Item 3 (M) IJB 17.5.23
North Lanarkshire Council · 27 September 2023
Back to Health and Social Care Integration Joint Board — 27 September 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 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 17th May 2023 at 9.30am-10.40pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Claire Barclay 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 James Muir NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Amanda Kilburn Chief Finance Officer North HSCP Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative Officer in Attendance: Stacey Anderson Support Services Project Manager Stacey Connor Minute Secretary Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communications Manager Jann Gardner Chief Executive NHS Lanarkshire Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Dr Lucy Munro Medical Director NL Des Murray Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) Maggs Thomson Head of Health North HSCP Paul Carey Audit Scotland APOLOGIES: Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddie Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director NLHSCP
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2 Fiona Owens Audit Scotland John Watson Employee Representative NLC Unison 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 (22nd March 2023) 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: Action log actions are mainly centred around IJB Liaison sessions. 5. IJB Risk Register 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. 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. Following discussions at the last meeting of PFA on 19th April 2023, the risk register has been updated and additional controls/actions added to: 1. IJB 01/21 – Financial Challenges 2. IJB 04/21 – Set Aside
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3 3. IJB 06/21 – Prescribing 4. IJB 11/21 – Performance 5. IJB 13/21 – Care Homes 6. IJB 14/22 – CAMHS 7. IJB 17/22 – Unscheduled Care There are currently two risks rated as Very High on the IJB risk register. 1. IJB 06/21 – Prescribing Activity and Costs 2. 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 Ally Boyle queried how will the prescribing risk progress, can we make the saving efficiencies required. Ross McGuffie noted month 1 has gone well got roughly £600k in savings but it is still early days that can change throughout the year; so it will remain as a high risk. Brian Moore asked are there any update in terms of local care home financial sustainability plans. Ross McGuffie replied it will depend on National Care Service negotiations which are still on going, there have been some care homes already gone into administrations which has created challenges. If this continues it will increase financial challenges for the board. Philip Couser queried for prescribing should this be a future agenda item as it is a high risk. Ross McGuffie confirmed a performance report will come to a future committee. Dr Lucy Munro confirmed work is ongoing already but reports will offer the committee some assurance. Dr Tyra Smyth added drugs are getting more expensive and more advanced. The board has a responsibility to promote medication usage. North Lanarkshire is underspent in comparison to South Lanarkshire which is linked to inequalities. The IJB agreed the following recommendation: They 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. 6. Governance Report The report provides an overview of the recently reviewed/updated governance documents in regards to reporting for the North Lanarkshire
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4 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. Update on the governance arrangements will come to the committee on a quarterly basis. Recommendations agreed by the IJB: Review the updated IJB Governance documents and approve the documents and associated templates for IJB use during the 2023-24 period. 7. 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. 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. The next stage of operation flow is being planning with 5 task and finish groups up and running to progress the work. For delayed discharges there were some challenges over the Easter weekend relating to increase in staff absence and an increase in demand. Through Covid have been able to stay within upper and lower confidence levels for beds. Philip Couser queried should we be changing the wording of the risk relating to winter pressures as we are now in Summer. Ross McGuffie advised pulling together winter plan for 2023/24 nationally so this will be picked up as part of that but will also review our risk register. Ally Boyle asked with face mask requirements being stood down how are we going to manage staff sickness levels. Ross McGuffie noted will continue to monitor staff absence and if see any spikes still got resilience structures in place. Dr Lucy Munro noted still have national infection control manual which has a number of measures which should be undertaken regularly. RMcG
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5 Brian Moore asked what are the issues around progressing planned date of discharge. Ross McGuffie noted the earlier we are involved in a patients case the better the outcome as staff are involved and can offer expertise when required as part of multi-disciplinary teams. The IJB agreed: (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 8. Delayed Discharge and Site Occupancy Plans The paper sets out Scottish Government’s action plan to improve delayed discharge and hospital occupancy. 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. 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. 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. 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. Have agreed increase in payment cost to £10.90 which will be back dated to 1st April for providers. Brian Moore asked is there any significant updates around Adults with Incapacity (AWI) reforms. Ross McGuffie advised there is a national group up and running to review this but there is little potential of a short term impact. In Lanarkshire got 16 AWI cases in the system there are 1920 bed days between these patients which provide some context to delays data. The IJB: (1) Note the Scottish Government action plan on delayed discharge and hospital occupancy;
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6 (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. 9. Winter Plan Business Case Progress Report 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. 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 Philip Couser asked have we got the appropriate risks around the workforce challenges noted for this and he also asked do we have sufficient evaluation mechanisms in place to review what is working and what is not. Ross McGuffie advised got programme board and each service area is starting to coordinate the data from the additional posts they have so show improvements. Ally Boyle noted it would be useful to have some key points summarised for each work stream to show why they remain at amber and allow mitigations to be considered. Ross McGuffie acknowledged this comment and can make this more apparent in future reports. Noted working with national teams to progress creating band 4 nursing roles, Cathy McGinty confirmed unions are involved in these discussions.
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7 The IJB endorse and support the progress reports of each of the workstreams which comprise the Winter Planning & Enhance Supports Business Case 10. Fairer Scotland Duty 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. 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. 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. 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. 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. 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. 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. 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.
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8 11. Implementation of National Trauma Framework 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. 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. 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. Section 5.4 within the report outlines what is being done to embed trauma in practice and the links to the strategic commissioning plan. It has been a key feature in developing community hubs. 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.
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9 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. It was agreed Ross McGuffie, Brian Moore, Alison Gordon and Cllr Khan will meet to discuss further. 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 12. Our Health Together 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. 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’. 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 detailed below which has resulted in the formal of Stakeholder Engagement Programme which took place on Friday 21st April 2023. The IJB note the contents of this report. 13. Risk Ross McGuffie noted updates to winter business case and workforce risks in terms of review but no new risks have been identified. 14. Date of Next Meeting 27th September 2023 2pm