Item 9 - Winter Plan Business Case Progress Report
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 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