the deconditioning of those who either were waiting for care or had their care delayed due to fear of Covid-19 and/or a wish not to add to the strain on the health and social care system. In response to what we knew was going to be a challenging period, the Winter Resilience Plan set out a number of priorities in preparation for winter. Now that seasonal demand is subsiding, this Action Plan reflects on the strong evidence of what we know works and builds on the firm foundations of best practice to reduce delayed discharges and overall hospital occupancy, and reasserts the Scottish Government’s commitment to responding to the many challenges that still exist over the coming weeks and months. The Action Plan sets out the key actions which should be taken now to address the urgent issues around delayed discharge and high hospital occupancy we continue to experience and whose impacts are felt across the whole system. Immediate actions to ensure we are getting the fundamentals right consistently and in a way we can sustain can be found on pp10-11 of this plan. This Action Plan recognises the complexities of the challenges we are facing, whilst also acknowledging that the demands upon health and social care have changed significantly post-pandemic. Delayed discharge impacts on length of stay, and exit blocks cause access blocks, hence this plan emphasises the importance of a whole system response involving hospitals (acute led care), residential care (care homes) and primary/community care (including care at home). As set out in the recent NHS Delivery Plan Guidance for Board Annual Delivery Plans, the health and social care system must respond at all points along the patient journey, recognising the significant impacts interruptions to patient flow have on other parts of the system, such as the ambulance service and A&E. This plan proposes a set of immediate actions to be taken which represent good practice - and consideration should be given in delivery plans around how to embed and sustain these activities. Flow, the alignment of the discharge pattern with the admission curve, ensures patients get to the right bed at the right time and prevents unnecessary consumed capacity or increased length of stay. Working together across traditional boundaries will help us to improve flow through our acute settings, and delayed discharge as we work towards winter 2023/24. Multi-disciplinary and multi-agency teams are vital in enabling that all-important flow, and in moving the public away from the notion of doctor-led care as the default, particularly, in the context of this Action Plan, when it comes to discharge from hospital. Whilst it is impressive that around 97% of all discharges are without delay, we need to implement actions that we know are effective now to increase that figure and reduce the pressures we are experiencing across the NHS and in social care. The 3% of patients who do go on to be delayed in their care have a disproportionately poorer experience and poorer outcomes, and their delay consumes a high proportion of capacity (bed days lost). In all of our actions, we must bear the principles of realistic medicine in mind: ensuring patients, people, are involved in decisions about their own care and that we listen to their needs and wants at as early a stage as we can – particularly with regards to their wishes when it comes to leaving hospital and on into the care system. We must also recognise the ethical issues surrounding unnecessary, long-term hospital stays, and we must continue our concerted effort to reduced delayed discharge. Reducing delayed discharge is not a silver bullet to reducing hospital occupancy, but it is an important element to consider as part of the package of measures needed to improve flow. We must sustain the changes that have happened over winter 2022/23 to improve the flow of patients through urgent and unscheduled care, including, but not limited to discharge without delay.
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9 This Plan also recognises that there are challenges that will be difficult to address in the short term, such as recruitment and retention (in part itself caused by a declining supply of a working age population) and variability of capacity and demand throughout Scotland. But we know from the experience we have gained over the past months what works. This Action Plan draws together 12 actions we can take immediately under the following areas, with an over-arching aim alongside other measures of returning occupancy to pre-pandemic levels: Good practice – the evidence regarding what works is clear, and we need to adopt this consistently across both health and social care and ensure there is a continuous focus on evidence-based improvement. Data management – the data tells us the challenge and pressure the system is under, but we need to ensure that we continue to improve data and information so we move towards a whole system approach to developing intelligence that can be used to improve health and social care. Workforce – vacancy levels (particularly in social care) remain a key challenge and we must do all we can to support recruitment and retention. Whilst the immediate actions set out in this plan are essential in reducing pressure on staff and the system, assuring patient safety and addressing the ethical issues of unnecessary hospital stays, we must use these actions and learnings to support our ongoing commitment that people receive the right care in the right place at the right time. This Action Plan should be seen as a relatively short-term but important constituent part of our overall improvement agenda that gives assurance that we are as prepared as we can be for winter 2023/24 and beyond. With this longer-term objective in mind, we have commenced our annual planning cycle to help us assess current capacity against anticipated demand which will include surge activity at times when we know that the health and social care system is likely to come under increased pressure. This is set out in the NHS Delivery Plan which covers plans for both 2023/24, and for the medium term. John Burns Angie Wood NHS Scotland Chief Operating Officer Scottish Government Interim Director Social Care
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10 1. Context Winter 22/23 has seen extreme pressure across our health and social care system. But the pressures are not exclusive to the winter months alone. The average length of stay in hospital now stands at 8.4 days, which is a day longer when compared to the three years before the pandemic. This Action Plan sets out the issues facing the system and the actions we can take now to address them, with a particular focus on the bridge between hospital and care settings. There is a clear need to consider the potential social care needs of patients at an early stage in their hospital journey, and to discuss those with the patient and their family and current carers. Involving the patient in decisions about their health care and their subsequent care outwith the hospital setting is vital in both working towards our ambition of putting the patient’s needs and wishes at the heart of their care path, and in helping smooth the flow of patients as they transition into ongoing care, where necessary. 1.1 Older Population Scotland’s demographics are being shaped by an increasing older population and while we celebrate that people are living longer, this does mean that we are seeing a shift in front door presentation: we are admitting people who are older, with multi-morbidity and higher acuity than ever before. An increasing older population and the health inequalities which persist in our society mean that many people are entering their later years in poorer health, frail and with multiple morbidities. All of which is translating into longer hospital stays and a knock-on impact on the flow of patients through our hospitals and on into care after hospital. 1.2 Risks of Longer Hospital Stays People being in hospital for longer than necessary is one of the current key issues facing the system, which presents a number of ethical issues as this can be to the detriment of the patient. Spending too long in hospital can lead to: risk of deconditioning and frailty risk of healthcare associated infection, falls and delirium a sense of disconnection from family, friends and usual social networks leading to boredom, loneliness and loss of confidence distress for family and carers who have to spend time and money on regular visits to a hospital that may be some distance from home 1.3 Hospital Occupancy Hospital occupancy is an important measure as it reflects the pressure in a system and the ability of a hospital to move patients efficiently through a hospital and to a specialty bed. We know that hospital occupancy is high and this in itself is leading to an increased level of clinical risk as patient care is being delayed, which is most visible in the media coverage of long waits in Accident and Emergency (A&E) and ambulances queuing as they seek to admit patients. This is of course in spite of considerable effort being taken to divert the general public to the right place for their healthcare needs when A&E or a GP practice is not appropriate, and pausing of elective activity in some Board areas in order to generate capacity in acute settings. Pre-covid quarterly official statistics showed that acute bed occupancy was subject to seasonality, running between 85-89%. Official statistics also show that the medical group of acute beds generally run at a higher occupancy than the surgical grouping. But we know that in order to reduce occupancy levels to around these pre-covid levels, it requires a whole system response with both health and social care working together. Acknowledging that there are actions that can be taken at every point in the patient
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11 journey and implementing those actions we know work now will help relieve those pressures and set us on a path to better manage the inevitable increased demand we will see in Winter 23/24. Further context is given at Annex A. 2. Delayed Discharge 2.1 Defining a delayed discharge Put simply, a delayed discharge is when a patient remains in a clinical setting when they are deemed to be clinically fit to be discharged. Importantly around 97% of all discharges from hospital are not delayed. However, as of 24 February 2023 there are circa 1,800 patients whose discharge has been delayed, recorded via our management information systems. Whilst addressing delayed discharge is not the only solution to reduce hospital occupancy, it remains an important element, not least as these statistics represent people who are in a setting that is not appropriate for their care. It is also important to note that these figures are management information, are submitted daily, are not revised and have not been verified. Although the detail behind the overall number of patients whose discharge is delayed is often not reported, it is important to note that there are different categories of delayed discharge. These are broken down firstly by setting: acute, mental health and community hospitals. Public Health Scotland share a list of acute hospitals on their Official statistics Delayed Discharge publication and local authorities follow the same definitions as Public Health Scotland. They are further broken down by the type of delayed discharge: a standard delay or code 9 delay. Code 9 delays are when partnerships are unable, for reasons beyond their control, to secure a patient’s safe, timely and appropriate discharge from hospital. Code 9 delays can be split further into Adults With Incapacity (AWI) delays and Complex (also known as Code 9: Other delays). These are used where: the patient lacks capacity, is going through a Guardianship process, and for whom the use of S13ZA of the Social Work (Scotland) Act 1968 is being considered (AWI delay). the patient is delayed awaiting availability of a place in a specialist facility, where no facilities exist and an interim move would not be appropriate (i.e. no other suitable facility available) (Complex/Code 9: Other) patients for whom an interim move is not possible or reasonable (Complex/Code 9: Other). More detail on Delayed Discharge can be found at ANNEX B. 2.2 January 2023 Discharge Events On 17 January 2023, the Chief Executives of NHS Scotland and COSLA wrote to all Territorial Boards, IJBs and LAs to request a focused discharge event beginning in the week commencing 23 January 2023 as a means of addressing unacceptably high occupancy rates. This letter includes a clear definition of the expectations around those events, which can be found at ANNEX C. These events proved invaluable, but learnings from these must be implemented, and should now lead to sustained action, as set out in this plan. 3. Delivery Action It is important that we focus efforts on improving the way we plan, prepare for and execute the discharge process from all inpatient settings, but particularly from acute hospitals. To do that it will be important
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12 that we focus initially on delivering improvements in both discharge from delay and discharge without delay. But we also need to improve the flow through our hospital settings, not least as it is important we create the capacity to increase the volume of elective activity some of which has been paused or delayed as a result of the pressure across the system. It is also and most fundamentally about improving the safety of our acute systems and avoiding harm. The following therefore sets out the actions that are required in the short term to help address the immediate pressure being experienced, much of which has been communicated previously. 3.1 Good practice 3.1.1 Reduce length of stay and ensure people are discharged when they are clinically fit. Patient length of stay can be affected by many factors including patient complexity as already described. We also know that two patients with identical complexity and acuity can have very different lengths of stay in different settings. This can be affected by system configurations (such as same day emergency care replacing admission in some settings), system efficiencies (such as delays to access downstream beds leading to acute de-functioning or delays to treatment), clinical risk thresholds (junior staff having a more cautious approach to discharging compared to senior staff) and provision of support services such as variation in follow up, investigation delays or community supports in place. We know that for older people with frailty, access to specialist Geriatric Medicine beds reduces the risks of death or nursing home at discharge1. We also know that delays to access specialty older people’s beds directly correlates with longer lengths of stay such that every day’s delay in accessing a specialty bed adds three days onto the overall length of stay2. 3.1.2 Getting the basics right The objective of this plan is not just about reducing occupancy as a measure, but this is important in mitigating risk factors such as hospital associated infections and thus a measure of patient safety. We have work already underway through the Discharge without Delay (DwD) programme. Evidence suggests that leadership must be committed to continuous focus on good discharge processes and be relentless in the pursuit of good practice every time. The majority of NHS Board/partnerships have engaged with DwD and will shortly be provided with a DwD care bundle which supports acute wards to plan effectively with patients and carers from admission, and sets out the approach to wider-MDT planning for more complex patients. Leadership across the health and social care system should ensure that this best practice is applied reliably and consistently and monitored for effectiveness. Reducing occupancy levels is a whole-system aim, with action incumbent on each component part of the system to deliver it. In acute sites, that means optimising in day flow through early and effective discharge planning and preparation (using a planned date of discharge (PDD) approach) leading to pre-noon and weekend discharges. In community teams, a PDD approach means contributing to discharge plans, from admission, and responding to the ‘queue’ in advance of completion of treatment. There is strong 1 Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD006211. DOI: 10.1002/14651858.CD006211.pub3 2 SCoOP Acute Hospitals Outcome Report 2018-2019 reduced.pdf (abdn.ac.uk)
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13 evidence of system and individual benefit from focus on whole system wraparound in the first 48 hours of admission, supporting discharge and avoiding further deconditioning of patients. The work we have undertaken over the course of the winter has led to a richer and deeper understanding of what works and much of this has been communicated out to both the NHS and Social Care systems. The discharge intervention undertaken in January 2023 in all systems with a targeted and focused approach to ensuring all patients discharge is being effectively managed has also given some critical learning. The combination of all of this has led to the creation of a package of measures that we know has an impact on reducing delayed discharge and improving flow. There is very little in this package that is necessarily new or novel, but there is extensive evidence to support that when in place and used collectively and consistently, these actions can deliver big improvements in the discharge process and flow. We would therefore ask that the following measures be continued and/or implemented, and sustained, as a matter of priority: GETTING THE BASICS RIGHT TO PREVENT DELAYED DISCHARGE AND IMPROVE FLOW Implement admission avoidance, locality rapid response wrap-around models, care management, multiagency input at the front door approaches. Whole-system input at an early point in the first 48 hours of admission to engage patient/family/carers in discharge discussions and prevent deconditioning of patients. Ensure the social care needs of patients are considered on every ward and that there is social work input into wards with high frailty and ongoing care needs. Service managers/care at home managers should attend ward rounds (this may be virtually) to understand/challenge referrals, manage and mitigate risk or perceived risk, provide expert advice and engage in planning and preparation for discharge as part of wider MDT discussions. All systems should implement Discharge without Delay principles to plan together as the patient recovers, and jointly set a Planned Date of Discharge – using the PDD bundle to aid implementation and reliable and consistent practice. Every patient must have a planned date of discharge, reviewed daily and this be used to plan and prepare in real time. Senior decision-making should happen with multi-agency teams, with regular communication and visibility of the plan. Daily senior oversight and escalation in both Health Boards and HSCPs/LAs should be in place to prevent/resolve delay-causing issues. Utilise performance data to apply continuous improvement to any emerging systemic issues. Structured ward rounds or white board assessment 7 days per week to ensure there is a plan for every day, which sets out tasks for the day and agrees the ward round priority order (sick, discharges, others) alongside parameters for criteria-led discharge to support early discharge. Commission/organise care in response to the pipeline of upcoming work (patients approaching their PDD), not just when patients are delayed. Early identification of complex discharges and appropriate referral as soon as possible. Every older person with frailty should have a clinical frailty score identified on admission to the ED or the admissions ward and appropriate referrals for specialist care made in
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14 accordance with local guidelines as well as early identification of needs (Medical, Mobility and self-care, Medicines, Mental Health, Me and Mine – family and carer support, and What Matters to Me) on admission with onward referral to appropriate professions and coordinated multi-agency team management. Earliest possible engagement with families/carers to manage expectations, recognising it is not a valid option to remain in an acute setting once clinically fit to be discharged. Implement discharge to assess models and intermediate care (bed or team) to support discharge home, wherever possible patients should not be assessed for ongoing care whilst at their most vulnerable or in an unfamiliar environment. Use community rehabilitation as the preferred place of recovery and intermediate care (and interim care home beds in the short-term) with a clear recovery plan in place. Implement discharge to assess models and intermediate care (bed or team) to support discharge. Use community rehabilitation as the preferred place of recovery and intermediate care (and interim care home beds in the short-term) with a clear recovery plan in place. Although all of these are important, perhaps one of the most critical is the need to ensure it is truly a whole system, person-centred approach based on the fundamentals of realistic medicine. It is therefore essential that social care, social workers, clinicians, families and critically the patients themselves work together in lockstep. Notwithstanding that this may require life-changing decisions to be taken – particularly following what could be a prolonged stay in hospital. 3.1.3 Support already provided A range of additional support and supporting materials have been prepared and issued to delivery partners to support the health and social care system. Additional funding of £528m was allocated directly to Health and Social Care Partnerships for 2022/23. This funding was aimed at the following social care measures: £124m to enhance care at home £144m to support the December 2021 uplift to £10.02, as well as a further £200 million to increase the minimum hourly rate of pay in adult social care to £10.50 in 2022/23. This will rise to £10.90 in 2023/24 £20m to support interim care arrangements £40m to enhance multi-disciplinary teams so that more social work assessments can be carried out, and to support joint working between health and social care This funding was designed to maximise capacity, ensuring flow through the system. Over and above this an additional £8m was made available in January 2023 to support up to 300 extra interim care home beds as there was evidence that there was capacity in the system that was unable to be used without additional funding. All of this builds on the existing investment to support activity to alleviate pressure such as the £62m to expand Care at Home and support an increase in the use of community equipment and Technology- Enabled Care (TEC) where appropriate supporting prevention and early intervention. Work has also been undertaken to support Health Boards and HSCPs to support patients and their families who have been classified as AWI as we know in those areas where best practice is implemented, it can dramatically reduce the delays for these patients
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15 A programme of meetings with all HSCPs is underway, beginning with those with the highest number of AWI delays per population. Each pinch point in the guardianship system and S.13ZA is examined with the HSCPs to see where improvements can be made and support provided. Good practice has been shared with HSCPs. Work is underway to identify emerging issues and develop a good practice paper in advance of next winter. We are considering whether it would be helpful to supplement this with a webinar where good practice can be discussed and an update given on plans to reform AWI legislation in the short to medium term. The work with HSCPs has been supplemented by joint statements on AWI practice by the Scottish Government with the Mental Welfare Commission and COSLA. 3.1.4 Actions for Best Practice 1 All systems to review and implement learning from their discharge event to embed improvements in an ongoing, ‘business as usual’ way Boards and IJBs to confirm this has been actioned by end March 2023 2 Put systems in place to provide the assurance necessary to confirm the measures set out in ‘Getting the Basics Right’ are consistently being applied Boards and IJBs to confirm this has been actioned by end April 2023 3 SG will continue work with NES to develop a toolkit of support and training materials to support discharge Toolkit and materials to be available by end April 2023 4 Boards and IJBs to assess their systems and processes in terms of acute discharge planning and apply the DwD toolkit in every inpatient area, community hospitals and other off-site beds Boards and IJBs to confirm this has been actioned by end April 2023 3.2 Data and Managing Variation 3.2.1 Analysis for future planning The work to gather and analyse data undertaken thus far has enabled a better understanding of the pressures being experienced across the health and social care system, but also provides us with a platform to consider how we can support future operational planning. Notwithstanding the IJB’s statutory strategic planning function, work is underway to provide modelled forecasting based on demography and historical demand trends to support future planning. This should also help local partners develop a good understanding of future demand based on their current capacity within both care at home and the care homes within their geographical area. 3.2.2 Using data-driven insights to manage variation Although the vast majority of local systems have detailed and granular data, we know that the quality of information is often not as robust or consistent as we would wish, given the different local systems in place and the number of different providers across the country. Within Social Care we also have not developed routine mechanisms to share information with local decision makers, but work is in hand to address this. Supported by analytical and digital colleagues within the SG, a tactical social care dashboarding solution is currently in development to support HSCPs and HBs to have access to a core set of indicators to enable consistent and comparable data to be available at different levels of geography. A cross-organisational
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16 forum will also be established to improve data collection including a review of methodology, processes and indicators. In parallel, joint SG/PHS/NSS work has now commenced looking at how to provide existing and robust MI data for insights across health and social care using NSS’s Seer2 platform alongside this faster-paced work. This work sits within the wider context of the Data Strategy for Health and Social Care Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age (www.gov.scot) and will report into the Data Board for Health and Social Care. 3.2.3 Actions for Data and Managing Variation 5 SG to provide a tactical social care dashboarding solution to support HSCPs and HBs to have access to a core set of indicators, predicated on existing and robust management information to enable consistent and comparable data to be available at different levels of geography Dashboard to be available by end April 2023 6 SG to provide modelling of potential future demand to support more effective local planning Modelling to be available by end April 2023 7 SG to support partners to develop forum to drive work towards more consistent and comprehensive data Forum to be established by end March 2023 8 SG/PHS/NSS to provide a strategic solution for the delivery of MI data for insights across health and social care using NSS’s Seer2 platform Solution to be agreed by end May 2023 3.3 Workforce 3.3.1 Labour Shortages We know there are significant recruitment challenges within Health and Social Care and particularly when compared to other sectors such as hospitality and retail. Social care in particular has been identified as an area with high levels of vacancies. A critical question is how to grow the care home workforce to accommodate higher occupancy levels. The actions set out below aim to address labour shortages across the sector. Staff demand for Healthcare and Social Care workers for the week to 13 January was 22.1% below the pre-pandemic baseline (February 2020). However, this data may obscure differences in demand between the health and social care sectors. So whilst it is important to take the action necessary to recruit additional staff, it is equally important to ensure that staff within the sector feel sufficiently valued and appreciated in order to retain this critical workforce. Staffing challenges in Social Work are also having an impact on the ability to discharge patients from hospital, given this sector’s statutory role in assessment and support planning (including the public protection role of Social Work). A workforce improvement plan is being developed jointly by COSLA and SG to address the immediate recruitment and retention issues for the Social Work workforce. This includes reserves lists, international recruitment and widening access into the profession through a fast- track route and graduate apprenticeships. There is reason to think that current pressures in social care may be a more significant contributor to delayed discharges than they were in the past, and that resolving the social care capacity crisis is vital if we are to improve discharge rates. The number of social care workers in Scotland decreased from 2020 to 2021 and there is no reason to think that it has increased significantly since then. Therefore work will
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17 continue to support Social Care Workforce capacity to undertake assessment of need and care planning required for hospital discharge. 3.3.2 Actions for Workforce 9 SG to support local partners through NES to utilise international recruitment Ongoing 10 Continue to pursue national recruitment campaign Ongoing 11 Continue to pursue recruitment activity with DWP for Ukrainian displaced people and UK residents that are economically inactive Ongoing 12 Increase in pay to £10.90 per hour in 23/24 for adult social care sector in commissioned services. Looking at improvements to terms and conditions for adult social care in 2023/24 April 2023 and ongoing 4. Sustaining Change Winter often results in both the NHS and Social Care experiencing the greatest pressure and involves many of the partners developing and implementing winter plans. But given what we know, it is essential that we mitigate against the need for crisis responses and develop Annual Delivery Plans that recognise there are peaks of demand and challenges at various points. We believe it is important to continue to focus on reducing discharges from delay as a priority, given the resultant impact on overall hospital occupancy and system flow, and indeed given the disbenefits to patients themselves of keeping them in a hospital setting unnecessarily. ADPs should, however, also focus on increasing discharges without delay once the delays pool has reduced in size. We will then, consequently, expect to see higher levels of patients being discharged without delay. This focus will support the wider whole-system approach to limiting hospital occupancy to safe and effective levels, which in turn will enable us to more quickly address the backlog of elective care exacerbated by the pandemic. Whilst not proposing to set a new target as such, we recognise stakeholder views that 85-90% generally represents a safe level of occupancy, and slightly higher (up to 92%) can perhaps be justified in certain local and short-term circumstances. As outlined earlier, reducing delayed discharge will not necessarily of itself reduce hospital occupancy to safe and effective levels, but it is an important element of the package of measures needed to improve flow. 4.1 Transparency We intend to use this data on a weekly basis and fully expect local systems such as all Integrated Joint Boards to be actively monitoring, managing and sharing delayed discharge statistics as part of their core responsibilities. We also fully expect local systems to be making the necessary resource decisions to support these responsibilities to those they are accountable to through the Integrated Joint Board. 4.2 Measuring Progress The number of people whose discharge has been delayed remains stubbornly at around 1,800 across Scotland. We would expect that as we move past peak demand and towards the quieter summer months, this will move towards pre-pandemic levels (c1,400-1,550).
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18 Hospital occupancy levels of c85-89% - also pre-pandemic levels – remain a target which Boards are working towards using the range of measures available to them, including the actions in this plan. Currently, 97% of discharges are without delay, which is very encouraging, but again, it is important to focus on increasing this number to continue to free up flow. 5. Conclusion and Next Steps As outlined earlier, this action plan is intended to both highlight the broad-ranging work that is happening to improve hospital occupancy in both the short and medium term, and to set out the clear steps we know work that we can take now and in the coming weeks to address the urgent situation regarding discharge and occupancy we have been facing over winter. We must collectively direct resource and effort to focus on these actions in the short-term, and bake them into longer-term planning via ADPs. We know Winter 2023/24 will again be demanding for the health and social care system, but with the knowledge and tools we have, we have strong evidence pointing to where we should be focusing attention to ensure we are as prepared as possible to mitigate the spikes in demand on the system. It is only in collaboration between the NHS and social care – including with patients themselves – that we will be able to meet the stretching targets we have set in this paper. But we know that for the sake of our staff and patient safety, and to begin now to mitigate future challenges, we must be ambitious and purposeful in attempting to meet and exceed these targets.
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19 ANNEX A – Context Short-term pressures on the NHS As outlined above, we also know there is short-term demand due to high incidence of flu in particular, along with Covid-19, RSV, Group A strep and other respiratory infections that have placed exceptional pressure on an already strained system. This is compounded by the indirect consequences of Covid-19 which has led to diagnosis and/or treatment being delayed. All of this has translated into increased deconditioning of patients upon admission to hospital which in turns leads to increased length of stay and the need for a more complex care package (if applicable) in place on discharge. Furthermore, early and high impact flu seasons also have a direct impact on our acute settings. The numbers of hospitalised patients who tested positive for influenza reported in weeks 51 and 52 of 2022 (1319 and 1283, respectively) were higher than those reported for any week since the start of the 2016/2017 season. Persistent Demand But beyond the short-term pressure, wider demand on the NHS is continually having an impact due to an ageing population, disease morbidity, health inequalities (potentially compounded by the pandemic). These increase the demand for health and care services. NRS report that life expectancy has fallen in 2018-20 and 2019-21 and that healthy life expectancy has also been decreasing in Scotland, resulting in a lower proportion of life being spent in good health, which may have implications for both demand and supply of social care. In 2019-21, life expectancy at birth in Scotland was 76.6 years for males and 80.8 years for females. The gap in life expectancy between the most and least deprived Scottish Index of Multiple Deprivation (SIMD) deciles was 13.7 years for males
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20 and 10.5 years for females. Meanwhile population ageing continues and the number of over 85s, who are more likely to have complex and multiple health and care needs, is projected to double in 20 years. A recent cross-sectional study which linked national health and social care data to explore multimorbidity and social care use in those aged over 65, found that 93.3% of those receiving social care had multimorbidity, and that 16.2% of those with multimorbidity had received social care, compared with 3.7% of those without. In addition to the acute pressures, the wider context is that the number of people requiring social care is steadily increasing as a result of the population pyramid and increases in the burden of disease. Population projections indicate that the proportion of older people in the population, who typically have greater care needs, is increasing. This is alongside the impact of more people living with a disability or disease. Admissions into Acute However, we are not seeing an increase in acute admissions. The following presents a summary of emergency admission data alongside A&E performance: The shift in admission levels is due to multiple factors, including significant change in clinical pathways and investment to enhance out-of-hospital based care to ensure that patients receive the most appropriate care in the right setting for their needs. We are also making significant efforts to double our hospital treatment in the home through priority pathways including Hospital at Home, Outpatient Parenteral Antimicrobial Therapy and Community Respiratory Teams. Our virtual capacity now provides acute care the equivalent to the size of a large teaching hospital, again reducing admissions.
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21 Additionally, many patients spend longer in A&E receiving care and are discharged directly from the Emergency Department, due to capacity pressures elsewhere in the hospital. There has also been an increase in pathways which provide rapid assessment and streaming out of the Emergency Department and prevent admission, such as Same Day Emergency Care. Ageing Population Social care demand is affected by the ageing population and increased prevalence of long term conditions3. Scottish Health Survey data provides evidence that the proportion of people living with limiting long-term conditions increases with age4. Population projections indicate that the proportion of older people in the population, who typically have greater care needs, is increasing. This is alongside the impact of more people living with a disability or disease.5 NRS analysis has further found that life expectancy has been stalling and healthy life expectancy has been decreasing in Scotland, resulting in a lower proportion of life being spent in good health6, which will have implications for both demand and supply of health and social care. Frailty and Deconditioning In older people deconditioning can happen really quickly – 24 hours in bed can reduce muscle power by 2- 5%, and in 7 days up to 20%, mostly in lower limbs which may be the difference between being able to walk or not. We know prevention is much more effective than treatment, and while deconditioning is, in theory, reversible, most older people do not regain their prior functionality and independence (https://thecareruk.com/deconditioning-the-warning-signs-and-how-to-prevent-it/). A survey conducted in Autumn 2022 examined reasons for increased length of stay compared to 2019/20 and highlights the impact of deconditioning. Health Boards were invited to complete the survey and 9/14 responded. Most Health Boards confirmed that they had an increase in bed days for patients with femur fractures, and frailty related conditions. High occupancy levels have been affected by COVID-19, with lockdowns impacting physical deconditioning due to reduced mobility. Social care vacancy levels Compounding this are the challenges in the social care sector, specifically in relation to staff vacancies and retention which in turn are making it more difficult for care to be provided in the community (care at home) but also to provide timely discharge from hospital. The following is an outline of reported staff vacancies within both care homes and the care at home sector, although it should be noted that this data is unpublished management information and therefore the quality and return rate is not as robust as other data sources. It is reasonable to conclude that the consistent high levels of vacancies in social care services could have a bearing on the waits for care packages as outlined above in the reasons for standard delayed discharge. 3 Demand and expenditure for adult social care in Scotland | FAI (fraserofallander.org) 4 Summary - The Scottish Health Survey 2021: summary report - gov.scot (www.gov.scot) 5 Population Projections Scotland | National Records of Scotland (nrscotland.gov.uk) Scottish Burden of Disease Forecasting Briefing (scotpho.org.uk) 6 Healthy Life Expectancy decreases | National Records of Scotland (nrscotland.gov.uk)
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22 Published figures from the Scottish Social Services Council (SSSC) show that, in 2021, the percentage of whole time equivalent (WTE) vacancies in care homes for adults was 7.9% compared to 5.4% in 2019. According to the RBS report on Jobs7 in December 2022 the strongest upturns in demand for permanent staff were seen across the Nursing/ Medical/Care and IT & Computing sectors. Nursing/Medical/Care also ranked second in strongest increase in demand for temporary staff among the eight monitored sectors. Hospitality and Retail have been identified as potential sectors that may be in competition for labour with social care. These sectors are characterised by notable proportions of jobs with low entry qualifications. In 2020, 49% of jobs in Accommodation & Food Services and 12% of jobs in Wholesale & Retail were classed as Occupation Skill Level 1, compared to a Scottish average of 9.9%.8 But even within these areas are experiencing challenges as the Business Insights Conditions Survey (BICS) indicate that 49.1% of Scottish Accommodation & Food Services businesses experienced difficulties filling vacancies in November 2022, compared with 38% of Scottish businesses overall, and 34.4% of businesses in Wholesale & Retail9. Social care providers are also very clear that they continue to lose staff to the NHS which has much better pay and conditions in comparison to social care staff, they anticipate that this will only get worse with the anticipated 23/24 NHS pay uplift. Entry level pay for adult social care in commissioned services will be a minimum of £10.90ph from 2023/24. The current Agenda for Change Band 3 minimum is £12.23ph and the expected increase for 23/24 is currently £13.03ph. This is £2.13ph above the social care minimum rate. Finally, pay is often cited as a predominant factor relating to staff vacancies in this sector as despite this workforce being certified and regulated by the minimum £10.50 hourly social care wage. For comparison supermarket and retailers hourly pay ranges from £9.75 to £11 and NHS Staff at level 1 earning around £12.23 per hour. 7 RBS report on Jobs, December 2022. Results based on responses to questionnaires sent to a panel of around 100 Scottish recruitment and employment consultancies. 8 Scotland’s Labour Market: People, Places and Regions – background tables and charts - gov.scot (www.gov.scot). Level 1 occupations are those which equate to a competence associated with a general education and may require short periods of work-related training (e.g. bar staff, cleaning). 9 Business Concerns - BICS weighted Scotland estimates: data to wave 73 - gov.scot (www.gov.scot)
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23 ANNEX B – Delayed Discharge Standard delays refer to all delays other than Code 9 delays. The following is a table breaking down delayed discharge by setting and type of delay between 23 November 2022 and 25 January 2023. The above table demonstrates the split across setting and type of delay: of the 1,764 delayed discharge (of 18/01/23) 50% were in acute, 15% were in mental health and 35% in community hospitals. These data are management information, are submitted daily, are not revised and have not been verified. However, this level of detail helps us to understand what lies behind the headline figure to manage flow. Although, standard delays have increased from about 900 in June 2021 to almost 1,300 in December 2022 (higher than a pre Covid-19 pandemic average of 1,100 delays). The following illustrates the trend of delayed discharge by category over time: Reasons for delayed discharge The majority of standard delays (about 70%) are usually waiting for suitable care arrangements in order to live at home (due to unavailability of services) or a place in a nursing home, and a post-hospital social care Standard AWI Complex Total Acute Standard AWI Complex Total Mental Health Standard AWI Complex Total Community Hospital 23/11/2022 692 191 20 903 180 32 52 264 483 182 12 677 1,844 30/11/2022 668 189 33 890 175 36 56 267 468 171 11 650 1,807 07/12/2022 681 181 41 903 168 37 56 261 471 175 18 664 1,828 14/12/2022 646 183 41 870 160 44 51 255 454 170 32 656 1,781 21/12/2022 673 186 44 872 158 41 58 288 446 169 29 644 1,804 28/12/2022 605 185 42 832 150 37 61 248 433 171 29 633 1,713 04/01/2023 624 174 46 844 143 38 62 243 463 163 26 652 1,739 11/01/2023 628 176 46 844 147 40 56 248 473 151 24 649 1,741 18/01/2023 665 176 35 877 154 42 64 260 455 158 14 627 1,764 Change -27 -15 15 -26 -26 10 12 -4 -28 -24 2 -50 -80 % Change -4% -9% 43% -3% -17% 24% 19% -2% -6% -15% 14% -8% -5% Date Acute Mental Health Community Hospital All Delays
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24 assessment as their principle reason for their delay at the monthly census point. Other reasons may include: awaiting commencement of post-hospital social care assessment non-availability of statutory funding to purchase Care Home Place non-availability of statutory funding to purchase any Other Care Package awaiting place availability in Local Authority Residential Home awaiting place availability in Independent Residential Home awaiting place availability in Specialist Residential Facility for younger age groups (<65) awaiting place availability in Specialist Residential Facility for older age groups (65+) awaiting place availability in care home (Dementia bed required) awaiting place availability in an Intermediate Care facility awaiting completion of care arrangements for care home placement awaiting completion of care arrangements in order to live in their own home – awaiting procurement/delivery of equipment/adaptations fitted awaiting completion of care arrangements - re-housing provision (including sheltered housing and homeless patients) awaiting availability of transport The following illustrates the principle reasons over time: From the above chart, we can see that waiting for care arrangements in order to live at home is the most common reason for delays at the monthly census point. Between June 2020 and December 2021 this percentage has increased to a peak of 48%. Overall, this percentage has been decreasing since December 2021, with a slight increase in November 2022 to 41%. Community demand is complex and depends too on competing demands for mental health and drug & alcohol services as well as for social care packages and social work support. Trends in delayed discharge Published data indicates the number of delayed discharges in November 2021 was 1,539, which when compared to the 1,977 seen in November 2022, equates to an average growth of eight additional delays per week in the year up to November 2022. Although this sounds like a small amount of growth, this mounts up over time. Which leads to the conclusion that the system needs to be calibrated to deal with this higher throughput.
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25 On analysing the trends in delays that were discharged from 2016 to 2022, both the average length of stay prior to delay and the average length of delay have risen higher than pre Covid-19 levels. The chart on the left hand side shows that the average length of stay prior to delay has increased since the Covid-19 pandemic (about 20 days before the pandemic) and is now higher than the pre pandemic levels (27 days in December 2022): a 35% increase. The chart on the right hand side shows that the average length of stay at the point of discharge has increased from about 7 days before the pandemic to a peak of 13 days, in August 2022, and has decreased to an average of 10 days in December 2022: a 43% increase from the pre-pandemic levels. Flow through delayed discharge It is however important to note that the total number of recorded delayed discharges is only a snapshot in time. Patients in delayed discharge can become delayed as well as resolved and discharged, resulting in a constant flow of patients. If the flow of new patients into the delayed discharges pool is greater than the flow of patients being discharged or removed through other pathways, the delayed discharges will increase. For example, 1,557 people were discharged following delay in November 2022 but the total delayed discharges still grew by 67 from October, (1,910 to 1,977). As outlined, the length of delay can also vary. For some patients their discharge can be delayed by only a few days and for others by much longer. There is therefore clear evidence that more needs to be done to both increase the number of discharges from delay and reduce the number of patients becoming delayed in the first place.
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26 ANNEX C – Definition of Discharge Event Below is an excerpt from the letter to Boards, IJBs and LAs from Chief Executives of COSLA and NHS Scotland of 17 January: Discharge intervention required It is now necessary to undertake an urgent and focused piece of work in every health board and health and social care partnership area to meticulously review all patients currently in in-patient care across acute and community hospitals. It should be noted that none of the activity proposed is new but this is a renewed and joint focus on taking forward actions appropriate for your area, reflective of your specific challenges. This review should focus on all opportunities to set Planned Dates of Discharge (PDD), discharge patients home or to a homely setting and ultimately improve patient flow across the system. The review process should engage joint clinical and community health and social care operational teams from across the whole system and ensure that feedback and intelligence is triangulated with immediate action. It is expected that this approach will be supported by identification of additional interim and permanent placements. Alongside ongoing work to support PDDs, any reason for patient delays and the patient’s discharge plan must be considered for immediate resolution. Poorer outcomes for patients who have a longer stay in hospital than necessary are well evidenced, and current pressures are increasing this risk. In all discussions with patients, their unpaid carers and families we must ensure a clear understanding of this potential for harm. Remaining in hospital is not a safe choice when clinically and therapeutically fit for discharge. It will be essential that this exercise accounts for the changed risk profile for our acute systems at this time, recognising the risk to patients whose care and treatment is delayed with best efforts being achieved to support early discharge and prevention of further delay. Initiatives and services which support Discharge to Assess, plus choice and safety must inform decisions. The skills and knowledge of the community teams should contribute to assessment of risk. The Discharge without Delay and PDD approach should continue as an organisational priority. Information and guidance can be found on the Turas website: learn.nes.nhs.scot/63373 With urgency, whole-system teams must mobilise to operationalise and deliver this review. We are asking you to use this week commencing 16 January to prepare for this and agree an implementation plan with the review to begin week commencing 23 January across all acute and community sites. This will require visible leadership from both Accountable Officers and from all Professional Leaders. It is essential that this activity translates into a sustained overall increase in all possible discharges from these settings, including those deemed in delay, to release the much needed capacity within hospital settings. In practice we are asking you to work across the system to take forward a combination of actions. The following tools are considered best practice and useful in the identification of the tasks or services which contribute to delay, and support robust evidence-based action and improvement planning: • Day of Care Audit: Used by most health boards regularly to understand delay in their systems, should form the basis of whole-system improvement planning discussions (guidance and toolkit attached to this letter); • MADE: (Multi-Agency Discharge Event) an English approach adopted by many health boards to discuss and problem-solve existing delays. The guidance can be found here: england.nhs.uk/south/wp- content/uploads/sites/6/2016/12/rig-multi-agencydischarge.pdf
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27 • Criteria To Reside: used as a snapshot or a daily process to capture delay information and find solutions. Information can be found here on the definitions: england.nhs.uk/publication/process-and-definitions- for-the-daily-situation-report/. (A ‘what why how’ poster is attached to this letter which explains the context and how this information is used locally). Each area should prepare and hold a live list of all patients with PDDs as well as those patients who are delayed. PDDs should be reviewed daily to ensure timely discharge. Patients who are delayed should have a plan which is reviewed daily as a whole system and any mitigating actions taken to resolve this as soon as possible. You should ensure the appropriate local governance is in place to actively pursue and monitor the outcomes from the review on a daily and weekly basis. Further information on the expectation of national reporting to evidence the impact of this approach will be provided in the coming days.
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28 ANNEX D - Improving Urgent and Unscheduled Care Increasing capacity outwith hospitals We know that services managing demand must include both preventing the estimated 20% of admissions that are thought to be preventable. It must also include increasing alternatives to hospital admissions where services to provide acute specialist input at home (virtual capacity) exist for acute conditions that would normally need hospital admission. We know that these services are cheaper, safe and preferred by patients. It is important to focus on the wider system that impacts on flow, capacity, demand and ultimately results in delays across the system. Key priorities are to reduce inappropriate attendances to ensure the Right Care is delivered in the Right Place at the Right Time; avoiding unnecessary admissions that keeps care as close to home as possible; reducing length of stay to ensure patients are discharged when clinically and therapeutically fit; and avoiding delay wherever possible. This is underpinned by a collaborative improvement programme that supports improvement in systems and process that reduces unwanted variation and failure demand. The redesigned Urgent Care Programme focusses on reduced unnecessary attendances by signposting and triaging to more appropriate care. Where possible attendances at A&E services can be scheduled to a more appropriate service at the right time. This process has reduced self-presentations by circa 13% with an ambition to continue to improve through initiatives such as Call before you convey, which has proven particularly successful for care homes, and for pathways such as low risk chest pain. The Virtual Capacity programme focusses on keeping care as close to home as possible. Increasing out-of- hospital care to reduce attendances and admissions through priority pathways helps to develop a virtual hospital that improves outcomes, increases capacity and reduces risk of nosocomial infections. Current aims are to: Increase Hospital at Home services by 50% Spread successful OPAT services to all Health Boards Establish Respiratory pathways Develop case for other pathways of care such as Heart Failure Using data to monitor and drive increases in performance Supporting MDT collaboration and shared understanding of risk Embed governance & oversight strategic functions in an integrated manner Review next steps to develop urgent care – OOHs/SAS/NHS24 Improving Flow through the whole system will reduce length of stay and will be supported by consistent systems and processes that improve communication across multidisciplinary teams and multi- agency organisations to reduce variation.
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1 REPORT Item No: 9 SUBJECT: Winter Plan Business Case Progress Report TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance & Quality Assurance Author(s) of Report Graeme Cowan, Senior Manager, Strategy & Performance DATE: 17 May 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 By: Senior Manager, Strategy & Performance ☐ Reviewed By: Head of Planning, Performance & Quality Assurance ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB Committee: (1) Endorse and support the progress reports of each of the workstreams which comprise the Winter Planning & Enhance Supports Business Case 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Scottish Government allocated additional funding in 2021/2022 and 2022/2023 to increase capacity across the health and social care system. In February 2022, the Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target nonrecurring reserves to implement a series of proposals, including the development of a Home First model in North Lanarkshire, additional community nursing capacity, enhanced care at home capacity, and additional infrastructure supports. This report provides an update on the progress made with implementing these proposals. 5.2 Within each phase of the implementation process, the business case proposals have been re-evaluated both within workstreams and through the Strategic Commissioning Plan Programme Board. Implementation plans are revised and reconfigured regularly to reflect the reality of recruitment challenges, the funding available and the outcomes achieved through the preceding phases. 5.3 The original aims of the business case were to increase assessment and planning capacity across the system and enhance direct provision of supports and services across a range of organisations. Workstreams have been established to implement plans and proposal against the following headings: Home Assessment Team & Enhanced Integrated Rehabilitation Provision Community Nursing Increased Capacity Across Home Support Service, Equipment and Adaptations Service, Community Alarms Service & Assistive Technology Hospital at Home Building Capacity of Independent Sector Providers Investment in Communities Yes ☐ No ☒ N/A ☐
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3 5.4 Progress updates on each of the workstreams are attached to the report as Appendix One, offering a summary of progress-to-date and planned future actions. 6. CONCLUSIONS 6.1 Progress continues to be made to implement the business case and undertake the recruitment as approved in order to progress the necessary change activity in line with the Scottish Government funding allocations. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 PEOPLE 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Appendix one – Business Case Workstream Updates Appendix two – Summary of Winter Planning Funding & FTE CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Graeme Cowan CowanG@northlan.gov.uk Yes ☐ No ☒ N/A ☐ Yes ☐ No ☐ N/A ☒
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5 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix One Winter Planning & Enhanced Supports Business Case – Workstream Updates Workstream Home Assessment Team & Enhanced Integrated Rehabilitation Provision Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition Ring-fenced teams to enable: • A designated workforce with focus on facilitating discharge without delay and enabling admission avoidance • A robust discharge pathway for those who require home assessment and rehabilitation following discharge from both front door and downstream wards • A robust admission avoidance pathway for those not requiring hospital admission but requiring the benefit of a person centred approach to assessment in their own home setting • Flexibility to deploy the workforce across the sectors • Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?) • Clear leadership within discharge services • An approach to avoiding admission to be developed with the IRT and locality teams- Systems in place to ensure that Home Support, Community IRT and Locality Social Work Teams will be aware of patients likely to transition to them from HAT at the end of the agreed assessment period. Agreement in place to ensure HAT transition outwards is not jeapardised. • Wide-ranging strong links with discharge facilitators within the hospital discharge hub- HAT is embedded in the Hospital Discharge Hubs and communication, liaison and multi-agency working in inherent. • Utilisation of the embedded Planned Date of Discharge (PDD) approach to identify suitable patients pathways • Close working relationship with associated teams: hospital Multi-Disciplinary Teams (MDTs), District Nursing, Integrated Rehabilitation Teams, Third sector colleagues with access to satellite equipment stores. Highlights Progress and Achievements: • Home Assessment Team soft launched in Wishaw in late April 2022 taking referrals from University Hospital Wishaw and University Hospital Monklands. • Cumbernauld soft launch in August 2022 • Cumbernauld and Wishaw Home Assessment Teams operating and almost fully staffed. • As of 3rd April 2023, 561 patients had been referred and discharge supported by the Home Assessment Team. The growth in the referral rate to the Home Assessment Team has shown a sustained growth, particularly since the beginning of November 2022. The Hospitals involved in the referral were UHM 42%, UHW 55%, other 1% and 1% offsite bed. • During the month of March 2023 HAT had a total of 118 (up 26 referrals from February 2023) referrals across both sites. Patients were discharged into localities including Wishaw 31 (up 3 from February 2023), Motherwell 38 (up 22 from February 2023, Cumbernauld 26 (up 4 from February 2023), Airdrie 19 (down 3 from February 2023) • Workshops held in October to map pathways and review and agree pan-Lanarkshire referral criteria with all key stakeholders in the MDT including transfers of care into mainstream home support and rehabilitation services. • Interface with other teams/staff eg IRT, Locality Social Work, Home Support Teams, GPs
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7 • Of the 35.75 FTE Integrated Rehabilitation Team (IRT) posts supported within the Business Case, 29.5FTE have been recruited to. Ongoing Actions • HAT service model in development phase, this will be finalised by end of April 2023. • Additional accommodation restructuring ongoing at UHW to ensure teams are co-located appropriately for next steps. Review by planning team at UHW due to complete end of April 2023 - possibility of new options following same - previous review on hold. • Recruitment to HAT ongoing to build capacity and roll out across other NL localities (see appendix 1 for update). The pressures within the system regarding workforce are widely acknowledged. These pressures have been impacted by the competitive employment market with staff leaving for better pay and conditions, training and career opportunities. The social care sector is facing significant challenges, as a regulated workforce, the number of people leaving to seek alternative careers is at its highest. Additionally, the cost of living and fuel costs are impacting directly on the workforce • Virtual Board to be discussed to communicate and act as an early warning system/ barometer to downstream statutory support services re expected transition from HAT- discussion with IRT T/Ls, Advanced Practitioners reached agreement re early warning practices and agree no requirement for virtual board as highlighted in gap analysis • Discussions re CCA/ increase requests etc and implications for HAT • Further review of HAT/ Home First pan-Lan criteria to encompass admission avoidance and plan to develop pan-Lan poster for staff when complete Future Actions • A number of recruitment campaigns have been progressed across health and social care to recruit across the team including Home Support, Physiotherapy and Occupational Therapy staff. This is with the intention that the Wishaw and Cumbernauld Team will be fully operational by end February. Work ongoing to stabilise Airdrie and Cumbernauld localities for HAT with cross cover • Moving on to implement HAT in remaining localities, with Coatbridge and Bellshill • Communication and engagement activities are progressing including staff briefing sessions, reaching out to comms department re other comms including animation video • Review, analysis and recommendations to be undertaken to ensure HAT and home first approach is intrinsic within the wider HSCP teams and not a stand-alone service • Establish key links within the Health & Social Care Whole System Dashboard and track wider impacts of the service on Delayed Discharge performance, and capacity of the home support service.
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8 Workstream Community Nursing Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition As part of the SCP/ Winter planning work supported by Scottish Government, funding was agreed to support increased capacity in community nursing teams and to support delivery of the Community Nursing Review. Funding agreed and recruitment progress is highlighted below Posts Funded In post Band 3 HCSW 40 WTE 32.63 WTE Band 3 admin 8WTE 5WTE Band 5 RGN 15 WTE 11 WTE Band 7 ANP 2 WTE 1WTE Band 7 Practice assessor 2 WTE 2 WTE Band 8a Senior Nurse 1WTE 1WTE There has been turnover in the Band 3 HCSW staff group which has made growth challenging. Band 5 recruitment growth has also been challenging due to vacancies within current funded establishment which is prioritised. Progress and Achievements: • Community Nursing Review Programme Board established with two Short Life Working Groups set up and running o Care Management o Vision and modelling • Roadshows held • District Nursing Pathway Evaluation now ready for final comments • A rolling program for recruitment is being considered and evaluated • Delays to some actions due to work being carried out on Operation Flow • Work with Scottish Government in relation to retention, development of workplace and improving culture Future • Caseload complexity review • Define the criteria for core and additional caseloads in conjunction with the views of staff. Consideration will need to be given as to how this fits in with the MORSE system. Although changes are unlikely to be made before the end of the year/beginning of next year, simple changes of benefit to staff may be adopted. A couple of roadshows will be scheduled for further down the line. • The District Nursing service is aiming for a transformation surrounding how it delivers its services. There is a shift in the balance of care from acute to primary care and will need to consider what that will look like and how it can be made ‘fit for purpose’. There is further emphasis on health promotion and educating families.
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9 Workstream Increased Capacity Across Home Support Service, Equipment and Adaptations Service, Community Alarms Service & Assistive Technology Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition The expansion of current direct provision of support will include: • Home support expansion, making permanent some temporary measures which are required longer term to facilitate improved capacity and quality of service. Both frontline practitioners as well as logistics and operational management posts are included in the immediate requirements. • Increased capacity within the Equipment and Adaptation Service • Development of a dedicated Technology Team to support the use of technology within the HSCP to support individuals within their homes and communities. This team will focus on embedding technology into assessment and planning processes; providing training to all staff groups on technology and its use in care and support; supporting with risk assessments; ensuring technology support advice is embedded in SDS; and providing high level data on the technology being used within our communities. Highlights Home Support 71.89 WTE permanent posts funded by the Business case allocated across localities; process commencing to match existing temporary staff into these posts within each team. New Home Support Delivery Project Board established to progress high level Project Plan, with Risk Register, Benefits Realisation Plan and Workstreams agreed and being progressed. Technology Team and Equipment & Adaptation Service Recruitment to posts complete for the Technology Team and in progress for the Integrated Equipment & Adaption Service Technology team now embedded and links with locality teams being developed. Workstream Hospital at Home Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition Extension of Working Hours Introduction of Advanced Nurse Practitioners (Band 7) to allow service hours and patient admission to service to continue until 10pm. To allow 2 Band 7 ANPs to be rostered on 7 days a week (one from 8am-6pm, and one from 2pm-10pm) would require 4.58 WTE (including 22.5% planned leave allowance). There is a current national shortfall in the availability of qualified Advanced Practitioners, therefore a training programme would need to be offered and supported, this requires up to 2 years to complete (although some potential internal Hospital @ Home candidates have already been supported through the advanced clinical care and Non-Medical Prescribing programmes, so may require less support before becoming fully qualified). Permanent Funding of Step-Down Pathway During the Covid pandemic to assist with anticipated hospital flow and to increase our ability to serve GPs with hospital admission a “step down” hub was created to ring fence staff and
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10 create a designated flow for Acute inpatients to be discharged into the Hospital @ Home service. This service improvement contributed to the increased referral activity and has admitted an average of 38 patients per month in 2021. Due to the clinical presentation of the patients at admission to Hospital @ Home the model could be slightly adapted to allow the patients to be managed by a Junior doctor (with Consultant in-reach when necessary) and band 5 nurses. Junior doctors have been difficult to recruit on a continuing basis, however an ANP band 7 nurse could provide clinical management to these patients. Highlights • Step down pathway has been operational since May 2020. The permanent funding of this allowed us to continue this service provision. Since the initial programme we have had some Band 5 RGNs leave the service for various reasons, some gaining promotion within the service. This has allowed them to be successful at gaining Band 6 Nurse Practitioner posts within the service. • The Band 5s and Band 4 have been in temporary posts, the permanent funding has allowed us to appoint on a permanent basis. We have 3 of the 4 Band 5 posts filled permanently with the third at the recruitment stage, after the previous successful candidate withdrew. The Band 4 is appointed permanently. • The Band 7 ANP who was appointed withdrew due to personal reasons, the new COR is with finance for approval to re-advertise. • The stepdown pathway has supported 390 patients from NHSL Acute wards from April 2022 to Feb 2023 Workstream Building Capacity of Independent Sector Providers Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition It was agreed that a local provider sustainability fund is established to facilitate an individualised approach to: • Supporting recruitment and retention • Supporting staff wellbeing • Supporting cross sector support to SVQ2 • Increase to Scottish Care support to the sector Highlights Two phases of funding bids have been completed Successful implementation of Interim care home beds programme Successful uptake of financial support in place to support Carers
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11 Workstream Investment in Communities Overall RAG Status AMBER (some concerns that need to be monitored closely) Workstream Ambition To make prevention and early intervention a reality, additional investment is required to add to the community capacity building work already well embedded in the Community Solutions Programme through VANL. Further investment through the new Improving Lives workstream will see development across a number of key priorities for the Partnership, in line with the Strategic Commissioning Plan, and to ensure there is sufficient capacity within the community and voluntary sector to respond to demand. The range of achievements via the Community Solutions Programme Approach has seen significant development through anchor organisations of; Support in the Right Direction, Community Connectors, Improving Cancer Journey and Social Prescribing. Early findings from the innovation test site introducing 3 conversations to improve First Point of Contact, has indicated that there is a need to invest more significantly in a robust response through the sector which would facilitate a further focus on prevention and wellbeing. This will be achieved through connectedness and valued activity with a combination of paid roles and community investment funding. Funding proposals are based on the appointment of Community Connector posts across key anchor organisations to support 3 Conversations with Older Adults, Younger Adults and Carers. An umbrella approach through Community Solutions will ensure a co-ordinated approach throughout North Lanarkshire and link clearly to the Community Consortia in promoting local opportunities for and with people, avoiding the need for more formal services for longer. The Community Connectors will also play an important role in the transitional arrangements for people at the point they may need more formal responses from the HSCP. A core, recurring investment of £1.1m pa supports the Community Solutions programme but an additional £1.2m over a two-year period would see the considerable expansion of the offer. Achievements: • Project to be embedded in the Community Solutions programme and named Improving Lives. • Project plan finalise and agreed by Chief Officer and Head of Planning, Performance and Quality Assurance. • Model for recruitment and deployment of Community Connectors agreed. • The current Support in the Right Direction link workers (2wte) have received a 12 month extension to their funding from SG (to 31 March 2024). This will be of benefit to the new Community Connectors as these existing staff have established good relationships across NL and can share learning thought their previous involvement in the 3 Conversation test of change. • Opportunity to extend the reach of the Community Connector posts by building in the Improving Cancer Journey funding. This investment means there will be a total of 10wte posts (NB this is an increase from the original proposal of 9.5wte). • Commissioning of locality hosts complete which allows us to recruit to the Community Connector posts once the ICJ application agreed by Macmillan. Activities: Complete
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12 • Project plan agreed. • Funding for physical activity programmes confirmed for 22/23. • New part time senior manager recruited to provide capacity to oversee implementation of Improving Lives programme. • Six Locality hosts agreed. Outstanding • Finance to be transferred to VANL • Governance arrangements for test of Individual Support Fund • Relationship to GP Community Link Workers to be strengthened with the aim of developing future joint proposals to make best use of available resources where possible. • Community Solutions thematic priorities review (first meeting took place 09 Feb) Future • Recruitment of 10 Community Connectors will be progressed once Macmillan agree the ICJ application (expect approval imminently).
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13 Appendix 2 Funding 2022/2023 Projected Costs 2022/2023 Variance 2022/2023 £m £m £m Recurring Budget 15.750 7.104 8.646 Non-Recurring Budget 1.162 0.448 0.714 Earmarked Reserves 7.712 2.447 5.265 TOTAL FUNDING 24.624 9.999 14.625 APPROVED IN POST VARIANCE Integrated Rehabilitation Team 49.33 22.02 27.31 Home Assessment Team 138.68 58.08 80.6 Home Support 165.78 125.2 40.58 Infrastructure 18 9 9 Social Work Management 4 3 1 Community Alarms/Stores/Tech 20.2 13 7.2 Community Nursing 69.35 39.71 29.64 Hospital at Home 8.58 3 5.58 TOTAL FTE AS AT PERIOD 12 473.92 273.01 200.91 SUMMARY OF WINTER PLANNING FUNDING AND POSTS FUNDING DESCRIPTION OPERATIONAL CATEGORY FTE
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1 REPORT Item No: 10 SUBJECT: Fairer Scotland Duty guidance update TO: Integration Joint Board Performance, Finance & Audit Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Kerri Todd, Head of Health Improvement DATE: 17 May 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ The purpose of this report is to update the committee on progress made on embedding Fairer Scotland Duty requirements into routine business of the HSCP. 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerri Todd, Head of Health Improvement ☒ Reviewed By: HSCNL Core Management Team ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB Committee: (1) acknowledge the amendments that have been made to committee templates to embed reporting on Fairer Scotland Duty assessments. (2) approve the project management approach being taken through the Strategic Commissioning Plan Programme of Work which will monitor the actions that arise from the Fairer Scotland Duty assessments. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 The Fairer Scotland Duty (FSD) came into force in Scotland on 1st April 2018 and aims to protect those most affected by poverty in communities. The duty places a legal responsibility on particular public bodies to actively consider (pay ‘due regard to’) socio-economic inequalities of outcome when making strategic decisions. 5.2 The duty is enshrined in Section 1 of the Equality Act 2010 and places a legal responsibility on particular public bodies, including Integrated Joint Boards, NHS Boards and Councils. The duty does not override other considerations such as equality or best value. 5.3 The 2010 Act specifies that in deciding how to fulfil the duty, organisations must take into account any guidance issued. The Scottish Government published interim guidance for public bodies in March 2018 which was refreshed in October 2021 to incorporate learning from the implementation plan. The implications of the updated guidance for the FSD were reported to this committee in February 2022. 5.4 It was agreed that robust governance processes required to be implemented to assure the Integrated Joint Board that the FSD was being met and review processes were embedded into the project management of the Programme of Work. Additionally, professional and operation leads required support to undertake these assessments. Progress Yes ☐ No ☒ N/A ☐
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3 5.5 Discussions with key personnel in NHSL and NLC have progressed to ensure that robust processes are in place to meet the requirements of the FSD as well as equalities mainstreaming. 5.6 IJB committee papers have been amended to include specific reference to Equality Impact Assessments and FSD assessments so members can be assured that the needs of specific populations have been considered and action taken where required to meet these (see section 7.6). 5.7 The NHSL integrated equality impact assessment (EQIA) template has been updated to incorporate the FSD seven key questions to help public bodies determine how well they have paid ‘due regard to’ their strategic decisions. Recognising the need to be comprehensive, the template also includes questions to incorporate the key elements of the Children’s Rights and Wellbeing Impact Assessment tool. Where assessments indicate it is required, an action plan is developed to address any inequalities odentified. The NHSL Equalities Lead has implemented a monitoring process to prompt lead managers to review their action plans and confirm they are completed. All EQIAs are saved on the NHSL intranet so they are available for scrutiny and as examples of good practice. 5.8 NLC has updated its template for committee reports to include reference to the Public Sector Equality Duty and FSD so all papers must consider if a full assessment is required and document if this has been undertaken. 5.9 In keeping with these approaches, project management of the Strategic Commissioning Plan Programme of Work will support monitoring across all elements of equalities and the FSD, ensuring that robust assessments are undertaken and action plans are delivered. In line with the requirements from the Equalities and Human Rights Commission, EQIAs will be added to the HSCNL website (https://hscnl.org.uk/about-us/). 5.10 To build capacity across professional and operational leads to implement EQIAs and FSD assessments, Scottish Government Covid Recovery funding was secured to create a 2 year, fixed term post to provide training and support for managers. The postholder advises staff undertaking EQIAs and supports them to access local datasets to aid decision making. 6. CONCLUSIONS 6.1 Significant progress has been made to embed robust processes that ensure the requirements of the FSD (alongside EQIAs) are in place. 6.2 The Programme of Work to implement the Strategic Commissioning Plan will take a project management approach that will support these processes and monitor any actions that arise from FSD (or EQIA) assessments.
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4 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 PEOPLE Yes ☐ No ☐ N/A ☒
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5 Where required, professional and operational leads are supported to implement the FSD guidance and complete EQIAs for their services. This ensures that services are as inclusive as possible and consider the specific needs of people who experience poorer outcomes. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Fairer Scotland Duty – Guidance for Public Bodies https://www.gov.scot/publications/fairer-scotland-duty-guidance-public-bodies/ 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Kerri Todd, Head of Health Improvement, kerri.todd@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes ☐ No ☐ N/A ☒
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6
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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8
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1 REPORT Item No: 11 SUBJECT: Implementation of the National Trauma Framework for North Lanarkshire TO: Integrated Joint Board Lead Officer for Report: Alison Gordon, Chief Social Work Officer (Children, Families, Justice and Integrated Practice) Author(s) of Report Margaret Flavell, Senior Manager Adult Social Work Services DATE: 17 May 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 By: ☐ Reviewed By: ☐ Endorsed By: ☐ 3. RECOMMENDATIONS IJB Committee: (1) Endorse the approach to the implementation of Trauma Informed Practice across the Health and Social Care Partnership as set out in this report. (2) Agree that the workforce should be trained at the ‘informed level’ as part of the suite of mandatory training. (3) Consider IJB members and/or Health Board members being a Trauma Informed Champion
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Summary 5.1.1 The Transforming Psychological Trauma: Knowledge and Skills Framework (The Framework) has been developed by NHS Education Scotland (NES) to support the delivery of Scottish Government and COSLA’s joint policy intention to create a trauma- informed workforce. 5.1.2 Being trauma-informed is about long-term culture and system change across the Health and Social Care Partnership (HSCP) and the Council to create the conditions in which staff feel supported to care for and respond to citizens in ways that recognise the impacts of trauma and create relationships that heal and resist re-traumatisation. It will support the delivery of the ambitions of the Strategic Commissioning Plan and changes within the Council’s new Programme of Work. 5.1.3 The purpose of this paper is to set out for the Integrated Joint Board the actions being taken to embed the Framework in North Lanarkshire, highlight areas of practice where a trauma informed approach is already making a positive difference for children and individuals and outlining next steps, in ensuring North Lanarkshire becomes a leading trauma informed HSCP and council. 5.2 Background 5.2.1 Evidence of the full impact of trauma, particularly adverse childhood experiences (ACES) has been emerging now for some time, establishing beyond doubt that its effects can be wide-ranging, substantial, long-lasting, and costly (NHS Education for Scotland, 2021). In response to this Scottish Government established a National Trauma Training Programme, led by NHS Education for Scotland (NES) to support the ambition, agreed with COSLA, to create trauma-informed and trauma-responsive workforce and services across Scotland. 5.2.2 In 2019 the Scottish Government published the Scottish Psychological Trauma Training Plan (Trauma Training Plan) to support the local implementation of Transforming Psychological Trauma: Knowledge and Skills framework for the Scottish Workforce (The Trauma Framework). Working with COSLA, the commitment to the implementation of The Trauma Framework was reiterated in the Programme for Government 2021-22 along with the initiation of a Leadership Pledge of Support for Trauma Informed Practice to raise the standard of support across public and third sector organisations. COSLA and several local authorities and HSPCs have signed this pledge, including North Lanarkshire HSCP. See Leadership Pledge Signatories. Yes ☐ No ☒ N/A ☐
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3 5.2.3 The Trauma Framework outlines the importance of creating a trauma-informed system and organisation that supports the workforce engage with citizens in a trauma-informed way. This is reflected in 5-key drivers for trauma-informed practice which emphasise the importance of leadership and the wellbeing of the workforce: 1. Leadership and management 2. Workforce wellbeing 3. Workforce knowledge and skills 4. Experts by experience 5. Data and feedback loops 5.2.4 Being ‘Trauma Informed’, both at the practitioner and organisational level means being able to recognise when someone may be affected by trauma, taking this into account, and responding in a way that supports recovery, does no harm, and recognises and supports people's resilience. To achieve this, a trauma informed approach comprises 5 key principles: Safety, Trust, Choice, Empowerment, and Collaboration (see Appendix A). 5.2.5 The Trauma Training Plan, developed by NES, tailors training to the type of role and function performed by staff across 4 practice levels: trauma informed; trauma skilled; trauma enhanced, and trauma specialist (see Appendix B). 5.2.6 Being trauma-informed as an organisation has significant benefits for staff and the people they serve. Services are organised in ways that promote safety and trust to prevent re-traumatisation, and this is effective in preventing concerns and difficulties escalate, which in turn have a human and economic cost. The approach is about addressing inequality by ensuring that those affected by trauma (staff or those they serve) do not experience barriers to life chances and choice as a result of trauma and that trauma is recognised and responded to in order to support recovery. Becoming a trauma-informed organisation is not simply about doing what we already do better, rather it is transformative in the way services are organised and delivery and therefore requires to be key part of the delivery of the ambitions of the Strategic Commissioning Plan. 5.3 Report 5.3.1 Scottish Government and COSLA asked all local authorities and health boards to appoint trauma champions to ‘oversee, encourage and raise awareness of trauma informed and trauma responsive practice across all services within their area’. The champions have a specific responsibility to influence local leaders to embed the five key drivers of trauma-informed practice (as detailed in 1.3) across their area. 5.3.2 The North HSCP nominated Margaret Flavell, Senior Manager Adult Social Work as the champion. As requested by COSLA and Scottish Government, Ministers have been advised of this, who are working with national leads in Scottish Government and the Improvement Service, as well as local leads in NHS Lanarkshire in relation to implementation.
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4 5.3.3 Two steering groups have been established, one that is Pan Lanarkshire and a north operations group of staff from the HSCP and North Lanarkshire officers from Education and Families, Enterprise and Communities, People Resources with the purpose of providing strategic direction and coordination of support and training to promote the implementation of Trauma-Informed Practice. The Scottish Government has made £100K available to all local authorities over two years to support the implementation of Trauma-Informed Practice. An officer was therefore appointed in January 2023, to lead on the implementation of Trauma Informed Practice and build on, and add pace to, the work started to integrate the Trauma Training Programme with current training plans in place to deliver The Plan for North Lanarkshire. Additionally there are 2 Health and Wellbeing officers being employed for the HSCP to support staff wellbeing that will be aligned with the outlined Trauma Informed Practice approach. 5.4 Trauma Informed Practice across the HSCP 5.4.1 The importance of being trauma-informed in our approach to support citizens has been recognised by services across the partnership. The Strategic Commissioning Plan, is underpinned by the strategy to develop a trauma skilled work force, building on established work around nurture, resilience and other approaches based on forming strong relationships with children and families. Awareness about the importance of trauma recovery has been integrated into the delivery of nurture and resilience work and critical incidents; this is evident in Adult Protection practice. 5.4.2 The importance of being trauma-informed also underpins the Partnership’s longstanding investment in prevention and early intervention work with our existing workforce and our third sector partners with its principles incorporated within the multiagency adult protection training, domestic abuse training and others although this requires further development. 5.4.3 The housing service is working to embed trauma-informed understanding of working with people through its implementation of the Solihull approach across the service. Other initiatives such as psychologically informed environments, ‘Family Plus’ and ‘Forever Homes’ have been piloted with housing and partners recognising the importance of trauma-informed approaches on improving outcomes. The Local Housing Strategy (2021-2026) and the Rapid Rehousing Transition Plan also set out how a trauma-informed workforce will improve outcomes for people in need of support with housing. Work is also underway to help identify the barriers and enablers for adopting a trauma-informed approach within housing to inform the actions and support required to embed trauma-informed practice in housing practice. 5.4.4 An awareness of the impact of trauma is now also embedded into the approach to the design and development of North Lanarkshire’s community hub programme. Working with the Promise Development team and Council equalities officer we applied a ‘trauma lens’ using the Scottish Government toolkit and identified a number of improvement actions e.g. paint colours, signage, seating, layouts and signposting to supports and services. This work will continue as our new community hubs are introduced and through tests of
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5 change to address the barriers that those affected by trauma can experience while accessing supports and services. This work will be further developed through existing workplaces across the partnership by teams applying a ‘trauma lens’ to their working environments. 5.4.5 The Council’s Equalities Delivery Board also has Trauma Informed Practice firmly sitting within its strategy, delivery framework and five objectives to ‘ensure that local public services are responsive to different needs and treat users with dignity and respect’. 5.5 Training 5.5.1 The North steering group is developing a strategy to use the national Trauma Training Plan to support implementation across the HSCP and North Lanarkshire. An e-learning module at the ‘informed level’ (see Appendix B) is in development for all staff in the Council and committee is asked to approve its inclusion within the mandatory suite of training for Council employees. The Health Board is asked to consider this also for NHSL staff. Beyond this, an assessment tool is being developed for services to identify at what level groups staff need training across the continuum of informed to specialist and training plans will be built around analysis of need, integrating trauma informed practice wherever possible. A specific training offer for education staff has been developed in collaboration with Education Scotland to enhance understanding of trauma responsive strategies, aligned with the outcomes within the Roadmap to Recovery. 5.5.2 Dr Claire Stark, Lanarkshire Trauma Coordinator, has delivered introductory sessions to 100 plus first line managers across the partnership. There are further planned sessions by Dr Claire Stewart, Lanarkshire Trauma Coordinator to the Strategic Leadership Team to increase leadership understanding, refresh engagement and to agree next steps. Additionally, Dr Claire Stewart has delivered an introduction to The Trauma Framework to the NL Council Corporate Management Team and elected members, which is now available to members digitally. 5.5.3 The principles of being trauma informed underpin and support all work with children, families, and adults. As such, the steering group has coordinated a review of training delivered to social work practitioners, housing staff, within Education and across public protection to identify where the principles of trauma informed practice are embedded in training already. Training packages have been updated to reflect these principles where required. This is required across health staff training and the HSCP Organisational Development lead officer will support this. 5.6 Next Steps 5.6.1 There has been a lot of activity to raise awareness about trauma-informed practice to lay the foundations for a trauma informed workforce through training. However, the success of such initiatives will be limited without clear and unambiguous strategic and organisational support for the approach, which
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6 ensures it ties in with the vision and ambition of the Strategic Commissioning Plan (SCP) and the Plan for North Lanarkshire. We are at the beginning of this process that moves from an organisation that is trauma aware to one that is trauma informed as set out in Appendix C. Particular attention needs to be given to ensuring that we understand the impact and how outcomes for people are being improved through the development of a trauma informed workforce. 5.6.2 Embedding sustainable trauma-informed ways of working is about long-term culture change. The steering group has identified key priorities below linked to the 5 strategic drivers for a Trauma Informed organisation outlined in 1.3: Leadership: Appoint an elected member as Trauma Champion to support the work of the steering group develop plans for North Lanarkshire becoming a trauma-informed Council to support the fulfilment of the ambition of the Plan for North Lanarkshire and the new Programme of work. Health Board members would assist this also. Likewise further SLT to support the SCP ambitions and embed trauma informed practice across the partnership. Re-fresh governance and membership of the of steering group. Workforce Wellbeing: The actions to deliver the NHSL and Council’s Mental Health Strategy for staff are underpinned by the 5 principles of a trauma-informed organisation. Workforce knowledge and skills: Each service across the partnership should assess the level at which staff need training and a base line is established in order to update the training strategy for trauma informed practice. Experts by experience: Individuals, families and communities drive our approach to becoming a trauma informed organisation using existing structures for participation and engagement. Data and Feedback Loops: Base lines and outcome data for trauma informed practice are integrated and aligned with measures of success within the SCP and the Council’s new Programme of Work. 5.7 Leadership Pledge 5.7.1 As set out in the Programme for Government 2021, a Leadership Pledge of Support has been introduced for organisations to demonstrate their commitment to supporting and embedding a trauma informed culture across their workforce and services. Signatories to this pledge agree to: • Work with others to put trauma-informed and responsive practice in place across our workforce and services. • Deliver services that wherever possible are actively informed by people with lived experience of trauma.
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7 • Recognise the central importance of relationships that offer collaboration, choice, empowerment, safety, and trust as part of a trauma-informed approach. • Respond in ways that prevent further harm, and that reduce barriers so that people affected by trauma have equal access to the services they need, when they need it, to support their own journey of recovery. 5.7.2 The IJB are asked to endorse the HSCPs Pledge as a commitment to becoming trauma informed as a way of working and approach in everything it does and its importance for the delivery of high-quality services and support to people in North Lanarkshire. 6. CONCLUSIONS 6.1 The IJB is asked to endorse and promote the implementation of Trauma Improved Practice across the HSCP workforce and subsequently service delivery to our NL citizens. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.2.1 Staff are trained in Trauma Informed Practice at the level commensurate with their role. 7.2.2 Improvement action on trauma design of spaces are delivered in line with the implementation of town and community hubs with ongoing learning feeding into future design.
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8 7.2.3 Staff engagement, retention and wellbeing is improved through the implementation of trauma informed work at a systems level. 7.2.4 HSCP, Council staff, partners, services, and environments recognise the prevalence and impact of trauma, how they may create barriers to support, the key role they play in people’s recovery, and how they can reduce the possibility of re-traumatisation. 7.2.5 Outcomes for children, young people and adults are improved through positive relationships with staff and evidenced in feedback from citizens on their experiences. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.3.1 Cost of the Trauma Informed Practice implementation post (NLC 12) at mid- point including on costs is £58,381. Post is funded from approved carry forward and 2022-23 funding from Scottish Government. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner There are risks to children, individuals and families of re-traumatisation and increased distress if staff are insufficiently trauma- informed in their approach and practice. The roll out of The Training Plan is a national policy priority and the extent to which services have integrated and applied the approach will be subject to external scrutiny, particularly in any joint strategic inspection of children’s or adult services. If our workforce do not recognise trauma as an important factor impacting health throughout a person’s life, there is a risk that we do not enhance the positive impact we are seeking to achieve against our citizens health and wellbeing outcomes. If our physical spaces are not designed and maintained to offer a sense of safety, calmness, dignity, and promoting choice and control it could significantly impact the positive impact and aspiration we have for our town and community hubs. This also Choose an item. Margaret Flavell (HSCP) Yes ☒ No ☐ N/A ☐
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9 extends to an impact on productivity of staff and our ability to provide supports and services that are inclusive and responsive in their delivery. The trauma roadmap applied to our operating model for town and community hubs will address this risk through the improvement action. Attention to the principles of Trauma Informed Practice has now been incorporated into the revised Strategic Policy Framework adopted by the Policy and Strategy Committee on 16 March 2023. Furthermore, Trauma Informed Practice now firmly sits within the objectives of the Council’s Equalities Delivery Board. The steering group is creating a project risk register in line with the development of the implementation plan as outlined in 2.11 which will identify the baseline risk level. 7.5 PEOPLE 7.5.1 Trauma Informed Practice features as a firm commitment within the strategy, delivery framework and objectives of the Equalities Delivery Board. In terms of trauma design of town and community hubs and their spaces, the Council’s Safety and Wellbeing team and Equalities officer are involved in plans and improvement actions. 7.5.2 The TOD team are engaged in training roll out proposals contained in this report and as HR policies are reviewed the impacts of trauma will be considered in development of guidance and toolkits to promote the wellbeing of staff. It is important to note that many staff may have experienced trauma themselves, and some research suggests that those in human services have a higher prevalence of adverse experiences, which means that staff support and strategies to mitigate secondary traumatic stress are crucial (Scottish Government, 2021). 7.5.3 There will be some impact around communication and engagement with communities and with staff if the report is approved. Particular emphasis will need to be given to engagement and communication around the training roll out. In terms of physical design of spaces, environment, and buildings there may be requirements to replace signage and other communications material. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report:
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10 EQIA added to website: 7.6.1 There is a growing body of evidence that impact of adverse childhood experiences and trauma contribute to increased risk of a wide range of physical and mental health conditions and social problems, including involvement in the justice system (Scottish Government, 2018). A trauma-informed approach to the delivery of services mitigates these risks and is an important component in the strategic work to reduce inequalities and delivering priorities within the HSCPs Strategic Commissioning Plan and the Council’s new Programme of Work. 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. 9.1 Appendix A Trauma-Informed System 9.2 Appendix B Trauma Training Plan 9.3 Appendix C Trauma Informed Roadmap 2023-25 9.4 Appendix D The Scottish Psychological Trauma Training Plan trauma-training-plan-final.pdf (transformingpsychologicaltrauma.scot) CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact the following; Margaret Flavell, Senior Manager Adult Social Work Services Yes ☒ No ☐ N/A ☐ Yes ☐ No ☒ N/A ☐
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11 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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12 Appendix A: Trauma-Informed System
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13 Appendix B: Trauma Training Plan
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14 Appendix C: Trauma Informed Roadmap 2023-25
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1 REPORT Item No: 12 SUBJECT: Our Health Together TO: IJB Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Stacey Anderson, Support Services, Project Manager DATE: 17 May 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 By: ☐ Reviewed By: The Planning, Performance and Resource Committee ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB note the content of the report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Our Health Together - Living Our Best Lives in Lanarkshire 5.1.1 The engagement to inform NHS Lanarkshire’s new healthcare strategy ‘Our Health Together’ launched on 21st April and gives our communities and those who work in the service the chance to shape how we deliver healthcare for future generations. 5.1.2 The aim is to deliver a wide-ranging stakeholder engagement programme involving patients, unpaid carers, our staff and local communities (including children and young people), working together to inform the development of our new strategy ‘Our Health Together – Living Our Best Lives in Lanarkshire’. 5.1.3 Now is the time for everyone in Lanarkshire, residents and staff, to play a major role in shaping services for the future and to be involved in discussions about: Factors that affect people’s health and wellbeing; Ways in which NHS Lanarkshire can support local people to stay well; Access to NHS Lanarkshire services The role of digital developments in healthcare. 5.1.4 Advances in medicines, technology and science provide opportunities to change and modernise the way we deliver care. There are also challenges that we need to plan for now. To help treat and support those who need healthcare the most we need to maximise what we can provide within our resource. Local residents and staff need to play a vital role in shaping services that deliver modern healthcare. 5.1.5 In February the NHS Lanarkshire Planning, Performance and Resource Committee signed off the Our Health Together (OHT) Public Engagement Pack, with approval to finalise and move to engagement thereafter. Since February a number of actions have been completed by the Our Health Together team as Yes ☐ No ☒ N/A ☐
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3 detailed below which has resulted in the formal of Stakeholder Engagement Programme which took place on Friday 21st April 2023. 5.2 Our Health Together Development Actions Feb- April 2023. 5.2.1 Communications Communication plan finalised (Appendix 1 OHT Engagement Plan) OHT web page developed Animation Video and BSL video produced detailing the purpose of the engagement Social media and media campaign agreed 5.2.2 Documentation and Resources Review and update of the engagement briefing concluded ensuring compliance with plain English guidelines Graphics incorporated to make the document more engaging and accessible Development of an “in-brief” version Development of an “easy-read” version of the briefing Demographic questions incorporated Presentation developed Facilitators pack developed Staff engagement questions consulted on and finalised based on agreed themes and the community engagement plan Questionnaire (staff and community) build completed on Smart Survey platform 5.2.3 Pre Engagement Testing Consultation and testing of the briefing pack and community engagement questions Successful pre-engagement event with the NL Community Board undertaken to test the approach 5.2.4 Review and Evaluation Engagement with Healthcare Improvement Scotland – Community Engagement Directorate who have reviewed and fed back positively on the approach we are adopting Development of an Evaluation process which will allow us to review and adjust our approach as we progress Mid engagement review process agreed to review reach and feedback to date based on collated demographics Evaluation timeline agreed (quantitative evaluation to be concluded early July)
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4 5.3 The next steps. 5.3.1 Work will continue to: review feedback to further refine the Engagement Programme Plan (Appendix 1); and review staff and community responses to determine if additional targeted communications are required. 6. CONCLUSIONS 6.1 The IJB is asked to note the ongoing development and refinement of the Stakeholder Engagement programme to inform the development of our new Our Health Together strategy. The OHT Development Timeline is detailed below for information. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 ☐
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5 Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Progress against implementation of the final strategy will be monitored via NHS Lanarkshire’s Planning, Performance and Resources Committee. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Corporate Risk 2062 Choose an item. Strategy Delivery Team 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design Yes ☐ No ☐ N/A ☒
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6 and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: An EQIA on the communications and engagement process has been completed, with EQIAs developed/being developed for individual work stream engagement. EQIA added to website: 8. BACKGROUND PAPERS Yes ☒ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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7 9. APPENDICES Appendix 1 – Engagement Programme Plan CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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NHS LANARKSHIRE OUR HEALTH TOGETHER Engagement Plan Updated 18.4.23 DATE ACTIVITY DETAILS WORKSTREAMS/THEMES STAKEHOLDERS STATUS Jul-Sep '23 Development of Equality Impact Assessment on the engagement process EQIA developed to inform final engagement plan and support an inclusive approach to the process Our Health Together Public, staff Complete Aug-Sep '22 Staff briefing, The Pulse Sustainability and Climate Change Strategy survey Sustainability Staff Complete 6.9.22 NHS Lanarkshire Public Reference Forum Update on Our Health Together and discussion to inform engagement plan Our Health Together Public Complete Sep '22 Online survey Public and staff survey to inform development of digital strategy Digital Public, staff Complete Sep '22 Online survey Public and staff survey to inform development of quality strategy Quality Public, staff Complete 26.19.22 Cluster Quality Leads Update with GPs in Lanarkshire Our Health Together Staff Complete 28.9.22 Planning, Policy and Resources Committee Meeting Our Health Together framework and draft engagement plan Our Health Together NHS Lanarkshire Board Complete 30.11.22 Planning, Policy and Resources Committee Meeting Update report Our Health Together NHS Lanarkshire Board Complete 25.1.23 NHSL Board Meeting Update report Our Health Together NHS Lanarkshire Board Planned 7.2.23 NHS Lanarkshire Public Reference Forum Update on Our Health Together and discussion to inform engagement plan Our Health Together Public Complete 22.2.23 Planning, Policy and Resources Committee Meeting / NHSL Board Meeting Board sign-off of framework and engagement document Our Health Together NHS Lanarkshire Board Complete 23.3.23 Our Health Together - Future Engagement with Community Boards MS Teams engagement meeting including presentation and breakout group discussion Our Health Together Members of North Lanarkshire Community Boards Complete 29.3.23 Lanarkshire Rehabilitation Strategy Steering Group MS Teams meeting including presentation and questions. Calvin attending. Our Health Together Staff, public, third sector and partners Complete 14.4.23 Area Medical Advisory Committee MS Teams meeting including presentation and questions. Calvin attending. Meeting postponed as not quorate. Our Health Together Staff Complete 21.4.23 Launch of Our Health Together community and staff engagement programme Engagement period runs from 17 April to 23 June 2023. Details of specific communications and engagement activity below. Our Health Together All Planned 21.4.23 Our Health Together public webpages New Our Health Together web section on NHSL public website https://www.nhslanarkshire.scot.nhs.uk/our-health-together/ including: engagement document; in brief engagement document; video; BSL video; EQIAs - comms/engagement; survey links; details of engagement events; email inbox: ourhealthtogether@lanarkshire.scot.nhs.uk Our Health Together All In progress 21.4.23 Full engagement document Distributed electronically to stakeholders and available on the website. Printed copies available on request. Our Health Together All In progress 21.4.23 In brief engagement document Distributed electronically to stakeholders and available on the website. Printed copies available on request. Our Health Together All In progress Appendix 1
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DATE ACTIVITY DETAILS WORKSTREAMS/THEMES STAKEHOLDERS STATUS 21.4.23 Easy read (assessible) engagement document Easy read version of document for people with learning disabilities Our Health Together All In progress 21.4.23 Online surveys Online stakeholder surveys developed and delivered with support from Snook. Separate surveys for public and staff stakeholders. Our Health Together All In progress 21.4.23 Paper survey Paper alterative for those unable to access online survey Our Health Together All In progress 21.4.23 Engagement feedback email address Our Health Together email address for stakeholder feedback and questions: ourhealthtogether@lanarkshire.scot.nhs.uk Our Health Together All In progress 21.4.23 Stakeholder electronic newsletters Reguar newsletters issued to stakeholders during the engagement process up to launch of the final strategy including: link to video; link to survey; link to documents Our Health Together All In progress 21.4.23 Media release on launch of engagement Engagement launch media release followed by reguar media releases issued to stakeholders during the engagement process up to launch of the final strategy Our Health Together All In progress 21.4.23 Engagement video Overview engagement video for use on website social media Our Health Together All In progress 21.4.23 Engagement BSL video British Sign Language engagement video for use on website and social media Our Health Together All In progress 21.4.23 Social media posts Regular social media posts to inform, update and encourage stakeholder participation Our Health Together All In progress 21.4.23 Flyers A5 flyer for use at in person engagement opportunities to encourage update of engagement survey Our Health Together All In progress 21.4.23 Posters Our Health Together All In progress 21.4.23 Pulse article on launch of engagement Engagement launch media release followed by reguar articles during the engagement process Our Health Together Staff and GPs In progress 21.4.23 All in Lanarkshire staff email on launch of engagement Engagement launch email to all NHS Lanarkshire staff and GPs Our Health Together Staff and GPs In progress TBC NHS Lanarkshire Ethnic Minority Employee Network Newsletter Article in newsletter on Our Health Together Our Health Together Staff In progress 21.4.23 Weekly email staff briefing Item on engagement launch followed by regular reminders during the engagement process Our Health Together Staff and GPs In progress 24.4.23 Disabillity Network MS Teams meeting including presentation and questions. Calvin attending. Our Health Together Staff Planned 24.4.23 GP Sub Committee MS Teams meeting including presentation and questions Our Health Together GPs Planned 26.4.23 Planning, Policy and Resources Committee Meeting Update report Our Health Together NHS Lanarkshire Board Planned 27.4.23 Area Clinical Forum 2pm - Presentation and feedback discussion with ACF Our Health Together Area Clinical Forum, staff and GPs Planned 4.5.23 Acute Site Medical Staff Association - UHM MS Teams meeting including presentation and questions Our Health Together Staff Planned 2.5.23 Public Reference Forum MS Teams meeting including presentation and questions. Single item agenda to focus on OHT discussion. Calvin attending. Our Health Together Staff and Public Planned
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DATE ACTIVITY DETAILS WORKSTREAMS/THEMES STAKEHOLDERS STATUS 10.5.23 In person - staff engagement roadshows Staff engagement roadshow at University Hospital Hairmyres Lecture Theatre (10-11am) All staff from NHS Lanarkshire and health and social care partnerships invited. Our Health Together Staff Planned 12.5.23 Mid-engagement review meeting Meeting of NHS Lanarkshire Communications and Engagement Strategy Delivery Goup (with stakeholder involvement) to review progress with engagement process Our Health Together All Planned 16.5.23 In person - staff engagement roadshows Staff engagement roadshow at University Hospital Wishaw Ronald Miller Lecture Theatre (10-11am) All staff from NHS Lanarkshire and health and social care partnerships invited. Our Health Together Staff Planned 22.5.23 snook 23.5.23 Area Partnership Forum 9.30am - Presentation and feedback discussion with APF Our Health Together Area Partnership Forum Planned 24.5.23 In person - staff engagement roadshows Staff engagement roadshow at University Hospital Monklands Lecture Theatre (10-11am) All staff from NHS Lanarkshire and health and social care partnerships invited. Our Health Together Staff Planned 9.6.23 Elected represenative briefing session MS Teams elected representative engagement session open to Lanarkshire MSPs, MPs and councillors. Presentation by Colin and Chris Our Health Together MSPs, MPs, councillors Planned 21.6.22 AHP Area Advisory Committee MS Teams meeting including presentation and questions Our Health Together Staff Planned Apr-Jun '23 Online community engagement events MS Teams meetings including presentation, questions and group discussion. Invite to be open to all stakeholders. One daytime and one evening session planned. Details to be confirmed Our Health Together All Planned Apr-Jun '23 Engagement outreach Face-to-face engagement opportunities to raise awareness of engagement, encourage completion of survey and answer questions. Locations to include hospitals, health centres, vaccination clinics Our Health Together All Planned Apr-Jun '23 Health Improvement engagement opportunities Health Improvement Team to undertake engagement with relevant groups and make use of exisiting interactions with services users to raise awareness of the engagement process and encourage completion of the survey Our Health Together All Planned Apr-Jun '23 Engagement presentation to community groups Opportunity for local groups to request engagement presentation at their meeting Our Health Together Community stakeholders Planned Apr-Jun '23 Online staff engagement event Two online staff engagement events - one aimed at North Lanarkshire and one at South Lanarkshire health and social care partnerships staff. Our Health Together Staff Planned Apr-Jun '23 Voluntary Action South Lanarkshire (VASLAN) locality network engagement events Two engagement sessions (one rural, one urban) with the VASLAN localtiy networks. Details to be confirmed. Our Health Together Voluntary Action South Lanarkshire Planned Apr-Jun '23 Voluntary Action North Lanarkshire (VANL) locality engagement events Engagement sessions with VANL localities. Details to be confirmed. Our Health Together Voluntary Action South Lanarkshire Planned 23.6.23 Close of Our Health Together community and staff engagement programme Closing date for official engagement period and survey. Our Health Together All Planned Sep '23 Stakeholder review of draft strategy Post engagement stakeholder meeting to review how feedback has informed the draft strategy document Our Health Together All Planned Nov '23 Launch of Our Health Together strategy Launch of final document following sign off and Board approval Our Health Together All Planned