Combined IJB Pack 22.11.23
North Lanarkshire Council · 22 November 2023
Back to Health and Social Care Integration Joint Board — 22 November 2023 and its agenda
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A meeting of the IJB will be held on Wednesday 22nd November 2023 at 2pm-4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB ( 27th September 2023) For Approval Attachment Chair 4. Minutes IJB PFA (18th October 2023) For Approval Attachment Chair 5. Matters Arising/ Rolling Action Log For Approval Attachment Ross McGuffie 6. Chief Officer Update For Noting Verbal Ross McGuffie Strategic Planning & Development 7. Frailty Strategy For Endorsement Attachment Trudi Marshall 8. GIRFE For Endorsement Attachment Trudi Marshall 9. JRF Poverty in Scotland (2023) Report For Noting Attachment Ross McGuffie 10. Public Sector Equality Duty For Noting Attachment Ross McGuffie 11. Assistive Technology For Endorsement Attachment Ross McGuffie Performance & Finance 12. Risk Management Report For Approval Attachment Stacey Anderson 13. Financial Monitoring For Noting Attachment Amanda Kilburn
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Governance & Policy 14. IJB Terms of Reference Review & Future Dates For Approval Attachment Stacey Anderson 15. Committee Draft Work plan For Endorsement Attachment Ross McGuffie 16. Updated Integration Scheme For Approval Attachment Stacey Anderson 17. SCCG HQAIC Report For Noting Attachment Dr Lucy Munro 18. Climate Change Report For Approval Attachment Stacey Anderson For Noting 19. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 20. Date of Next Meeting 24th January 2024 9.30am-11.30am (Winter Session) For Noting
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1 ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 27th September 2023 at 2pm to 4.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Brian Moore (Chair) 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 John Watson Employee Representative NLC Unison Officer in Attendance: Stacey Anderson Support Services Project Manager Stacey Connor Minute Secretary Graeme Cowan (Item 7) Senior Officer Mark Dell Communications Manager Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Maddie Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director NLHSCP Lesley McDonald (Shadowing) NHS Lanarkshire Nominated Non Exec Director Dr Lucy Munro Medical Director NL Dr Tyra Smyth General Practitioner (GP) Dr Josephine Pravinkumar Director of Public Health Maria Williamson (Item 10) Interim Head of Planning, Performance & Quality APOLOGIES: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Paul Carey Audit Scotland Dr Kenneth Dagg Secondary Care Medical Practitioner
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2 Morag Dendy Head of Planning, Performance & Quality Jann Gardner Chief Executive NHS Lanarkshire Diane Fraser Head of Adult Social Work Services Councillor Martin McCulloch North Lanarkshire Council Nominated Councillor James Muir NHS Lanarkshire Nominated Non Exec Director Des Murray Chief Executive NLC Fiona Owens Audit Scotland Harry Robertson Carer Representative Maggs Thomson Head of Health North HSCP 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 (17th May 2023) The previous minutes were approved as an accurate reflection of the discussion. 4. Minutes of IJB PFA (21st June 2023) The minutes from the IJB PFA subcommittee were noted by the committee. 5. Matters Arising/ IJB Action Log There were no matters arising. Ross McGuffie provided an update on the IJB action log and noted the following key points: Item 12 SCP -Community Nursing review work will come back as an update as part of a programme of work. Item 6 Self-Assessment Report- Ross McGuffie noted due to the level of turn over and change for the committee it may not be worthwhile to carry on the review but instead to undertake a fresh review. It was proposed to close the action and to start fresh; this was noted. Item 13 Mental Health Strategy- This will be reviewed in more detail at a future IJB Liaison session as the existing strategy ends in 2024. Item 5 Risk Management Strategy- This is on the November IJB liaison session agenda.
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3 Improving Cancer Journey Board- Note update planned for future IJB committee. 6. Chief Officer Update Ross McGuffie provided the committee with a general update on the following: iMatter – A survey is undertaken every year with all staff to look at areas that at working well and areas that can be improvement, this year’s engagement score was 80%. When survey results are received individual teams review the results to generate action plans for areas of improvement. Positive feedback around line managers and staff recommending their team to work with. Areas identified for improvement is Board members being more visible and staff do not feel involved in decisions made for the organisation. To help these areas leadership walk rounds are taking place as well as Staff Roadshows. Also using Chief Officer newsletter to promote visibility. NL HSCP Website is now up and running. Joint bid with South Lanarkshire HSCP, NLC & NHS for Health determinate research collaborative, have requested funding for research capacity to look at health determinants. Involved in Scottish bid for peace plus process relating to frailty key partner in Scotland submitting a bid to the work programme relating to operation flow. Recently visited Hairmyers to meet frontline staff in respiratory and urology Delayed discharge position has been positive sitting with 79 delays in system today home assessment team have supported over 1000 patients home. Home Support have had visits to other partnerships in Scotland to look at good areas of practice –particularly Glasgow have largely moved to 7 days on and 7 days off. Working with West of Scotland resilience group looking at next survey around category 1 responder duties with local resilience partnership. Updating survey to be issued soon. Looking at pre pandemic comparison particularly around delayed discharges to see areas which have improved, pulling together an assurance framework for winter, self-assessments have gone out from operation flow work. Pulling together session for to look at best practice models in home assessment and home first. 7. Strategic Commissioning Plan 2023-26 Programme of Work The report tabled is to set out the partnership’s Programme of Work which supports the delivery of the priorities within the Strategic Commissioning Plan 2023-2026.
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4 The Strategic Commissioning Plan 2020-2023 was approved and published in March 2023 on the assumption that a more detailed Programme of Work would be presented to the Board thereafter. The Programme of Work has been compiled following consultation and engagement with stakeholders across the Health & Social Care Partnership and beyond. It is aligned with the key strategic drivers across both NHS Lanarkshire and North Lanarkshire Council, dovetailing with the developments associated with Operation Flow, the strategic developments in relation to Our Health Together, and the Council’s refreshed Programme of Work (as part of the Plan for North Lanarkshire). Graeme Cowan advised there are 13 key areas within the plan which are grouped into 4 bundles. The paper also outlines the timeline for each of the areas to report into the committee. Phillip Couser asked if there are details linked to the reporting timescales and do we have methods to measure success. Graeme Cowan advised some areas are more defined than others but undertaking more work for some areas. Maddy Halliday advised community solutions are down to report in May but due to availability of data will need to report in September. This was noted and the committee acknowledge there will be a degree of flexibility to reports. The IJB committee: Note and approve the Programme of Work included in appendix 1, and its associated scope and timescales for reporting. 8. Prescribing Efficiencies Dr Lucy Munro tabled a report which provided the committee with an update on the prescribing efficiencies programme. The Prescribing Team is set an annual target for efficiencies and in 22/23 achieved a total of £2.24 million across Lanarkshire in cost mitigation, £1.2 million of which was in North Lanarkshire. The actions already taken in this financial year 2023/24 are projected to save circa £2 million in NHS Lanarkshire which is more in a single quarter than has been saved in a whole year for most of our recent years but the effect of the data streams is those savings will not be visible at present. Additionally, the unpredictably of increasing cost of medicines could outstrip even these ambitious savings. Dr Lucy Munro outlined the governance arrangements for prescribing. She reassured the committee that there are systems and processes in place to ensure if medication is changed for patients it will not impact on their quality of life. There are a number of factors which can impact on the costs of medication which is out with our control, so it is difficult to predict future spend.
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5 Traditional methods to make prescribing efficiency savings are to switch patients from 1 medication to another if there is no clinical difference. In North Lanarkshire we prescribe a high number of items, looking at de prescribing drugs of low therapeutic value and undertaking more medication reviews. A piece of work is being undertaken to review currently prescribing risks on the different risk registers to merge them and ensure mitigations are relevant for the current risk. Cllr Kelly noted for 11% of hospital admissions these are related to medication harm is this for Lanarkshire alone or in general. Dr Lucy Munro advised these are National figures and we are aware there are certain combinations of medications which can interact to causes these admissions which are monitored by prescribers. Maddy Halliday noted there can be alternative supports that can be offered rather than medication and could be linked through community solutions. She asked is there an opportunity to raise aware that it is not just to save money but to promote effective prescribing to the public. Dr Lucy Munro noted for patients with chronic pain there are links to mental and wellbeing and social supports this is an example of the wider links in the community. Tyra Smyth added should be encouraging staff not to offer own advice about medication unless they are qualified to do so and not promote sharing medication from someone else which should be promoted to the public. Brian Moore asked if we are seeing an impact of support to GPs and where does community pharmacy sit, are we able to capture volume and usage of this. Dr Lucy Munro advised constantly collecting data from community pharmacy and on track for target savings, there are challenges as we don’t have all information we would like but working on this. Julie Russell added we get information on consultations undertaken in community pharmacy even those who do not result in medication being given. Cllr Barclay asked how are GPs responding to this programme. Dr Lucy Munro advised we have pharmacists in every practice who have a plan and link into meetings so they are involved in the programme. The committee agreed to get a 6 monthly update via a future financial report, Amanda Kilburn will link with Dr Lucy Munro for this. The IJB committee note progress to date and the background information. AK/LM 9. Risk Management Report The report provided a summary to the Integration Joint Board on risk management activity, noting any amendments or additions to the current risk register.
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6 Following discussions at the last meeting of PFA on 23rd June 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 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 There are 17 risks currently, 10 with no change and 7 with changes which are outlined within the report tabled. Phillip Couser noted one of the biggest risk is the increasing demands from demographics how can be include this. Also he noted the wording of the risk around fraud for ineffective governance doesn’t feel worded right. Stacey Anderson noted will look at demographics as a whole and for the fraud risk can look at a deeper dive and see how we word the risk going forward. Ross McGuffie added doing work collaboratively on demographics working with Health Board and council and look at using the risk sharing form to share across partner bodies. Maddy Halliday noted currently have a high risk around funding for community sector which is likely to move into a high risk as funding fragility is getting worse. Launching a fair funding charter for the sector which will speak to all funders in the sector. This was noted and will be considered going forward. Brian Moore asked that the care home risk is re visited in terms of wording as the definition of the risk may have changed due to covid changes. Also for the National Care Service the risk defined initially may not fit current position. Ross McGuffie proposed can look at producing an update paper on National Care Service for a future committee. RMcG
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7 Cllr Kelly requested getting an update in advance of winter, particularly how significant the risk is for covid around winter planning and vaccination Programme. Dr Josephine Pravinkumar noted there is uncertainty around new variants but there is now community immunity and vaccinations programs in place so at present the risk is low. The data we previously had is less due to the change in testing guidance but there is still national surveillance being undertaken. 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. 10. Quality Assurance Annual Report Quality Assurance have a wide and varied function including monitoring and evaluating key aspects of social work practice and performance. A central activity is the on-going contract monitoring of external social care providers. This report highlights Quality Assurance activity over the period 1 April 22 to 31 March 23 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Communications, Adult Support & Protection, In House Monitoring, Participation & Engagement, Carer Developments and Risk Management. Maria Williamson took the committee through the different elements of the report in greater detail. Cllr Barclay requested more information on why families are not participating when there has been a duty of candour case. Maria Williamson advised rolling out training to staff to raise awareness and looking at revised monitoring arrangements so that families are aware they can be involved. Brian Moore noted the report is more social work focused so needs work to get to a point to have a joint position from both partners. Ross McGuffie added doing joint working across different teams, Support Care and Clinical Governance is a committee which is bringing the element together. Dr Lucy Munro advised have looked at reporting arrangements for the group recently to better align reporting arrangements for both partners. The IJB committee endorse the report tabled. 11. Financial Monitoring This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period 1 April 2024 to 30 June 2023. The IJB year to date position is an underspend of £0.969m and the projected outturn for 2023/24 is an underspend of £3.182m, assuming the current
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8 trajectory of spend continues throughout the financial year. There is no ring- fenced funding included in this reported projected outturn. Key pressures/challenges are in employee costs, payments to other bodies, prescribing and North Lanarkshire Hosted Services. It was noted need to spend reserves before new funding sources can be drawn down. The IJB agreed the following recommendations: (1) Acknowledge the contents of the report; and (2) Acknowledge the projected outturn for 2023/24 is an underspend of £3.182m. 12. IJB Membership Proposal A paper was shared seeking endorsement that Dr Josephine Pravinkumar join the committee as a professional advisor. At present, the Integration Scheme does not include any Public Health specialist in the membership of the IJB. Given the significant current focus, as set out in the Strategic Commissioning Plan, around tackling inequalities and developing our role as an anchor institution, it feels timely to review the Board membership to fill this gap. The IJB endorse the proposed membership of Dr Josephine Pravinkumar as a professional advisor to the board on public health related matters. 13. Whistleblowing Update “Whistleblowing” refers to the act of reporting concerns or wrongdoing in the public interest either within an organisation or externally, for example to a regulator. The law on whistleblowing is contained within the Employment Rights Act 1996 as amended by the Public Interest Disclosures Act 1998. Both North Lanarkshire Council and NHS Lanarkshire’s Whistleblowing Policies provide a mechanism for employees within the Council and the NHS to report a concern about serious wrongdoing within the Council or NHS and to do so with security and in confidence. The annual review of both the North Lanarkshire Council and the NHS Lanarkshire Whistleblowing Policy has been undertaken on the use of the Whistleblowing Policies and on any amendments required to the Policies. Copies of each report is attached within the Appendices. The North Lanarkshire Annual Review of Whistleblowing Procedure 2022- 23 details that the North Lanarkshire Council’s Whistleblowing Procedure has been reviewed with the following key findings:
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9 No amendments requiring approval are considered necessary at this time. This is on the basis that the principal objectives of the policy and procedure remain. Since the last review in 2022, Health and Social Care received one whistleblowing report. The report remains under investigation and is expected to conclude shortly. The key findings of the NHS Lanarkshire Whistleblowing Annual Report for April 2022- March 2023 include: • 3 concerns were investigated under the Standards during 2022/2023 • All 3 of the concerns related to independent primary care contractors • None of the concerns were upheld. • All 3 of the investigations were granted an extension. • Learning from the concerns include reviewing clinical supervision in line with best practice and reviewing the hybrid model of appointments, communication and organisational structures and TURAS training compliance. • 4 concerns originally raised as potential whistleblowing concerns were dealt with under HR procedures. • A review by the Internal Audit Consortium of Lanarkshire of the introduction of the Standards was positive in its findings. The IJB: Note the update and the content of each Whistleblowing report and seek assurance that whistleblowing standards are being followed and learning shared. 14. Privacy Notice NL IJB are committed to protecting the privacy and confidentiality of any personal information that we hold. This privacy notice will tell you how we look after your personal information and tell you about your rights. In line with the UK General Data Protection Regulation (“UK GDPR”) and the Data Protection Act 2018 a privacy notice for the IJB has been developed to ensure that personal information is kept secure is detailed under appendix 1 within the report. NL IJB will tend to rely upon anonymised, aggregated or statistical data provided by the partner agencies (North Lanarkshire Council and NHS Lanarkshire). One or both of these statutory bodies would generally hold the individual personal data about service users from which the general data reported to NL IJB is derived. However, the privacy notice provides assurance to the Board and the public that any data collected by the IJB follows legal guidelines.
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10 Recommendations agreed: • Approve IJB Privacy Notice. • IJB Privacy Notice to be added to the NL H&SCP Website. 15. New Strategy and Child Poverty Annual Report The ‘Towards a Fairer North Lanarkshire’ Tackling Poverty Strategy 2020- 2023 and its associated Action Plan was approved at the Policy and Strategy Committee Meeting on 11th June 2020. This merged four of the original Plan for North Lanarkshire programme of work priorities for action in order to ensure a better integrated approach which maximised impact and outcomes for our communities. In view of the clear link between child poverty and wider drivers of poverty across our communities the strategy encompassed the statutory requirement to prepare and publish an annual Local Child Poverty Action Report for North Lanarkshire. Amongst the many achievements throughout the lifespan of the 2020 to 2023, Tackling Poverty Strategy: We saw a reduction in the proportion of children in poverty – from 25.2% to 23.2%, against a very challenging context. Nonetheless one in four children in North Lanarkshire remain living in poverty, which is higher than the national average of one in five children. The Tackling Poverty Team in partnership with services generated over £99 million in additional benefit income for the residents of North Lanarkshire during this 3-year period. This together with the £22.6 million generated via the Citizens Advice Bureaux, means that over £121 million has been generated by supporting people through the benefits system. In addition, a key achievement supported by investment, business support and employability initiatives are that for the first time ever the gross weekly pay for local residents is now higher than the national average – an increase of 10%. Further notable achievements are that from our baseline of 5 employers achieving accreditation for paying the living wage, we now having 123 employers accredited. Alison Gordon reminded the committee that the IJB did previously committed some funding to the tackling poverty team and this is why the report is coming to the committee for assurance. Phillip Couser asked is this intended to be a public facing document or will there be a summary document for the public and also will we get an annual update of progress. Alison Gordon replied that the strategy has not yet been through the graphics department so it will look different and consideration will be given to a summary document. In terms of reporting the primary governance is through the well-being tackling poverty committee and through the NL partnership group but progress reports can come to the IJB.
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11 Recommendations agreed by the committee are: 1) Endorse the ‘Towards a Fairer North Lanarkshire’ Tackling Poverty Strategy and its associated Action Plan as set out in Appendix 1 of this report, noting that it will be submitted to the Council’s Policy & Strategy Committee for approval. 2) Note the 2022 to 2023 Local Child Poverty Action Report as set out in Appendix 2 of this report, noting this will also be submitted to Council’s Policy and Strategy Committee for approval. 3) Note that this report will also be submitted to the NHS Lanarkshire Health and Population Board for approval of the Local Child Poverty Action Report2022 to 2023 in line with statutory requirements. 16. North Lanarkshire Children’s Services Plan 2023 The Children and Young People’s (Scotland) Act 2014 introduced requirements for each Local Authority and linked Health Board to prepare and publish the following (attached separately): - (a) A Children’s Services Plan (CSP) covering the period April 2017– March 2020 (and then in a continuing three-year cycle); and (b) A Children’s Rights Report by March 2020 (and then in a continuing three- year cycle). The final report and plan for 2023-26 will be published and submitted to the Scottish Government as per statutory duty and cascaded across the North Lanarkshire partner organisations. Alison Gordon noted we are doing extra work around family support there is a specific plan to support this. The plan has also been reviewed as part of recent Children Inspection. There is currently a vacancy on the Board for an IJB non-executive representative, which will be considered out with the meeting. Brian Moore asked do we have structures in place for data sharing. Alison Gordon advised have just done a multi-agency review and there has been no significant concerns raised around data sharing. Ross McGuffie added that he chairs a data sharing board which ensures the right systems are in place to support this, working with broader partners also. The IJB approved the North Lanarkshire Children’s Services Plan 2023- 26. 17. Community Solutions Update The paper shared is to provides an update of the Community Solutions Programme progress and achievements for 2022-23, including a summary report on the reach and impact of funded projects during this period.
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12 As can be seen in Appendix One, during 2022-23, 233 unique projects were funded which collectively supported 43,100 individuals, achieving positive outcomes for the majority. This was achieved with a total of £3.1 million in funding awards to 98 community and voluntary sector organistions. In addition, the following work was achieved during 2022-23. • Development and agreement of the new, Community Solutions Strategy and Investment Plan 2022-25. (Will be available to download from the new Community Solutions website from Oct. 2023.) • Development and agreement of a proposal for a Community Solutions Improving Lives pilot initiative (ILI) (see further information on new Community Solutions website from Oct. 2023.) • with implementation in phases from April-autumn 2023 for delivery for two years, which will support the following. o Piloting of the “three conversations” approach to assisting people in the community with health and related challenges to access community supports provided by the community and voluntary sector (CVS) and access appropriate formal support if needed. This will include supporting people affected by cancer in collaboration with MacMillan which is providing part- funding. o Building capacity of local CVS organisations generally through provision of support and guidance from Voluntary Action North Lanarkshire, the six Community Solutions Locality Hosts and other sources. o Increasing the amount of funding available to the six Community Solutions Locality Consortia to award to CVS organisations through the rough the Community Solutions (Improving Lives) Local Activity Fund. • Review and improvement of the Community Solutions Performance Management, Evaluation, Learning and Improvement Framework and supporting resources, including online surveys for funded projects and preparation of an introductory-level online Evaluation Toolkit. (See new Community Solutions website from Oct. 2023 for more details.) The committee note the report and requested a full copy of the report when it is available. 18. Tackling Poverty Team Report 2022 2023 This report provides details of the income maximisation work carried out by the Tackling Poverty Team and council services during 2022/23 which generated £35,480,020 in additional benefit income for the residents of North Lanarkshire. It also highlights the activity of the external services commissioned by the Council under the new commissioning model which started in April 2018 which generated£5,267,650 in additional benefit income for the residents of North Lanarkshire during the same period.
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13 Noted that the IJB has previously supported funding some additional capacity for the team. Alison Gordon advised the committee of some of the key projects undertaken by the team and some key legislative changes such as Scottish Child payment. Cllr Barclay noted concerns around the changeover to universal credit and the impact on the council and NHS, this was noted. The IJB committee note the update. 19. Risk There were no new risks identified by the committee. 20. Date of Next Meeting 22nd November 2023 2-4.30pm
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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 18th October 2023 9.30am-11.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director James Muir NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Stacey Connor (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Jacqueline Farmer (Item 7) Senior Auditor Audit Scotland Stephen Forrest (Item 10) Performance Manager Maddy Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director North HSCP Dr Lucy Munro Medical Director North HSCP Maggs Thomson Head of Health NHSCP Apologies: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Paul Carey Audit Scotland Phillip Couser NHS Lanarkshire Nominated Non Exec Director Diane Fraser Head of Adult Social Work Services Amanda Kilburn Section 95 Finance Officer Cathy McGinty Unison Staff Side Rep (NHSL) Councillor Martin McCulloch North Lanarkshire Council Nominated Councillor
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2 Elizabeth Seaton Partnership for Change User Rep 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 IJB PFA 21st June 2023 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. The committee noted the action log updates which shows the actions are progressing well. 5. PF & A Risk Register The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. Following discussions at the last meeting of PFA on 23rd. June 2023 and the meeting of the IJB on 27th September 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 IJB 02/22- Ineffective Governance Arrangements 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
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3 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 A key change has been to the fraud risk this was described as “ineffective governance arrangements” it is now described as “Prevention and Detection of Fraud, Bribery and/or Corruption”. The prescribing risk has also been amended as shown on risk IJB06.A risk session is planned for the IJB Liaison session in November to have a deeper dive into risks. Ross McGuffie advised population health have raised a risk around demographic changes which has led to a working group being established to manage this and using the risk sharing form to share across to NLC and South IJB. So he will consider the implications of this to the North IJB risk register. Brian Moore requested risk IJB10 (Ineffective Governance Arrangements Due to the Covid‐19 Pandemic) be reviewed to ensure the risk is still current. Stacey Anderson replied this is reflective of the risk on the NHS register and it is planned to have a deeper dive into this at the IJB Liaison session. James Muir asked do we look at risks across other Boards to see how we compare. Ross McGuffie advised this is not usually done for IJB but informally we have looked at other boards, this was noted and Ross McGuffie will provide a briefing paper for a future meeting to offer assurance to the committee. The IJB PFA 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. RMcG 6. Integration Scheme The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. The Integration Scheme sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. On 12th April 2019, the Cabinet Secretary approved the integration scheme changes, namely to remove children, families and justice social work. In order to meet the 5-year review timeline, a review and update of the North Lanarkshire Integration Scheme for 2024 has taken place and an update of the document as discussed by the IJB PFA committee members. The Integration Scheme should be subjected to consultation process which will include the document being published on the relevant public websites,
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4 with letters sent to the prescribed list of standard consultees and then submitted to Scottish Government for final approval. Once approval has been received from Scottish Government, the Integration Scheme will be uploaded to the North Lanarkshire Health and Social Care Partnership Website. Brian Moore requested terms referencing to the IJB PFA be standardised, terms should reflect current voting members and also to ensure language is reflective of current position. It was also pointed out that current version refers to the PFA as a non-decision making forum. Ross McGuffie noted we have given delegated authority to this committee through the terms of reference. Stacey Anderson added have been reviewing governance arrangements going forward to ensure linking with both partners and ensuring we have directions tracker in place. Brian Moore also requested updates come from Support Care and Clinical governance, Stacey Anderson advised 6 monthly HQAIC report from SCCG is being drafted just now so this can come to a future meeting. Maddy Halliday suggested referencing links to community solution, this was noted. Once the changes have been made the integration scheme will come back to the IJB committee for approval. The IJB PFA agreed the following recommendations: The IJB PFA acknowledge the refresh of the IJB Integration Scheme Provide any further comments and feedback regarding the Integration Scheme. 7. External Auditor Report This report provides the outcomes of the annual audit and the proposed management response to the action points detailed in the External Auditor’s Annual Audit Report. Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB have to meet to consider whether to approve the audited IJB Annual Accounts 2022/2023 for signature. The members should therefore consider any report made or advice provided by the External Auditor. The External Auditor’s Annual Audit Report on the IJB Annual Accounts extends across several subjects, as follows: IJB Annual Accounts 2022/2023; Financial management and sustainability; and Governance, transparency, and best value.
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5 The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2022/2023 give a true and fair view of the net expenditure for the year and have therefore issued an unqualified independent report. This report included the key messages at page 3 and an action plan on pages 21 to 23 which have been agreed by both the Chief Officer and the Chief Finance Officer. Ross McGuffie noted special thanks to Amanda Kilburn in helping to produce the report. He also advised that for the internal audit we are still waiting on a final date for the plan, this has been delayed due to staffing challenges leading to a delay in completion of the plan but we are working with the NHS and NLC partners on risks. The IJB PFA committee agreed the following recommendations: (1) Consider the External Auditor’s Annual Audit Report in advance of the approval of the IJB Annual Accounts 2022/2023; and (2) Approve the management response to the action points which is highlighted at pages 21 to 23 of the annual audit report, attached at appendix 2. 8. Audited Annual Accounts The report tabled provides details of the unsigned audited IJB Annual Accounts 2022/2023 for approval by the PFA. The External Auditor has concluded that the 2022/2023 financial statements of the North Lanarkshire IJB give a true and fair view of its net expenditure for the year and have therefore issued an unqualified independent audit report. Ross McGuffie noted there has been no significant change to the paper since it has been previously been reviewed by the IJB committee. Recommendations agreed by the committee: (1) Acknowledge the External Auditor’s opinions; (2) Approve the IJB Annual Accounts 2022/2023 for signature; and (3) Acknowledge that the signed audited IJB Annual Accounts will be available to view electronically on the HSCP website. 9. Progress Report on Agreed Actions The report provides an outline of the actions agreed with the External Auditor, Internal Auditor, and the Senior Management Team to further develop the IJB governance framework. Recommendations to further strengthen the IJB governance framework were made by both external and internal audit. The Senior Management Team
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6 (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements. An update on the progress made to date was reported to the PFA Committee on 19 April 2023. A summary of the current position statement is shown in the table below: Source Total Actions Completed Actions Ongoing Actions External Audit 1 1 - Internal Audit 4 3 1 Senior Management 1 - 1 Total 6 4 2 67% 33% Ross McGuffie advised this work has been an area of focus to manage timescales. The outstanding actions are link to progress of National Care Service; an update will be brought to the committee in due course. There are 6 working groups being established but there has not been an ask of the partnership for a representative yet. There has been work undertaken with COSLA around shared accountability arrangements which is still in a draft stage. Recommendations agreed: (1) Acknowledge the contents of the report; and (2) Agree that further progress reports will be presented to future meetings of the PFA Committee in respect of the ongoing actions. 10. Annual Performance Report North Lanarkshire IJB is required by the Public Bodies (Joint Working) Regulations 2014 to publish an Annual Performance Report by July 31st each year. The content of the Annual Performance Report is focused on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). The purpose of standardising Annual Performance Reports for Integration Authorities in this way is to support Integration Authorities in improving the consistency of reporting for these indicator sets. The Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire describes significant progress made in pursuit of the National Health & Wellbeing Outcomes. This progress has been made against a challenging position of recovery and remobilisation of services following the C19 pandemic, which is reflected in the performance in some of the metrics presented in the report. Performance in North Lanarkshire is broadly
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7 comparable with similar authorities and the Scottish average in many areas and in those areas where performance improvements are required, this is managed through the performance framework in place within the Health and Social Care Partnership. James Muir asked how does this report link to risks on our risk register. Stephen Forrest advised in the new chief executive scorecard this will link. It is planned to have a draft scorecard for the end of this year. Also the new committee reporting template makes direct reference to appropriate risk registers and this is already in use. Cllr Burgess asked from the data does the performance show a relation to staff absences. Ross McGuffie replied it is a challenge to relate fully but to note this data is behind so it will relate to some covid data which overall will have had an impact on service performance. Maddy Halliday suggested we have some additional narrative in the report to help public understanding of the data and to offer some context, this was noted. Morag Dendy added we need to consider national requirements but also how this feels in North Lanarkshire and this report will link to strategic commissioning plan and the Programme of work. Brian Moore noted some of the areas reported in the report are not reported to the committee out with this annual report, so will need to consider this going forward. Also to consider the committee receiving updates on SWISS procurement at a future meeting, this was noted. The IJB PFA committee: (1) Reviewed the content of the draft Annual Performance Report 2022/23 – Health & Social Care North Lanarkshire. (2) Approved for publication the content of the draft Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire. 11. Q1 Performance Report The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or
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8 corrective action. The performance review meetings are used as a means for jointly agreeing these actions. The areas for improvement and corrective action were attached as Appendix 1. of the report. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. Areas for Improvement: Alcohol Brief Interventions- Cervical Screening Child immunisations 6-8 Week Reviews Reablement and Rehabilitation Services Delayed Discharge CAMHS Adult Mental Health Paediatrics- Speech and Language Therapies Cllr Burgess asked is there any regulation around garden pubs. Morag Dendy replied advised we are able to get to a point where this is regulated in future but can consider using community board structures to influence lifestyle choices. Maddy Halliday queried the change in child immunisation and asked if this around change in public views. Trudi Marshall advised of ongoing work with public health colleagues as recognise there has been a cultural change in communities and think the covid vaccine has had an impact. There are some practical impacts around how we deliver vaccines also; considering having evenings and weekend appointment to make it more accessible. Ross McGuffie added pulling together an SBAR around 6-8 weeks screening to get agreement to move forward with an electronic system. For the Planned Date of Discharge (PDD) there is a lot of work on going across sites. North Lanarkshire has significant number of supported discharges in comparison to other areas. The committee note the report and its contents. 12. Drug Related Death in North Lanarkshire & ADP Self-Assessment The National Record of Scotland (NRS) Drug Related Deaths was published in July 2023, this report highlights the information specific to North Lanarkshire. A summary paper is presented at Appendix 1 of the report provided more detail to the summarized information noted below.
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9 There were Sixty-five Drug Related Deaths in North Lanarkshire in 2022, down nineteen percent (15 deaths) on 2021. This reduction is the third fall in three successive years. (Highest number of deaths 95 in 2019) though figures remain high. The figures represent the fifth highest number of Drug Related Deaths on record. Cllr Burgess asked is there data available to show if Naloxone was not administered would the drug deaths be higher, Morag Dendy advised this information will be included in a future report, there is evidence that this does make a difference. The committee: (1) Noted the content of the report; (2) Acknowledged the content of the National Record of Scotland (NRS) Drug Related Deaths in North Lanarkshire report, setting out the detail of the confirmed drug related health data from 2022, published by NRS in July 2023. (3) Recognised that there are a range of current arrangements in place to reduce harms. (4) Recognised a more detailed report on the impact of commissioned services and progress will follow in March 2024. This will include a financial overview of spend and forecast arrangements. 13. Resilience Response This paper sets out the actions being taken in response to current whole system service pressures. Intensive work continues to embed best practice accountability and leadership to deliver our plan. However, it is recognised that new ways of working and the resource additionally required will take some time to implement the changes and see the sustained unscheduled care performance that is required to improve patient safety and well-being, across our system. It was disappointing that our performance against the 4-hour standard did not meet our August 2023 trajectory of 70% (65%) despite significant efforts. It should, however, be recognised that many of the additional resources identified through the plan will take some time to get in place, not least due to the current challenges around recruitment. The recovery actions agreed to be progressed through September include: Enhanced duty manager support across our sites to support flow during our vulnerable times which includes the OOHs period and Monday mornings
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10 Increased Senior Clinical Decision Makers within the FNC to support direction of patients to the right service and reduce demand where appropriate Expansion of Hospital at Home capacity to increase admission avoidance Focused improvement work to embed the flow foundation bundles across acute and off site areas Focused communications by the FNC service team outlining the role and function to ensure shared understanding of the opportunities of this service across our system Ross McGuffie drew the committee’s attention to section 5.2 and 5.3 within the report which updates on the progress of operation flow. He advised Cumbernauld care home was previously closing but now we will have 15 interim care beds to assist the flow from Acute beds. Brian Moore asked what stage of development are the interface teams for frailty at. Ross McGuffie stated been pulling together a bid with HIS around peace plus funding relating to frailty which is on-going. Trudi Marshall added the frailty strategy GIFE work is coming to the next IJB committee. Post are out for advert and interviews are being planning, there has been a challenge with 1 post so reviewing how to manage this. He also requested update regarding the off-site beds in terms of having specialist areas and current progress. Ross McGuffie stated we are working towards this for the winter period and working on this as part of the bed modelling with each of the Acute sites to get the right model going forward. Trudi Marshall advised doing an audit to look at why patients are in beds, the audits and data pulled is going to help some focused work to get better outcomes for patients. The PFA: (1) Recognised the whole system Operation Flow 2 plans and implementation structures set out in the report; (2) Requested future updates on progress. 14. Analogue to Digital Telecare Transition This report provides an update on the analogue to digital telecare transition within North Lanarkshire Health and Social Care Partnership. Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout is scheduled to be completed by 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. North Lanarkshire Council currently provides Community Alarm telecare services to around 6500 service users using Analogue Dispersed Alarm
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11 Units (DAU). North Lanarkshire also provides a telecare service to around 800 users within sheltered accommodation. This service receives alerts into an Alarm Receiving Centre, which co-ordinates appropriate response e.g., Emergency Services or Community Alarm Home Support Workers to attend someone in their own home. The analogue to digital transition in North Lanarkshire is still currently on track with work already underway in several key areas. • Digital devices roll out plan – 2890 devices of 6500 have been migrated to date. • Data cleanse of current system- all live records now have a SWIS identifier. • National Shared ARC due for award October 2023 but full implementation not anticipated until at least September 2024 • Interim Software as a Solution (SaaS) purchase agreed to replace current on-site PNC system- to go live in Feb 2024 to provide service continuity to the Community Alarm Service The next step is to identify the project team to support transfer of records to the new system. Cllr Barclay noted thanks for the work of the team which has offered assurance in communities, particularly when this was an external factor that has impacted on HSCP services. The committee noted the progress of the project to date. 15. Risk There was no new risk identified by the committee. 16. Date of Next Meeting TBC
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1 ITEM 5 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. PoW on Sept 23 agenda Report to be tabled at Feb 2024 meeting 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 IJB Liaison session 8th Nov
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2 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 Winter plan will be reviewed in line with risk register May 2023 Planned for Nov IJB liaison session 5. Improving Cancer Journey R McGuffie Bring back a further update to the Board on the roll out of the programme and
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1 REPORT Item No: 7 SUBJECT: Frailty Strategy TO: Integration Joint Board Lead Officer for Report: Trudi Marshall, Nurse Director, Health & Social Care North Lanarkshire Author(s) of Report Trudi Marshall, Nurse Director, Health & Social Care North Lanarkshire DATE: 22nd November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for to share the draft NHS Lanarkshire Frailty Strategy for endorsement and support. For Approval: ☐ For Endorsement: ☒ To Note: ☐ 2. ROUTE TO THE BOARD This report was prepared by Trudi Marshall, Nurse Director who is leading the development of the frailty strategy. The report has been reviewed by Strategic Commissioning Plan Board and Strategic Delivery Team for “Our Health Together” This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB Committee: (1) Endorse Lanarkshire Draft Frailty Strategy 4. VARIATIONS TO DIRECTIONS? 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 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 NHS Lanarkshire is developing a new Healthcare Strategy “Our Health Together”. As part of this development a working group was established to consider the inclusion of frailty in the strategy. 5.2 The group has contribution to the wider development of NHS Lanarkshire’s strategy but has also developed a standalone whole system frailty strategy that aligns with both HSCP SCP, GIRFE and the Human Learning System. 5.3 The main aim for the strategy is: Every older person in Lanarkshire with, or at risk of, frailty is supported to be healthier, to remain independent for longer and to live their best lives. All partners work together, and with older people, unpaid carers, families and communities, to prevent, detect and delay escalation of frailty through proactive, personalised, coordinated support at home, or closer to home, and age attuned integrated acute and community services. 5.4 The strategy utilises Jeanie’s journey to illustrates the key touchpoints in a persons life . 6. CONCLUSIONS This report shares the draft strategy and welcomes further discussion and comments 7. IMPLICATIONS Yes ☐ No ☒ N/A ☐
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3 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) Associated measures include: A&E attendances Unscheduled bed days LOS Delayed discharges Emergency admissions Re-admissions Improved assessment/planning outcomes Co design evidence People dying in place of choice 7.3 FINANCIAL None 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 Low 7.5 ENGAGEMENT & PARTICIPATION 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 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:
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5 A EQIA and Fairer Scotland Impact Assessment has been commenced and maintained throughout the duration of this work. It will have final sign off and be published on the website when Strategy approved. Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1Frailty Strategy Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact the Trudi Marshall, Nurse Director North HSCP trudi.marshall@lanarkshire.scot.nhs.uk
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6 Appendix 1 Strategy for Preventing and Managing Frailty: 2023 – 2028 Living our Best Lives in Lanarkshire
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7 Contents Foreword Why Frailty Matters How this strategy was developed Vision and Ways of Working Jeanie’s Journey Key Touchpoints o Promoting wellbeing and independence o Planned and Proactive care o Urgent care o Enhanced support in care homes A Workforce fit for frailty Realising our Vision References Foreword Ross and Trudi Why Frailty Matters Improvements in healthcare and in tackling some social contributing factors of health means people are living longer. This is good news. However, we don’t just want to add years to our lives. We all want to enjoy good quality health and wellbeing in later life. In other words: Healthy Ageing. The United Nations Decade of Healthy Ageing (2021-2030) aims to add life to years and create fairer, healthier and happier communities.i The priority goals are tackling ageism, creating age-friendly environments, creating integrated and responsive health and care systems and services, and ensuring access to long-term care for older people who need it. Many older people are currently living with multiple physical and mental health conditions. They are more likely to experience frailty – an age related condition in which multiple body systems gradually lose their in-built reserves, resulting in an increased risk of unpredictable deterioration from minor events.ii Frailty affects around 12% of people aged over 65 years living in the community and over half of adults aged over 85 years or in a hospital or care home setting.iii Older people living with frailty often experience five common syndromes: Falls (e.g. collapse, legs give way, found lying on the floor)
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8 Immobility (e.g. sudden change in mobility, ‘gone off legs’, stuck on toilet) Delirium (e.g. acute or worsening of pre-existing confusion or memory loss) Incontinence (e.g. new onset or worsening of urinary or faecal incontinence) Medication-related harms Frailty presents an increased risk of harm (including from healthcare interventions) and a disproportionate loss of functional ability from even minor insults. The consequences of escalating frailty are adverse outcomes such as disability and its consequences, frequent hospital admissions and increasing demand for long-term social care support. iv v Many people with frailty will have cognitive impairment or dementia and vice versa, increasing the complexity of their care and support needs. If we don’t change the way we support older people as they age, we can anticipate a dramatic increase in frailty- related disability and dependency, escalation of health and social care costs and of the human and economic costs of unpaid caregiving, and a negative impact on survival and quality of life.vi However, frailty is not an inevitable consequence of ageing. It is potentially reversible, especially in the early stages. Frailty has a range from mild to severe and its consequences can be reduced if it is managed well at key touchpoints across the health and social care system.vii Creating age friendly environments and communities where people age well, and designing a health and care system where frailty is prevented and managed effectively are sound investments in human and economic terms.viii In a ‘frailty informed’ system, older people and all who support them will understand the impact that even a minor illness may have on functional ability and cognition. Their shared decision making will thoughtfully consider the balance of risk and benefit from each intervention, including a decision to admit to hospital. This strategy for preventing and managing frailty supports our vision for Healthy Ageing and Living our Best Lives in Lanarkshire. Ageing in Lanarkshire Both North Lanarkshire and South Lanarkshire Health and Social Care Partnerships (HSCPs) have seen significant increases in the population aged over 65 years with a much higher growth in those over 85 years as illustrated in Figures 1 and 2. Figure 1
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9 Figure 2 Figures 3 – 6 show that as people age, they are more likely to have a long term condition (LTC). Figure 3 Figure 4 South Lanarkshire North Lanarkshire Figure 5
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10 Figure 6 Compared to younger adults, older people with LTCs are more likely to have multiple LTCs (MLTCs), known as multi-morbidity (figures 7 and 8). Having MLTCs increases clinical complexity, particularly when associated with frailty. Figure 7 Figure 8 Therefore, older people are also more likely to experience health crises that result in attendance at A&E (figure 9), or emergency admission where their hospital stay is often longer (figure 10), associated with a delay in discharge (figure 11) and a higher risk of readmission (figure 12).
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11 Figure 9 Figure 10 Figure 11
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12 Figure 12 Current and Future Demand for Services Older people are the main users of health and social care services. The current profile of services used by older people in Lanarkshire is described in Annex 1. Data analysed for University Hospital Monkland’s rebuild programme projects a growth in demand for local hospital services for the next decade. The highest projected growth in demand is for the geriatric medicine specialty, averaging 2.6% growth per year (figure 13). This projected increase in demand would require up to nine additional beds per year on the new Monklands site, a trend that would be mirrored at the other Lanarkshire acute hospitals. Figure 13
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13 Without a shift in the way we plan and deliver care for older people with MLTCs and frailty, the projected increase in demand for acute hospital care will be matched by a proportionate increase in demand for primary care, community services, rehabilitation, long term social care, residential care and palliative and end of life care. This comes at a time when we are facing many challenges in recruiting and retaining our workforce. There are considerable interdependencies between this strategy and NHS Lanarkshire’s plans for people living with long term conditions, cancer, dementia, falls, and palliative and end of life care. Older people are the main users of both emergency and planned care, meaning work in these areas must consider the specific needs of older people with frailty. We will ensure this strategy informs and supports the work of these other groups and builds on the commitments of the Strategic Plans for the North and South Lanarkshire HSCPs. How the Strategy was developed This strategy has been developed by an interdisciplinary and cross sector group chaired by the Nurse Director, Health and Social Care North Lanarkshire. Membership included: HSCPs: Heads of Health, medical, nursing and AHP representation Acute: Clinical Leads COTE, Hospital at Home, operational and nursing leads; Corporate: Public Health, Health Improvement, planning leads, staff-side, EDI lead Third sector representatives including older people and carer advocacy Local Authority representatives Members of the strategy group engaged with their respective networks and formed five short life working groups to explore what changes are required at different parts
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14 of the system to improve how we work together to prevent and manage frailty. The five working groups sense- checked and further developed their proposals through six whole system stakeholder events hosted between August 2022 and March 2023. Detailed work on acute services was developed further through Operation Flow task and finish group five. In developing their new Strategic Plans, both North and South Lanarkshire HSCPs involved local communities, older people and carer representatives. We have drawn heavily on this lived experience and on recent engagement by North Lanarkshire’s Getting It Right for Everyone (GIRFE) Pathfinder for older people and frailty. GIRFE places the person at the centre of all decisions that affect them to achieve their best outcomes, through a joined-up, coherent and consistent multi-agency approach (Figure 14).ix Figure 14 This strategy embraces the GIRFE five key principles: 1. Focused on individual care needs 2. Based on an understanding of the physical and mental well-being of individuals in their current situation 3. Based on early intervention 4. Requires joined-up working/information sharing 5. Based on a human rights approach Our Vision Every older person in Lanarkshire with, or at risk of, frailty is supported to be healthier, to remain independent for longer and to live their best lives. All partners work together, and with older people, unpaid carers, families and communities, to prevent, detect and delay escalation of frailty through proactive, personalised, coordinated support at home, or closer to home, and age attuned integrated acute and community services. Ways of Working Promoting Health and Wellbeing
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15 We will work with Public Health and community partners to build social capital, community assets and create inclusive, compassionate, age and dementia-friendly communities We will deliver wide and inclusive public messaging on healthy ageing and wellbeing in later life We will ensure systematic identification of frailty in all care settings to allow early intervention through a proactive, anticipatory and enabling approach, avoiding crisis wherever possible We will enhance digital inclusion with community partners and use technology to support older people to remain well and independent in the place they call home for as long as possible and to mitigate deterioration and complications Tackling Inequalities We will ensure non-discrimination on the basis of gender, age, ethnicity, sexuality, physical function, cognitive ability, social or economic circumstances or place of residence - so all people experiencing frailty access the right care, at the right time, in the right place We will co-design services with older people, families and carers for inclusion and equity and to recognise and mitigate health inequalities across communities and all life stages We will involve carers as equal partners and offer information and support to support carers to remain well and reduce carer strain We will build confidence and capability for comprehensive person centred assessment relevant to their role for all disciplines and in all care settings Delivering Sustainable Healthcare We will scale up proactive anticipatory care and support for people with frailty in each locality, working together to plan and coordinate care, support wellbeing and optimise independence We will deliver high-quality emergency care attuned to the needs of older people with frailty with a specific focus on the first 72 hours through pathways that fully integrate urgent community response, short term hospital level care at home, and acute assessment in hospital Urgent community response in all localities will be well aligned with goal oriented reablement, intermediate care and rehabilitation that enable people to regain their independence All hospitals teams will plan for discharge from admission, take actions to reduce deconditioning, identify and manage delirium and work with community partners to reduce length of stay and improve transitions of care Outpatient and ambulatory care models will be accessible for older people and offer same day, ‘one stop’ and virtual options for pre-assessment, assessment and follow up consultations that value patient, carer and staff time and reduce carbon footprint We will enhance healthcare support for residents in Lanarkshire care homes Jeanie’s journey.
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16 The strategy considers what we need to do at specific system Touchpoints to improve outcomes for people such as Jeanie, for her family and for the health and care system. Jeanie is 81 years old, a widow who lives alone and is independent but uses a stick to walk outside. She has high blood pressure, hypothyroidism, pernicious anaemia, osteoarthritis and cataracts in both eyes and takes eight different medicines. She attends the practice nurse every three months for blood pressure checks. Jeanie used to play bowls regularly and get the bus to the shops with her friends but recently stopped doing these activities as her eyesight is failing. She missed her optician appointments during the pandemic. She feels less steady on her feet and is afraid she may fall. Now she generally only goes out with her family in their car. One afternoon she went out to the shops alone to buy a birthday gift for her daughter. Unfortunately, she tripped over a paving slab and fell. She was shaken but thankfully was not badly hurt. A passing driver took her home. Jeanie called her GP surgery and was given an appointment for a check-up with the nurse who referred her to a local exercise class. However, Jeanie didn’t want to go along on her own. She still felt stiff and sore from her fall. She began to spend more time in bed and couldn’t be bothered cooking. As the weeks went by Jeanie became more anxious and depressed, felt weaker and struggled to get up and down the stairs at home. Jeanie’s daughter visited one weekend and found her mum to be muddled, unable to get out of bed, and had been incontinent. She called 111 and Jeanie was referred to hospital. Doctors in A&E diagnosed a chest infection and delirium as a complication of her immobility. Jeanie was admitted to hospital after some hours waiting for a bed. The only bed available was in a surgical ward. Jeanie improved after a few days of antibiotics and fluids and was given a walking aid and helped to mobilise again. She wanted to return home but her daughter was worried that the same issues may recur. She had caring responsibilities for her own grandchildren and asked if it would be better to think about Jeanie moving into a care home. Jeanie’s return home was deferred until a full assessment could be carried out. Unfortunately, while undergoing rehabilitation and assessment in the ward, Jeanie fell and sustained a hip fracture. Progress after surgery was slow, complicated by recurrent urine infections and another episode of delirium. The whole team were unsure if Jeanie would be able to return home now. What could help Jeanie stay well and remain independent for longer? How might proactive care and early intervention delay her health decline? What could support her care at home / timely return home in a crisis? What enhanced support will she need if she moves to a care home? How can we build a workforce that is fit for frailty? How can we create the conditions for more collaborative working together?
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17 Promoting wellbeing and independence Ageing well enables older people to achieve the things they value, fosters their ongoing social participation, helps to prevent isolation and has much broader benefit for our society and local communities.x Those with the least resources or who live in the poorest areas are most at risk of poor health.xi Poor health in later life can also take a heavy toll on unpaid carers and families. Achieving good health outcomes requires much more than just good healthcare. Affordable transport, easily accessible streets, buildings and green spaces, supportive age friendly communities, social connections and opportunities to participate are all crucial to wellbeing in later life. Modifiable risk factors for frailty are also risk factors for dementia so a preventative approach will impact on both conditions.xii Loneliness and social isolation are associated with higher mortality, increased risk of heart disease, stroke, high blood pressure, depression and suicidal thoughts, and contribute to frailty and dementia risk as much as physical inactivity.xiii Regular exercise, particularly strength and balance training, reduces falls and slows progression of frailty. xiv People with communication, cognitive, sensory or physical impairments may need tailored support to take part in physical activity and to access other key interventions such as influenza, pneumococcal and Covid-19 vaccinations. Inadequate nutritional intake is an important modifiable risk factor for frailty and falls and is highly influenced by social determinants such as poverty, food insecurity and social networks. xv What we are doing now: Locality Planning Groups for Frail Elderly and LTC (FELT) Comprehensive immunisation programmes that target older people Community Solutions programme in North Lanarkshire Training in community led support and asset based community development Third sector and community partners support our workforce to co-produce care and support with a more holistic, person centred and inequalities focus Social prescribing support, GP link workers and development of community assets and third sector capacity and resources for health and wellbeing Carer Support Link Workers based within Acute Hospitals offer staff training in holistic needs assessments for patients and their carers Investment in technology enabled care with initiatives such as Making Life Easier app and website in North Lanarkshire, and the Locator tool in South Lanarkshire Blantyre Life campus for technology enabled housing with care services Use of telecare and assistive technologies across both HSCPs Exercise prescriptions with leisure services and our Natural health service Working with library services on information and support for self-management Implementing Lanarkshire’s strategy to prevent falls and fractures Collaboration with Scottish Fire and Rescue service on home safety visits South Lanarkshire Council has committed to being an Age Friendly Council What we will do more of:
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18 Support staff to have strength based, good conversations on What Matters to You with information, advice and resources for healthy ageing and self-management Improve staff awareness and confidence to refer/signpost to community, CVS partners and NHS services such as the Quit Your Way smoking cessation and Physical Activity programmes Use information from all partners to ensure preventative supports and services reach older people who are at greatest risk of frailty, addressing current inequity of access Develop a Lanarkshire-wide cross sector “good practice” and information sharing forum on healthy ageing and preventing frailty involving voluntary sector, primary care, community and acute staff Ensure the appropriate CVS organisations and statutory staff are linked into Locality Planning Groups for Frail Elderly and LTC (FELT) Link people more quickly into community supports which will benefit their mental and physical wellbeing, reduce social isolation and develop wider social networks Increase investment in Social Prescribing with longer term financial support to CVS partners so that initiatives can be scaled up and embedded in communities Provide more information, advice, education and support for unpaid carers to stay well and continue in their role Build on established community and intergenerational assets and networks Promote use of Making Life Easier (MLE) and other digital tools, addressing inclusion Support early self-identification of frailty through public health promotion campaigns including intergenerational work with schools and nurseries What this would mean for Jeanie: When Jeanie sees the practice nurse for her blood pressure check they talk about what matters to Jeanie and what she can do to stay well. They discuss her family support and social networks and why Jeanie has stopped seeing friends and going to the bowls. The nurse wonders if Jeanie’s cataract has deteriorated and recommends she makes an appointment with her optician. They agree that getting back to bowling would allow her to keep fit and catch up with old friends but Jeanie says she won’t go along on her own. The nurse refers Jeanie to a Link worker who calls and arranges to meet with her and her daughter at home. The Link worker identifies a local walking group and a volunteer befriender who will support Jeanie to rebuild her confidence going out walking and travelling by bus to the bowling club. Jeanie’s optician diagnoses macular degeneration and refers her for urgent outpatient treatment to prevent this worsening. Jeanie’s local library provides information and resources on keeping active at home and how to reduce her risk of falling. Planned and Proactive Care The identification of frailty is everyone’s business. Earlier and targeted intervention requires a simple, easily reproducible, validated tool that the public and non-specialist
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19 workforce can use. The Rockwood Clinical Frailty Score xvi is proving useful in a pilot with district nurses but other tools may be more suitable for lay workforce and the public. Older people living with frailty can be identified routinely in primary care using the electronic Frailty Index.xvii Many professionals, services, community partners, family and unpaid carers will contribute to an individual’s care and support, often with little or no communication between them. People with significant or escalating frailty should be offered a comprehensive multi-disciplinary assessment and personalised interventions co- ordinated by a local multidisciplinary team (MDT) of healthcare, social care and community or voluntary service partners working together. The older person and their unpaid carer or family should be involved in developing a personalised care plan based on their goals and preferences. ‘Polypharmacy’, the prescribing of multiple medicines, increases the likelihood of experiencing harmful side effects. People with frailty require medications to be tailored to their individual needs rather than strictly following guidance designed for single diseases. Structured medication reviews xviii allow patients to make informed decisions and prioritise medicines for continuation or discontinuation, in order to maximise benefit and minimise harm. Emerging evidence shows that this proactive approach can improve care continuity and co-ordination, reduce medicine related harm and costs, and reduce emergency attendances. What we are doing now: Enhanced primary care teams have additional roles including Occupational Therapist, Physiotherapist, Pharmacist and GP link workers in line with the Primary Care Improvement plans. This provides a foundation for a proactive MDT approach Coatbridge locality Frailty MDT pilot in selected GP practices to identify escalating frailty. Selected patients are offered a face to face ‘What Matters to Me’ conversation with a trained professional from a local advocacy organisation. This conversation is an opportunity for a shared decision-making approach to anticipatory care planning, assessment of frailty and carer’s assessment. The advocacy worker discusses the assessments with the locality virtual MDT who formalise a diagnosis of frailty, allocate a key worker, organise a medication review and additional interventions tailored to the person’s priorities and values. Piloting a similar virtual MDT in seven care homes Introduced Anticipatory Care Plans for people with MLTCs and in care homes Testing care co-ordination for people with complex needs in two localities Targeting earlier evidence based interventions for people at risk of falls and fracture Testing use of participatory design to develop a relational and proactive technology enabled approach for people who have presented with falls or syncope What we will do more of:
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20 Adapt the community frailty MDT and care co-ordination model to all localities, recognising the exact model may differ between localities Further develop the Locality Response model as a virtual MDT to coordinate care for those with most complex needs, supported by a Single point of access / hub(s) as community front door(s) in the demonstrator localities Test the advanced practitioner for frailty role in localities Design a referral pathway and process for holistic assessment, early intervention and person centred goal setting for individuals considered to have mild frailty Consider using the skills and experience of voluntary sector partners for initial holistic assessments and care coordination for mild frailty, with clear criteria for escalation Identify and target individuals who do not engage with Primary Care services who may be on the cusp of decline and are likely to benefit from proactive care Support individuals to stay well in their own homes by addressing income maximisation, food and fuel poverty, as well as physical and nutritional needs Wrap care and support around the person, involving those who are important to them in the caring circle Improve the recording and sharing of assessments and care plans with all partners Include frailty screening within the pre-assessment process prior to elective surgery and consider implications for treatment escalation plans and discharge planning What this would mean for Jeanie: After her fall, Jeanie’s practice nurse discusses her changed condition at the locality frailty MDT. The pharmacist reviews her medicines and suggests reducing the dose of one of her blood pressure medicines and changing her painkiller to reduce the risk of falling. Jeanie is seen by the falls team physiotherapist who gives her some exercises she can do at home to improve her strength and balance. The occupational therapist visits Jeanie at home to provide advice on how to adapt to her failing vision. She requests a grab rail for the front and back steps. The telecare service make contact and Jeanie takes up the community alarm service. This provides her daughter with much needed reassurance. The link worker provides information about Making Life Easier and how Jeanie can access dial-a-bus to attend her planned ophthalmic appointments. The GP has a conversation with Jeanie about her wishes for her future care and completes a Key Information Summary which is available for Out of Hours services and acute care staff to view in a crisis. Jeanie asks her daughter to be her welfare power of attorney and makes the application. Urgent Care A journey through acute hospital care can be complex and potentially harmful for people living with frailty. Multiple ward moves increase the risk of delirium and
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21 deconditioning and reduce the likelihood of returning home. Comprehensive Geriatric Assessment (CGA) by a team skilled in managing frailty and practising Realistic Medicine is highly cost-effective.xix CGA arranges relevant diagnostics, delivers timely tailored interventions, proactive discharge planning and access to transitional care, reablement and intermediate care services at home or in a step down bed.xx Hospital at Home offers short term hospital- level care at home for selected patients with acute conditions that would normally require an acute hospital admission.xxi Outcomes are at least equivalent to those of inpatient care. xxii xxiii We aim to ensure that every older person living with frailty in Lanarkshire is able to avoid emergency hospital admission, if safe and appropriate, and return home without delay. This requires the right care and support to be available to manage the acute crisis along with reablement and rehabilitation to avoid cyclical decline. Acute services have a duty to foster stronger multi-disciplinary links with community and primary care teams and to provide the required specialist advice and support to avoid crisis admissions. Local demographic and geographic factors need to be considered when designing urgent care services so they are equitable but flexible to the needs of different communities. A ‘one model fits all’ approach will not suit a diverse area like Lanarkshire. Effective interface working requires better communication, embracing novel technology to raise awareness of the capability of community services, community and third sector supports. We look to Lanarkshire’s digital health and care strategy to improve the sharing of information so that everyone involved in an individual’s care can access and record the relevant results, medication changes, functional abilities and wishes for future care including treatment escalation planning. What we are doing now: Hospital at Home (H@H) services operates across the majority of Lanarkshire Reinstating the urgent locality response model in East Kilbride and testing a model for rapid triage and urgent MDT response to crisis in Wishaw locality Enhancing capacity for community nursing and health care support workers Established Home First team in South Lanarkshire and Home Assessment Team in North Lanarkshire to facilitate timely and successful discharges Reviewing reablement and community rehabilitation capacity Introduced a technology enabled intermediate care housing development at Blantyre Introduced a Flow Navigation Centre for urgent referrals to acute care Consultant Connect building great relationships between hospital / community staff Enabled access to Key Information Summaries for ED and Out of Hours staff Expanded the Acute Care for the Elderly practitioner posts in the three acute hospitals Roll out of Planned Date of Discharge for the Discharge without Delay programme
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22 What we will do more of: Include a baseline Rockwood Clinical Frailty Score with the Key Information Summary on a sharable Electronic Health Record to support decision-making by paramedics and Out of Hours’ services and introduce the tool in ED Further develop ‘call before convey’ and community falls response pathways and protocols with the Scottish Ambulance Service, telecare providers and Care Homes Scale up the Consultant Connect for Geriatrician telephone advice and triage to rapid access outpatient clinic appointment or Hospital at Home alternative pathway Ensure early identification of frailty in the ED to trigger early comprehensive front door assessment by staff with expertise in frailty Assess older people in an acute frailty unit or frailty–friendly environment, with rapid ‘pull’ pathways to the right specialty bed, H@H or locality MDT support Right size capacity required to manage older people with frailty in an acute Frailty Unit or ward staffed by teams trained in Comprehensive Geriatric Assessment Make boarding older people with frailty to a non-Care of the Elderly ward a ‘never event’ because of the associated potential harms Develop transitional care follow up processes that include anticipatory care planning and treatment escalation plans for people at high risk of decline and readmissions Learn from the two locality urgent response models and scale up the approach, introducing single points of access to urgent care in each locality Consolidate and enhance community reablement, intermediate care and rehabilitation capacity to support recovery of independence at home Review the capacity, function and staffing associated with community beds across Lanarkshire to improve their contribution to specialist led step up and step down intermediate care, interim care and hospital based complex clinical care What this would mean for Jeanie: Jeanie’s Key Information Summary flags she has frailty and wishes to have her care at home. The flow navigation centre directs the call to ED as H@H does not yet accept new referrals at weekends. ED staff complete a frailty score and Jeanie is fast tracked to the acute frailty team. They commence treatment and start to mobilise her immediately, moving her to a Care of the Elderly bed to manage her delirium and chest infection. A frailty flag on Trakcare records her as high risk for boarding. The ward MDT links with H@H and Home First on Monday and plans discharge for when IV antibiotics switch to oral. The MDT involve Jeanie and her daughter in her discharge planning so they are confident the support and equipment will be in place. Jeanie returns home and is monitored by the H@H team for a week. Her daughter stays with Jeanie for a few days to help her settle back home. The reablement team supports Jeanie to regain her independence over the next month and the locality MDT co-ordinates her care and support. Jeanie reconnects with her friends.
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23 Enhanced Support in Care Homes The Scottish Government Healthcare framework for adults living in care homes xxiv outlines six key elements to enhance clinical and care support. This is done through a strong partnership approach that recognises the knowledge and experience of care home staff and wraps care around the resident. The enhanced approach is illustrated in Figure 17. Figure 17. What we are doing now: Established a Care Home Assurance Team Expanded the number of Care Home Liaison nurses across Lanarkshire Appointed a Practice development educator for care homes Delivered an initial six month education programme for care home staff Piloted and developed a model for Frailty MDT meetings in care homes Increased the uptake of anticipatory care planning Piloted the use of the ReSPECT document Introduced care home pharmacist sessions to review and optimise polypharmacy Reduced the use of medicines associated with falls and harm and related costs Aligned many of our care homes with GP practices using a local enhanced service (LES) Testing extended hours for Hospital at Home support for care homes Scoping an alternative pathway for radiology and specific flow navigation response What we will do more of: Rebrand the Care Home Assurance Team to a Care Home Support Team reflecting a shift from inspection to a model of assurance based on appreciative inquiry and a focus on clinical support by care home liaison nurses
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24 Improve collaborative working by ensuring care homes are fully involved in co-design of improvement projects Improve access for residents through the use of technology and remote consultations Review the LES contract arrangements, listening to concerns of GPs and care homes and promote GP uptake of LES for care homes without this service to improve resident access to primary care Recruit dedicated care home pharmacists to ensure a realistic medicine approach for all new residents in care homes Continue to roll out the Care Home MDT model - set to expand to 24 care homes MDT to review clinical portal referrals for assessment and treatments of residents to ensure they are still appropriate Promote use of SBAR to communicate in acute and emergency situations Explore professional to professional lines of communication Extend availability of Hospital at Home hours support to residents in care homes Explore mechanisms for care homes to stock certain drugs Use a standard transfer document to improve communication at care transitions Promote the adoption of Enriching and Improving Experience framework and Scotland’s Bereavement Charter within care homes What this would mean for Jeanie Over time, following a series of further health problems, Jeanie and her family come to a shared decision with the locality MDT to move to a care home. A comprehensive clinical transfer document gives the care home the information they need to care for Jeanie. Jeanie’s social worker reviews her progress in the care home, within 4-6 weeks, involving staff and family. Care Home staff work with Jeanie and her family to develop a personal care plan that includes an anticipatory care plan and ReSPECT document. The Care Home liaison team provide support and training to the Care Home staff as required. The GP aligned to the Care Home undertakes a full medical assessment and review of her medication within 4 weeks of admission. and polypharmacy. Staff help Jeanie use video-consultation for her healthcare appointments to reduce travel and future health crises are managed in the care home by the locality MDT with advice and support from Hospital at Home if required.
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25 A Workforce Fit for Frailty Older people are already the main users of healthcare and social care and support. That means the majority of the health and care workforce will care primarily for older people. All workers, in the context of their own role and work remit, have a unique and essential role in responding to people who are affected by frailty. This doesn’t mean that everyone needs to be an expert in frailty. A wide range of expertise and skills are required to support people in different settings. The inclusion of guidance and competencies in preventing, identifying and managing frailty within educational curricula and quality standards is critical to help skill up the wider workforce. Developing an integrated workforce fit for frailty is a vital step for realising our vision and to deliver the best possible health and social care for older people. The Skills for Health Frailty Core Capabilities Frameworkxxv provides a single, consistent and comprehensive framework on which to base workforce development. The framework builds on, and cross-references, other core skills frameworks for dementia, end of life care and person-centred approaches. Fifteen core capabilities are defined for three tiers of stakeholders: Tier 1 Those who require general awareness of frailty Tier 2 Health, social care and others who regularly work with people living with frailty Tier 3 Health, social care and other professionals who provide expert care and lead services for people living with frailty. Our education and training working group proposed a fourth tier as there should be greater public awareness of frailty, how to prevent frailty, and how to access support to live our best lives. Figure 16 illustrates our proposed four tier approach to frailty education. Figure 16 The group has reviewed the range of educational resources on frailty available to people working at these different tiers and in all care settings. These include outputs from a local Frailty Matters project that involved citizen co-coaches to strengthen the leadership role of community nurses in managing frailty within interdisciplinary teams.xxvi
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26 What we will do more of: Raise public awareness of healthy ageing and what people and communities can do to promote wellbeing in later life and prevent frailty Support citizens and staff to identify early signs of frailty using validated tools Support community and voluntary sector staff to carry out an initial assessment of people who present with early signs of frailty, with clear criteria for escalation Scale up training in community led support, asset based community development approaches and enabling self-directed support Develop an education and training plan to enhance knowledge and skills on frailty in all staff who regularly provide care and support for older people Improve confidence and capability of staff in using and demonstrating assistive technologies and digital solutions to enable people to have greater choice and control in their care and support Develop advanced practice skills in frailty for a greater number of staff and disciplines who work in community settings Identify opportunities for shadowing and rotational posts to promote system wide understanding and capability to prevent, detect and manage frailty Support staff to work differently in new roles / in new ways with more autonomy Build greater readiness for relational working and collaborative practice What this would mean for Jeanie: Jeanie had heard about healthy ageing and preventing frailty in a talk at her local church and had picked up some information from her local library. Her family had noticed information on line about staying active and Making Life Easier. Jeanie’s GP practice team and the staff in the local pharmacy have had training in identifying the early signs of frailty and know where to signpost Jeanie. The locality MDT have had training in good conversations and in using the Clinical Frailty Score to identify the suspected level of frailty. Each locality has a sufficient number of staff from different disciplines who are trained in comprehensive holistic assessment of frailty and coordination of care. Each locality has a sufficient number of staff who have advanced practice skills in case management of people with complex needs associated with frailty. Everyone pulls together to support Jeanie achieve what matters to her with the people who are important to her and to live her best life.
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27 Realising our Vision To successfully prevent and manage frailty, reverse cyclical decline, and reduce crisis admissions, we need to scale up proactive, person centred and integrated care and support and effectively manage transitions when the individual or carer’s condition or circumstances change. This requires a collaborative approach where all of our workforce have a better understanding of each other’s roles and where they can add value, minimising repetition and waste. Building relationships and trust within MDTs and at the interface between teams and care settings is critical for successful continuity and coordination. Excellent communication and information sharing is an important enabler of informational continuity and we look to the digital health and care strategy for the required infrastructure and resources. Geriatric medicine is the largest clinical specialty in NHS Lanarkshire with over 450 hospital beds and a range of outpatient clinics across many sites. It is recognised as a progressive service in Scotland but specialist resources are not equitably distributed and some communities are relatively underserved. The specialty recognises the need to become even more community facing and to explore new roles and novel technologies to extend its reach. To realise our vision and transform care for people living with frailty will require collaboration, innovation and improvement across disciplines, settings and sectors across Lanarkshire. We propose to create a network where staff from all disciplines and partners can learn from the lived experience of people affected by frailty, share good practice and exchange learning with colleagues across Scotland and beyond. The network will identify and challenge variance in practice, lever professional curiosity and pride to ensure the highest quality of care in all settings, and enable the best outcomes for people, professionals and the system. We will take forward three strategic enabling actions: 1. Establish a Lanarkshire-wide Frailty network supported by a clinical lead, nurse/ AHP consultant and dedicated QI capacity. The multidisciplinary, cross sector network will seek ways to include the voice of lived experience. 2. Develop a Quality Assurance Framework and dashboard of indicators to track system performance, using mixed methods to analyse what matters to people, professionals and the health and care system.
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28 3. Collaborate with NHS national boards and local universities to create a virtual ‘Living Lab’ to foster innovation, action research and evaluation of our efforts to promote healthy ageing and prevent and manage frailty. References i The UN Decade of Healthy Ageing. Accessible at https://www.decadeofhealthyageing.org/ ii World Health Organisation. (2017). Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization, Department of Ageing and Life Course. iii O'Caoimh, R., Sezgin, D., O'Donovan, M.R., Molloy, D.W., Clegg, A., Rockwood, K. & Liew, A. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing. 2021 Jan 8;50(1):96-104. doi: 10.1093/ageing/afaa219. iv Han, L, Clegg, A, Doran, T et al. (2019) The impact of frailty on healthcare resource use: a longitudinal analysis using the Clinical Practice Research Datalink in England. Age and Ageing, 48 (5). pp. 665-671. ISSN 0002-0729 v Doody et al. 2022. ‘The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta- analysis of 467,779 geriatric hospital inpatients’, Ageing Research Reviews. Sep;80:101666. doi: 10.1016/j.arr.2022.101666 vi Murray CJ, Lopez AD (2013). Measuring the global burden of disease. New England Journal of Medicine, 369(5):448-457. doi:10.1056/nejmra1201534 vii Joining the dots: A blueprint for preventing and managing frailty. British Geriatrics Society. 2023. Available at https://www.bgs.org.uk/Blueprint viii Rodríguez Mañas L, García-Sánchez I, Hendry A et al. Key messages for a frailty prevention and management policy in Europe from the ADVANTAGE JOINT ACTION Consortium. Journal of Nutrition Health and Ageing 2018: 22 (8); 892- 897 http://dx.doi.org/10.1007/s12603-018-1064-y ix Scottish Government 2023. Getting it Right for Everyone. Available at https://www.gov.scot/publications/getting-it-right-for-everyone-girfe/ GIRFE x Anderson LA, Prohaska TR. Fostering Engagement and Independence: Opportunities and Challenges for an Aging Society. Health Education & Behavior. 2014;41(1_suppl):5S-9S. doi:10.1177/1090198114547818 xi The Health Foundation 2023. David Finch, Heather Wilson, Jo Bibby. Leave no one behind. The state of health and health inequalities in Scotland.
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29 xii Petermann-Rocha F, Lyall DM, Gray SR, Esteban-Cornejo I, Quinn TJ, Ho FK, Pell JP, Celis-Morales C. Associations between physical frailty and dementia incidence: a prospective study from UK Biobank. Lancet Healthy Longev. 2020 Nov;1(2):e58-e68. doi: 10.1016/S2666-7568(20)30007-6. Epub 2020 Nov 2. PMID: 36094146. xiii Davies K, Maharani A, Chandola T, Todd C, Pendleton N. The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. The Lancet Healthy Longevity. 2021; 2:(2)E70-E77 https://doi.org/10.1016/S2666-7568(20)30038-6 xiv Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: A systematic review. J Aging Res. 2011; 2011:569194. [PubMed: 21584244 xv Food Train, undated. Eat Well Age Well: Tackling malnutrition in older people living at home in Scotland. Available at: https://eatwellagewell.org.uk/ (accessed 7 February 2023) xvi Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., & Mitniski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Cmaj. 2005;173(5):489–95. xvii Andrew Clegg, Chris Bates, Jon Young, Ronan Ryan, Linda Nichols, Elizabeth Ann Teale, Mohammed A. Mohammed, John Parry, Tom Marshall, Development and validation of an electronic frailty index using routine primary care electronic health record data, Age and Ageing, Volume 45, Issue 3, May 2016, Pages 353–360, https://doi.org/10.1093/ageing/afw039 xviii Polypharmacy Guidance and tools are available at http://www.polypharmacy.scot.nhs.uk xix Ellis, G., Gardner, M., Tsiachristas, A., Langhorne, P., Burke, O., Harwood, R.H.,.. Shepperd, S. (2017). Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews Issue 9. Art. No.: CD006211. DOI: 10.1002/14651858.CD006211.pub3 xx Sezgin, D., O’Caoimh, R., Liew, A., O’Donovan, M.R., Illario, M., Salem, M.A.,….. Hendry, A. (2020). The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 11, 961–974 https://doi.org/10.1007/s41999-020-00365-4 xxi UK Hospital at Home Society, 2022: What is Hospital at Home? Available at: https://www.hospitalathome.org.uk/whatis xxii Singh et al (2021) Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people?, Age and Ageing, https://doi.org/10.1093/ageing/afab220 xxiii Leong, M.Q., Lim, C.W., & Lai, Y.F. (2021). Comparison of Hospital at-Home models: a systematic review of reviews. BMJ Open 2021;11:e043285. doi:10.1136/ bmjopen-2020-043285
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30 xxiv Scottish Government (2022). My Health, My Care, My Home - healthcare framework for adults living in care homes. Available at https://www.gov.scot/publications/health-care-home-healthcare- framework-adults-living-care-homes/ xxv Skills for Health, 2018. Frailty Core Capabilities Framework. Available at: https://www.skillsforhealth.org.uk/info-hub/frailty-2018/ xxvi Papadopoulou C, Duffy R, Andrew M, Barrie J, Martin J, Birt A, and Hendry A. The Frailty Matters Project. British Journal of Community Nursing 2023 28:7, 324- 330 https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2023.28.7.324 Annex 1
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1 REPORT Item No: 8 SUBJECT: Getting It Right For Everyone TO: Integration Joint Board Lead Officer for Report: Trudi Marshall, Nurse Director, Health and Social Care North Lanarkshire Author(s) of Report Margaret Flavell, Senior Manager Adult Social Work DATE: 22 November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared: ☒ Reviewed: ☐ Endorsed: ☐ By: the Health and Social Care Partnership Strategic Commissioning Plan Programme Board. 3. RECOMMENDATIONS The Board is asked to: (1) Note the participation of Health & Social Care North Lanarkshire in the national Getting it Right for Everyone (GIRFE) pathfinder programme, focussing on older people and adults living with frailty. (2) Endorse and the approach and planned work to develop GIRFE across North Lanarkshire.
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2 (3) Agree a further update on the progress of the GIRFE work to be brought back to a future meeting of the Board. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 Health & Social Care North Lanarkshire has a strong track record of integrated working. North Lanarkshire introduced the first multidisciplinary Hospital at Home Team in Scotland and are currently building on our existing best practice in adult services by embedding a Home First approach to hospital discharge through the establishment of a Home Assessment Team. In addition, to this we have implemented Integrated Rehabilitation Teams, along with our addiction teams. Over the past 2 years we have been piloting geriatrician supported multi-disciplinary reviews within GP practices and Care Homes as highlighted in the recent Chief Medical Officer report. We have a strong third sector which promotes welcoming communities, encourages connections and supports people in a range of ways when they require some assistance. 5.1.2 The Plan for North Lanarkshire sets out a vision for town and community hubs whereby citizens have easier and earlier access to support and services in their local neighbourhood or town. It takes a place based, whole systems approach that mobilises all assets within a community, promoting equity and increasing people’s control over their health and lives. 5.1.3 The NLHSCP Strategic Commissioning Plan further reinforces this by seeking to build on community capacity to take action together through collaboration and partnerships where approaches connect people to community resources and increase active participation through activities and volunteering. Concurrently, several transformational change programmes are underway and a number of these, in particular the refresh of the Home Support Redesign, Home Assessment Team/Discharge without Delay, Integrated Day Services Review, Community Alarm Review, Integrated Equipment and Adaptations Service Review and Community Nursing Review are intrinsically linked to the GIRFE pathfinder project. In addition, NHS Lanarkshire is currently developing a Strategy for Prevention and Management of Frailty as part of NHS Lanarkshire’s ‘Our Health Together – Living Our Best Life in Lanarkshire’ strategy. A key aim of the strategy is supporting older people to remain well and active within our communities.
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3 5.2 Getting it Right for Everybody 5.2.1 Getting it Right for Everybody (GIRFE) provides a framework and a set of principles for person centred and community centred ways of working as outlined below: GIRFE is a proposed multi-agency approach of support and services from young adulthood to end of life care. GIRFE will help define the adult’s journey through individualised support and services and will respect the role that everyone involved has in contributing to collaborative care and support planning, review and personalised interventions. Too often, adults and their families are excluded from assessment and support processes by complex bureaucracy. GIRFE is about providing a more personalised way to access help and support when it is needed – placing the person at the centre of all decision-making that affects them to achieve the best outcomes, with a joined-up, coherent and consistent multi- agency approach regardless of the support needed at any stage of life. 5.2.2 GIRFE: builds on existing adult best practice and Getting it Right for Every Child (GIRFEC) provides a national practice model to embed inter-agency working. does not replace the framework for Community Health and Social Care Integrated Services but provides a model to deliver the framework that supports person centred outcomes. GIRFE Principles 5.2.3 GIRFE is: Focused on individual care needs – it ensures that every person is empowered and involved in multi-disciplinary decision-making and the support available to them. Based on an understanding of the physical and mental well-being of individuals in their current situation – it adopts a holistic approach to ensure
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4 that individual needs are considered, and that appropriate support is provided while acknowledging that a person’s needs will vary over time. GIRFE Pathfinder projects 5.2.4 GIRFE pathfinder work will be tested and developed in local areas, with practitioners and with the people the initiative is designed to benefit, to understand how it will be interpreted and implemented in different contexts. 5.2.5 The Pathfinder programme is taking a co-design approach with: GIRFE Learning Networks to support a national practice model. GIRFE Design School - a support model which can help teams to come together, get ready for co-design work, and engage people with lived experience on a specific policy area, problem exploration or redesign challenge. 5.2.6 There are 11 place-based pathfinders across Scotland aligned to five thematic areas: i. People in prisons ii. People in addiction services iii. People registered at Deep end GP Practices iv. Families with multiple and/or complex needs and young people in transition from GIRFEC to GIRFE v. Older people and frailty 5.2.7 The North Lanarkshire GIRFE pathfinder links to a range of national policies including Home First, Discharge without Delay, Realistic Medicine, Self Directed Support, Unscheduled Care and reducing the number of people whose discharge from hospital is delayed. Reshaping Care for Older People continues to influence our local work as does the Health Improvement Scotland Frailty Change Package and national and local Mental Health and Wellbeing Strategies. It is also a priority outlined in the Winter Planning Business Case agreed by the Integration Joint Board in February 2022. 5.2.8 GIRFE will support the person-centred, integrated and multi-agency approach required to support individuals. Within an overarching commitment to self- direction this will improve access and embed practice in shared decision- making and promoting self-determination, encouraging those with lived experience, including unpaid carers and families to be equal partners in their care and support. This is aligned to the Human Learning System approach. 5.3 Aims and objectives of the North Lanarkshire GIRFE Pathfinder To agree a vision for GIRFE for Older People & Frailty in North Lanarkshire. To establish a multi-agency approach of support and services for older people and adults living with frailty.
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5 To define the person’s journey through individualised support and services, respecting the role that everyone involved has in contributing to shared care and support planning, review and personalised interventions. To create a single point of access within localities to ensure holistic assessment of people and coordination of services to support them achieve their personal outcomes, enabling them to be as independent as possible and live their best lives. To ensure that, when people are admitted to secondary care (planned or unscheduled) their journey meets GIRFE principles. To embed a Home First approach to enable timely discharge from hospital and prevent unnecessary admission to hospital or premature admission to long term care through the establishment of multi-disciplinary assessment and coordinated care, rehabilitation and support at home or closer to home: Rapid access to the treatment, rehabilitation and support that people require to enable them to return home from hospital at the right time or receive their acute care and rehabilitation at home or closer to home as an alternative to emergency admission to hospital. Time-limited support and rehabilitation to enable an assessment of each person’s immediate and longer-term support needs in their own home, optimising use of personal and community networks and reablement to support recovery and optimise wellbeing and independence. A designated workforce, equipped with the appropriate education, competence and capability, focussed on maximising functional ability in the home environment by providing proactive anticipatory care, timely multi- disciplinary assessment and a rapid community response. An agreed care plan based on what matters to the individual and shared decision making. An integrated, multi-agency care coordination and review process. Clear pathways and a range of resources to support unpaid/family carers. Embedding a technology first approach to promoting independence and connectedness. To take co-creation approaches to the design of support and services. To identify if services could be strengthened through a community hub model and, if there are opportunities presented with the implementation of the Newmains & St Brigid’s Community Hub (and linked network of support) as an early adopter. 5.4 Project plan 5.4.1 Pathfinder activity will be divided into two phases: Phase 1: An Engagement Plan will be developed by each Health & Social Care Partnership for their pathfinder. Journey Maps, developed from intial Engagement Sessions with service users within each pathfinder, will inform a National Sensemaking Process, which will determine ‘How Might We…’ statements for the second phase of Engagement.
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6 Phase 2: The Engagement Plan will be updated following involvement with the National Sensemaking Process and will detail further engagement sessions with people with lived experience to co-design ideas and concepts. A further Sensemaking Session will take place following submission of each idea/concept. 5.4.2 The detailed timeline is as follows: 5.5 Governance 5.5.1 Following a Development Session with representation from both NHS Lanarkshire HSCP and North Lanarkshire Council, an initial Operational Group in Wishaw locality has been established to ensure the GIRFE principles are incorporated into current workstreams, with a Steering Group providing overarching guidance and governance for specific GIRFE work activity. The learning from this work will determine further work across the other 5 localities. 5.5.2 A Facilitation team has been established to lead and co-ordinate the GIRFE pathfinder project in North Lanarkshire, linking to all relevant programme and workstreams, and to engage with the national GIRFE learning network and design schools. 5.5.3 The GIRFE Framework is set out in Appendix A. 6. CONCLUSIONS 6.1 Health & Social Care North Lanarkshire is participating the national Getting it Right for Everyone (GIRFE) pathfinder programme. 6.2 The initial focus for GIRFE in North Lanarkshire is on older people and adults living with frailty, working with the Locality Planning Group to develop the
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7 approach in the Wishaw Locality. The learning from this work will inform further work across the other 5 localities. The Board will receive further updates on the implementation and impact of at a future meetings. 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) Associated measures include: A&E attendances Unscheduled bed days Delayed discharges Emergency admissions Re-admissions Improved assessment/planning outcomes Co design evidence 7.3 FINANCIAL This paper has been reviewed by Finance:
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8 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 ☐ 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 Yes ☐ No ☒ N/A ☐
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9 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☒ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☒ N/A ☐ 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix A: GIRFE Framework CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Trudi Marshall Trudi.Marshall@lanarkshire.scot.nhs.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 202311-12 2 Report Title GIRFE 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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11 Appendix A: GIRFE Framework
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1 REPORT Item No: 9 SUBJECT: JRF Poverty in Scotland (2023) Report TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Alana McGlynn, Health Improvement Programme Manager Kerri Todd, Head of Health improvement Jo Duffy, Senior Health Improvement Officer DATE: 22 November 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: ☐ Alana McGlynn, Health Improvement Programme Manager Kerri Todd, Head of Health improvement
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2 3. RECOMMENDATIONS It is recommended that the IJB: (1) Review the main points of the JRF Poverty in Scotland (2023) report (2) Note the strategies and plans already in place across North Lanarkshire to tackle poverty (3) Discuss and consider any wider implications or areas for improvement 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Every year at the start of Challenge Poverty Week in October, the Joseph Rowntree Foundation (JRF) publish their ‘Poverty in Scotland’ report. This year’s report considers whether ‘work is working’ for the people of Scotland. The main findings are: Over one million people still live in poverty in Scotland, with nearly half of those (490,000) living in very deep poverty. The statutory child poverty reduction targets are unlikely to be met without significant additional Scottish Government action. While the Scottish Child Payment is likely to reduce child poverty, the growth of in-work poverty is holding back further progress. Just over 10% of workers in Scotland are locked in persistent low-pay, i.e. they are paid below the real Living Wage. Of this cohort, 72% are women. Five high-priority industries play a key role in maintaining in-work poverty: retail, hospitality, manufacturing, health and social work, and the administration and support services. The report details several recommendations for the Scottish and UK Governments and provides specific findings and recommendations for the high-priority industries to work with and support their employees to make ends meet. Yes ☐ No ☐ N/A ☒
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3 5.1 Families most likely to experience in-work poverty The report analyses which families are most likely to experience in-work poverty. The findings are consistent with who experiences low pay, fewer hours and barriers to working in the first place. One in four people in working single-parent families are in poverty – around 10 percentage points higher than the average poverty rate for families where someone works. Larger families, that is, families with three or more children, also face an in-work poverty rate of around one in four. And while couples with children face a lower risk of in-work poverty, they still make up around half of the families experiencing in-work poverty, with more than 1 in 10 people experiencing in-work poverty that live in couple families with children having both parents in full-time work. This is further proof of the perverse situation where having children is a consistent risk factor of being in poverty in Scotland. People from a minority ethnic background also experience a rate of in-work poverty that is three times that of the rate of white workers. Workers in minority ethnic families where everyone works full-time are also nearly twice as likely to experience in-work poverty than white workers. Finally, households where someone is disabled and/or someone is a carer also face an increased risk of in-work poverty. For some families this will be due to the disabled person either being unable to work or having been excluded from the workforce by inaccessible employment. For example, a family where someone is disabled is half as likely as a family where no one is disabled to have everyone in full-time work. These groups of people are also most likely to not be in work at all. 5.2 Industries where in-work poverty is most prevalent JRF analysed which industries had the largest number of people working in them whose families were experiencing in-work poverty. This identified five ‘high-priority industries’. They called them this because of their centrality to our economy but also because things have to change. Nearly three-quarters of people experiencing in-work poverty have someone in their family who works in hospitality, health and social work, retail, administrative support and/or manufacturing. Linked to that, 80% of people locked in low pay work in one of these industries. The reasons are complex but include low pay, insecurity of contracts, higher proportion of female workers in some industries, under-employment, caring responsibilities and part time working. 5.3 Household costs The report also highlights that homeowners are facing a difficult time with increased mortgage rates.
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4 Families are doing all they can to cut back on costs. Participants in focus groups said that they had shared meal preparation with other households, had unplugged electric devices, gone without heating for hours, worn extra clothes to stay warm and moved furniture to heat less of their house. In spring 2023, of families experiencing in-work poverty: More than 8 in 10 (83%) had cut back on an essential. Nearly 6 in 10 (59%) had heated their home less than needed. And one in four had skipped or reduced the size of their meal and not heated their home as much as needed. 5.4 Solutions and recommendations for employers For businesses, the solution is in this respect simple. It is to consult and listen to their employees. As JRF highlight in their report, in-work poverty does not have a single solution, and it is highly individualised. As a result, the relationship between employees and their line managers and those who run businesses is key. Where employee voice is heard, employees do better. Businesses also need to have a serious look at how their employment practices and policies are affecting women. You are far more likely to be on low pay if you are a woman. You are more likely to be part-time. You are likely to get paid less than men. You are less likely to progress in your role. You are more likely to undertake unpaid work. In light of these litanies of unfairness, greater regulation is required, but businesses do not need to wait for government to catch up with these gross inequities. Businesses also need to work on: Pay: Payment of the real Living Wage should be a goal of all employers. Committing to higher cost of living pay increases and where possible one-off bonus payments, or direct help with key costs, to help with the cost of living. Playing a role in increasing employees’ income by being proactive and encouraging employees to ensure they are in receipt of all benefits available to them. Adopting enhanced maternity pay and also work to increase take-up, and adequacy, of paternity pay for low-paid men. Progression: Target training and progression opportunities at employees on lower pay. Reduce costs and barriers to training for staff – ensure barriers are not put in place for low-paid employees. Understand when progression might not be appealing. This is partly about marginal increases in pay for disproportionate levels of work and responsibility. For example, if management positions move from hourly pay to salaried, yet there is a culture of managers continually working beyond their contracted
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5 hours. Additionally, the interaction with Universal Credit should also be considered by employers. When presenting opportunities for increased pay, employers should understand taper rates. Flexibility as a tool and not an end in itself. Employers should try to create flexible roles within organisations that are targeted at offering more progression opportunities. Hours and Employment Security: Employers should aim to become Living Hours accredited. Employees should be offered contracts that reflect their hours of work. Give employees minimum of four weeks’ notice for shifts. Pay staff in full for any changes or cancellations in shifts. 5.5 Solutions and recommendations for Scottish Government: Operationalise Fair Work (move on from discussion). Prioritise progression. Progression should have equal status with participation when it comes to employment support strategy and services that are designed with people with lived experience of in-work poverty. Redesign and enhance employment support offer. The ambitions outlined in the most recent Scottish Government Tackling Child Poverty Delivery Plan are inadequate in comparison to the scale of change needed. Improve childcare. The lack of availability and flexibility is a barrier to work. Create an independent agency that deals with racism in the workplace 5.6 Solutions and recommendations for UK Government: A real Living Wage for all workers aged 18 and up should replace the National Minimum Wage and National Living Wage. A new wage floor calculation tied to what people need to lead a dignified life should be the statutory minimum. Create a new Statutory Carer Pay entitlement, which mirrors statutory maternity pay and provides earnings-related financial support for carers with high-intensity caring demands for up to nine months. Increase Statutory Maternity Pay (SMP). A first step to increasing SMP would be to have it replicate enhanced maternity pay, a policy which is already well known with employers. Increase Statutory Paternity Pay. JRF support the proposal put forth by Pregnant Then Screwed and the Centre for Progressive Policy that Statutory Paternity Pay is increased to a minimum of six weeks, during which employees would be paid 90% of their salary, aligning with the existing SMP. Make flexible working the default from day one of employment, and reconsider the business exemptions for refusing a request, so jobs work around caring responsibilities and health needs; this would shift the onus onto employers to think about what flexibility they can offer.
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6 6. CONCLUSIONS It is clear from the report that the situation facing many employees and their families is becoming increasingly difficult and JRF have been clear that more needs to be done to improve the situation. JRF have made a call for action to all employers, Scottish Government and the UK Government highlighting that all agencies must do whatever is in their powers to support those most likely to experience in-work poverty. The authors report it’s unlikely that Scotland will meet its child poverty targets without urgent action. There is also an implication for recruiting and retaining skilled staff who may look elsewhere for more flexible roles where staff are better supported around cost of living issues. Transport is a key theme that has come up throughout the report. 7. IMPLICATIONS The current and future implications for the workforce, who are also our community have been outlined above. All agencies must work together to maximise the opportunities they have within their control. It is well established that people who are experiencing poverty can have poorer health and wellbeing outcomes and experience greater inequalities. By tackling in- work poverty and other social determinants of health, inequalities can be reduced and health and wellbeing outcomes improved. North Lanarkshire has a comprehensive Tackling Poverty Strategy that has recently been updated for the next three years. The strategy recognises the relationship with child poverty and therefore includes specific actions to deliver the national targets. There is also a strong Local Employability Partnership in North Lanarkshire with good representation from partners. North Lanarkshire Council is progressing community wealth building principles through the Plan for North Lanarkshire and NHS Lanarkshire has developed an anchor plan (incorporating cost of living actions) which also prioritises those who are more vulnerable to in-work poverty. However, this report is a stark reminder to ensure we continue to prioritise this work across all services as all can contribute to the collective effort to reduce poverty and it is not the remit of specialist teams. It is also worth remembering that a number of HSCP employees will be affected by these issues and efforts should feature in staff health and wellbeing plans. 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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7 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) There are a variety of plans in North Lanarkshire which aim to reduce poverty, each of which has its associated measurement and monitoring plan. Key documents include: NLC Tackling Poverty Strategy Child Poverty Action report NHS Lanarkshire anchor organisation action plan (includes cost of living actions) 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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8 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 JRF involved stakeholders in the development of the report. ☐ 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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9 EQIA added to website: 8. BACKGROUND PAPERS JRF Poverty in Scotland (2023) Report https://www.jrf.org.uk/report/poverty- scotland-2023 North Lanarkshire Tackling Poverty Strategy 2023-26 TOWARDS A FAIRER NORTH LANARKSHIRE 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie 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 / Date added ☐ No ☐ N/A ☒
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10 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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1 REPORT Item No: 10 SUBJECT: Public Sector Equality Duty TO: Integrated Joint Board Lead Officer for Report: Ross McGuffie - Chief Officer North HSCP Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 22 November 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: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP and endorsed by Core.
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to note the contents of the report which includes details of changes being made to the Public Sector Equality Duty. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Sector Equality Duty came into force in April 2011 (s.149 of the Equality Act 2010). The act set out the requirement of public authorities to ensure that they meet the objectives set out under s149 of Equality Act 2010 including: • Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010 • Advance equality of opportunity between persons who share a relevant protected characteristics and persons who do not share it • Foster good relations between persons who share a relevant protected characteristics and persons who do not share it 5.2 As part of the Equality Act 2010 (Specific Duties) Regulations 2011, public authorities are required to publish: • Equality objectives at least every four years • Information to demonstrate their compliance with the public sector duty. 5.3 Following a review of the effectiveness of the Public Sector Equality Duty (PSED) in Scotland there will be a phased approach to implementing changes to the duty in order to improve the PSED regime by April 2025. 5.4 These initial changes will include the delivery on two key prioritised regulatory changes around the revising of the current pay gap reporting duty and the introduction of a new duty on listed public bodies in relation to their use of inclusive communication. A decision has also been taken to repeat the current regulation 6A of the Scottish Specific Duties which relate to the collection of data on listed
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3 authorities’ members ‘characteristics’ and a consultation on the development of the Mainstreaming Strategy will also take place by the end of 2023. 5.5 The revising of the pay gap reporting will help to drive action and reduce the pay inequalities affecting certain disadvantaged groups within society. Following consultation with stakeholders it was agreed that listed authorities should publish ethnicity and disability pay gap information. Extending the reporting requirements to include pay gaps relating to disability and ethnicity will encourage public bodies to take more effective action on reducing any inequalities. 5.6 Introducing a new Scottish Specific Duty on inclusive communication has been supported across stakeholders and will aim to use inclusive communication to improve accessibility, reducing barriers, increasing participation and promoting inclusion. 5.7 The decision to repeal current regulation 6A relating to the collection of data on listed authorities’ members’ characteristics is due to barriers and challenges around how the data collection requirement of the regulation is framed and compliance with this regulation has been difficult. Therefore, other mechanisms are being explored for achieving the intended policy outcomes, including through dialogue with the Public Appointments Team. 5.8 The consultation on a Mainstreaming Strategy will also take place by the end of 2023, with the aim of improving the lives of the most disadvantage people in Scotland. The main themes of the strategy include: • Strengthening leadership • Accountability and Transparency • Regulatory and policy environment • Evidence and experience • Enhancing capability and culture • Ensuring capacity
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4 6. CONCLUSIONS 6.1 A lead-in period is being implemented to provide support to authorities to prepare for these changes with technical guidance also being planned to be issued from Scottish Government. 6.2 Once additional guidance has been released, a further review by the H&SCP will take place to agree and knowledge the implementation of these changes by both NHS Lanarkshire and North Lanarkshire and any additional governance/ reporting arrangement required by the IJB in order to comply with the duty. 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:
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5 Yes ☐ No ☐ N/A ☒ 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 □ 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
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6 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS Appendix 1Scottish Government, Public Sector Equality Duty (PSED) Letter. 9. APPENDICES None. 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 Stacey Anderson stacey.anderson4@nhsl.lanarkshire.scot.nhs.uk
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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 Appendix 1 Minister for Equalities, Migration and Refugees Emma Roddick MSP T: 0300 244 4000 04 October 2023 Dear Colleagues, Thank you for your interest to date on the review of the effectiveness of the Public Sector Equality Duty (PSED) in Scotland. I am now writing to update you on the next stages of the review. However, this work does not sit in isolation. I have therefore included some further information on how this relates to wider activity, including the development of the forthcoming Mainstreaming Strategy and the Human Rights Bill. As you will be aware, in our public consultation (published December 2021 and open until April 2022), we consulted on a series of proposals, both for legislative changes and changes to the wider implementation environment in relation to the Scottish Specific Duties. Consultation responses have since been published alongside independent analysis of these responses. As we move forward with the review, we will be taking a phased approach to improving the PSED regime. New or revised Regulations Initially this will include delivering on two key prioritised regulatory changes, which I believe will be highly impactful in terms of advancing equality in Scotland for some of the most disadvantaged groups, with the aim of implementing these changes by the end of April 2025. These are: revising the current pay gap reporting duty to include reporting on ethnicity and disability pay gaps; and introducing a new duty on listed public bodies in relation to their use of inclusive communication. Revising pay gap reporting Pay gap reporting is an important means of driving action to spotlight and reduce the pay inequalities affecting certain disadvantaged groups in our society. Pay gaps represent different groups’ divergent experiences of not only the workplace, but also education, skills acquisition, care and other domestic labour, and wider societal conventions. The proposal to extend the existing duty to publish gender pay gap information (regulation 7 of the Scottish Specific Duties) to include ethnicity and disability first appeared in the 2021 SNP manifesto; and a commitment to consult on these proposals was subsequently contained in the 2021 Programme for Government.
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9 Following consultation, we found stakeholders are largely in agreement (93%) that listed authorities should publish ethnicity and disability pay gap information. It was also evident that several listed authorities already voluntarily publish this information. While pay gap reporting is vital, stakeholders have suggested that it does have some limitations. Reporting statistics alone can be of limited value without contextualising data, as it shows only part of the story. Therefore, we are considering feedback regarding the need for wider reform of pay gap reporting duties, to achieve meaningful change. It is also our priority that individuals cannot be identifiable under any new reporting duties, and my officials are considering how reporting useful data on an aggregated and disaggregated basis might best be achieved. In the consultation, one stakeholder commented “this proposal will help increase transparency and accountability and may lead to better employment outcomes for people with disabilities and those of ethnic minority origin. Using the pay gap information and an action plan will provide an opportunity to identifying [sic] actions required to address disadvantage or different needs connected to disability, sex or race.” I agree with stakeholders that any new duties must be focused on meaningful action and that “it will also be important to use this data to help understand and progress measures to address the under-representation of people with disabilities and those who belong to minority ethnic groups in the workforce.” By extending the current requirement to report on pay gaps between men and women to include reporting on pay gaps related to disability and ethnicity, we can encourage public bodies to take more effective action on equality issues affecting their disabled and ethnic minority staff. Introducing a new duty on inclusive communication A commitment to improving inclusive communications also first appeared in the 2021 SNP manifesto; and a commitment to consult on this proposal was subsequently contained in the 2021 Programme for Government. As part of our public consultation, we proposed to create a new Scottish Specific Duty that seeks to ensure inclusive communication is embedded proportionately across the work of listed authorities. Stakeholder feedback on that proposal was overwhelmingly positive, both from equality advocacy groups and listed authorities. Most respondents expressed support in principle for the proposal to place a duty on listed authorities to embed inclusive communication proportionately across their work. Introducing a new duty in this area should be beneficial for everyone in Scotland. We believe this is an important step towards a larger cultural change around the way we communicate and will make a real difference to the lives of the people of Scotland. Many consultation respondents highlighted the benefits of inclusive communication (e.g. improving accessibility, reducing barriers, increasing participation, promoting inclusion). The new duty will sit alongside the Scottish Government’s other work to embed inclusive communication across the public sector, such as developing national standards, best practice, and monitoring systems.
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1 0 For both of the above proposals we are in the process of developing our final policy based on your consultation responses, and on extensive stakeholder engagement. Guidance An appropriate lead-in period will be provided to ensure that listed authorities understand and can prepare for what will be required of them under new or revised Regulations. We will work with the Equality and Human Rights Commission, who produce technical guidance on all aspects of the PSED regime under section 13 of the Equality Act 2006, to ensure that listed authorities are fully prepared for any new duties. It is our belief that these proposals would represent realistic incremental change, while also having a significant impact on the advancement of equality. Repeal of regulation 6A Following careful consideration of all elements of the regime, including aspects which are not working well, I have decided to take steps to repeal regulation 6A of the Scottish Specific Duties. I have asked my officials to continue to consider what other means could deliver the policy outcomes intended when that regulation was created, as part of the ongoing programme of PSED improvement activity. As you may know, regulation 6A relates to the collection of data on listed authorities’ members’ characteristics. Officials have taken steps over many years to seek to set up a workable process to comply with this regulation, however it has not yet been achieved due to barriers and challenges around how the data collection requirement of the regulation is framed. Since this regulation was introduced, the landscape relating to board diversity has changed considerably. Much has been done to diversify boards. There have been specific schemes targeted at under-represented groups, including work with a Disabled People’s Organisation and workshops with minority ethnic communities on board applications. Another important development since regulation 6A was enacted is the passing of the Gender Representation on Public Boards (Scotland) Act 2018. This Act makes provision about gender representation on boards of Scottish public authorities. The intention of the Act is to help address the historic and persistent under-representation of women in public life. The Act has been subject to legal challenges relating to the definition of ‘woman’ but nonetheless it has led to important debate about board diversity. As of the end of 2022, 51% of regulated board members are women. Taking all of the above into account, my decision is to repeal the current regulation 6A, and to ask my officials to continue to explore possible future means of achieving the intended policy outcomes, including through dialogue with the Public Appointments Team. Making use of regulation 11 powers to highlight key emerging issues Regulation 11 of the Scottish Specific Duties says that “In carrying out its duties under these Regulations, a listed authority may be required to consider such matters as may be specified from time to time by the Scottish Ministers.”
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1 1 I have asked my officials to explore how I might use this power in the coming months to highlight issues which I consider would have an immediate impact on public bodies’ progress in equality mainstreaming, such as making more effective use of intersectional equality data in policy making and increasing consideration of equality in budget process. I will issue a further update on this in the coming months. Longer-term changes Reporting Further legislative changes will be considered over the longer-term; this includes how we create a more cohesive regime. This phased approach enables us to very deliberately work towards increasing alignment with other changes which are currently proposed regarding the mainstreaming of equality and human rights – such as the introduction of the Human Rights Bill which is currently out for consultation. We recognise that reducing the perceived reporting burden was a key concern in many consultation responses and are keen to make that a reality. Outcome setting Many consultation responses supported the Scottish Government taking on more of a leadership role in setting national equality outcomes, which would inform the outcomes of listed authorities. I have asked my officials to further explore the appetite for this, using a non-regulatory route to improve the current equality outcome-setting process, subject to resource and capacity, and dialogue with relevant policy teams and stakeholders about their expectations in regard to future outcome-setting work. The new National Performance Framework, which is currently under development, will be a key element in our thinking. Learning from International Best Practice You may be aware that in April 2023, my officials commissioned research on international best practice in relation to equality duties to help inform policy development. That research is now nearing completion, and my officials are considering the findings. This will inform our thinking about further changes to the PSED regime in Scotland over the longer-term. The research will be published on the Scottish Government website shortly. Regulations which remain unchanged At this point in time, I am not proposing any change to the procurement duty (regulation 9), or to the duty to assess and review policies and practices (regulation 5). My intention, like that of my predecessor Ms McKelvie, who steered the review in its early stages, is to deliver a balance of continuity and change. This is in recognition of the extensive work already underway in listed authorities, who work with this regime day in and day out. It also recognises the desire for faster progress on mainstreaming equality that was articulated in consultation responses and in my officials’ engagement with interested parties. I would emphasise that I have decided on a phased approach to improving this regime, and that my officials will continue to engage with interested parties as they consider what more could be done over the medium and longer term.
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1 2 Legislative competence The changes I am proposing to particular elements of the current suite of Scottish Specific Duties will necessarily require to fall within the limits of devolved competence. Wider mainstreaming activity: forthcoming strategy We also intend by the end of this year to consult on a Mainstreaming Strategy, as part of our commitment to embed equality and human rights throughout government and the public sector. This provides a parallel route to progress other, non-legislative, improvements to equality and human rights mainstreaming across the public sector, with the aim of improving the lives of the most disadvantaged people in Scotland. After earlier engagement with internal and external stakeholders, the main themes of the Strategy which we will formally consult on, will be: o Strengthening Leadership; o Accountability and Transparency; o Regulatory and Policy Environment; o Evidence and Experience; o Enhancing Capability and Culture; and o Ensuring Capacity. We are also using the information provided through the PSED review consultation to inform this work and look forward to hearing your views as part of this. In conclusion I would like to thank you for your input and patience to date. I appreciate that this review has been underway for some time, and has been affected by pauses, while officials were redeployed to work on emergent crises. I want to reassure you that I am committed to implementing changes that will improve the PSED regime, and to keeping our valued stakeholders updated and involved throughout the process. The ongoing review aims to strengthen the approach to advancing equality in Scotland, which I would intend to have the effect of ensuring that equality is built into future crisis management processes. I believe that this phased approach to improving the effectiveness of PSED in Scotland will enable us to collectively make progress; while still considering what more could be done, and how. If you have any questions about anything above, please get in touch with Jenny Kemp or Sandra Malloy (Jenny.Kemp@gov.scot; Sandra.Malloy@gov.scot). Yours sincerely, EMMA RODDICK
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REPORT Item No: 11 SUBJECT: Assistive Technology TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Margaret Flavell, Senior Manager Adult Social Work Claire Farren, Service Manager DATE: 22nd November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ This report provides an update on the new assistive technology team within North Lanarkshire Health and Social Care Partnership and its impact since inception and aims going forward. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒ This paper has been: Prepared by the Assistive Technology Team and reviewed and endorsed by senior management. 1
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3. RECOMMENDATIONS 3.1. The PFA committee is asked to: a) Note the progress of the new assistive technology team to date. b) Note the progress on promotion of digital services by the team. c) Note the uptake in technology and increase in engagement. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES Background to Assistive Technology Team and its links to meeting digital plan for North Lanarkshire 5.1 Following The guidance of the Scottish Government and COSLA (Convention of Scottish Local Authorities) North Lanarkshire Council have been working to meet the expectations of the new digital strategy for Scotland “A changing nation: how Scotland will thrive in a digital world.” This has resulted in the partnership’s dedication to getting the right support to the right people in the right way. There is a focus on wellbeing and an acceptance that exclusion from the digital world can increase isolation and limit our life chances. In 2022 it was recognised that a team was required to support the necessary steps to enhance and safeguard wellbeing through digital technology as well as making sure the most vulnerable people that we support have the skills, connectivity, and devices to participate in a digital nation. 5.2 Changing demographics, pressures on existing services and budget restraints have motivated us to consider how we can continue to provide service to individuals who need it at the right time. Prior to 2019, there was a team of two people in a central assistive technology team who coordinated the standards, processes, training, and innovation for assistive technology provision across North Lanarkshire Social Work Services. When the staff left the organisation this level of work was maintained, but there was limited capacity to actively develop the service despite the rapidly changing enhancements to this sector. 5.3 North Lanarkshire Health and Social Care Partnership agreed an innovative approach and wanted to accelerate their approach of using assistive technology solutions to support people differently. The Assistive Technology Team (ATT) was created in January 2023. The new ATT consists of a Senior Officer, 4 Resource Workers and 8 Technology Support Assistants. The ethos of the team is to ‘Think Tech First’ and the ambition is to promote the use of assistive technology to improve quality, delivery and safety in care planning across the partnership. Assistive Technology is at the forefront of The Strategic Commissioning Plan 2023-2026 and is 2
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integral to achieving better outcomes for people to maximise their independence and safety. The Team is based in the Dalziel Building, Motherwell with regular presence in localities. Aims and Progress 5.4 In accordance with ‘Care in the Digital Age’ the team aims to deliver new digital solutions to support the national priorities around proactive and preventative care. The team are embedded within social work localities and work alongside community alarm, access social work, community care teams, reablement and intensive home support, Home Assessment Team (HAT), Integrated Day Services, Locality Support Services, Community Mental Health Team, Integrated Rehabilitation teams and third sector agencies. It is an ambition that the development of assistive technology across these services will have a positive impact on our ability to deliver support and services at the right time whilst reducing pressures on the afore mentioned teams. Since the inception of the new assistive technology team, work has been ongoing to increase awareness, knowledge and uptake of digital solutions. 5.5 Digital solutions are becoming more accessible and increasing in variety and as a result can be utilised as options for service delivery and service use. The Assistive Technology Team (ATT) work to the ambition that health and social care services are safe, person centred, secure and ethical. In doing so the aim is to ensure staff, people, carers, and family feel confident in the use of digital solutions to improve and enhance the delivery of care and support. Since its inception 558 referrals have been received by the service. 5.6 A Komp test of change, funded by National Services Scotland began in March 2023 and there are now ten KOMPS supporting people in our communities; five of these to facilitate medication prompting. The Komp itself is a large self-standing screen with one button that turns it on and off. It is self-answering following a ten second count down. The Komp is accompanied with a separate app that allows service users families and friends to connect to the device. It is very user friendly. The simplicity of the device makes it a more inclusive option for those requiring supports, in line with Scotland’s digital strategy “getting the right support to the right people in the right way” with a focus on “wellbeing and that exclusion from the digital world can increase isolation and limit our life chances.” The focus being on supporting people in controlling the home environment, medication prompting, reducing isolation, mitigating risks, and reducing carer stress. The initial findings have found a 100% reduction in home support where the device has been utilised. As a result of the trial none of the individuals required homecare support with the KOMP meeting their current needs. This has eliminated the need for a combined total of 84 medication prompts a week for homecare. 5.7 It is essential that we include the people in our communities and their families/carers in decisions regarding future planning around the use of assistive 3
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technology. While North Lanarkshire has a long history of good relationships with our communities it is essential that any future developments in the use of technology to support service users/carers are coproduced. To date the ATT have participated in 38 events with community-based groups. This work is aligned to Getting It Right For Everyone (GIRFE) and the Human Learning System approach. 5.8 We have an assistive technology flat used to showcase technology solutions and facilitate training to staff groups across the partnership and council. Visits to the flat have increased by 300% since the ATT have been in place. The tech flat offers the opportunity to see technology in use and the ways in which it can promote independence and enhance quality of life. Engagement with the technology flat continues to increase as it is recognised as an integral part of new worker induction across health and social work. The outcome being that staff are educated on and able to recommend technology solutions to those they support. The technology flat is also a platform to compliment and promote North Lanarkshire Council’s self-management platform, Making Life Easier (MLE) which allows individuals to access information, professional advice and direct access to services and support. 5.9 NHS Lanarkshire, North and South Lanarkshire Health Social Care Partnership (HSCP) recognise that people in receipt of social care have some of the highest risk of falls and related poor outcomes. Unfortunately, this high-risk group struggle to access and fully benefit from proactive approaches (timely and appropriate intervention before fall or injury occurs). Funded by the Tech for Better Care programme (https://htn.co.uk/), we are carrying out a short piece of work in partnership with Scotland’s Digital Health & Care Innovation Centre to develop a technology-enabled approach to relational and proactive falls prevention. It is called ‘No need to Fall’. In doing this we can help to ensure people spend better quality time in the home and in turn improve outcomes for families, carers and the workforce. Key Issues and future developments 5.10 Co-production work with communities to identify what their needs are in relation to assistive technologies. 5.11 Making Life Easier development for self-assessment of technology. 5.12 Devise systems to ensure effective ongoing monitoring of impact of use of assistive Technology across Health and Social Work Services 5.13 Assessment and planning- embedding technology into practice o PDD work to supplement home support provision with use of assistive technology. o Assessment and planning/SDS o Use of technology embedded into MySWIS and the future MOSAIC. 4
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o Use of technology "experts" throughout all aspects of assessment and planning and review processes o Use of technology at first point of assessment - Access Social Work, Home Assessment Team 5.14 A process of co-production to support the implementation of the use of assistive technology across services presents significant development opportunities for staff as well as the potential for increased job satisfaction as demonstrated through local experience and national research. 5.15 Continue to develop a training suite in the use of technology and how this can be used to support people living in North Lanarkshire. 5.16 ‘No Need to Fall’ Project with SLC, NHS Lanarkshire and DHI 5.17 Ongoing pressures on the system and our ability to provide Care at Home services have pushed us to think more creatively about how we can offer support. People who would have historically received care at home services now need to be reviewed with urgency and we need to embed a culture where we consider the use of technology in all assessment and planning. Doing this will have its challenges as we require to ensure that staff have the confidence and skills and that our communities are supportive of such innovation while making sure all solutions are person centred and the person is safeguarded. 6. CONCLUSIONS 6.1 In 10 months the Assistive Technology Team has made a considerable impact on assessment and planning and to the outcomes of people supported by the partnership. 6.2 The team have been well received by all services and they are now embedded across teams. 6.3 The team continue to evolve and develop whilst responding to the challenges faced by the partnership as well as the fast-paced developments in the technology sector. 5
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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 ☒ 7.1.1 The communities of North Lanarkshire will continue to be informed of changes in digital technology and consideration of this will be part of any health and social care assessment. People will be given support to ensure they understand and engage with recommended technology. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☒ N/A ☐ 7.3.1 Finance have not reviewed this current paper; however, finance have been consulted throughout the life of the project and are currently members of the analogue to digital board. 6
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7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Assistive Technology Low Margaret Flavell 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 As outlined above and ongoing ☒ Provide stakeholders with information on how to get involved As above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs As above ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services As above ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery As above ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings As above ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff As above ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership As above 7.5.1. The communities of North Lanarkshire will continue to be informed of changes in digital technology and consideration of this will be part of any health and social care assessment. People will be given support to ensure they understand and engage with recommended technology. 7
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7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☒ No ☐ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☒ N/A ☐ 8. BACKGROUND PAPERS Care in the Digital Age: Delivery Plan 2023-24 - Care in the Digital Age: Delivery Plan 2023-24 - gov.scot (www.gov.scot) Scotland Digital Health and Care Strategy - Digital health and care strategy - gov.scot (www.gov.scot) The Health Foundation launches Tech for Better Care funding scheme - htn 9. APPENDICES Appendix 1 Analogue to Digital Equality Impact Assessment CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Claire Farren – farrencl@northlan.gov.uk 8
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Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 202310-10 2 Report Title Assistive Technology 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 9
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Document Text Appendix 1 EqIA version number EqIA status Complete X Incomplete If Incomplete please say why - for instance pending further consultation / research Governance Committee Date approved insert date Review date Insert date McClungR@northlan.gov.uk FraserDi@northlan.gov.uk Contact details Robert McClung Diane Fraser Author Owner Analogue to Digital Transition Project Name of Policy / Budget Saving
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Section 1. About the Policy 1.1 Name of the policy / strategy / function / procedure: Is this a: - A new policy /strategy / function / procedure / service Budget saving Review of policy /strategy / function / procedure Review of Service Other (please specify) Community Asset Transfer Is this is a key strategic decision subject to the Fairer Scotland Duty Yes No 1.2 Person Responsible for the policy etc. Name: Robert McClung Job Title and Service / Team: Senior Officer Analogue to Digital project Lead (Adult Services) 1.3 What is the scope of the assessment? Detail where appropriate Whole of the organisation Service specific Discipline specific Other 1.4 What is the policy/ strategy/ function/ saving trying to achieve / do? Analogue to Digital Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started, and the rollout is scheduled to be completed by 2025. As of 2021 services can no longer sell analogue services such as BT and Virgin, and by and escalated process by 2023 no analogue tech nology can be sold also by any company. Analogue to Digital in Community Alarm Current telecare solutions in use in Scotland use analogue technology. This means that they send signals between the alarm device and Alarm Receiving Centre (ARC) by making a dialup phone call and sending a series of audible tones. Analogue signalling does not work reliably when sent over the digital phone lines that are being installed in user’s homes, grouped schemes, and ARCs Telecare is digital when signalling traffic is carried end-to-end (from a user’s alarm device to the ARC) in a digital format. This device is not connected to the user’s telephone line, instead it contains a SIM card that allows it to connect to the mobile telephone networks.
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This means that the Alarm Receving Centre, alarm devices and peripherals will now need to be digitally enabled to meet the future needs of the service users within our community. This project fits directly into the council’s ambition priority to - Improve the health and wellbeing of our communities. North Lanarkshire Health and Social Care partnership and North Lanarkshire Council is looking to develop a strategic business plan for the analogue to digital transition through the review and analysis of current service provision and their users. This project will look to have an in-depth look at understanding of current technology in place, current HSCNL digital workstreams and their impact on this project and collaboration, engagement of community alarm users, engagement of HSCNL staff in respect of technology and community alarm service and appraisal of alternative technology for future use within the partnership This project will look to provide our communities with the ability for self-management, proactive responses from services and for a holistic person-centered basis for a person’s wellbeing using technology. This project will have produced a strategic business plan for the analogue to digital transition along with all relevant risk assessments. Following the strategic business plan, this project will then focus on implementing the organizations transition from analogue to digital. This will come in the form of procuring a new alarm receiving center through a cloud hosted based system or hardware-based system, to replace our current analogue alarm receiving center. This will then allow for us to look at digitally enabled devices to replace our current analogue community alarms. 1.5 If this is a budget saving, how will the saving be achieved? This project will not focus on budget savings. Section 2. What do I know now? 2.1 Who are the stakeholders and beneficiaries? The stakeholders will be our residents within North Lanarkshire Council areas who are provided with a community alarm service or a telecare service. Other stakeholders will be employees who work for the community alarm service and Health and Social care who assess and prescribe telecare equipment. 2.2 What data, consultation, research and other evidence or information is available relevant to this assessment? (This is a desktop exercise) Digital Telecare National Briefing Document (2020) gives an overview of the work done by telephony providers around the transition of their analogue copper lines to new fibre digital lines. This was done without consultation of the public or any organisation.
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This document also outlines An estimated timeline with an in-depth breakdown of the timescales to complete key operational components of the transition. Estimated resources and costings for the transition. Information on the impact that the transition will have on service users. Potential benefits and opportunities of a digital telecare service. Risks to be considered. Recommendations that telecare service providers should follow to minimise disruption to their service users. Information on resources available from the Digital Telecare Programme which will support the transition journey. North Lanarkshire have also enlisted a third part organisation to carry out reviews of the community alarm service which details peoples experience of using this alarm system. 2.3 Considering the information in Section 1 and 2.1 and 2.2 2.3.1 If this policy is subject to the FSD what does it suggest about the impact or potential impact on socio-economic disadvantage? (please refer to FSD Interim Guidance) Low income People in receipt of a community alarm are now in the process of being charged for this. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Low wealth Material deprivation Area deprivation 2.3.2 Are any of the people communities listed below likely to be more affected by this policy than others? People who share one or more of the protected characteristics of the Equality Act 2010 Yes Details No Details Don’t Know Age (a particular age or range of ages) X 78.1% of community alarm users are aged 70 years and over. Disabled people and people with long term health conditions X Most users of the community alarm service fall within this characteristic. We are unable to pull statistics for this. Women and men, girls and boys X
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People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Pregnant women and new mothers (including breastfeeding women) X Lesbian, gay and bisexual people X People transitioning from one gender to another X People of different religions or beliefs or non-beliefs X Other groups Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Carers will be affected due their possible requirement to use the community alarm systems to summon support fore the person they are providing the care Asylum seekers X Employees – full and part time. Including SES, MAs etc. X Staff who work within the service will be affected by changes to their operating systems and procedures. Others 2.4 Do you have evidence or reason to believe that this policy will, or may potentially affect the Council’s duty to: (Please tick all that apply). Yes No Don’t Know
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1. Eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Equality Act 2010? X 2.Advance equality of opportunity between people who share a relevant protected characteristic and those who do not X 3. Foster good relations between people who share a protected characteristic and those who do not? X 4. Protect and promote human rights? X 5. Reduce socio-economic disadvantage X Please provide details. Section 3. What else do I need to know /find out? 3.1 Further consultation – Please use the table directly below to say who you will consult with (tick Yes or No). Consider those groups from section 2.3 where you ticked yes or don’t know. Once consultation has taken place provide the details below. People and communities Yes No Describe what you did, with whom and when. Please provide a brief summary of the responses gained and links to relevant documents, as well as any actions Age (a particular age or range of ages) X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Disabled people and people with long term health conditions X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Women and men, girls and boys X People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Pregnant women and new mothers and breastfeeding women. X Lesbian, gay and bisexual people X People transitioning from one gender to another X
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People of different religions or beliefs or non-beliefs X Other groups X Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Asylum Seekers X Trade Unions X Employee Equality Forum X Others X 3.2 What additional research or data is required? At this time all research and data has been provided by the Digital Office for Scotland as this is a nationwide activity being completed by external telephony providers which will affect all areas. 3.3 What does the additional research and data tell you about potential or known effects? N/A Section 4. Assessing the impact and strengthening the policy Considering all the evidence you now have from section 1-3, how will the policy affect different people and communities in relation to equality, socio-economic disadvantage and human rights?
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4.1 How does/will the policy and resulting activity affect those with the characteristics listed below (including employees)? Please use the table below to provide details. Detail any Positive impact Detail any adverse impact If adverse how can we mitigate this? Where no mitigating action is planned please say why not Age (a particular age or range of ages) The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Ensure that benefits have been maximised. Disabled people and people with long term health conditions The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Ensure that benefits have been maximised. Women and men, girls and boys People defined by their race, colour and nationality, ethnic or national origins. Married people and civil partners Pregnant women and new mothers (including breastfeeding women) Lesbian, gay and bisexual people People transitioning from
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one gender to another People of different religions or beliefs or non- beliefs Other groups Children and families Homeless people Looked after and accommodated people Care leavers Carers – paid / unpaid, family members The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Support is provide to ensure the person they care with has their benefits maximised to allow them to keep this service. Asylum Seekers Employees – full and part time. Including SES, MAs etc. The introduction to the digital telecare should provide a better working platform for staff with better call reliability and handling. This should reflect in their ability to take and field calls more efficiently A new way of working may need to be introduced which will require further training and support for staff to follow Support will be provided throughout the project. Others 4.2 What measures could be taken to strengthen the policy / strategy to help advance equality of opportunity, foster good relations, promote human rights and reduce socio-economic disadvantage. North Lanarkshire could look to build on its use of community alarm service reviews to carry out a more holistic in-depth review of a person’s needs. This would allow the service to maintain and enhance its relationship with the users of the alarm service. 4.3 Considering questions 4.1 and 4.2 what actions / measures will be put in place before introducing this policy please provide details.
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Action Timescales Responsible Officer Review details (include timescales) Section 5. Monitoring, evaluating and reviewing Section 6. Making a decision and sign-off Recommendation Tick Comment (where applicable, please give more information e.g. where to pilot, what modifications, etc.) Timescales Introduce the policy New policy and procedures will be put in place once digital transformation of the service is complete 12 Months Adjust the policy then introduce Introduce the policy with justification regarding potential adverse impact Stop and withdraw the policy Name of Policy Head of Service /Senior Manager sign-off: Name Job title and division/ team Date Signature 5.1. How will you monitor the impact and effectiveness of the new policy? This will be reviewed at the beginning of the transition and throughout the implementation of the digital equipment. The full project will be subject to a review as in line with North Lanarkshire’s project management policy.
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For further information please contact: Name: Hugh Holt Job title: Senior Officer Service: Adult Services Contact details: Holth@northlan.gov.uk
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1 REPORT Item No: 12 SUBJECT: Risk Management Report TO: Integration Joint Board Lead Officer for Report: Ross McGuffie , Chief Officer North HSCP Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 22nd November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For approval ☒ For endorsement ☐ To note ☐ The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP.
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2 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? Yes ☐ No ☒ N/A ☐ 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. 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. 5.3 A full review of the risk management reporting within the IJB has taken place 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. This review included 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 was held at the IJB Liaison Session in November. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. 5.4 Following discussions at the IJB Liaison Session, the last meeting of PFA on 18th October 2023 and the meeting of the IJB on 27th September 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
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3 IJB 11/21 – Performance IJB 13/21 – Care Homes IJB 14/22 – CAMHS IJB 17/22 – Unscheduled Care IJB 02/22- Ineffective Governance Arrangements 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 within the Risk Register (Appendix 1) and Risk Dashboard (Appendix 2)
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4 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 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 centered 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 ☐
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5 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 ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Risk Register Choose an item. Multi 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
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6 □ 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 ☐ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS None.
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7 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Register Appendix 2 – Risk Overview Dashboard CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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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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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programs 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. 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 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 HIGH MEDIUM AmandaKilburn AmandaKilburn SLT, IJB PFA,IJB 31.12.23 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. IJB02. 21 Financial Reputational 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption 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' Declaration 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 RossMcGuffie AmandaKilburn SLT, IJB PFA,IJB 31.03.24 Previously IJB6. Reviewed and updated on March 2023. Reviewed and Updated Oct 2023, (previously title ineffective governance arrangements).
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer 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 Next 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 MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.12.2023 Reviewed and Updated May 2023. Reviewed Oct 2023. 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. MEDIUM MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.12.23 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. Medium 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 McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.12.23 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. 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. 2. Updated SLA with VANL nearing completion LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.12.23 Previously IJB16.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer 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 Next 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. MEDIUM 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. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP ACTIONS 1. Staff health and wellbeing is a key priority for both partners and all key stakeholders. The commitment to staff health and wellbeing is being actively promoted through all available forums. 2. Work is being carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse MEDIUM LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.12.23 Reviewed and updated June 2023. Reviewed and updated Oct 2023. 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 McGuffie Morag 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 absence 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 received by Scottish Government specifically targeting staff wellbeing 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 McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 31.12.23 Reviewed and Updated May 2023. IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. 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. All care homes advised to use PPE in line with national addendum. 4. Development day on 12th May 23 to agree structures and approach for year ahead medium medium Ross McGuffie Trudi Marshall IJB, PF&A, SLT, SC&SC, A H &SC 31.12.2023 Reviewed and updated Oct 2023.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer 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 Next 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 ‐ first cycle (16wks) nearing completion 3. Refurbishment of North Lanarkshire facilities commences early summer 2023 High medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 31.12.2023 Reviewed and Updated May 2023. 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 4. NLC approved cost of living contract increases in May 2023 ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High Medium Ross McGuffie Ross McGuffie SLT, IJB 31.12.23 Reviewed and Updated May 2023. Reviewed Oct 2023. 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 3. SG/COSLA working groups being established ‐ local reps nominated for each High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.23 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. 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 Equipment 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 Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 30.12.2023 Reviewed and Updated in June 2023. Reviewed Oct 2023
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate 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 center 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 Medium Low Diane Fraser RossMcGuffie SLT, IJB PFA,IJB, ASW C&W B 30.12.23 Reviewed and updated June 2023. Reviewed Oct 2023. IJB.19. 2023 Performance 27/02/2023 Service Sustainability Dueto competing service prioritiesand workforce/ operational and financial challenges there is a risk thatthe IJB will be unable to implement the strategic plan/commission 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 regularly reviewed and agreed. 7. Capacity plans in place to maximize 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 regularly 2. Re‐introduction of scrutiny 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 continuous review of services/ service developments. 5. Development of the programme of work to ensure regular reporting structure in place for service review. 6. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. High Low RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 31.12.2023 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. IJB.20. 2023 Workforce Sustainability 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 provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal 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 trialed in Home Support 4. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 5. Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. High Medium RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 31.12.23 Reviewed and Updated May 2023 Reviewed and updated Oct 2023.
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Appendix 2 NORTH LANARKSHIRE IJB RISK REGISTER OVERVIEW Oct 2023
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North Lanarkshire IJB Risks – Dashboard Executive Summary Following an agreement of the IJB Risk Strategy at the IJB held in May 2023, 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 Risk Registers Number of Risks IJB 17 NL Council 3 NHS Lanarkshire 21 IJB Risk movement since last report No Change Risk Level Increase Risk Level Decrease New Risks Closed Risks Risks with Action Updates 10 0 0 0 0 7 IJB IJB 06/21 – Prescribing Activity and Costs Very High Started as Medium Risk (April 2021) IJB 17/22 – Unscheduled Care Very High IJB 01/21 ‐ Financial Challenges High IJB 04/21 ‐ Notional Set Aside Budget High Started as Very High Risk (April 2021) IJB 12/21 ‐ Staff Health & wellbeing High Started as Medium Risk (Aug 2021)
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IJB 14/22 – CAMHS High IJB 15/22 – Cost of Living High Started as Very High Risk (April 2022) IJB 20/23 – Workforce sustainability High IJB 19/23‐ Service Sustainability High IJB 16/22‐ National Care Service High NL Council Risk Score Trend RIS0000569 -Data Migration and Information Governance Service delivery or business operations are interrupted. RIS0000584-Potential Enforcement Action to Home Support Services RIS0000704-Proposals to Create a National Care Service Very High High Very High NHS Lanarkshire Risk Score Trend 1882‐ Acute Sector Bed Capacity ‐
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availability of acute beds due to delays experienced for onwards movement of patients 'fit for transfer' to care homes, those requiring care at home, exacerbated by rising cases of Covid and high demand Very High 2085 ‐ Capacity within NHSL to respond to ongoing challenges due to Covid 19 and associated variants Very High 1379‐ Delayed Discharge Performance and Impact High 1984‐ Impact From Stepping Down Non‐Urgent Services High 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 659‐ Failure to deal effectively with major emergency Very High 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 1992 ‐ Continuous Covid Response & impact on routine PH Screening & surveillance programmes High 1587 ‐ Sustainability of the two‐site model for the Out‐of‐Hours Service Very High
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2004 ‐ Potential Impact on patients resulting from disruption of day to day clinical care in response to Covid pandemic Very High 1989 ‐ Ability to maintain a workforce commensurate with the need to suppress Covid, deliver Vaccination Programme, Recover & Remobilise Very High 2014 ‐ Recovery of Performance 2021/22 Very High 2086‐ Sustaining GP Services Very High
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Details of IJB Risk Movement/ Update of Actions Risk (Reference Date Risk Review Current Trend Target Commentary Actions for the and Title) Added to Date Score Score risk Register IJB.01/21 Financial Strategic Financial Challenges 01/04/2021 31/05/23 High Medium '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. ACTIONS 1. Annual budget setting processes within each of the partners takes place before the start of each financial year. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget
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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. IJB04.21Financial Strategic Notional Set‐ Aside Budget 01/04/2021 31.05.23 High Medium 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. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level.
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IJB05.21 Financial Strategic Prescribing Activity and Costs 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 01/04/2021 31/06/23 Very High Low 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 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and potential carry forward from 22/23 budget ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch.
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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. IJB.1121 Performance Staff Health & Wellbeing 30/08/2021 31.05.23 High Low 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 Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports,
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5. Well established Occupational Health supports available to support staff sickness. access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff wellbeing 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
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5. Findings of the audit to be shared with IJB. IJB.13.2021 Performance Care Homes Actions Establishment of Care Home Assurance 1. Public Health teams providing Escalation Process in place. guidance on National protocol to support discharge of infection control. Covid 19 patients in place. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3.All care homes advised to use PPE in line with national addendum. Development day on 12th May 23 to agree structures and approach for year ahead.
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IJB.14.2022 Strategic & Performance CAMHS IJB.17.2022 Strategic & Performance Unscheduled Care 30.4.22 31.05.23 High Medium 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 05/09/22 28/06/23 Very High Medium 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 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 4. Progress report will be submitted to IJB approx. Nov 23. 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
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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 support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equipment 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
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out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23)
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IJB02-21 Ineffective Governance Arrangements now titled Prevention of Fraud, Bribery and/or Corruption 01/04/2021 03/10/2023 Low Low 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' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA.
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1 REPORT Item No: 13 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) for: For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period 1 April 2023 to 30 September 2023. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge the contents of the report; and (2) Acknowledge the revised projected outturn for 2023/24 is an underspend of £3.640m. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Head of Financial Solutions. The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in the following table, the IJB year to date position, prior to removal of ring-fenced funding, is an underspend of £2.323m and the projected outturn for 2023/24 is an underspend of £4.313m, assuming the current trajectory of spend continues throughout the financial year. SUBJECT: Financial Monitoring Report 2023/2024 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Chief Officer NHSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22 November 2023 Yes No N/A
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2 6.2 In line with Scottish Government guidance, unspent ring-fenced funding must be transferred to relevant reserves at the end of each financial year for use in later years. 6.3 Removing this from the current projected outturn gives a revised year to date underspend and projected outturn for 2023/24 of £1.961m and £3.640m respectively. Service 2023/24 Year to Date Position £m 2023/24 Projected Year End Outturn £m Health Care Services 0.006 0.010 Social Care Services 2.317 4.303 Total North Lanarkshire HSCP 2.323 4.313 Ring-Fenced Funding (0.362) (0.673) Revised Outturn Total 2023/2024 1.961 3.640 6.4 Subject to IJB approval, in-year underspends will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB Medium-Term Financial Plan 2023-2026. 6.5 A summary of the current financial challenges and key pressures are highlighted in the table below: Area Projected Outturn under/(over) £m Main Factors Employee Costs 11.774 There are continuing challenges in terms of recruitment and retention 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 sectors. Work is underway to scrutinise all vacant posts which have been challenging to recruit to, with a view to realign, and create posts for current service need and workforce availability. This projected underspend is currently offsetting the projected overspends below. Payments to Other Bodies (PTOB) (0.849) There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. The independent care homes have a yearly budget to fund 1,361 care plans but at present the number of projected care plans is 1,466 resulting in a projected overspend of £0.323m. SDS is similarly overspent due to a budget to fund 2,617 care plans against 3,068 estimated care plans for 23/24. This increase was forecast and reported in the Medium-Term Financial Plan. In line with the IJB strategy to address the demand pressures within the plan, a drawdown of £3.682m from the social care demand reserve is being used to offset the current projection reducing the overspend to £1.356m. Additional work is also underway including investment in a review team to work across home support and SDS.
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3 Prescribing (4.680) The current projection is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on April data and 2022/23 trends as no current prescribing data is available due to an ongoing problem related to a recent system upgrade. The supplier has informed boards this situation is likely to continue for the next couple of months making current projections extremely difficult to profile. Similar to the increase in SDS demand, the prescribing increase was in part forecast and reported in the Medium-Term Financial Plan and therefore a drawdown of £3.835m from the prescribing reserve is being used to offset the current overspend. North Lanarkshire Hosted Services (2.071) The three main areas of overspend within North Lanarkshire hosted services, relate to continence service, children services and prisoner healthcare: Continence Service overspend is due to an increase in costs relating to continence products. Children Services overspend relates to health and safety requirements and diabetic equipment including diabetic glucose monitoring machines and insulin pumps. Prisoner Healthcare overspend is due to the increase in drug charges similar to the increase seen in prescribing. 6.6 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and the table below shows the current funding allocation received from Scottish Government: Scottish Government Allocations 2023/24 £m Additional Staffing Band 2-4 1.093 Alcohol and Drug Partnership 8.149 Child Death Review 0.024 Digital Therapy Posts 0.111 Distress Brief Intervention 3.070 District Nursing 0.608 Family Nurse Practitioner Funding 1.150 ICU Bed Capacity Uplift 0.045 Learning Disabilities Health Checks 0.172 Long Covid Support Fund 0.224 Mental Health Action 15 3.930 Mental Health Community Perinatal 0.505 Mental Health Infant and Maternity 0.476 Mental Health Outcomes Framework 4.753 Mental Health Support Veterans 0.126 Multi-Disciplinary Teams 1.996 Neonatal Psychological Interventions 0.138 Outcomes Framework 2.770 School Nursing Posts 0.840 North Lanarkshire Council Sustainability Payment 0.220 TOTAL 30.400
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4 7. SAVINGS 7.1 Within 2023/24 prescribing budget, a savings target of £2.7m has been set by NHS Lanarkshire to help reduce the continuing increasing overspend. 7.2 A wide range of work has commenced from March to ensure the balance of the savings target is achieved, ranging from reducing waste and inefficiencies to changing prescribing practices and culture. The impact of this work has recorded savings at the end of September totalling £0.669m and if this continues the forecast annual savings expected by March 2024 is £1.590m. 7.3 The table below shows the volatility in cost per item within prescribing as at May 2023, average cost per item was £10.43 compared to April 2022 when the average cost was £9.38: 7.4 The following two tables give additional information on the cost of prescribing from April 2022 to May 2023 and number of items dispended for the same period. These tables will be refreshed once current data on prescribing is made available: 2.700 1.590 0.509 Savings Target Savings Expected Savings Achieved 0.000 0.500 1.000 1.500 2.000 2.500 3.000 £m 2023/24 Prescribing Savings £m £8.80 £9.00 £9.20 £9.40 £9.60 £9.80 £10.00 £10.20 £10.40 £10.60 Cost Per Item Cost Per Item April 2022 - May 2023
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5 7.5 It should be noted that due to the volatility within this area and the time lag in receiving up to date information from the recording systems, the current projection is likely to change month on month. Additional monitoring is in place with the data being analysed by a dedicated working group and regular updates on progress will be reported to the IJB throughout the year. 8. GENERAL RESERVES 8.1 The current IJB reserves position for 2023/24 after adjustment for the drawdown of reserves, is a revised balance of £70.631m and is summarised in the table below: 8.2 Appendix 5 shows a detailed list of all reserve movement during 2023/24. 0.000 1.000 2.000 3.000 4.000 5.000 6.000 7.000 8.000 £m Table 1: Prescribing Cost £m April 2023 - May 2024 540,000 560,000 580,000 600,000 620,000 640,000 660,000 680,000 700,000 720,000 No. of Items Dispensed Table 2: Prescribing Items Dispensed April 2022 - May 2023 Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Ring-Fenced Reserves 23.397 (0.224) (8.860) 14.313 NHSL & NLC Earmarked Reserves 44.497 0.084 (3.672) 40.909 NHSL & NLC Risk-Based Reserves 14.901 (0.253) (7.517) 7.131 NHSL Contingency Reserves 8.060 0.218 0.000 8.278 NHSL & NLC Closed Reserves 7.091 0.175 (7.266) 0.000 97.946 0.000 (27.315) 70.631 LEAD SUMMARY Total
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6 8.3 Regular updates will be provided to the IJB throughout the year as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 9. CURRENT VACANCY POSITION 9.1 As highlighted throughout this report, employee costs are projecting a significant underspend within all services. Recruitment continues to be progressed for vacant posts in all areas. 9.2 The table below shows the full time equivalent (FTE) vacancy numbers within each service against their budgeted establishment: 9.3 To help cover the vacant posts, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 6. 10. DELEGATED SERVICES 2023/2024 10.1 The following table shows the costs of other North Lanarkshire Council services delegated to the IJB during 2023/24. The projected outturn position at 31 March 2024 is breakeven for both services. Service Expenditure £m Income £m Housing 2.095 (2.095) Breakeven Transport 0.551 (0.551) Breakeven Total 2.646 (2.646) Breakeven Establishment Actual Vacancies FTE FTE FTE North West Locality 394.12 338.99 55.13 North East Locality 332.48 292.83 39.65 Adult Services 287.24 275.41 11.83 Children Services 599.72 554.98 44.74 Mental Health 1,189.52 1,139.33 50.19 Social Care Services 986.81 758.57 228.24 Home Support 1,000.17 1,008.70 -8.53 Other 200.13 218.53 -18.40 TOTAL 4,990.19 4,587.34 402.85 Service Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.084 0.025 0.439 0.154 0.702 North East Locality 0.033 0.016 0.238 0.032 0.319 Adult Services 0.038 0.045 0.208 0.069 0.361 Children Services 0.136 0.035 0.337 0.063 0.570 Mental Health 0.266 0.040 1.772 2.391 4.469 Social Care Services 0.550 - - 0.200 0.750 Home Support 2.079 - - - 2.079 Other 0.022 0.012 0.050 0.043 0.128 TOTAL 3.208 0.174 3.044 2.953 9.378 SERVICE Year to Date Cost
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7 11. IMPLICATIONS 11.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have 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 ☒ 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges High Amanda Kilburn Prescribing Activity and Costs Very High Ross McGuffie 11.5 ENGAGEMENT & PARTICIPATION 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 The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the NL IJB. ☐ 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
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8 ☐ 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 Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ 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 IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 11.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 12. BACKGROUND PAPERS None. 13. APPENDICES Appendix 1 - North Lanarkshire Health and Social Care Partnership Budget Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2023/24 Appendix 5 - North Lanarkshire IJB General Reserves 2023/24 Appendix 6 - Analysis of Additional Employee Costs Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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9 North Lanarkshire Revenue Budget Position 1 April 2023 to 30 September 2023 Appendix 1 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2023/2024 September 2023 September 2023 September 2023 2023/2024 £m £m £m £m £m Health Care Services Locality and Other Services 66.248 30.465 28.586 1.879 3.758 Addiction Services 6.941 2.056 2.070 (0.014) (0.028) Medical and Nursing Directorate 4.261 2.165 2.109 0.056 0.112 Prescribing 74.808 36.903 39.243 (2.340) (4.680) Out of Area Services 4.641 3.040 2.620 0.420 0.840 Area Wide Services 7.657 3.543 3.314 0.229 0.456 Hosted Services 188.639 92.329 92.552 (0.224) (0.447) Family Health Services 120.561 58.767 58.767 0.000 0.000 Set-Aside Budget 70.502 35.251 35.251 0.000 0.000 Total Expenditure - NHSL 544.258 264.518 264.512 0.006 0.010 Social Care Services Social Care Services Gross Expenditure 251.856 135.615 133.300 2.315 4.299 Social Care Services Gross Income (3.909) (2.105) (2.108) 0.002 0.005 Social Care Services Net Expenditure 247.946 133.510 131.192 2.317 4.304 Housing Revenue Account 2.095 1.128 1.128 0.000 0.000 Transport Services Account 0.551 0.297 0.297 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 250.592 134.934 132.617 2.317 4.304 Total Expenditure - NHSL and NLC 794.851 399.452 397.129 2.323 4.313 Annual Budget 2023/2024 £m NHS Lanarkshire Funding (523.801) Social Care Funding (23.417) Resource Transfer (23.887) Commissioned Services (6.740) Transfer from Reserves (Approved) (20.457) Total Funding - NHSL (598.302) NLC Funding - Social Care Services (190.727) NLC Funding - Housing Services (2.095) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) (3.176) Total Funding - NLC (196.549) Total Funding - NHSL and NLC (794.851) Year To Date Care Group Funded By:
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10 Hosted Services Appendix 2 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 3.346 1.678 1.745 (0.067) 1.740 0.873 0.940 (0.067) 1.606 0.806 0.806 0.000 Continence Services 2.466 1.237 1.678 (0.441) 1.283 0.643 1.084 (0.441) 1.184 0.594 0.594 0.000 Immunisation Services 3.119 2.141 2.162 (0.021) 1.622 1.113 1.134 (0.021) 1.497 1.028 1.028 0.000 Speech and Language Therapy Services 7.082 3.590 3.512 0.078 3.682 1.867 1.789 0.078 3.399 1.723 1.723 0.000 Children and Adolescents Mental Health Services 15.150 6.691 6.623 0.068 7.878 3.479 3.411 0.068 7.272 3.212 3.212 0.000 Childrens Services 12.911 6.428 6.871 (0.443) 6.714 3.342 3.786 (0.443) 6.197 3.085 3.085 0.000 Integrated Equipment and Adaptations Store 0.567 0.284 0.275 0.009 0.295 0.148 0.139 0.009 0.272 0.136 0.136 0.000 Dietetics Services 4.250 2.173 2.052 0.121 2.210 1.130 1.009 0.121 2.040 1.043 1.043 0.000 Podiatry Services 4.938 2.523 2.444 0.079 2.568 1.312 1.233 0.079 2.370 1.211 1.211 0.000 Prisoner Healthcare Services 2.009 1.019 1.306 (0.287) 1.045 0.530 0.817 (0.287) 0.964 0.489 0.489 0.000 Blood Borne Viruses Services 1.596 0.816 0.904 (0.088) 0.830 0.424 0.513 (0.088) 0.766 0.392 0.392 0.000 Hospital at Home 2.631 1.351 1.396 (0.044) 1.368 0.703 0.747 (0.044) 1.263 0.649 0.649 0.000 Mental Health and Learning Disability Services 87.914 42.102 41.290 0.812 45.715 21.893 21.081 0.812 42.199 20.209 20.209 0.000 TOTAL 147.980 72.033 72.256 (0.224) 76.949 37.457 37.681 (0.224) 71.030 34.576 34.576 0.000 Led by the North Partnership South Lanarkshire IJB - 48% Share Year to Date Annual Budget 2023/2024 Annual Budget 2023/2024 Year to Date North Lanarkshire IJB - 52% ShareYear to DateAnnual Budget 2023/2024 Hosted Services Appendix 3 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 September 2023 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 2023/2024 £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 8.107 4.032 3.650 0.381 4.216 2.097 2.097 0.000 3.891 1.935 1.554 0.381 Brain Injury Unit 2.954 1.144 1.353 (0.209) 1.536 0.595 0.595 0.000 1.418 0.549 0.758 (0.209) Out of Hours Services 9.980 4.891 4.803 0.088 5.190 2.543 2.543 0.000 4.790 2.348 2.260 0.088 Palliative Care Services 7.544 3.775 3.748 0.026 3.923 1.963 1.963 0.000 3.621 1.812 1.786 0.026 Physiotherapy Services 11.731 5.944 6.100 (0.156) 6.100 3.091 3.091 0.000 5.631 2.853 3.009 (0.156) Primary Care Services 0.876 0.452 0.413 0.039 0.455 0.235 0.235 0.000 0.420 0.217 0.178 0.039 Occupational Therapy Services 8.940 4.543 4.432 0.111 4.649 2.362 2.362 0.000 4.291 2.181 2.070 0.111 Diabetic Services 4.416 2.311 2.304 0.007 2.296 1.202 1.202 0.000 2.120 1.109 1.102 0.007 Sub Total 54.547 27.092 26.804 0.288 28.365 14.088 14.088 0.000 26.183 13.004 12.716 0.288 Ring Fenced Funding Primary Care Improvement Fund 23.644 11.940 10.412 1.527 12.295 6.209 6.209 0.000 11.349 5.731 4.204 1.527 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Sub Total 23.644 11.940 10.412 1.527 12.295 6.209 6.209 0.000 11.349 5.731 4.204 1.527 TOTAL 78.191 39.031 37.216 1.815 40.660 20.296 20.296 0.000 37.532 18.735 16.920 1.815 Annual Budget 2023/2024 Year to Date South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2023/2024 Year to Date Annual Budget 2023/2024 Year to Date North Lanarkshire IJB - 52% Share
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11 North Lanarkshire IJB Budget Reconciliation 2023/24 Appendix 4 2023/24 NHSL Financial Allocation to North Lanarkshire HSCP £m 2023/24 NLC Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 333.065 2023/24 North Lanarkshire HSCP Financial Allocation 190.727 Set-Aside Budget 70.502 NLC Funding - Housing Services 2.095 South Hosted @ 52% 37.901 NLC Funding - Transport Services 0.551 Family Health Service South @ 52% 116.616 Pay Award Drawdown from Reserves 3.176 NHSL Financial Allocation at 30 June 2023 558.084 NLC Financial Allocation at 21 July 2023 196.549 Budget Adjustments Posted in Month 4 Draw Down From Reserves 1.845 Pay Award Uplift Including One-Off Payments 14.592 Scottish Government 2% Uplift to Resource Transfer and Contracts 1.135 Scottish Government Non Recurring Ring Fenced Monies 7.073 Increase in Hosted Services Led by South 1.843 Increase in Area Wide Services 0.571 Other Budget Adjustments 0.185 NHSL Financial Allocation at 31 July 2023 585.328 Budget Adjustments Posted in Month 5 Draw Down From Reserves 4.985 NHS Lanarkshire Unscheduled Care Reserve -2.790 North Lanarkshire Council Provider Sustainability Payment 0.220 Scottish Government Non Recurring Ring Fenced Monies 0.125 Increase in Hosted Services Led by South 1.058 Other Budget Adjustments 0.200 NHSL Financial Allocation at 31 August 2023 589.126 Budget Adjustments Posted in Month 6 Draw Down From Reserves 3.276 Increase in Family Health Services 3.944 Medical Pay Award 1.705 Funding from NES and Digitial Therapy Posts 0.366 Decrease in Hosted Services Led by South -0.142 Other Budget Adjustments 0.027 NHSL Financial Allocation at 30 September 2023 598.302
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12 North Lanarkshire IJB APPENDIX 5 Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Ring-Fenced Reserves 23.397 (0.224) (8.860) 14.313 NHSL & NLC Earmarked Reserves 44.497 0.084 (3.672) 40.909 NHSL & NLC Risk-Based Reserves 14.901 (0.253) (7.517) 7.131 NHSL Contingency Reserves 8.060 0.218 0.000 8.278 NHSL & NLC Closed Reserves 7.091 0.175 (7.266) 0.000 97.946 0.000 (27.315) 70.631 Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 0.000 0.000 0.255 NHSL Area Wide Services - Refugees and Displaced Persons 0.250 0.000 (0.131) 0.119 NHSL Blood-Borne Viruses Services 0.171 0.000 (0.028) 0.143 NHSL Children and Adolescent Mental Health Services 4.101 0.000 (1.146) 2.955 NHSL Community Living Change Fund 1.298 0.000 0.000 1.298 NHSL District Nursing - Scottish Government Funded 0.376 0.000 (0.369) 0.007 NHSL Hospital at Home Services - Support Development 0.621 0.000 (0.105) 0.516 NHSL Learning Disabilities Health Checks 0.246 0.000 0.000 0.246 NHSL Long Covid Pathways 0.764 (0.224) (0.300) 0.240 NHSL Mental Health and Learning Disability Services - Action 15 3.930 0.000 (1.764) 2.166 NHSL Mental Health and Learning Disability Services - Distress Brief Intervention 3.155 0.000 (1.262) 1.893 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.751 0.000 (0.051) 0.700 NHSL Mental Health Eating Disorders 0.070 0.000 (0.034) 0.036 NHSL Mental Health Neurodevelopmental Pathways 0.100 0.000 (0.004) 0.096 NHSL Mental Health Perinatal, Infant, Maternity and Neonatal 0.005 0.000 0.000 0.005 NHSL Mental Health Psychology Posts 0.670 0.000 (0.497) 0.173 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 0.000 0.000 1.840 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.000 0.000 0.148 NHSL North Planning Band 2-4 Posts 0.933 0.000 (0.377) 0.556 NHSL Staff Wellbeing 0.254 0.000 0.000 0.254 NHSL Third Sector Initiatives To Improve Health 0.306 0.000 0.000 0.306 NHSL Unscheduled Care Funding 3.120 0.000 (2.790) 0.330 NHSL Upper GI Dietetics Band 4 0.033 0.000 0.000 0.033 23.397 (0.224) (8.860) 14.313 LEAD SUMMARY 2023/24 TOTAL RING-FENCED RESERVES LEAD RING-FENCED RESERVES Total Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NLC Long Covid Contingency 1.949 (1.199) 0.000 0.750 NHSL Prescribing Fund 4.361 0.000 (3.835) 0.526 NLC Social Care Demand 8.591 0.946 (3.682) 5.855 14.901 (0.253) (7.517) 7.131 Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Contingency Balance Held By NHSL 8.060 0.218 0.000 8.278 8.060 0.218 0.000 8.278 Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Alcohol and Drug Partnership Funding 2.926 (2.926) 0.000 NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 (0.167) 0.000 NHSL Area Wide Services - NES Training 0.132 0.006 (0.138) 0.000 NHSL Assistive Technology Contract x 12 months (ATC) 0.008 (0.008) 0.000 NHSL Covid-19 Funding 0.007 (0.007) 0.000 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 (0.118) 0.000 NLC Local Government Pay Award 23/24 2.653 0.177 (2.830) 0.000 NHSL Medical Director - Child Death Review Funding 0.012 (0.012) 0.000 NHSL Mental Health Covid Clinicians (Cossette) 0.200 (0.200) 0.000 NHSL Mental Health Pharmacy Recovery Plan 0.175 (0.175) 0.000 NHSL NES SLA Pharmacy Training 0.173 (0.173) 0.000 NHSL Test and Protect Funding 0.520 (0.520) 0.000 7.091 0.175 (7.266) 0.000 CLOSED RESERVES TOTAL CLOSED RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES TOTAL CONTINGENCY FUND RESERVES LEAD
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13 Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.941 0.000 (0.941) 1.000 NLC Adaptations Fund 0.289 0.099 0.000 0.388 NLC Adult Protection (share with C&F and NHSL) 0.050 0.000 0.000 0.050 NLC Advocacy Services 0.118 0.000 0.000 0.118 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 0.000 0.000 0.123 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 0.000 0.000 0.034 NHSL Breast Feeding Team (2 year funding) 0.828 0.000 (0.019) 0.809 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.797 0.000 (1.486) 0.311 NLC Business Case - Non-Recurring NLC Costs 3.811 0.001 0.000 3.812 NHSL Care Homes Allocation 0.318 0.000 0.000 0.318 NLC Carers Act 2018 - Support 2.643 0.058 0.000 2.701 NHSL Champions Board Funding 0.172 0.000 0.000 0.172 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 0.000 0.000 0.346 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.414 0.000 (0.144) 0.270 NHSL Development of Chryston Community Health Clinic 0.212 0.000 0.000 0.212 NHSL Dietetics Services - Double Running Costs 0.110 0.000 (0.030) 0.080 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.588 0.000 0.000 0.588 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.776 0.000 0.000 3.776 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.000 0.000 0.566 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.000 0.000 0.700 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.000 0.000 0.107 NHSL Distinction Awards 0.036 0.000 0.000 0.036 NLC Financial Strategy - Changes to LA Services Muirpark 1.099 (0.499) 0.000 0.600 NHSL Forensic Band 3 x 5 WTE 0.147 (0.035) 0.000 0.112 NHSL GPIT Reprovisioning Gap 0.181 0.000 0.000 0.181 NHSL Health Inequalities - Screening 0.071 0.000 (0.013) 0.058 NHSL Health Visiting Students/Trainees 0.484 0.000 (0.161) 0.323 NLC Home Support Resilience (2 year funding) 3.498 0.148 0.000 3.646 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.187 0.000 (0.101) 0.087 NLC IJB Helpline (2 years funding) 0.575 0.000 0.000 0.575 NHSL Integrated Authority Support 4.926 0.000 0.000 4.926 NHSL Kylepark Works 1.578 0.000 0.000 1.578 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.069 0.120 0.000 0.189 NHSL Mental Health Wards Window Replacement 0.650 0.000 0.000 0.650 NHSL Minor Capital Works 1.162 0.000 (0.088) 1.074 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 0.000 (0.011) 0.539 NHSL Organisational Development Fund 0.260 0.000 0.000 0.260 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.881 0.000 (0.050) 0.831 NLC Planned Date of Discharge - Discharge To Assess 0.304 0.000 0.000 0.304 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.077 0.000 0.000 0.077 NHSL Podiatry Services - Foot Screening 0.426 0.000 (0.035) 0.391 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.000 (0.027) 0.043 NHSL Psychology Posts 2 x Band 6 0.098 0.000 0.000 0.098 NHSL Regrading of Posts Including Backpay 0.250 0.000 0.000 0.250 NHSL Scottish Clinical Leadership Fellowship 0.100 0.000 (0.011) 0.089 NHSL Sexual Health Services - Forensic Medical 0.175 0.035 (0.035) 0.175 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.491 0.000 (0.037) 0.454 NLC Social Care Contracting Staff within Quality Assurance Services 0.003 0.157 0.000 0.160 NLC Social Care Regrading of Staff (SSW, SP, SW, OT, TL and TM) 3.169 0.000 (0.346) 2.823 NLC/NHSL Staff Training Academy 2.400 0.000 (0.038) 2.362 NHSL Stigma Free Lanarkshire (3 year funding) 0.450 0.000 0.000 0.450 NHSL Supervisor Training 0.065 0.000 0.000 0.065 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.000 0.000 0.030 NHSL Vulnerable and Complex Cases - Test of Change 1.092 0.000 (0.099) 0.993 44.497 0.084 (3.672) 40.909 LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES
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14 Analysis of Additional Employee Costs 2023/2024 Appendix 6 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 63,500 21,000 29,000 54,500 250,000 5,000 423,000 2 63,500 21,000 29,000 54,500 250,000 5,000 423,000 3 71,000 24,728 23,000 54,000 223,198 5,000 400,926 4 93,591 83,893 50,097 77,392 412,888 19,046 736,907 5 73,672 36,830 42,883 48,749 315,568 8,740 526,442 6 73,699 50,064 34,182 47,520 320,258 7,555 533,278 7 0 8 0 9 0 10 0 11 0 TOTAL 438,962 237,515 208,162 336,661 1,771,912 50,341 3,043,553 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ Social Care Services £ TOTAL £ 1 42,416 - 2,717 1,571 406,062 - -13,522 439,244 2 62,289 2,876 25,213 5,520 389,942 - 32,744 518,584 3 27,805 2,262 9,143 18,437 405,161 - 36,290 499,098 4 5,197 16,099 14,458 18,437 410,166 - 53,866 518,223 5 6,542 734 11,784 18,438 382,959 - 44,091 464,548 6 9,846 10,346 5,834 309 396,614 43,125 5,887 471,961 7 40,989 40,989 8 0 9 0 10 0 11 0 12 0 TOTAL 154,095 32,317 69,149 62,712 2,390,904 43,125 200,345 2,952,647 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Service s £ Home Support £ Other £ TOTAL £ 1 15,591 5,617 9,055 25,740 47,690 4,691 87,355 5,664 201,403 2 13,874 6,412 7,221 23,070 40,800 86,847 309,302 4,051 491,577 3 13,617 5,469 5,833 24,261 40,838 105,859 304,161 2,651 502,689 4 11,666 3,537 6,890 19,867 38,083 85,974 314,146 2,718 482,881 5 18,101 4,007 4,757 20,670 53,362 87,461 355,153 3,486 546,997 6 10,892 7,970 4,565 22,477 44,961 92,742 358,190 3,201 544,998 7 86,480 350,687 437,167 8 0 9 0 10 0 11 0 12 0 TOTAL 83,741 33,012 38,321 136,085 265,734 550,054 2,078,994 21,771 3,207,712 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,273 4,839 7,436 7,174 11,599 2,093 39,414 2 3,055 1,717 5,869 5,494 6,373 2,626 25,134 3 4,200 2,878 7,399 5,563 6,369 972 27,381 4 3,944 2,268 6,222 5,946 5,735 2,039 26,154 5 3,958 2,798 8,666 7,518 5,736 2,723 31,399 6 3,725 1,451 9,861 3,175 4,302 2,020 24,534 7 0 8 0 9 0 10 0 11 0 TOTAL 25,155 15,951 45,453 34,870 40,114 12,473 174,016 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period AGENCY COSTS YEAR TO DATE
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1 REPORT Item No: 14 SUBJECT: Terms of Reference Integration Joint Board (IJB) and Performance, Finance & Audit Committee (P,F&A) TO: Integration Joint Board Lead Officer for Report: Ross McGuffie , Chief Officer North HSCP Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 22 November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ To review the Terms of Reference for the IJB and PF&A and approve any proposed amendments, note the schedule of dates for both committees during 2021 and approve revisions to the standard reporting template. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP.
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to approve the revised Terms of Reference for the IJB. 3.2 The IJB is asked to note the schedule of dates proposed for the IJB and P, F&A meetings for future meetings. 3.3. It is recommended that stakeholder membership of the IJB committee is reviewed in line with the IJB membership guidance that all IJB members (apart from Chief Accountable Officer, Financial Officer and Chief Social Work Officer) are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Terms of Reference for the Integration Joint Board are formally set out in the Public Bodies (Joint Working) Integration Joint Monitoring Committees (Scotland Act) Orders 2014 with particular reference to the Scottish Statutory Instruments 2014 No.285. http://www.legislation.gov.uk/ssi/2014/285/pdfs/ssi_20140285_en.pdf 5.2 The Terms of Reference for both committees were formally approved at the IJB meeting on 23rd November 2017 and membership of both committees was formally reviewed in March 2018, June 2019 and November 2020.The Terms of Reference for the IJB PFA was amended and formally approved in March 2023. 5.3 Minor amendments to the original Terms of Reference for the IJB are proposed to reflect the primary functions of the IJB and the addition of the new North Lanarkshire Health and Social Care Website. 5.4 The Schedule of dates for the IJB and PF&A is attached as Appendix 3 for noting. Yes ☐ No ☒ N/A ☐
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3 6. CONCLUSIONS 6.1 The Terms of Reference for the IJB has been reviewed and amended to include the introduction of the North Lanarkshire Health and Social Care Partnership and clearer definition of the primary functions of the IJB. 6.2 The schedule of dates for the future meetings of the IJB and PF&A is attached for noting. 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:
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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 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 Yes ☐ No ☒ N/A ☐
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5 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 None. 9. APPENDICES Appendix 1IJB Terms of Reference Appendix 2 IJB PFA Terms of Reference Appendix 3Future Schedule of Dates 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; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 202311-14 2 Report Title Terms of Reference 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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7 Appendix 1 INTEGRATION JOINT BOARD TERMS OF REFERENCE November 2023 1. Purpose The primary function of the IJB is to; Develop an annual commissioning plan Direct NLC and NHSL to carry out of the functions delegated to it through the North Lanarkshire Integration Scheme. Produce an annual report on progress Oversee operational delivery of integrated services Approve the annual accounts Adhere to the content of any future regulations or guidance issued by Scottish Ministers Ensure stakeholder engagement Take into consideration national developments in policy and practice 2. Membership and Quoracy The IJB will meet four times per annum. Additional or extended meetings may be held as necessary. The procedure for appointment of members and transaction of business is set out in the Scottish Statutory Instruments (2014) No.285. No business is to be transacted at a meeting of the IJB unless at least one half of the voting members are present as follows; Two members from NLC Two members from NHSL The role of Chair and Vice Chair will alternate between the constituent authorities on a 3-year cycle. All IJB members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. This rule applies to all members with the exception of the Chief Accountable Officer, Financial Officer and the Chief Social Work Officer who remain on the Board as long as they hold their respective posts. Current IJB membership is set out in section 5 below.
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8 3. Reporting Arrangements Minutes of each meeting will be ratified at the next IJB meeting and thereafter made publically available via the North Lanarkshire Health and Social Care Partnership Website https://hscnl.org.uk 4. Key Responsibilities The IJB will; Approve the directions to NHSL and NLC Approve the Strategic Commissioning Plan Approve the annual Performance Report Approve the Financial Offer Approve the appointment of the Chief Accountable Officer Approve the appointment of the Chief Financial Officer (Section 95) Approve the annual accounts Approve, review and maintain effective governance arrangements for the discharge of IJB functions Ensure that a Participation and Engagement strategy is developed and is effectively put in place Ensure that a records management plan is developed and implemented in line with the duties as set out in the Public Records Act Issue directions to Health Boards and Local Authorities as to how to integration functions are to be carried out. Ensure effective communication and engagement with key partner organisations, in particular NHSL, NLC and North Lanarkshire Partnership Board Monitor risk Review its Terms of Reference on an annual basis Review its committee structure on annual basis The IJB may delegate functions to its subcommittee (Performance, Finance & Audit Committee) as set out in their Terms of Reference. Reviewed by Committee: November 2017 December 2020 November 2023 Ratified by Integration Joint Board : November 2018 Review Date: November 2024
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9
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10 Section 5. Integration Joint Board Membership Voting Members Name Title Mr Ally Boyle NHS Lanarkshire Nominated Non Executive Cllr Claire Barclay NLC Nominated Councillor Cllr Bob Burgess NLC Nominated Councillor Mr Philip Couser NHS Lanarkshire Nominated Non Executive Cllr Paul Kelly NLC Nominated Councillor Cllr Martin McCulloch (Chair) NLC Nominated Councillor Mr Brian Moore (Vice Chair) NHS Lanarkshire Nominated None Executive Mr James Muir NHS Lanarkshire Nominated Non Executive Non-Voting Members Professional Advisors Dr Kenneth Dagg Consultant in Geriatric Medicine, Acute Division /Secondary Medical Care Practitioner Alison Gordon Head of Children’s, Families & Justice Services Chief Social Work Officer of NLC Amanda Kilburn Chief Finance Officer (Section 95) Trudi Marshall Nurse Director NL HSCP Nurse Representative Ross McGuffie Chief Office NL HSCP Dr Josephine Pravinkumar Director of Public Health Dr Tyra Smyth General Practitioner (GP) Stakeholder Members Maddy Halliday Chief Executive VANL Third Sector Representative Cathy McGinty Unison Staff Side Representative (NHSL) Elizabeth Seaton Partnership for Change User Representative Harry Robertson North Lanarkshire Carers Together Carer Representative John Watson Unison Employee Representative NLC Officers in Attendance
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11 Stacey Anderson Support Services Manager, Project Manager Stacey Connor Governance Support Manager Minute Secretary Others Invited Paul Carey Audit Scotland Rep Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Care Martin Hill Chair NHS Lanarkshire Jann Gardner Chief Executive NHS Lanarkshire Dr Lucy Munro Medical Director North HSCP Des Murray Chief Executive NLC Thomas Moan Senior Manager – Community Solutions VANL Maggs Thomson Head of Health North HSCP
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12 Appendix 2 TERMS OF REFERENCE COMMITTEE: PERFORMANCE, FINANCE AND AUDIT COMMITTEE DATE: March 2023 Version 4 1. Purpose The Performance, Finance and Audit Committee has been established by the Integration Joint Board (IJB) to: Oversee a range of matters relating to finance, internal audit, and external audit. Ensure financial and other controls are in place to operate effectively, including processes for audit and risk management. Oversee the development of the annual integrated budget and financial statement. Oversee a range of matters relating to service provision and performance reporting. Ensure the delivery of the highest possible quality of service to users by monitoring performance and considering audit inspection reports. Oversee the development of the annual performance report. 2. Membership and Quoracy Meetings will be held four times a year. Additional meetings may be held as necessary. The IJB shall appoint members to the Committee and nominate a Chair and Vice Chair. The Committee will comprise of 13 members as follows: 4 voting members appointed by the NHS Lanarkshire Health Board (NHSL). 4 voting members appointed by North Lanarkshire Council (NLC). 5 non-voting members representing stakeholders. The quorum for meetings of the Committee is four voting members, comprising two NLC members and two NHSL members.
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13 The Chief Accountable Officer and the Chief Finance Officer will attend all meetings. Attendance by other staff and officers will be agreed by the Chair in advance. Any updates or proposed variation to membership will be approved by the IJB in line with the IJB Terms of Reference and Statutory Instruments. 3. Reporting Arrangements The Committee will report to the IJB. The minutes of Committee meetings will be submitted to the next appropriate meeting of the Committee for approval as a correct record and will then be submitted to the next IJB meeting for noting. 4. Key Responsibilities In relation to finance matters, the PF&A Committee is authorised to: Provide financial governance and scrutiny of the in-scope budget for the IJB. Review the annual budgets with recommendations to the IJB. Review the overall internal control arrangements of the IJB and ensure that appropriate levels of accountability, scrutiny and discussion are undertaken in the key areas of business. Ensure that the senior management team maintain effective controls within their services which comply with financial procedures and regulations. Ensure effective arrangements are in place to register all finance and audit risks as soon as possible and that the appropriate lead officer is notified to ensure compliance and mitigating actions are detailed. Review risk management arrangements and receive regular risk management updates and reports, as appropriate. Report and review the IJB’s financial strategy in support of the strategic commissioning plan and recommend approval to the IJB. Receive reports on any new and emerging national policy developments related to health and social care and consider any impact on the financial position.
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14 Consider the unaudited Annual Accounts and oversee the preparation of the Governance Statement before submission to and approval by the IJB. Approve the Annual Accounts. In relation to audit matters, the Committee is authorised to: On an annual basis, approve the risk-based Internal Audit plan, including Internal Audit’s resource requirements. Consider reports from Internal Audit on their activity and performance during the year including the Internal Audit annual opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control. Consider the external auditor’s annual plan and all relevant external audit reports issued to those charged with governance. Consider, where appropriate, responses to internal and external audit and scrutiny reports and to monitor any subsequent recommendations and requirements emanating from these. Consider and review strategic financial risks pertaining to the IJB’s responsibilities. In relation to performance matters, the Committee will: Review service performance reporting processes. Review quarterly performance and recommend remedial action to address concerns. Consider response/actions in relation to any external scrutiny reports that relate to service provision. Oversee the implementation of any recommendations made within external scrutiny reports. Ensure a rigorous and systematic approach to the monitoring of delivery of national and local priorities. Ensure effective arrangements are in place to identify and register all performance and finance risks as soon as possible and review high rated risks at each meeting to ensure effective mitigating actions are being followed and risks regularly updated. Oversee the development of the annual performance report.
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15 Ratified by Integration Joint Board: Version 1 – December 2017 Version 2 – March 2018 Version 3 – December 2020 Version 4 – March 2023 Review Date: The Terms of Reference for the Performance, Finance & Audit Committee will be reviewed every 3 years and approved at the Integration Joint Board. Planned Review Date – March 2026
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16 Appendix 3 Future Schedule of Committee Dates 2024-2027 2024 Integration Joint Board Committee Integration Joint Board Performance, Finance & Audit Committee Integration Joint Board Liaison Sessions 24th January 2024 9.30am-11.30am 21st February 2024 2pm-4.30pm 13th March 2024 9.30am-11.30am 27th March 2024 2pm-4.30pm 22nd May 2024 2pm-4.30pm 29th May 2024 2pm-4pm 19th June 2024 9.30am-12pm 21st August 2024 2pm-4.30pm 11th September 2024 2pm-4pm 18th September 2024 2pm-4.30pm 23rd October 2024 2pm-4.30pm 13th November 2024 9.30am-11.30am 4th December 2024 9.30am-12pm 2025 Integration Joint Board Committee Integration Joint Board Performance, Finance & Audit Committee Integration Joint Board Liaison Sessions 22nd January 2025 2pm-4pm 26th February 2025 2pm-4.30pm 12th March 2025 9.30am-11.30am 19th March 2025 9.30am-12pm 21st May 2025 2pm-4.30pm 11th June 2025 9.30am-11.30am 18th June 2025 9.30am-12pm 27th August 2025 2pm-4.30pm 10th September 2025 2pm-4pm 17th September 2025 9.30am-12pm 22nd October 2025 9.30am-12pm 3rd December 2025 9.30am-11.30am 10th December 2025 9.30am-12pm
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17 2026 Integration Joint Board Committee Integration Joint Board Performance, Finance & Audit Committee Integration Joint Board Liaison Sessions 21st January 2026 9.30am-11.30am 18th February 2026 2pm-4.30pm 11th March 2026 9.30am-11.30am 18th March 2026 9.30am-12pm 20th May 2026 9.30am-12pm 10th June 2026 9.30am-11.30am 17th June 2026 9.30am-12pm 19th August 2026 9.30am-12pm 9th September 2026 9.30am-11.30am 16th September 2026 9.30am-12pm 21st October 2026 9.30am-12pm 9th December 2026 9.30am-11.30am 16th December 2026 9.30am-12pm 2027 Integration Joint Board Committee Integration Joint Board Performance, Finance & Audit Committee Integration Joint Board Liaison Sessions 20th January 2027 9.30am-11.30am 17th February 2027 2pm-4.30pm 10th March 2027 9.30am-11.30am 17th March 2027 9.30am-12pm
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ITEM 15 1 North Health & Social Care Partnership Committee Programme of Work 2024 This work plan is derived from the responsibilities and information requirements set out in the IJB Committee Terms of Reference. Should these change as a result of a further review of committee roles, the work plan will be revisited. 24th January 2024-IJB Committee Winter Business Case National Care Service Update 21st February 2024- IJB PFA Committee Action log Risk Chryston Hub Update Community Nursing Review Hospital @ Home Community Alarms Resettlement Update Care Home Support Q2 Performance Report 13th March 2024- IJB Liaison Session Topic TBC 27th March 2024-IJB Committee Action log Risk Integration Scheme Prisoner Healthcare Alcohol & Drugs MAT Standards Staff Health & wellbeing Partnership with Universities Annual Chief Social Work Officer Report Category One Responders Update IJB Directions Letters Annual Audit Plan TBC Financial Plan Financial Monitoring North Integration Joint Board Committees
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ITEM 15 2 Reserve Strategy Delegated Health & Social Care Budget Risk Update PCIP Update 22nd May 2024-IJB PFA Committee Action Log Risk Q3 Performance Report Home Support Redesign Home Assessment Team Community Alarm Service Review SDS Transformation Carers Strategy Engagement & Participation Community Solutions Strategy & Investment Plan 29th May 2024-IJB Liaison Session Topic TBC 19th June 2024- IJB Committee Action Log Risk Financial Monitoring Declaration of Interest Forms Unaudited Accounts Code of Conduct Governance Report Records management plan Public Sector Equality Duty Mental Health Strategy Refresh 21st August 2024-IJB PFA Committee Action Log Risk Q4 Performance Report Improving Cancer Journey Our Health Together Public Health Annual Report 11th September 2024- IJB Liaison Session Topic TBC
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ITEM 15 3 18th September 2024- IJB Committee Action Log Risk Financial Monitoring Audited Accounts External Audited Accounts CAMHS Recovery & Renewal Paediatric Modernisation SLT Improvement Trauma Informed Practice Care Academy Annual Accounts Annual Performance Report Quality Assurance Annual Report Whistleblowing Annual Update Community Solutions Report Tackling Poverty Team Report Strategic Commissioning Plan Progress 23rd October 2024- IJB PFA Committee Action Log Risk GIRFE Community Nursing Review Digital Technology & System Developments Annual Climate Report Q1 Performance Report 13th November 2024-IJB Liaison Session Topic TBC 4th December 2024- IJB Committee Action Log Risk Financial Monitoring Terms of Reference Annual Review Support Care & Clinical Governance Update Topic still to be allocated a committee date Cost of living helpline update Ethical Commissioning Palliative Care
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1 REPORT Item No: 16 SUBJECT: IJB Integration Scheme 2024 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager DATE: 22 November 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 1.2 The paper details the update of the IJB Integration Scheme 2023 as per legal requirement. 2. ROUTE TO THE BOARD
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2 This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Service Support Project Manager 3. RECOMMENDATIONS 3.1. The IJB is asked to acknowledge the refresh of the IJB Integration Scheme 3.2 Provide any further comments and feedback regarding the Integration Scheme. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. The Integration Scheme sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. 5.2 Section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014, notes that “the local Yes ☐ No ☒ N/A ☐
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3 authority and the Health Board must carry out a review of the integration scheme before the expiry of the relevant period for the purpose of identifying whether any changes to the scheme are necessary or desirable”. The legislation clarifies the “relevant period” as “the period of five years beginning with the day on which the scheme was approved. 5.4 In September 2018 North Lanarkshire Council set out a new vision for the future direction of the council in ‘We Aspire’. The document set out a plan to revise the Integration Scheme and transfer the discretionary delegated functions for children, families and justice social work services to the newly reshaped Education and Families service within the council. 5.5 Following approval by the respective bodies, the Integration Scheme was updated and submitted to the Scottish Government for approval. 5.6 On 12th April 2019, the Cabinet Secretary approved the integration scheme changes, namely to remove children, families and justice social work. 5.7 In order to meet the 5-year review timeline, a review and update of the North Lanarkshire Integration Scheme for 2024 has taken place and an update of the document is attached for discussion order by the IJB PFA committee members. 5.8 The updated Integration Scheme and associated paper was presented to the IJB PFA in Oct 2023, the IJB PFA requested terms referencing to the IJB PFA be standardised, terms should reflect current voting members and also to ensure language is reflective of current position. Therefore, the Integration Scheme has been updated in line with this feedback. 6. CONCLUSIONS 6.1. Once the Integration Scheme has been approved by the IJB PFA, the Integration Scheme
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4 should be subjected to consultation process which will include the document being published on the relevant public websites, with letters sent to the prescribed list of standard consultees and then submitted to Scottish Government for final approval. 6.2 Once approval has been received from Scottish Government, the Integration Scheme will be uploaded to the North Lanarkshire Health and Social Care Partnership Website. 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 ☒
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5 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. 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. 7.5.1 Engagement and participation will be included as part of the consultation framework for the Yes ☐ No ☐ N/A ☒
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6 Integration Scheme. 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
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7 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 North Lanarkshire Integrated Joint Board Integration Scheme 2019 Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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8 9. APPENDICES Appendix 1NL IJB Integration Scheme 2024 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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9 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
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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 Appendix 1 Health and Social Care Integration North Lanarkshire Integration Scheme 2024 Version Control Version Date North Lanarkshire Integration Scheme 2014 V1 April 2014 North Lanarkshire Integration Scheme 2019 V2 April 2019 North Lanarkshire Integration Scheme 2024 V3 April 2024
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2 Contents 1. Introduction .............................................................................................................................. 4 2. The Parties................................................................................................................................ 8 3. Integration Model ..................................................................................................................... 9 4. Local Governance Arrangements ........................................................................................ 10 5. Delegation of functions ......................................................................................................... 14 6. Local Operational Delivery Arrangements .......................................................................... 19 7. Corporate Service Support ................................................................................................... 21 8. Supporting Strategic Planning ............................................................................................. 21 9. Performance Measurement ................................................................................................... 22 10. Support, Care and Clinical Governance ............................................................................ 24 11. Clinical and Professional Governance Framework .......................................................... 25 12. Chief Officer ......................................................................................................................... 29 13. Workforce ............................................................................................................................. 31 14. Finance ................................................................................................................................. 33 15. Communication, Participation and Engagement .............................................................. 39 16. Information-Sharing and Data Handling ............................................................................ 40 17. Complaints............................................................................................................................ 42 18.Claims Handling, Liability and Indemnity ........................................................................... 44 19.Risk Management ................................................................................................................. 46 20.Dispute Resolution Mechanism ........................................................................................... 48 Annex 1 – Delegated Functions ................................................................................................ 50
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3 Part 2- Integrated Services ........................................................................................................ 61 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board .......................................................................................................................................... 65 Health and Social Services and Social Security Adjudications Act 1983 ............................ 73 Part 2 -Services currently provided by the Local Authority which are to be integrated ..... 87 Annex 3 – Hosted Services Arrangements .............................................................................. 89 Annex 4 – Health and Wellbeing Outcomes ............................................................................ 91
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4 1. Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. This document sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. The creation of an integrated partnership required North Lanarkshire Council and NHS Lanarkshire Health Board to undertake a significant change agenda with the aim of creating services and supports which build on a solid foundation of success to date. The overall aim of the arrangement is the creation and continuation of a partnership which further improves outcomes for people who use health and social care services and their carers. Therefore, a primary focus of the partnership will be delivering on the nine National Health and Wellbeing Outcomes (hereinafter referred to as the “Outcomes”). of: 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, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community
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5 People who use health and social care services have positive experiences of those services and have their dignity respected • Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services • Health and social care services contribute to reducing health inequalities • People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing • People 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 From a North Lanarkshire perspective, our local vision reflects and underpins the higher level national outcomes. This is evidenced by the progress towards a personal outcomes approach which involves working with people to jointly agree how we support them to meet their aspirations and goals in life. Consequently, this drive towards supporting people to meet their outcomes has resulted in a shared partnership vision based upon:
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6 “Working together to improve health and wellbeing in the community – with the community” In pursuit of this vision, and central to our philosophy, will be the following commitments: • We will focus on promoting health improvement and tackling the underlying causes of ill – health. • We will continue to develop a health and social care system which is integrated around the needs of individuals, their carers and family members. • We will be working with people, their carers and families who have a range of complex support needs to identify the outcomes they want to achieve in life. In doing so, our aim will be to provide care and support to help them realise these outcomes. • We will put the leadership of clinicians and professionals at the heart of service delivery for people who require support and their carers. • We will work with partners in the third and independent sectors to remove unhelpful boundaries and using combined resources to achieve maximum benefit for patients, service users, carers and families. • We will work with a range of agencies and partners to address health and social inequalities and the subsequent impact of this experienced by people in their communities.
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7 The following detail provides information relating to ‘how’ the partnership has been created to deliver against the national outcomes and intentions of the Act. This integration Scheme is the vehicle through which assurance is given to North Lanarkshire Council, NHS Lanarkshire Health Board and the Scottish Government that the intentions of the Act are being delivered by the Integration Joint Board. This Integration Scheme forms the basis of a legal agreement with the Scottish Government and lasts for a maximum duration of five years, after which point it will be refreshed. However, in circumstances where there is agreement between the Parties, this Integration Scheme can be refreshed within an earlier timeframe. This Integration Scheme first came into effect in April 2016, with a refresh of the North Lanarkshire Integration Scheme implemented in April 2019.
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8 2. The Parties North Lanarkshire Council, established under the Local Government etc. (Scotland) Act 1994 and having its principal offices at the Civic Centre, Windmillhill Street, Motherwell, North Lanarkshire And NHS Lanarkshire Health Board, established under section 2(1) of the National Health Service (Scotland) Act 1978 and having its principal offices at Kirklands Hospital, Fallside Road, Bothwell, Lanarkshire (together referred to as “the Parties”) In implementation of their obligations under the Act, the Parties hereby agree as follows: Definitions and Interpretation “The Act” means the Public Bodies (Joint Working) (Scotland) Act 2014. “The Parties” means NHS Lanarkshire Board and North Lanarkshire Council. “The Health Board” means NHS Lanarkshire Health Board. “The Local Authority” means North Lanarkshire Council. “The Scheme” means this Integration Scheme.
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9 “Integration Joint Board” or “IJB” means the Integration Joint Board to be established by Order under section 9 of the Act. “Members” means Members of the Integration Joint Board. “Outcomes” means the Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Act. “The Integration Scheme Regulations” means the Public Bodies (Joint Working) (Integration Scheme) (Scotland) Regulations 2014. “Integration Board Order” means the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. “Integration Joint Board, Performance, Finance and Audit Committee” (IJB PFA) means the committee which the Integration Joint Board has delegated authority for business relating to performance, finance and audits reports/updates. “Strategic Plan” means the plan which the Integration Joint Board is required to prepare and implement in relation to the delegated provision of health and social care services in accordance with section 29 of the Act. 3. Integration Model In accordance with section 2(3) of the Act, the Parties have agreed that the integration model set out in sections 1(4)(a) of the Act will be put in place for North Lanarkshire, namely the delegation of functions by the Parties to a body corporate that is to be
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10 established by Order under section 9 of the Act. 4. Local Governance Arrangements a. The Integration Joint Board will be responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within this integration scheme. b. The regulation of the Integration Joint Board’s procedures, business and meetings will follow the IJB’s own standing orders which may include additional matters to those set out within the Integration Board Order. c. The Integration Joint Board and the Parties will collaborate and interact in order to contribute to the outcomes however the Integration Joint Board, when established, will have distinct legal personality and the consequent autonomy to manage itself. d. There will be eight voting members on the Integration Joint Board comprising four elected members from North Lanarkshire Council and 4 members from NHS Lanarkshire Health Board. e. The non-voting membership prescribed in the Integration Board Order is as follows;
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11 • The Chief Officer of the Integration Joint Board; • The Chief Social Work Officer of the Council appointed by it in terms of Section 3 of the Social Work (Scotland) Act 1968; • The proper officer of the Integration Joint Board appointed under section 95 of the Local Government (Scotland) Act 1973(a) i.e. the Chief Finance Officer; • A registered Primary Care medical practitioner; whose name is included in the list of primary medical service performers prepared by the Health Board in accordance with the regulations made under section 17P of the National Health Service (Scotland) Act 1978. • A registered Nurse who is employed by the Health Board or by a person or body with which the Health Board entered into a general medical services contract
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12 • A registered medical practitioner employed by the Health Board who does not provide primary medical services. f. Once the Integration Joint Board is established it must appoint, in addition, at least one member in respect of each of the following groups in terms of the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014: • Staff engaged in the provision of services provided under integration functions; • Third Sector bodies carrying out activities related to health or social care in North Lanarkshire; • Service users residing in North Lanarkshire; • Persons providing unpaid care in North Lanarkshire. g. The Integration Joint Board may appoint such additional members as it sees fit. h. The responsibility for appointing the Chair and Vice Chair will alternate between the Parties and the appointments will be made for a period of 3 years. Within this period,
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13 each Party may change its appointment as Chair or Vice Chair at any time and it is entirely at the discretion of the Party which is making the appointment to decide who it shall appoint. i. The term of office of a member of the Integration Joint Board is a maximum of three years. The Integration Joint Board voting members appointed by the Parties will cease to be members of the Integration Joint Board in the event that they cease to be a Non-Executive or Executive member of NHS Lanarkshire or an elected member of North Lanarkshire Council. At the end of a term of office a member may be reappointed for a further term of office. j. The Chief Social Work Officer, Chief Officer and Chief Finance Officer remain members of the Board for as long as they hold the office in respect of which they are appointed. k. Whilst serving on the Integration Joint Board its members carry out their functions under the Act on behalf of the Integration Joint Board itself, and not as delegates of their respective Heath Board or Local Authority. l. In accordance with good practice, it is expected that the Integration Joint Board will establish an audit committee to support the overall governance and scrutiny arrangements. The Parties recognise that the establishment of any committees by
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14 the IJB are a matter to be determined by the IJB. The North Lanarkshire Integrated Joint Board Performance, Finance and Audit committee has been established within North Lanarkshire to fulfil this purpose. m. Detailed protocols and reporting arrangements will be established to ensure the Parties and the Integration Joint Board have free access to all relevant information for the purposes of planning and decision making. 5. Delegation of functions The functions that are to be delegated by the Health Board to The Integration Joint Board are set out in Part 1 of Annex 1. These functions are delegated only to the extent that they relate to the listed services. The services to which these functions relate, which are currently provided by the Health Board and which are to be integrated, are set out in Part 2 of Annex 1. Broadly these are as follows; 5.1 Hospital Services The functions in relation to the hospital services noted below will be delegated in respect of adults and children. 5.1.1 Accident and emergency services provided in a hospital; 5.1.2 Inpatient hospital services relating to the following branches of medicine:
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15 • General medicine; • Geriatric medicine; • Rehabilitation medicine; • Respiratory medicine; • Palliative care services provided in a hospital; 5.1.1 Paediatrics; 5.1.2 Psychiatry of learning disability; 5.1.3 Inpatient hospital services provided by general medical practitioners; 5.1.4 Services provided in a hospital in relation to an addiction or dependence on any substance; 5.1.5 Mental health services provided in a hospital except regionally or nationally organised forensic mental health services. 5.2 Community Services The functions in relation to the community health services noted below will be delegated in respect of adults. • District nursing services;
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16 • Health Visiting; • Allied health professionals in an outpatient department, clinic, or out with a hospital; • Public dental services; • Primary medical services • General dental services • Ophthalmic services; • Pharmaceutical services; • Primary care out-of-hours; • Geriatric medicine; • Palliative care; • Community learning disability services; • Kidney dialysis services; • Mental health services • Continence services • Community paediatrics • Community children’s services • School nursing services • Services provided by health professionals that aim to promote public health;
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17 5.2 .1 The functions delegated by the Council to the Integration Joint Board are set out in Part 1 of Annex 2. The services to which these functions relate are set out in Part 2 of Annex 2 and relate to adult services only. • Social work services for adults and older people • Services and support for adults with physical disabilities and learning disabilities • Mental health services • Drug and alcohol services • Adult protection and domestic abuse • Carers support services • Community care assessment teams • Support services • Care home services • Adult placement services • Health improvement services • Aspects of housing support, including aids and adaptions • Day services • Local area co-ordination
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18 • Respite provision • Occupational therapy services • Re-ablement services, equipment and telecare. 5.3 Annex 3 sets out arrangements for hosted services. This relates specifically to health services which span more than one Integration Joint Board and are subject to Integration Joint Board approval. 5.4 The Integration Joint Board is a Category 1 responder under the Civil Contingencies Act 2004, as per the amendment to the Act in 2021. This ensures that where there is a risk of an emergency which will impact functions delegated to the Integration Joint Board, there will be formal coordinated and appropriate arrangements in place for emergency planning; information sharing and cooperation with other responders; and joined up information sharing and advice for the public. The IJB is represented at the Local Resilience Partnership by the Chief Officer.
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19 6. Local Operational Delivery Arrangements 6.1 The Integration Joint Board meets a minimum of four times per year in public and publishes all agendas, papers and minutes with responsibility for the delivery of integrated functions as set out in annexes 1,2 and 3 and provides operational oversight of integrated services delegated to them. It will do this directly for all services except for those noted in 6.2. The operational role of the Chief Officer is set out within section 8. 6.2 NHS Lanarkshire will retain direct operational oversight of the acute services as set out in annexes 1,2 and 3 and will provide information on a regular basis to the Integration Joint Board about the delivery of these services. 6.3 The Integration Joint Board is responsible for the development of a Strategic Commissioning Plan as per Section 29 of the Act. This plan sets out arrangements for carrying out the integration functions and how these contribute to achieving the Outcomes as outlined in Annex 4. 6.4 A locality model has been developed by the Integration Joint Board to underpin the development of the Strategic Commissioning Plan. 6.5 From an acute hospital service perspective, operational plans for integrated acute service delivery are subject to directions from the Integration Joint Board about the exercise of delegated functions in relation to these services. These will also be informed and directed by the Strategic Commissioning Plan. 6.6 The Chief officer is responsible for directly implementing the Integration Joint
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20 Board’s directions to locality delivery on the ground. 6.7 From an operational and performance management perspective, the Integration Joint Board/ the Integrated Joint Board Performance, Finance and Audit Committee will receive regular reports from the chief officer and other responsible officers of the parties on the delivery of integrated services and will issue directions in response to those reports to ensure improved performance. This includes a range of thematic reports will include, but are not limited to, the following; • Finance Reports • Performance against the National Health and Wellbeing Outcomes; • Regulation and scrutiny activity; • Inspection Outcomes. • Support, Care & Clinical Governance reports to be assured of the delivery of safe and effective services. • Public Protection reports. • Engagement and community co-production reports from each of the Locality Management teams. • Annual staff governance and workforce planning report. • Improvement plans and reports. • Risk reports/management plan.
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21 6.8 The Act requires the Integration Joint Board to publish an Annual Performance Report by July of each year. 7. Corporate Service Support 7.1 The Parties will support the work of the Integration Joint Board by supplying all relevant information, data and corporate support services such as financial, legal, human resources, IT, planning, risk management, audit, administrative etc. for the Integration Joint Board to carry out its functions. This will include information on cross boundary flow into and out with NHS Lanarkshire. 7.2 The current arrangements for providing corporate support services in respect of delegated functions and the associated service provision will be reviewed by the Chief Officer and the responsible officers of the Parties on an ongoing basis. 8. Supporting Strategic Planning 8.1 As outlined in Section 30(3) of the Act, the Integration Joint Board must have regard to the effect that their Strategic Commissioning Plan will have on facilities, services or resources which are used in relation to arrangements set out or being considered to be set out in a Strategic Plan prepared by another Integration Joint Board. 8.2 In assessing the health element of this, the NHS Board will provide the necessary activity and financial data for services, facilities and resources that relate to the planned use of services provided by other Health Boards by people who live within
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22 the area of the Integration Joint Board. 8.3 In circumstances where the NHS Board or the Council intend to change service provision of non-integrated services that will impact directly on the Strategic Commissioning Plan, they will advise the Integration Joint Board of this. 9. Performance Measurement 9.1 Through the development of the Strategic Commissioning Plan, the Outcomes are used to develop a performance reporting framework which underpins the Plan. 9.2 The Parties have established an integrated performance reporting framework which considers and develops a local suite of measures and targets that relate to the provision of integration functions. The measures and targets are aligned to the Outcomes and any subsequent guidance/core suit of indicators. The Parties develop the targets, measures and other arrangements that are devolved to the Integration Joint Board. In developing this, the Parties share with the Integration Joint Board other relevant NHS Board and Council targets and measures which the Integration Joint Board must take account of. 9.3 The Parties, in conjunction with the Integration Joint Board also consider and develop a list of targets, measures and arrangements that relate to the functions that are not delegated which the Integration Joint Board must take account of when it is preparing the strategic plan. 9.4 The work in respect of 9.2 and 9.3 takes into account: 9.4.1 The Outcomes.
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23 9.4.2 Delegated performance targets related to the commissioning and delivery accountabilities of the NHS Board and the Council. 9.4.3 Delayed discharge. 9.4.4 Recovery activity. 9.4.5 Locally agreed outcomes and targets identified through Community Planning and from the Local Outcomes Improvement Plan and attributable to Health and Social Care Outcomes and targets, including Health Improvement, for each of the localities identified and agreed in line with local needs determined for each population. 9.4.6 The Nationally prescribed core suite of integration indicators. 9.5 The reporting of information against this suite of indicators is provided by the Parties to the Integration Joint Board as a means of measuring progress and impact. 9.6 Where responsibility for the target is shared, the Parties set out in a document the accountability and responsibility of each of them. 9.7 Where the responsibility for the targets span integrated and non-integrated services, the NHS Board, the Council and the Integration Joint Board will work together to produce and deliver the measures and targets which assess performance. This will be evidenced through a standing performance item on Integration Joint Board meetings and also picked up through the Integration Joint Board Annual Performance report. 9.8 The Integration Joint Board Performance, Finance and Audit Committee which is accountable to the Integration Joint Board has been established as a decision
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24 making body to provide further scrutiny on matters related to finance, risk, performance and audit matters. 10. Support, Care and Clinical Governance 10.1 The Parties and the Integration Joint Board are accountable for ensuring appropriate support, care and clinical governance arrangements are in place for their duties under the Act. 10.2 The Parties remain responsible for the support, care, clinical and professional accountability of the services which the Integration Joint Board has directed the Parties to deliver and for the services delivered in respect of functions that are not delegated to the Integration Joint Board. 10.3 The Parties remain individually responsible for the assurance of the quality and safety of services commissioned from the third and independent sectors in line with the requirements set out within the strategic plan and any directions issued by the Integration Joint Board that relate to or have an impact on, integrated and non- integrated service provision. 10.4 The Integration Joint Board will have regard to the support, care and clinical framework that is set out in Section 6.6 when developing and agreeing its strategic plan and corresponding directions to the Parties. 10.5 As set out in Section 9 the Integration Joint Board will receive regular reports from professional leadership members for medical; nursing, AHPs; and Social Work to assure itself that support, care and clinical governance requirements are
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25 being met through these existing arrangements and that safe, effective person centred care is being consistently delivered. 11. Clinical and Professional Governance Framework 11.1 The Parties have in place support, care and clinical governance arrangements to provide assurance that the services that are delivered are safe, effective, person centred and focussed on personal outcomes. 11.2 The Parties recognise that the establishment and continuous review of the arrangements for support, care and clinical Governance and Professional Governance are essential in delivering their obligations and quality ambitions. 11.3 In the Health Board this is overseen by the Healthcare Quality Assurance and Improvement Committee, a committee of the Health Board which supports the Health Board in its responsibilities, with regards to issues of clinical risk, control and governance and associated assurance in the area of quality assurance and improvement through a process of constructive challenge. 11.4 The Healthcare Quality Assurance and Improvement Committee is responsible for the development of a strategic approach to quality assurance and improvement across the Health Board, ensuring that quality standards are being set, met and continuously improved for clinical activity. It ensures that effective arrangements for supporting, monitoring and reporting on quality assurance and improvement are in place and working, demonstrating compliance with statutory requirements in relation to clinical governance and authorising an accurate and honest annual
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26 clinical governance statement. 11.5 In North Lanarkshire Council the Chief Social Work Officer holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected members of North Lanarkshire Council in respect of professional social work matters. He/she is responsible for ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services Council. 11.6 The Parties are committed to developing a shared support, care and clinical governance framework for integrated services. The professional leadership of the Parties will work together to develop and agree this support, care and clinical governance framework. In the first instance this will be based on a self- assessment exercise to help identify areas of common practice, provide opportunities to learn from one another and streamline processes. 11.7 The existing process, procedures and reporting structures for support, care and clinical governance of integrated services will be reviewed in light of the agreed support, care and clinical framework. The framework will encompass the following: • Professional regulation, workload and workforce development; • Information assurance; • Service user experience and safety and quality of integrated service delivery and personal outcomes; • Person Centred Care; • Management of clinical risks; and • Learning from adverse events.
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27 11.8 Each of these domains will be underpinned by mechanisms to measure quality, clinical and service effectiveness and sustainability. They will be compliant with statutory, legal and policy obligations strongly underpinned by human rights values and social justice. Service delivery will be evidence- based, underpinned by robust mechanisms to integrate professional education, research and development. 11.9 The Parties and the Integration Joint Board will be asked to approve the framework and will then be responsible for ensuring that it is embedded within service planning, delivery and performance reporting mechanisms. The Integration Joint Board will be responsible for ensuring effective mechanisms for service user and carer feedback and for complaints handling. 11.10 The Area Clinical Forum, Managed Clinical Networks, GP Sub Committee, Area Medical Committee; Medical Staff Committee and any other appropriate professional groups, and the Adult Protection Committees will provide advice directly to the Integration Joint Board or through its professional members. 11.11 The Healthcare Quality Assurance and Improvement Committee and the Chief Social Work Officer (or his/her delegates) will provide advice, oversight and guidance to the North Lanarkshire Strategic Planning Group in respect of support, care, clinical and professional governance, for the delivery of health and social care services and to the localities identified in the strategic plan. 11.12 The Chief Officer will have access to professional advice from the Chief Social Work Officer of the local authority and the Medical Director and the Nursing Director of the Health Board in both their operational role as a senior officer of the parties
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28 and as the accountable officer to the Integration Joint Board. 11.13 Explicit lines of professional and operational accountability are essential to assure the Integration Joint Board and the Parties of the robustness of governance arrangements for their duties under the Act. They underpin delivery of safe, effective and person centred care in all care settings delivered by employees of NHS Lanarkshire and North Lanarkshire Council and of the third and independent sectors. 11.14 NHS Lanarkshire Board is accountable for Clinical Governance. Professional governance responsibilities are carried out by the professional leads through to the health professional regulatory bodies and Scottish Ministers. 11.15 The Chief Social Work Officer in North Lanarkshire holds professional accountability for social work and social care services. The Chief Social Work Officer reports directly to the Chief Executive and elected members of North Lanarkshire Council in respect of professional social work matters. He/she is responsible for ensuring that social work and social care services are delivered in accordance with relevant legislation and that staff delivering such services do so in accordance with the requirements of the Scottish Social Services Council. 11.16 The Medical Director and/or the Director of Nursing, Midwifery and Allied Health Professions, through delegated authority, hold professional accountability for the delivery of safe and effective clinical services within NHS Lanarkshire and report regularly on these matters to the Health Board. 11.17 The Integration Joint Board will have three health professional advisors. These members of the Integration Joint Board will be professionally accountable to the
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29 Medical Director and the Nurse Director as appropriate. 11.18 This arrangement does not limit the ability of the Medical Director and/or the Nurse Director to provide advice directly to the Integration Joint Board. Where this advice is offered, the Integration Joint Board must respond in writing and notify the Parties. The Chief Social Work Officer can provide advice directly through their membership of the Integration Joint Board. 11.19 The Chief Social Work Officer, through delegated authority holds professional accountability for the delivery of safe and effective social work and social care services within the Council. An annual report on these matters will continue to be provided to the relevant Council committee and will also be made available to the Integration Joint Board. 11.20 The Chief Social Work Officer will provide professional advice to the Integration Joint Board in respect of the delivery of social work and social care services by Council staff and commissioned care providers in North Lanarkshire. 12. Chief Officer 12.1 The Integration Joint Board will appoint a Chief Officer in accordance with section 10 of the Act. 12.2 The Chief Officer reports to the Council’s Chief Executive and the NHS Board’s Chief Executive. The Chief Officer’s formal contract of employment is with one of the Parties and whichever holds the contract of employment, manages the Chief Officer on a day to day basis.
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30 12.3 The Chief Officer will be operationally responsible with regards to the delivery of the delegated services (as set out in Annex 1 & 2) that do not relate to the acute medicine and Accident and Emergency services provided for within NHS Lanarkshire Hospitals. These services will continue to be operationally managed by NHS Lanarkshire, through the Director of Acute Services, in line with the Integration Joint Board’s Strategic Plan to ensure coherence across integrated and non-integrated hospital service provision. 12.4 The Acute Director will be a single point of managerial responsibility for NHS Lanarkshire hospitals. The Acute Director will provide updates to the Chief Officer on the operational delivery of integrated functions delivered within the acute hospital and the set aside budget on a regular basis. 12.5 The Chief Officer may also have responsibility for managing services that are hosted by the Integration Joint Board across North and South Lanarkshire. These arrangements will be determined by the North Integration Joint Board and the South Lanarkshire Integration Joint Board through the strategic planning process. 12.6 The Chief Officer will be a member of the Corporate Management Teams of the Health Board and Local Authority. 12.7 The Chief Officer will establish a senior management team to oversee day to day operation of the integrated services. 12.8 The Chief Officer’s objectives will be set annually. This will form the basis of the Chief Officer’s performance appraisal with the Council’s Chief Executive and the Chief Executive of the Health Board. 12.9 The Heads of Service will deputise for the Chief Officer as and when required. At
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31 the request of the Integration Joint Board the Heads of Service will carry out the functions of the Chief Officer if/when the Chief Officer is absent or otherwise unable to carry out their functions. 12.10 The Chief Officer has established and maintains effective working relationships with a range of key stakeholders across the NHS Board, the Council, the third and independent sectors, services users and carers, the Scottish Government, trade unions and relevant professional organisations. # 12.11 Current hosted services arrangements are set out in Annex 3. However, with regards to the future shaping of these services from a strategic planning perspective, the Integration Joint Board discusses with relevant neighbouring Integration Joint Boards how these are shaped now and in the future. The Chief Officer takes direction from the Integration Joint Board in respect of this. 13. Workforce 13.1 Human resource services and workforce planning information will continue to be provided by the appropriate corporate human resource functions within the Council and NHS Lanarkshire. 13.2 The Parties, with the involvement of the Chief Officer, will identify appropriate officers to develop a joint Workforce Development and Support Plan. In doing so the officers will be required to consider professional views and previous workforce modelling etc. however, there may be opportunities to adapt these plans when considering an integrated workforce. This will also have to build in consideration
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32 around Third Sector and Independent Sector capacity. The Workforce Development and Support plan will be regularly updated to ensure it remains contemporary. 13.3 An Organisational Development strategy (“OD Strategy”) will be maintained in relation to teams who will deliver integrated services. Through an intense focus on locality modelling, locality based focus groups and action learning sets, we have identified significant potential for harnessing the positivity and enthusiasm of frontline staff to achieve better outcomes for the public, the organisation and the staff. We intend to continue this process combined with other aspects of our plan which focuses on; • Integration Joint Board Development • Key Leaders Development Programme • Integrated Locality Team Development • Wider Stakeholder Development 13.3.1 In all cases, we will endeavour where appropriate, to carry out development work which is inclusive of all partners. Considerable progress has been made to develop an OD strategy, but it will need to be reviewed and revised over time. The Integration Joint Board will be given the opportunity to provide comment on the draft strategy upon its establishment. The strategy will be updated over the period of the strategic planning process. 13.4 Joint HR/OD processes have been agreed by the Parties over a number of years
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33 and many joint policies already exist which will assist in the process of integration. This integration scheme has no effect on these joint policies so, for example, any joint appointments will continue to report to one-line manager, except for the Chief Officer where different provision is made within this scheme. 14. Finance 14.1 Contributions from the Parties for delegated functions to the Integration Joint Board will be overseen by the Chief Officer and the Integration Joint Board Chief Financial Officer. They will develop a resource plan and budget based on available resources. The Integration Joint Board Chief Financial Officer will be responsible for the preparation of the annual financial statements as required by section 39 of the Act. 14.2 The Chief Officer and Chief Financial Officer will develop an integrated budget based on the Strategic Plan and present it to the parties for consideration as part of both of their annual budget setting processes. The Parties will evaluate the case for the Integrated Budget against their other priorities and will agree their respective contributions accordingly. The outcome of this work will be presented to the Integration Joint Board. Following on from the budget process, the Chief Officer and the Integration Joint Board Chief Financial Officer will prepare a financial plan supporting the Strategic Plan. 14.3 The budget will be evidenced based with transparency of assumptions including, but not limited to Pay Award, Contractual Uplift, Savings Requirements etc.
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34 14.4 The method for determining the amount set aside for hospital services will follow guidance issued by the Integrated Resources Advisory Group and be based initially on the notional direct costs of the relevant populations use of in scope hospital services as provided by Information Services Division (ISD) Scotland. The NHS Director of Finance and Integration Joint Board Chief Financial Officer will keep under review developments in national data sets or local systems that might allow more timely or more locally responsive information, and if enhancements can be made, propose this to the Integration Joint Board. If the Strategic Plan sets out a change in hospital capacity, the resource consequences will be determined through a bottom up process based on: • Planned changes in activity and case mix due to interventions in the Strategic Plan; • Projected activity and case mix changes due to changes in population need; • Analysis of the impact on the affected hospital budget, taking into account cost- behaviour i.e. fixed, semi fixed and variable costs and timing difference i.e. the lag between reduction in capacity and the release of resources. 14.5 Each partner will agree the formal budget setting timelines and reporting periods as defined in the Financial Regulations. 14.6 A schedule of notional payments will be provided by the Parties to the Integration Joint Board following the approval of the Strategic Plan and the Financial Plan. 14.7 It will remain the duty of the Local Authority Section 95 Officer and the NHS Board Accountable Officer to monitor and regulate the financial performance of their respective share of the resources available to the Integration Joint Board during each reporting period, throughout the financial year.
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35 14.8 It will be the responsibility of the Local Authority Section 95 Officer and the NHS Board Accountable Officer to comply with the agreed reporting timetable and to make available to the Integration Joint Board Chief Financial Officer the relevant financial information, including the sum set aside in line with 9.4.15, required for timely financial reporting to the Integration Joint Board. This will include such details as may be required to inform financial planning of revenue expenditure. 14.9 The frequency of reporting is set out in the Financial Regulations and will be at least on a quarterly basis. In advance of each financial year a timetable for financial reporting will be submitted to the Integration Joint Board for approval. 14.10 Regular management reports will be prepared in line with the financial regulations which will be agreed by the Integration Joint Board, and will include actual and projected outturns. The existing budgetary control frameworks adopted by each of the Parties will form the basis of generating the required information. 14.11 The Integration Joint Board Chief Financial Officer will manage the respective financial plan so as to deliver the agreed outcomes within the Strategic Plan viewed as a whole. 14.12 The Parties do not expect that there will be a schedule of cash payments, but rather annual accounting entries for the agreed budgets. There may be a requirement for an actual cash transfer to be made between the Parties to reflect the difference between the payment being made and the resources delegated to the party by the Integration Joint Board. Any cash transfer will take place at least annually. Any change to frequency will be jointly agreed by the Integration Joint Board and the Parties.
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36 14.13 The process for managing any in-year financial variations will be detailed within the Financial Regulations and are summarised below: 14.13.1 If the Integration Joint Board’s Chief Financial Officer is advised that a significant change is likely to the Integration Joint Board's overall financial position and the deviation involves a change of policy of the Integration Joint Board or results in revenue implications for future years, a report will be provided for the Integration Joint Board in good time detailing the financial consequences to enable appropriate action to be taken timeously. 14.13.2 If an overspend is forecast on either partner’s in scope budget, the Chief Officer and the Integration Joint Board’s Chief Financial Officer will aim to agree a recovery plan with the relevant partner to balance the overspending budget and determine the actions required to be taken to deliver the recovery plan. If the overspend arises from assumptions in the Integration Joint Board’s strategic plan on the impact of service changes that are not realised as anticipated this should be subject to a report and corrective action. This corrective action may include a recovery plan which should consider revisions to the commissioning of services and / or financial plans to account for the changed circumstances, and the use of any available reserves. 14.13.3 If the recovery plan is unsuccessful then the parties have the option to: • the relevant partner provides additional resources to the Integration Joint Board which is then recovered in future years from subsequent underspends in that partner’s contribution, (subject to scrutiny of the reasons for the overspend and assurance that there is a plan in place to address this) or;
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37 • the relevant partner makes additional one-off adjustment to the resources that it is making available to the Integration Joint Board. 14.13.4 Unplanned underspends that arise due to material differences between assumptions used in setting the budget and actual events effectively represent an overfunding by the Parties with respect to planned outcomes. The circumstances surrounding the action required to address unplanned underspends is set out in the Financial Regulations and Reserves Policy, which will be subject to agreement by the Parties and the Integration Joint Board. The options will include the underspend either being returned to the relevant party in year through an adjustment to their respective contributions, or maintained by the Integration Joint Board to be carried through the General Fund balance. 14.14 The Parties do not expect to reduce them in year payment to the Integration Joint Board without the consent of the Integration Joint Board and the other Party out with the following circumstances Unplanned underspends as defined above and the Financial Regulations and Reserves Policy. 14.15 Where the budget assumed a specific allocation from the Scottish Government which did not materialise in year to the extent anticipated. (The converse of this also applies in that should a specific allocation pertaining to a delegated function exceed the anticipated level, an additional payment to the Integration Joint Board may be agreed). 14.16 Monitoring arrangements will include the impact of activity on set aside budgets. 14.17 The Accounting Standards as adapted for the public sector will apply to the Integration Joint Board. The Code of Practice on Local Authority Accounting in the
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38 UK will be the applicable guidance for their interpretation. 14.18 The financial statements of the Integration Joint Board will be completed to meet the audit and publication timetable specified in regulations (Regulations under section 105 of the Local Government (Scotland) Act 1973). 14.19 Initially, recording of financial information in respect of the Integration Joint Board will be processed via the Local Authority ledger. The means for recording financial information will be reviewed by the Chief Financial Officer to ensure this method remains appropriate giving due regard to the needs of the Integration Joint Board. Should an amendment to this method be required the Chief Financial Officer will consult with both parties and present recommendations to the Integration Joint Board for approval. 14.20 The financial ledger transactions relating to the Integration Joint Board will be carried out prior to the end of the financial year with post year-end adjustments for material information only. Year-end balances and transactions will be agreed timeously in order to allow completion of the Accounts in line with required timescales. This date will be agreed annually by the Integration Joint Board and the Parties. 14.21 From an asset management and capital planning perspective, in the short term, the Integration Joint Board will not be empowered to own capital assets and the regimes of the Parties will apply to capital assets used to provide the delegated services. Ownership of assets and associated liabilities will remain with the Parties. 14.22 The Chief Officer will consider all of the resources which are required to deliver the integration outcomes including the relevant non-current assets owned by the
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39 Parties. The Chief Officer will consult with the Parties to make best use of existing resources. 14.23 Should the Integration Joint Board believe there is a requirement to develop assets in order to facilitate the delivery of the Strategic Plan’s outcomes, then the Chief Officer must present a business case to the Parties for consideration. This should be submitted as part of the partner’s capital planning process. Partnership discussion would be required at an early stage for jointly funded projects. 14.24 Detailed Financial Regulations governing the Integration Joint Board will be agreed between the Parties and approved by the Integration Joint Board before functions and resources are delegated. 15. Communication, Participation and Engagement 15.1 Communication, participation and engagement with all stakeholders is central to the development of the Integration Scheme and is stated requirements as outlined in Section 6 (2) of the Act. The stakeholders who have been directly engaged with to date include: • Health & Social Care Professionals; • Service Users & Carers; • Non Commercial Providers of Health & Social Care; • Non Commercial Providers of Housing; • Independent Sector; • Third Sector; • Staff likely to be affected by the integration; • Other Local Authorities operating within the area of the Health Board.
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40 15.2 The Parties have well-established local arrangements for involving and engaging with service users, carers, patients and communities. These have become embedded within North Lanarkshire and include the Public Partnership Forum. North Lanarkshire Integration Joint Board collaborates with the nationally recognised Third Sector Interface, and as such provides a seat on the IJB in order to develop and coordinate activity with third sector partners. 15.3 This public engagement activity will adhere to national standards for community engagement and participation. 15.4 The Integration Joint Board has an existing participation and engagement plan, supported via access to the corporate/directorate communication teams of both parties and a dedicated communications officer and support from staff who work directly in the field of community engagement/public involvement. 15.5 In preparing its strategic plan, the Integration Joint Board has established mechanisms to seek the views of key stakeholders, including a strategic planning group in accordance with the requirements of the Act. 16. Information-Sharing and Data Handling 16.1 The Parties agree to continue to operate under the existing Lanarkshire Information Sharing Protocol and the agreed procedures for sharing information, which is governed by the Lanarkshire Data Sharing Partnership (LDSP), until such time as any necessary changes are made by the process outlined below. The
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41 Lanarkshire Data Sharing Partnership Board is the key multi-agency forum with current partnership arrangements and includes representation from North and South Lanarkshire Councils, the NHS Board, Police Scotland, Fire Service and Third Sector. All staff employed by the Parties will continue to comply with all current polices and protocols with regards to information sharing. 16.2 The protocol and procedures for sharing information will be regularly reviewed and updated to reflect the new governance arrangements that pertain to health and social care by the Lanarkshire Data Sharing Partnership. The Chief Officer of the Integration Joint Board chairs the Local Data Sharing Partnership: and the revised protocol has been provided to the Parties and the Integration Joint Board. 16.3 The Lanarkshire Information Sharing Protocol is reviewed regularly by the LDSP. If the Parties or the Integration Joint Board have concerns about the Lanarkshire Information Sharing Protocol or agreement, or the processes for sharing information, they may request a review. Any such changes or amendments must be agreed by the Integration Joint Board and the Parties. 16.4 It is the intention to ensure that any resultant information sharing agreement will be established and maintained within legislative or regulatory requirements in place at that time, primarily with respect to confidentiality, data protection and privacy. 16.5 The Parties entered into an information sharing protocol (Scottish Accord on the Sharing of Personal Information – SASPI) in relation to health and social care integration, primarily to support strategic planning, commissioning and service design.
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42 17. Complaints 17.1 The Parties agree the following arrangements in respect of complaints by service users and those complaining on behalf of service users: 17.2 The Parties agree that feedback, comments, concerns and complaints should be viewed with a positive attitude and valued as feedback on service performance leading to a culture of learning from complaints. 17.3 The Parties agree the principle of frontline resolution to complaints wherever possible and have existing mechanisms in place to achieve this. 17.4 The Parties agree that irrespective of the point of contact the Parties will show a willingness to appropriately direct complaints to ensure an appropriate response. 17.5 Due to different legislative requirements the Parties agree that complaints will continue to be dealt with according to the procedures and policies in place for the Local Authority and the Health Board. 17.6 Where complaints cross the boundaries of health and social care the Parties will work together to achieve, where possible, a joint response to a complaint. 17.7 The Parties agree that complaints by patients, service users or carers will be managed and responded to by the lead organisation responsible for the delivery of the service to which the complaint refers in accordance with the procedures and policies in place for that Party, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.8 There are two established processes a complaint will follow depending on the
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43 lead organisation, these are the Statutory Social Work Complaints process; and NHS Lanarkshire’s complaints process. 17.9 These processes, together with the timescales for acknowledgement and response, are widely publicised by the respective organisations. Complaints to North Lanarkshire Council can be made through their website1 using the online form or by telephoning the Council. The arrangements for making complaints to NHS Lanarkshire Health Board are set out on their website2 or can be made by telephoning NHS Lanarkshire Health Board. 17.10 External service providers are required to have a complaints procedure in place. Where complaints are received that relate to a service provided by an external service provider the lead organisation will either arrange for investigation or refer the complainant to the external service provider for resolution of their complaint. 17.11 All complaints will be investigated and responded to according to the lead organisation’s procedure, completed within the timescales for the relevant procedure and monitored by the Chief Officer. 17.12 The Chief Officer will have an overview of complaints related to integrated functions and will provide a commitment to joint working, wherever necessary, between the Parties when dealing with complaints about integrated services. 17.13 If a complaint remains unresolved through the defined complaints-handling procedure, complainants will be informed of their right to go either to the Scottish Public Services Ombudsman for services provided by the Health Board, or to the Social Work Complaints Review Committee following which, if their complaints
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44 remains unresolved, they have the right to go to the Scottish Public Services Ombudsman for services provided by the Local Authority. 17.14 This arrangement will respect the statutory complaints-handling processes currently in place for health and social care services. This arrangement will benefit service users and carers by making use of existing complaints procedures and will not create an additional complaint handling process. 17.15 Data sharing requirements relating to any complaint will follow the Information and Data sharing protocol set in the Information and Data Handling section of this Scheme. 17.16 Relevant performance information and lessons learned from complaints will be collected and reported in line with the Support, Care and Clinical Governance section of this Scheme. 17.17 A joint performance report will be produced annually for consideration by the Integration Joint Board. 18. Claims Handling, Liability and Indemnity 18.1 The Parties and the Integration Joint Board recognise that they could receive a claim arising from or which relates to the work undertaken on behalf of the Integration Joint Board. 18.2 The Parties agree to ensure that any such claims are progressed quickly and in a manner which is equitable between them. 18.3 So far as reasonably practicable the normal common law and statutory rules
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45 relating to liability will apply, however it is also noted that decisions relating to claims and liabilities will also be subject to any requirements, obligations or conditions of any relevant insurance policies held by the Parties. 18.4 In the event of any claim against the Integration Joint Board in respect of which it is not clear which Party should assume responsibility, the Chief Officer (or his/her representatives) will liaise with the Chief Executives of the Parties (or their representatives) to determine which Party should assume responsibility for progressing the claim. 18.5 Where a claim has been settled by one of the Parties, and it thereafter transpires that liability (in whole or in part) should have rested with the other Party, then that Party shall indemnify the Party that settled the claim. 18.6 Claims regarding policy and/or strategic decisions made by the Integration Joint Board shall be the responsibility of the Integration Joint Board. For such claims, the Integration Joint Board will require to assess the need for, and if appropriate, obtain appropriate insurance cover. It may also require to engage independent legal advice. 18.7 If a claim has a “cross boundary” element whereby it relates to another Integration authority area, the Chief Officers of the Integration authorities concerned shall liaise with each other until an agreement is reached as to how the claim should be progressed and determined. 18.8 Each Party will ensure that appropriate risk financing arrangements are put in place and maintained, to meet the cost of claims and other associated costs. 18.9 Claims which pre-date the establishment of the Integration Joint Board will be dealt
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46 with by the Parties through the procedures that were in place prior to Integration. 19. Risk Management 19.1 The Parties and the Integration Joint Board have an agreed risk management strategy and methodology in relation to Health & Social Care Integration. The shared strategy and methodology ensures: • Identification, assessment, prioritisation and pro-active management of risk related to the delivery of services, particularly those which are likely to affect the Integration Joint Board's delivery of the strategic plan; • Identification and description of processes for mitigating these risks; • Mechanisms in place for risk sharing between the organisations; • Agreed reporting standards. 19.2 The risk management strategy and methodology sets out: • Roles and Responsibilities for managing risk; • How the Parties and the Integration Joint Board prepare risk registers, and arrangements to amend and update such registers; • Risks that should be reported from the date of delegation of functions and Resources; • An agreed risk monitoring framework; • An agreed risk reporting framework to senior management and those charged with governance; • An agreed process for sharing risks between partners; • The process for agreeing changes with the Integration Joint Board;
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47 • Protocols for communication and sharing risk information between the Parties. 19.3 The Parties and the Integration Joint Board will work collectively to support three risk registers: • IJB strategic register. • NHS Lanarkshire operational register for health services, as part of NHS Lanarkshire’s corporate risk processes. • NLC operational register for social work services, as part of North Lanarkshire Council’s corporate risk processes. 19.4 The Integration Joint Board regularly reviews and updates its Risk Register, with more detailed analysis through the Performance, Finance and Audit Sub Committee. 19.5 In addition to the above, the NHS Board, the Council and Integration Joint Board will consider and agree which risks should be taken from their own risk registers and placed on the shared risk register. Where these risk change, the NHS Board, the Council and Integration Joint Board will notify each other of where they have changed. This will be done formally through the risk register reports to Integration Joint Board and its Finance, Performance and Audit Sub Committee. 19.6 A risk sharing form has been agreed with both partners so that joint risks can be identified and shared timeously.
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48 20. Dispute Resolution Mechanism 20.1 In the event of a failure by the Parties to reach agreement between themselves in relation to any aspect of this Scheme or any of the duties or powers placed on them by the Act then they will follow the process laid out below: 20.2 Either Party can invoke this Dispute Resolution Mechanism by serving written notice of their intention to do so on the other Party. Such notice will be deemed to be received on the day following the issuing of the notice. The date following the issuing of the notice is herein referred to as “the relevant date”. 20.3 The Chief Executives of the Health Board and the Local Authority will meet, within 7 days of the relevant date, to attempt to resolve the issue. 20.4 If unresolved, and within 21 days of the relevant date, the Parties will each prepare a written note of their position on the issue and exchange it with the each other. 20.5 In the event that the issue remains unresolved, representatives of the Parties will proceed to mediation with a view to resolving the issue. 20.6 Within 28 days of the relevant date, duly authorised representatives of the Parties will meet with a view to appointing a suitable independent person to act as a mediator. If agreement cannot be reached, then a referral will be made to the President of the Law Society of Scotland inviting the President to appoint a person to act as mediator. The mediation process shall be determined by the mediator appointed and shall take place within 28 days of the mediator accepting appointment.
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49 20.7 Where the issue remains unresolved after following the processes outlined above, the Parties agree that they will notify Scottish Ministers that agreement cannot be reached. 20.8 The notification will explain the nature of the dispute and the actions taken to try to resolve the dispute including any written opinion or recommendations issued by the mediator. 20.9 The Parties agree to be bound by this determination of this dispute resolution mechanism.
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50 Annex 1 – Delegated Functions Part 1 Functions delegated by the Health Board to The Integration Joint Board Set out below is the list of functions that will be delegated by NHS Lanarkshire to the Integration Joint Board as set out in the Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. Functions prescribed for the purposes of section 1(8) of the Act Column A Enactment conferring function Column B Limitatio n The National Health Service (Scotland) Act 1978 All functions of Health Boards conferred by, or by virtue of, the National Health Service (Scotland) Act 1978 Except functions conferred by or by virtue of— section 2(7) (Health Boards); section 2CB( (Functions outside Scotland); of Health Boar ds
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51 section 9 (local consultative committees); section 17A (NHS Contracts); section 17C (personal services); medic al or dental section 17I (use of accommodation); section 17J (Health Boards’ power to enter into general medical services contracts); section 28A (remuneration for Part II services); section 38 children); (care of mother s an d youn g section 38A (breastfeeding); section 39 (medical and dental inspection, supervision and treatment of pupils and young persons); section 48 (provision of residential and practice accommodation);
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52 section 55 (hospital accommodation on part payment); section 57 (accommodation and services for private patients); section 64 (permission for use of facilities in private practice); section 75A (remission and repayment of charges and payment of travelling expenses);
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53 section 75B (reimbursement of the cost of services provided in another EEA state); section 75BA (reimbursement of the cost of services provided in another EEA state where expenditure is incurred on or after 25 October 2013); section 79 (purchase of land and moveable property); section 82 use and administration of certain endowments and other property held by Health Boards); section 83 (power of Health Boards and local health councils to hold property on trust); section 84A (power to raise money, etc., by appeals, collections etc.); section 86 (accounts of Health Boards and the Agency); section 88 (payment of allowances and remuneration to members of certain bodies connected with the
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54 health services); section 98 (charges in respect of non- residents); and paragraphs 4, 5, 11A and 13 of Schedule 1 to the Act (Health Boards); and functions conferred by— The National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 ; The Health Boards (Membership and Procedure) (Scotland) Regulations 2001/302; The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000/54; The National Health Services (Primary Medical Services Performers Lists) (Scotland) Regulations 2004/114;
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55 The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004; The National Health Service (Discipline Committees) Regulations 2006/330; The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006/135;
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56 The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009/183; The National Health Service (General Dental Services) (Scotland) Regulations 2010/205; and The National Health Service (Free Prescription and Charges for Drugs and Appliances) (Scotland) Regulations 2011/55. Disabled Persons (Services, Consultation and Representation) Act 1986 Section 7 (Persons discharged from hospital) Community Care and Health (Scotland) Act 2002 All functions of Health Boards conferred by, or by virtue of, the Community Care and Health (Scotland) Act 2002. Mental Health (Care and Treatment) (Scotland) Act 2003 All functions of Health Boards Except functions conferred by—
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57 conferred by, or by virtue of, the Mental Health (Care and Treatment) (Scotland) Act 2003. section 22 (Approved medical practitioners); section 34 (Inquiries under section 33: co-operation); section 38 (Duties on hospital managers: examination notification etc.); section 46 (Hospital managers’ duties: notification); section 124 (Transfer to other hospital); section 228 (Request for assessment of needs: duty on local authorities and Health Boards); section 230 (Appointment of a patient’s responsible medical officer);
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58 section 260 (Provision of information to patients); section 264 (Detention in conditions of excessive security: state hospitals); section 267 (Orders under sections 264 to 266: recall);
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59 section 281 (Correspondence of certain persons detained in hospital); and functions conferred by— The Mental Health (Safety and Security) (Scotland) Regulations 2005; The Mental Health (Cross Border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2005; The Mental Health (Use of Telephones) (Scotland) Regulations 2005; and The Mental Health (England and Wales Cross border transfer: patients subject to detention requirement or otherwise in hospital) (Scotland) Regulations 2008. Education (Additional Support for Learning) (Scotland) Act 2004 Section 23 (other agencies etc. to help in exercise of functions under this Act) Public Services Reform (Scotland) Act 2010
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60 All functions of Health Boards conferred by, or by virtue of, the Public Services Reform (Scotland) Act 2010 Except functions conferred by— section 31(Public functions: duties to provide information on certain expenditure etc.); and section 32 (Public functions: duty to provide information on exercise of functions). Patient Rights (Scotland) Act 2011 All functions of Health Boards conferred by, or by virtue of, the Patient Rights (Scotland) Act 2011 Except functions conferred by The Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012/36.
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61 Part 2- Integrated Services Services currently provided by the Health Board which are to be integrated The functions that are set out in Part 1 are delegated in relation to the services as set out below and relate to both adults and children. Interpretation 1. In this part— “Allied Health Professional” means a person registered as an allied health professional with the Health Professions Council; “general medical practitioner” means a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council; “general medical services contract” means a contract under section 17J of the National Health Service (Scotland) Act 1978; “hospital” has the meaning given by section 108(1) of the National Health Service (Scotland) Act 1978; “inpatient hospital services” means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services; “out of hours’ period” has the same meaning as in regulation 2 of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004;
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62 and “the public dental service” means services provided by dentists and dental staff employed by a health board under the public dental service contract. Services 2. Accident and Emergency services provided in a hospital. 3. Inpatient hospital services relating to the following branches of medicine— (a) general medicine; (b) geriatric medicine; (c) rehabilitation medicine; (d) respiratory medicine; and (e) psychiatry of learning disability. 4. Palliative care services provided in a hospital. 5. Inpatient hospital services provided by General Medical Practitioners. 6. Services provided in a hospital in relation to an addiction or dependence on any substance. 7. Mental health services provided in a hospital except regionally or nationally organised forensic mental health services 8. District nursing services. 9. Services provided out with a hospital in relation to an addiction or dependence on
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63 any substance Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 10. The public dental service. 11. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C (2) of the National Health Service (Scotland) Act 1978. 12. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978. 13. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978. 14. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978. 15. Services providing primary medical services to patients during the out-of-hours period. 16. Services provided out with a hospital in relation to geriatric medicine. 17. Palliative care services provided out with a hospital. 18. Community learning disability services. 19. Mental health services provided out with a hospital. 20. Continence services provided out with a hospital.
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64 21. Kidney dialysis services provided out with a hospital. 22. Services provided by health professionals that aim to promote public health. 23. Health visiting Services – denotes that this is in addition to the statutory list as outlined in points 8-23 above. 24.
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65 Annex 2 - Part 1 - Functions delegated by the Local Authority to the Integration Joint Board Set out below is the list of functions that will be delegated by North Lanarkshire Council to the Integration Joint Board. Schedule Regulation 2 Part 1 Functions prescribed for the purposes of section 1(7) of the Public Bodies (Joint Working) (Scotland) Act 2014 Column A Enactment conferring function Column B Limitatio n National Assistance Act 1948 Section 48 (Duty of councils to provide temporary protection for property of persons admitted to hospitals etc.) Section 45
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66 (Recovery in cases of misrepresentation or non- disclosure.).) The Disabled Persons (Employment) Act 1958 Section 3 (Provision of sheltered employment by local authorities) The Social Work (Scotland) Act 1968 Section 1 (Local authorities for the administration of the Act.) So far as it is exercisable in relation to another integration function. Section 4 (Provisions relating to performance of functions by local authorities.) Section 5 So far as it is exercisable in relation to another integration function.
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67 (Powers of Secretary of State.) Section 8 (Researc h.) So far as it is exercisable in relation to another integration function.
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68 Column A Enactment conferring function Column B Limitatio n Section 10 (Financial and other assistance to voluntary organisations etc. for social work.) So far as it is exercisable in relation to another integration function. Section 12 (General social welfare services of local authorities.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 12A (Duty of local authorities to assess needs.) So far as it is exercisable in relation to another integration function. Section 12AZA (Assessments under section 12A - assistance) So far as it is exercisable in relation to another integration function. Section 12AA (Assessment of ability to provide care.) Section 12AB (Duty of local authority to provide
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69 information to carer.) Section 13 (Power of local authorities to assist persons in need in disposal of produce of their work.) Section 13ZA (Provision of services to incapable adults.) So far as it is exercisable in relation to another integration function. Section 13A (Residential accommodation with nursing.) Section 13B (Provision of care or aftercare.) Section 14 (Home help and laundry facilities.) Section 27 (Supervision and care of persons put
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70 on probation or released from prisons etc.) Section 27ZA (Advice, guidance and assistance to persons arrested or on whom sentence deferred.) Section 28 (Burial or cremation of the dead.) So far as it is exercisable in relation to persons cared for or assisted under another integration function.
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71 Column A Enactment conferring function Column B Limitatio n Section 29 (Power of local authority to defray expenses of parent, etc., visiting persons or attending funerals.) Section 59 (Provision of residential and other establishments by local authorities and maximum period for repayment of sums borrowed for such provision.) Section 78A (Recovery of contributions) Section 80 (Enforcement of duty to make contributions.) So far as it is exercisable in relation to another integration function.
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72 Section 81 (Provisions as to decrees for ailment.) Section 83 (Variation of trusts.) Section 86 (Adjustment between authority providing accommodation etc., and authority of area of residence.) The Local Government and Planning (Scotland) Act 1982 Section 24(1) (The provision of gardening assistance for the disabled and the elderly.)
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73 Health and Social Services and Social Security Adjudications Act 1983 Section 21 (recovery of sums due to local authority where persons in residential accommodation have disposed of assets.) Section 22 (Arrears of contributions charged on interest in land in England and Wales) Section 23 (Arrears of contributions secured over interest in land in Scotland) Disabled Persons (Services, Consultation and Representation) Act 1986 Section 2 (Rights of authorised representatives of disabled persons.)
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74 Column A Enactment conferring function Column B Limitatio n Section 3 (Assessment by local authorities of needs of disabled persons.) Section 7 (Persons discharged from hospital.) In respect of the assessment of need for any services provided under functions contained in welfare enactments within the meaning of section 16 and which have been delegated. Section 8 (Duty of local authority to take into account abilities of carer.) In respect of the assessment of need for any services provided under functions contained in welfare enactments (within the meaning set out in section 16 of that Act) which are integration functions. The Adults with Incapacity (Scotland) Act 2000 Section 10
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75 (Functions of local authorities.) Section 12 (Investigatio ns.) Section 37 (Residents whose affairs may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 39 (Matters which may be managed.) Only in relation to residents of establishments which are managed under integration functions. Section 40 (Supervisory bodies.) Section 41 (Duties and functions of managers of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 42 (Authorisation of named manager to withdraw from resident’s account.) Only in relation to residents of establishments which are managed under integration functions Section 43 Only in relation to residents of
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76 (Statement of resident’s affairs.) establishments which are managed under integration functions Section 44 (Resident ceasing to be resident of authorised establishment.) Only in relation to residents of establishments which are managed under integration functions Section 45 (Appeal, revocation etc.) Only in relation to residents of establishments which are managed under integration functions
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77 Column A Enactment conferring function Column B Limitatio n The Housing (Scotland) Act 2001 Section 92 (Assistance to a registered for housing purposes.) Only in so far as it relates to an aid or adaptation. The Community Care and Health (Scotland) Act 2002 Section 4 The functions conferred by Regulation 2 of the Community Care (Additional Payments) (Scotland) Regulations 2002 Section 5 (Local authority arrangements for of residential accommodation out with Scotland.)
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78 Section 6 Deferred payment of accommodation costs.) Section 14 (Payments by local authorities towards expenditure by NHS bodies on prescribed functions.) The Mental Health (Care and Treatment) (Scotland) Act 2003 Section 17 (Duties of Scottish Ministers, local authorities and others as respects Commission.) Section 25 (Care and support services etc.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 26 (Services designed to promote well- Except in so far as it is exercisable in relation to the provision of housing support services.
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79 being and social development.) Section 27 (Assistance with travel.) Except in so far as it is exercisable in relation to the provision of housing support services. Section 33 (Duty to inquire.) Section 34 (Inquiries under section 33: Co- operation.) Section 228 (Request for assessment of needs: duty on local authorities and Health Boards.)
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80 Column A Enactment conferring function Column B Limitatio n Section 259 (Advocac y.) The Housing (Scotland) Act 2006 Section 71(1)(b) (Assistance for housing purposes.) Only in so far as it relates to an aid or adaptation. The Adult Support and Protection (Scotland) Act 2007 Section 4 (Council’s duty to make inquiries.) Section 5 (Co-operation.) Section 6 (Duty to consider importance of providing advocacy and other.)
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81 Section 7 (Visits) Section 8 (Interview s) Section 9 (Medical examinations) Section 10 (Examination of records etc.) Section 11 (Assessment Orders.) Section 14 (Removal orders.) Section 16 (Right to remove adult at risk)
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82 Section 18 (Protection of moved persons property.) Section 22 (Right to apply for a banning order.) Section 40 (Urgent cases.) Section 42 (Adult Protection Committees.)
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83 Column A Enactment conferring function Column B Limitatio n Section 43 (Membershi p.) Social Care (Self-directed Support) (Scotland) Act 2013 Section 3 (Support for adult carers.) Only in relation to assessments carried out under integration functions. Section 5 (Choice of options: adults.) Section 6 (Choice of options under section 5: assistances.) Section 7 (Choice of options: adult carers.) Section 9 (Provision of information about self-
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84 directed support.) Section 11 (Local authority functions.) Section 12 (Eligibility for direct payment: review.) Section 13 (Further choice of options on material change of circumstances.) Only in relation to a choice under section 5 or 7 of the Social Care (Self- directed Support) (Scotland) Act 2013 . Section 16 (Misuse of direct payment: recovery.) Section 19 (Promotion of options for self- directed support.) Carers (Scotland) Act 2016 (b)
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85 Section 6 (Duty to provide Adult carer support plan) Section 21 (Duty to set local eligibility criteria)
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86 Column A Enactment conferring function Column B Limitatio n Section 24 (duty to provide support) Section 25 (provision of support to carers: break from caring) Section 31 (duty to prepare local carer strategy) Section 34 (information and advice service for carers) Section 35 (short breaks services statements)
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87 Part 2 -Services currently provided by the Local Authority which are to be integrated The services that pertain to the functions in Part 1 and will be delegated are set out below. Social work services for adults and older people The functions in relation to social work services for adults and older people noted below will be delegated. a) Services and support for all adults with disabilities and long term conditions; b) Mental health services; c) Addiction services; d) Adult protection; e) Carers’ services; f) Community care assessment and planning services; g) Support services provided by contracted services;
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88 h) Care home services; i) Intermediate Care Services; j) Health and wellbeing improvement services; k) Aspects of housing support, including provision of equipment and adaptations to people’s homes; l) Day opportunities and day services; m) Homecare Services; n) Supported Living Services; o) Respite Support; p) Occupational therapy services; q) Re-ablement services; r) Smart technology, equipment and telecare.
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89 Annex 3 – Hosted Services Arrangements Hosted Services Proposed Arrangements between North and South Lanarkshire Integration Joint Board. Where a Health Board spans more than one Integration Joint Board, one of them might manage a service on behalf of the other(s). This Annex sets out those arrangements which the Parties wish to put in place. Such arrangements are subject to the approval of the Integration Joint Board but will not be subject to Ministerial approval. Services to be hosted by the South Lanarkshire Integration Joint Board Services to be hosted by the North Lanarkshire Integration Joint Board Community Dental Services Care Home Liaison Diabetes Community Children’s Services Health and Homelessness Paediatrics Palliative Care Dietetics Primary Care Out of Hours Mental Health and Learning Disability Traumatic Brian Injury Psychology Occupational Therapy Continence Services
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90 Physiotherapy Podiatry Sexual Health Speech and Language Substance Misuse Prisoner Health Care
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91 Annex 4 – Health and Wellbeing Outcomes Outcome 1- People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 2- People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. Outcome 3- People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4- Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5- Health and social care services contribute to reducing health inequalities. Outcome 6- People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.
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92 Outcome 7 – People who use health and social care services are safe from harm. Outcome 8- People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Outcome 9 – Resource are used effectively and efficiently in the provision of health and social care services.
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1 REPORT Item No: 17 SUBJECT: North Support Care & Clinical Governance (NSCCG) 6monthly healthcare Quality Assurance & Improvement Committee (HQAIC) Report TO: Integration Joint Board Lead Officer for Report: Dr Lucy Munro Medical Director NHSCP Author(s) of Report Dr Lucy Munro Medical Director NHSCP Stacey Connor Governance Support Manager DATE: 22 November 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: ☐ HQAIC group on 9th November 2023 3. RECOMMENDATIONS 3.1 The committee is asked to note the update from the Support Care and clinical governance committee. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The arrangements for Support, Care and Clinical Governance within Health and Social Care North Lanarkshire (HSCNL) build on well-established prior arrangements within NHS and NLC but bring processes together to receive assurance from both Health and Social work clinical services. 5.2 The group meets bi monthly and works to a work plan to allow service areas to report in routinely and to offer assurance. Part of the governance framework for the group it to provide a 6 monthly and yearly report to the HQAIC. 5.3 When drafting the report concerns were identified around the number of outstanding incidents within the holding area of Datix and also with outstanding actions from completed Significant Adverse Event Reviews (SAERs). The governance team within Kirklands undertook a deeper dive to understand and develop an action plan to manage this going forward. 5.4 For the holding area incidents when the report was submitted 212 incidents were in the holding area waiting to be approved up to 20th October 2023. Now there are 109 incidents –the oldest reported incidents are from 1st February 2023. The majority of incidents sit within mental health services this is linked to there being a number of staffing changes within the service and resultant issues with IT permissions for datix. Emails have been sent to incident holders individually and the numbers continue to reduce as a result of this. Going forward the holding area will be reviewed routinely by the different governance managers across the partnership. 5.5 In relation to the outstanding action from completed SAERs, when the report was submitted 238 actions were overdue; there are now 208 outstanding actions. The reduction in actions has been due to record cleansing allowing for duplicate actions to be closed. A tracking list is being established to monitor actions and a part of this will included gathering evidence to allow previous actions to be closed off. On undertaking a deeper dive the true number of outstanding SAER actions is 54, as actions are monitored since April 2021, the other outstanding actions were prior to this date. The team are prioritising closing the current 54 actions and then will look to cleanse the older actions. The adverse group are in the process of developing a standard operation procedure so that there is a clear process to offer assurance that actions have been completed after reviews. 6. CONCLUSIONS 6.1 The IJB is asked to note the 6 monthly progress report from the North support care & clinical governance group and to be assured that processes are being established to manage the key issues outlined.
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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. The committee routinely review level 2 and level 3 risk registers to identify any areas for escalation. 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: EQIA added to website: Yes ☐ No ☐ N/A ☒
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5 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 NSCCG HQAIC 6 monthly report 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; Dr Lucy Munro Lucy.Munro@lanarkshire.scot.nhs.uk Yes / Date added ☐ No ☐ N/A ☒
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6 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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7 31 3 299 86 1358 0 200 400 600 800 1000 1200 1400 1600 Incidents by Severity 272 249 294 249 278264 312 351352 326 370 293 309 332317 277 327 275 303 321 274 0 50 100 150 200 250 300 350 400 Jan 2022 Feb 2022 Mar 2022 Apr 2022 May 2022 Jun 2022 Jul 2022 Aug 2022 Sep 2022 Oct 2022 Nov 2022 Dec 2022 Jan 2023 Feb 2023 Mar 2023 Apr 2023 May 2023 Jun 2023 Jul 2023 Aug 2023 Sep 2023 X-axis Appendix 1 Governance group or area being reported on: North Support Care & Clinical Governance Lead: Dr Lucy Munro North HSCP Medical Director Item No: Author: Stacey Connor Governance Support Manager Dr Lucy Munro North HSCP Medical Director Date: 20/10/23 1.1 All Incidents Recorded on Datix (1st Januarys 2022-30th September 2023) 1.2 Total Adverse Events Recorded by Grading (1st April 2023-30th September 2023)
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8 1.3 Top Ten Recorded Incidents Between 1st April 2023-30th September 2023 1.4 On Going SAER Investigations Datix Reference Service Speciality Incident Date Description Comments WEB280206 Mental Health CMHT 23/03/2023 Self Harm 4 week extension granted until 9/9/23 2 week extension granted until 23/9/23 6 week extension dye to GGC colleagues 4/11/23 WEB282077 Mental Health Non NHS Premise 20/06/2023 Self Harm D&G are lead on this so our timeline doesn't count for this one. We have an NHSL rep and kept in the loop via her.
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9 We will hear from them when this review is complete. WEB282090 Mental Health CMHT 23/02/2023 Self Harm WEB282154 Mental Health Psychological Therapies Team 26/06/2023 Self Harm Extension requested due to the nature of this case, along with staff sickness which has resulted in a delay with meetings between the Team. 4 weeks granted due 23/10/23 WEB280290 Mental Health Wishaw General Hospital 21/05/2023 Fall Extension requested due to the Lead Reviewer been off -2 weeks due 17/10/23 WEB282548 Children's Motherwell Health Centre 30/01/2023 Medication Overdose Extension granted until 29/10/23- WEB282553 Mental Health Non NHS Premise 07/06/2023 Self Harm Questions raised by commissioners before sign off WEB276146 Children's CAMHS 17/02/2023 Self Harm 2/8/23- Difficulties seeking review team lead noted by commissioners 28/8/23 GM team lead asked about extension advised wait nearer date. 27/9/23- 4
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10 week extension granted until 2nd Nov WEB283061 Mental Health CMHT 24/06/2023 Self Harm WEB283792 Mental Health CMHT 24/07/2023 Potential Self Harm Questions raised by commissioners before sign off WEB283703 Prison HMP Shotts 01/08/2023 Prisoner Death WEB283869 Mental Health CMHT 14/07/2022 Self Harm WEB283873 Mental Health CMHT 20/07/2022 Self Harm Extension requested due to outstanding information from the Pharmacist which is key to having within this review 2 weeks granted 18/11/23 WEB284315 Prison HMP Shotts 14/08/2023 Prisoner Death WEB280396 Mental Health CMHT 12/05/2023 Child Death Had an initial due date of by CAMHS 19/08 Informed on 10.08.2023 should sit with Adult Mental Health . An extension will be requested. Mental Health requested SAER on 18/08/2023 - commissioned a SAER on 18/08/2023
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11 with clock start date of 18/08/2023 WEB284898 Mental Health Psychotherapy 22/08/2023 Self Harm WEB286354 Mental Health Adult Community Mental Health Team 18/09/2023 Self Harm WEB285914 Mental Health Addiction Recovery Team 12/08/2023 Not confirmed WEB287269 Mental Health Larkhall CMHT 30/09/2023 Suspected Overdose 19 2.1 Category 1 and Category 2 Moderate adverse events 1st April 2023- 30th September 2023 The information below is specific to commissioned and completed reviews where the clock start date was between 1st April 2023-30th September 2023. The clock start date is the date of incident and/or date of notification of the incident. There were 20 SAER reviews commissioned and signed off within this period. There are a further 11 SAER reviews which are still on going. There were 10 reviews commissioned and completed between January 2022-31st August 2022 as a comparison, as follows: 6 Extended Briefing Note Reviews 4 SAER’s The Causation Codes were recorded as below for the completed SAERs: Causation Code Numbers 1 - Appropriate care, well planned and delivered 7 2 – Issues identified but they did not contribute to the event 11
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12 3 – Issues identified which may have caused or contributed to the event 1 4 – Issues identified that directly related to cause the event 1 Other Category 1 incidents recorded during this period have been assigned/commissioned outwith the Adverse Event process: 7 Child Death Reviews 2 SUDI Reviews 3 Child Protection/Police Review 1 Local Learning Review All commissioned reviews are regularly monitored. 2.2 Incidents in Holding Area Awaiting Approval There are currently 212 incidents in the holding area waiting to be approved up to 20th October 2023. 150 are overdue (10 days past the date the incident was recorded). This becomes an issues as it means that incidents can be overlooked and not investigated. The North HSCP Governance Team has been working closely with the sector/unit Performance & Governance managers to try to reduce the delays in approving as this can result in missed opportunities to take immediate action and prevent a similar event occurring. Teams are encouraged to ensure that they have sufficient people nominated to approve incidents to cover periods of leave. 2.3 Adverse Event System Audit The North Governance Team continually monitors incidents recorded in Datix to ensure incidents are accurate and kept updated in line with the Adverse Event Policy. Some of the issues monitored are: Incidents in the holding area waiting to be approved Causation Code Name of Review Team Lead Action plan uploaded Action plans not updated Notepad/Progress Notes are updated Risk Facilitator section of Datix completed Incidents in the Holding area are approved timely
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13 Category 2 Moderate events are correctly graded in line with risk matrix. Incidents confirmed as Category 2 Moderate are escalated, a Briefing Note completes and submitted to the commissioners for consideration of review. The review checklist and shared learning templates have now been agreed and endorsed. Both documents should be attached alongside the completed review when submitted to the commissioners. All documents should also be uploaded to Datix for audit purposes. 3.0 OUTCOMES 3.1 Category 2 Moderate Adverse Events In line with the Adverse Event Policy, any incident graded as Category 2 Moderate should have a briefing note completed and submitted to the commissioners for consideration of further review. The chair of the group asked for a report outlining the position of the adverse events recorded and approved as Category 2 Moderate which was submitted at the last meeting. The incidents were forwarded on to the General Managers who were asked to take the appropriate action, incidents are being followed up and actioned. 3.2 Duty of Candour There was 1 Duty of Candour incident recorded on Datix during this period; it relates to a SAER commissioned within mental health. Annual duty of candour reports are available on first port: Annual Report 3.3 Actions from Significant Adverse Event Reviews/Briefing Note Reviews There are a total of 238 actions recorded on Datix from adverse events since 1st April 2021. 125 actions have been completed 5 action are delayed 107 actions have no status/progress recorded 3.4 Shared Learning Below is the link to the NHS Lanarkshire Learning Bulletin 11th Edition 11th Edition October 2023 3.5 Claims Since April 2021, there has been 9 claims intimated to NHSL, which are directly linked to adverse events that occurred within H&SC North Lanarkshire; Web175207/Claim1957 The patient sustained a significant head injury as a result of equipment falling on the patient.
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14 This claim was settled on 6th July 2021. Web209555/Claim1982 A member of staff sustained an injury following a patient assault. This claim is pending as at 5th October 2021. Web193571/Claim2012 Child death This claim is pending as at 5th April 2022 Web196649/Claim 2056 Poor Care Resulting in Sepsis The claim is pending as at 22nd November 2022 Web200495/Claim 2060 Failure to put patient on constant observation resulting in suicide The Claim is pending as at 22nd November 2022 Web215052/Claim 2064 Suicide after absconding from hospital The Claim is pending as at 22nd November 2022 Web Not Known/Claim 2066 Nerve Damage following Covid vaccination given into wrong area The Claim is pending as at 22nd November 2022 Web232421/Claim 2080 Care Received in Paediatrics (Patient Died) The Claim is pending as at 15th March 2023 WEB211114 /Claim 2112 Suicide - failures in care The claim is pending as at 27th July 2023 3.6 Fatal Accident Inquiries
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15 There are five notifications for forthcoming FAIs. All the incidents relate to the Prison Service and have completed reviews. • Web198446 - LB3/299 BC (July 2021) – FAI Complete with no recommendations for NHSL • Web204841 - LB3/291 JC (July 2021) • Web209787 - LB3/302 PJC (October 2021) • Web191247 - LB3/283 RA (July 2021) • Web220967 - HM21005653 WC (October 2022) • Web223681- LB3 313- MB (July 2021) • Web222395– LB3 313-JG (July 2021) • Web219314LB313 T (April 2021) 4.0 Quality of Support and Care The Child Death Review programme reported to the North SCCG (on behalf of Public Health) until 2nd August 2023. This has now moved formally to Public Health governance and no longer sits within North structures. Mental Health Service Position statement was presented to the group to provide an update after a FAI report (WEB128082), synopsis of outstanding key points relating the FAI report is appended under Appendix 1. Kylepark staffing issues was reviewed and considered by the group which led to a risk being created on the level 3 register. Medical vacancy issues across the partnership were reviewed and a risk added to the level 2 risk register. SBAR update on escalated health cases from Child protection audit was noted by the group and escalated through the appropriate governance groups. Sexual health SBAR was reviewed by the group to request more call handlers in the service, no clinical concerns were raised by the group and the SBAR was approved by the North core management meeting. True North engagement event was held to define in-year True North actions; a further event is planned for early 2024. Violence and aggression are the highest cause of adverse events in datix, work is underway to split those into ‘stress and distress’ events and intentional aggression/ violence to aid learning and actions. Director of nursing has commissioned a deep dive into pressure ulcers due to an increase in Datix incidents. HMIPS have undertaken a follow up visit to HMP Shotts and are content with progress against the improvement action plan. There has been an increase in SAERs since this time last year and have started work to get a full understand of this, increased capacity is being created for SAERs. There has been one category 4 event due to an inadequate frequency of patient review and a failure to recognise a deteriorating patient. The SAER team met with the patient’s family twice, apology given and outstanding questions answered. Family
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16 appreciative of the candour. Action plan for improvement created and in train, team being supported. Comments on variation from plan (where exists): There was some variation to the work plan for mental health reporting to allow this to align to local reporting arrangements. Risks and issues: Clinical risks on the level 2 and 3 register are reviewed at every meeting by the group. At the last North SCCG meeting it was agreed to move to a dashboard report for risk in future in line with the NHS Board reporting arrangements. As noted above a new risk for Kylepark staffing has been created on the level 3 register- this was initially scored at 20 likenesses but through mitigations of recruiting staff on a more permanent basis this has reduced to 15 moving from a very high risk to high. Actions planned for next reporting period: Date completed: New chair engagement meetings with chairs of the group in the sectors and units to support corporate listening and direction setting particularly in terms of integrated environment. Enhanced social work working. Current work plan (Appendix 2) is until December 2023 and new work plan is in progress due to changes of timing of some social work reports. Actions required from HQAI Committee: To identify any gaps, enhancements or removals in the report which we need to address
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17 Appendix 1 Significant Adverse Event Review Datix Ref: WEB 128082 / Healthcare Improvement Scotland Ref: 0615020 Summary of actions based on comments from FAI report, March 2023 DVLA guidance (ECT) Royal College of Psychiatrist patient information leaflets are completed as part of delivery of care and treatment in relation to ECT. The National review of the ECT Clinical standards will embed assurance that this has been completed. New standards developed nationally for ECT in 2022 have been mapped against current NHS Lanarkshire practice for assurance around on-going routine care. ECT and medication management ECT and medication-related issues are standard areas covered in the national training process for psychiatrists. The requirement for medication post-ECT is assessed clinically and using standard rating tools for mood and clinical improvement. Dedicated psychology input onto wards This has been put into place to aid access to Psychology in each of the adult inpatient areas. MORSE This electronic clinical record system is now embedded across all adult inpatient areas, supporting accurate, timeous clinical record keeping and multi-disciplinary team working. All medical staff have access to the shared electronic case-records on the MORSE system (rolled out across all inpatient areas November 2021), including locum medical staff. All inpatient care information is therefore available to all involved medical staff both within hours and during out of hours and unscheduled care settings. Nutritional needs All patients have a MUST assessment on admission, and weekly weights are measured with a focus on the accumulative weight gain or loss and escalation where required, under the overarching Food, Fluid and Nutrition Steering Group Medical record-keeping audit There is an annual record-keeping audit for all medical staff that is passed to the Clinical Quality department for analysis. Results are shared with medical staff and management/governance groups for learning. This is currently under review to ensure best fit with electronic recording systems. Review and improve protocols for family involvement in care
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18 The MH Management Team will coordinate each care group and service to agree a baseline set of standards aligned to ‘Triangle of Care’ for their patient group in order to meet the aim for all MH, LD & Addiction Services to support person centred care by improving and evidencing family & carer engagement and involvement, as part of the “True North” process to improve quality assurance.
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19 Report Person Reporting Contact for Report Notes Comments 31/01/2023 05/04/2023 22/06/2023 02/08/2023 03/10/2023 06/12/2023 MH/LD & Addictions Adam Brodie Adam Brodie Carrie Dickie Bi monthly x x x x Specialist Children's Health Services Adrienne Sullivan Julie Arthur Dawn Simpson Bi monthly x x x Adult Health Services Rashmi Ronghe Caroline Martin Rashmi Ronghe Bi monthly x x x Adult Social Work Raymond Taylor Raymond Taylor Bi monthly x x x North East Sector Update Sharon Murray David Barr Dawn Simpson Bi monthly x x x North West Sector Update Dr Claire Doran Lynne Brown Bi monthly x x x Infection Control Update Lyndsay Quarrell Clare Penrice Every x x x x x x North Hygiene Group Minutes Sharon Murray Sharon Murray Every x x x x x x Safety Plan Steering Group Jamie Quin Jamie Quin 6 weekly link to meetings x x Social Work Complaints Maria Williamson Maria Williamson April Q1, Mid July Q2, Mid Oct Q3, Mid Jan Q4 x Annual Report x x Health Complaints Valerie Fisher Valerie Fisher Every Adverse Events Reporting Stacey Connor Stacey Connor Every x x x x x x Public Protection Report Ann Marie Sangster Ann Marie Sangster Every x x x x x x Adult Protection Heather Irving Heather Irving Every x x x x x x Child Death Review Karen McGuigan Gemma Laird Bi monthly Removed from Octo to report to Public Health Gov meeting x x Health Technologies Assessment Briefings Lucy Munro Alison Slamin Only when require sign off Inspection Reports e.g. MWO, CI All All Ad Hoc South Support Care and Clinical Governance Minutes Lucy Munro Kayleigh MacLeod Every x x x x x x HQIAC Minutes Lucy Munro Margaret Angus Every x x x x x x Adult Health & Social Care Committee Minutes Lucy Munro Mars Website Every x x x x x x Acute Clinical Governance & Risk Management Committee Minutes Lucy Munro Nicola McCulloch Every x x x x x x Level 2/3 Risks Lucy Munro Stacey Connor Every x x x x x x Appendix 2
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1 REPORT Item No: 18 SUBJECT: Climate Change Reporting 2022-2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager DATE: 22 November 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: ☐ This paper has been prepared by Stacey Anderson, Service Support Project Manager.
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7. IMPLICATIONS 2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB review and agree the content of the Climate Change Duties Compliance Reporting template for 2022-2023 prior to its submission. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Mandatory reporting legislation in relation to Climate Change came into force in 2015 with the IJB, as a public body, required to report annually on compliance with climate change duties. The relevant legislation is the Climate Change (Duties of Public Bodies; Reporting Requirements) (Scotland) 2015 and the associated amendment order of 2020. 5.2 North Lanarkshire IJB has complied in full with reporting requirements since the enactment of the legislation. Further guidance specific to IJBs was issued by the Scottish Government for the 2022-2023 reporting period. This guidance relates to areas that NL IJB report on, including the structure of the IJB and its links to the bodies it is in partnership with. There is also a requirement to report on net zero targets and climate resilience and therefore links to the reports submitted by North Lanarkshire Council and NHS Lanarkshire, the bodies with responsibilities in these areas have been made within the NL IJB Climate Change Duties Compliance report. 6. CONCLUSIONS 6.1 The responsibility to enact measures to directly address climate change rests with NLC and NHSL. 6.2 The IJB’s Compliance with the 2022/2023 Climate Change reporting requirements necessitates submission of the attached report by 30 November 2023.
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3 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 ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION
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4 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 ☒ EQIA added to website:
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5 Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS 8.1 NHS Lanarkshire Sustainability and Climate Change Policy Sustainability-and- Climate-Change-Policy | NHS Lanarkshire (scot.nhs.uk) 8.2 North Lanarkshire Council Plan ACT2030 https://www.northlanarkshire.gov.uk/your-council/council-strategies-and- plans/council-strategies/climate-plan-act2030 9. APPENDICES Error! Not a valid bookmark self-reference.Appendix 1– Public Bodies’ Leadership on Global Climate Emergency Letter, Mairi McAllan MSP, May 2023. Appendix 2– Public Bodies Climate Change Duties Compliance Reporting 2022- 2023. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 202311-18 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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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Appendix 1 Cabinet Secretary for Net Zero and Just Transition Màiri McAllan MSP T: 0300 244 4000 E: scottish.ministers@gov.scot Council Leaders and Chief Executives Chairs and Chief Executives of Public Bodies University and College Chairs and Principals Regional Transport Partnerships Chairs and Leads May 2023 PUBLIC BODIES’ LEADERSHIP ON THE GLOBAL CLIMATE EMERGENCY I am delighted to be writing to you as Cabinet Secretary for Net Zero and Just Transition. I invite you to join me and public sector leaders at the Sustainable Scotland Network (SSN) virtual Conference on 24 May where we will be sharing experiences of the public sector’s central role in action on the global climate and environmental emergency. If you can spare some time to join the event personally at some point through the day your support would be greatly appreciated. As the Leaders, Chairs and Chief Executives of the Scottish public sector, I wish to convey my deep thanks for your commitment and achievement to date in playing your part in Scotland’s national endeavour on climate change. Scotland’s Councils, NHS Scotland, our universities and colleges, Scottish Water, and the wide range of public bodies strongly recognise the climate emergency. You are setting increasingly ambitious targets. You are steering major budgets to deliver net zero objectives - for example NHS Scotland’s capital budget, and the Scottish Government and local authorities jointly funded £2 billion Learing Estate Investment Programme. You are beginning to tackle the challenge of indirect and supply chain emissions. Importantly, you are demonstrating that the public sector is a centre of collaboration and best practice. I want to particularly thank you all for the excellent response to last year’s statutory climate change reporting round, with reports received from 100% of the public bodies legally required to report. Accountability is important, and you have demonstrated the sector’s strong commitment to reporting on actions and sharing experience. I hope we can work together to help you repeat this full compliance at the next reporting deadline on 30 November.
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot The analysis of last year’s reports shows that reported Scope 1 and Scope 2 emissions from Scotland’s public bodies have reduced by almost a third over the seven years since mandatory reporting began in 2015. Within that overall headline, we know that some public bodies have gone much further in delivering emissions cuts from their operations. This year we asked you for the first time to report on your net zero targets. I am impressed at the strength of many of the commitments to delivering net zero and climate resilience that are emerging from the public sector in Scotland. We need to translate those increasingly strong commitments into action, particulary over the next decade. As you know, the Bute House Agreement commits us to decarbonise heat in public buildings by no later than 2038 for the most difficult buildings such as hospitals – our £200m Green Public Sector Estate Decarbonisation Scheme can begin to help with that. To make the progress we need will require leaders to take challenging decisions over public sector priorities and budgets. The public sector can make a very meaningful contribution to national targets by cutting direct operational emissions, helping us reduce or delay the ask of individual members of the public. Decarbonising the £13 billion public sector supply chain is a key challenge, but we have found from our experience on City Deal and other projects that in many cases simply “asking the climate change question” of suppliers can deliver meaningful carbon savings. And of course, Scotland’s public sector needs to be in the forefront of delivering services which are resilient to the impacts of climate change. Capacity and skills are big challenges. The Scottish Government, Scotland’s Councils, NHS Scotland and NatureScot are co-funding the Sustainable Scotland Network as the key forum for collaboration and sharing experience and best practice by public bodies. I hope you can join us at our Annual Conference on the 24 May and I look forward to working closely with you on ensuring Scotland plays its part in tackling the global climate and environmental emergency. Màiri McAllan
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9 Appendix 2 Public Bodies Climate Change Duties Compliance Reporting Template 2022/23 1. Overview 2. Guidance 1. The "Profile of Body" tab must be completed before proceeding to add any other data. 2. Question 1f must be completed to ensure the correct emission factors are applied in Q3b. 3. If you need to add more rows in any table please email the file to ccreporting@ed.ac.uk 8. More detailed reporting guidance is available on the SSN website. 3. Colour Coding used in the template This template is provided for public bodies required to report annually in accordance with the Climate Change (Duties of Public Bodies Reporting Requirements) (Scotland) Order 2015, as amended by the Climate Change (Duties of Public Bodies: Reporting Requirements) (Scotland) Amendment Order 2020 which took effect for reporting periods commencing on or after 1 April 2021. Dropdown box - select from list of options Uneditable/fixed entry cell Editable cell Reports must be submitted to ccreporting@ed.ac.uk by 30th November. Late submissions will not be accepted for analysis and may be deemed non-compliant with Public Bodies Duties reporting requirements. 4. More emission factors from the UK Government (DESNZ) release have been included this year. When completing Q3b you can filter by the Emission Type dropdown in column C. 5. Please only use the "Other" emission source rows (130 onwards) when there is no relevant emission source in the dropdown lists or if you have bespoke data/emission factors. Please provide a brief explanation in the comment field. 6. The water supply and sewage emission factors are based on Scottish Water's carbon intensities of service supply, one of the lowest in the UK water industry. If you still wish to use the UK DESNZ (formerly BEIS) factors (which are more than double) you will need to enter consumption data in an "Other" row. 7. Some auto-checks have been added to improve the quality of data entries, e.g. correct emission scopes where only one category ever applies.
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10 PART 1 Profile of Reporting Body 1a Name of reporting body Provide the name of the listed body (the "body") which prepared this report. North Lanarkshire H&SCP- IJB 1b Type of body Select from the options below Integration Joint Boards 1c Highest number of full-time equivalent staff in the body during the report year 0 THIS MUST BE COMPLETED 1d Metrics used by the body Metric Units Value Comments Please select from drop down box Metric not specific to North Lanarkshire IJB. Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) 15 Other (please specify in comments) 1e Overall budget of the body Specify approximate £/annum for the report year. Budget Budget Comments £764,000,000 Broken down - North Lanarkshire council - £188.180m, National Set Aside £69.120m and NHS North Lanarkshire 506.968m 1f Report type Specify the report year type Report type Report year comments Financial March 22- April 23 THIS MUST BE COMPLETED 1g Context Public Sector Report on Compliance with Climate Change Duties 2023 Template Specify the metrics that the body uses to assess its performance in relation to climate change and sustainability. Provide a summary of the body's nature and functions that are relevant to climate change reporting. In line with the Public Bodies (Joint Working) (Scotland) Act 2014 and further than the minimum requirements, the strategic planning and monitoring of services set out in North Lanarkshire's (NL) Intergration Joint Board (IJB) Integration scheme have been delegated by the Council and the Health Board to the NL IJB, which then directs the Council and Health Board to deliver these services in line with its Strategic Plan and defined level of financial resources. Most services are provided for the people of North Lanarkshire, however, some services cover the entire the entire NHS Lanarkshire Board area, (for example, Mental Health and Learning Disability services, specialist children's health services, sexual health services, podiatry and dietetics.) The resident population of North Lanarkshire is 341,140 and NHS Lanarkshire is 664,030 (NRS population estimates.) The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies; North Lanarkshire Council and NHS Lanarkshire. A key responsibility for the IJB is to build a performance reporting framework and produce annually a performance report in relation to the Strategic Commissioning Plan. From an operational and performance management perspective, the IJB will receive regular reports from the Chief Officer and other responsible officers of North Lanarkshire Council and NHS Lanarkshire on the delivery of integrated services and will issue directions in response to those reports to ensure improved performance. The IJB, through the representation of the Chief Officer is a key partner of the Community Planning Partnership. Through this process the IJB will also demonstrate its contribution to Community Planning in a Health and Care context. All buildings are shared facilities between North Lanarkshire Council and NHS Lanarkshire and Carbon Emissions from these buildings are reported through the Council and NHS Lanarkshire's Climate Change duties reporting. It has been agreed with both the Council and NHS Lanarkshire that they will report on any emissions to avoid double counting.
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11 2e Provide the name of any such document and the timeframe covered. Topic area Name of document Link Time period covered Comments Adaptation Please see corresponding North Lanarkshire Council and NHS Lanarkshire Climate Change Duties report. Business travel Staff Travel Energy efficiency Fleet transport ICT Renewable energy Sustainable/renewable heat Waste management Water and sewerage Land Use Other (please specify in comments) Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2f What are the body’s top 5 priorities for climate change governance, management and strategy for the year ahead? Provide a brief summary of the body’s areas and activities of focus for the year ahead. 2g If yes, please provide details of the key findings and resultant action taken. (a) This refers to the tool developed by Resource Efficient Scotland for self-assessing an organisation’s capability / performance in relation to climate change. Further information 2h Supporting information and best practice Does the body have any plans or strategies covering the following areas that include climate change? Has the body used the Climate Change Assessment Tool (a) or equivalent tool to self-assess its capability / performance? Provide any other relevant supporting information and any examples of best practice by the body in relation to governance, management and strategy.
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12 PART 3 Corporate Emissions, Targets and Project Data Emissions 3a Emissions from the start of the year which the body uses as a baseline (for its carbon footprint) to the end of the report year Reference year Year Year type Scope 1 Scope 2 Scope 3 Total Units Comments Baseline Year 2020/21 Financial tCO2e 3 Year 1 carbon footprint 2021/22 Financial tCO2e 4 Year 2 carbon footprint 2022/23 Financial - tCO2e 5 Year 3 carbon footprint 0 Financial - tCO2e 6 Year 4 carbon footprint 0 Financial - tCO2e 7 Year 5 carbon footprint 0 Financial - tCO2e 8 Year 6 carbon footprint 0 Financial - tCO2e 9 Year 7 carbon footprint 0 Financial - tCO2e 10 Year 8 carbon footprint 0 Financial - tCO2e 11 Year 9 carbon footprint 0 Financial - tCO2e 12 Year 10 carbon footprint 0 Financial - tCO2e 13 Year 11 carbon footprint 0 Financial - tCO2e 14 Year 12 carbon footprint 0 Financial - tCO2e 15 Year 13 carbon footprint 0 Financial - tCO2e 16 Year 14 carbon footprint 0 Financial - tCO2e 17 Year 15 carbon footprint 0 Financial - tCO2e 18 Year 16 carbon footprint 0 Financial - tCO2e 19 Year 17 carbon footprint 0 Financial - tCO2e 3b Breakdown of emissions sources Emission Factor Year 2022 The emission factor year is auto-assigned based on your answer to Q1f, if it is incorrect please contact SSN. You can now filter emission sources by "type" in column C to enable quicker selection of emission source in column D. User defined emission sources can be entered in rows 130 onwards. Please only use these if you cannot find a relevant emission source in the dropdown list or you have a bespoke emission factor or non-standard derivation of emissions e.g. based on a survey/consumption data. If you require extra rows in the table please send the template to ccreporting@ed.ac.uk. Medical gas emission sources can be found under the "Process" Emission Type. The UK emission factor for homeworking has now been provided in the dropdown list. Emission Type Emission source Scope Consumption data Units Emission factor Units Emissions (tCO2e) Comments Transport - car Large fleet car - Battery Electric Vehicle Combined scopes (for EVs only) 1,000 km 0.00000 kg CO2e/km 0.00000 Transport - car Large business travel car - Battery Electric Vehicle Combined scopes (for EVs only) 1,000 miles 0.08932 kg CO2e/miles 0.08932 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop 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box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Plea elect f d d b Plea elect f d d b Plea elect f d d b 0 00000 Public Sector Report on Compliance with Climate Change Duties 2023 Template Complete the following table using the greenhouse gas emissions total for the body calculated on the same basis as for its annual carbon footprint / management reporting or, where applicable, its sustainability reporting. Include greenhouse gas emissions from the body’s estate and operations (a) (measured and reported in accordance with Scopes 1 & 2 and, to the extent applicable, selected Scope 3 of the Greenhouse Gas Protocol (b). If data is not available for any year from the start of the baseline year to the end of the report year, provide an explanation in the comments column. (a) No information is required on the effect of the body on emissions which are not from its estate and operations. (b) This refers to “The greenhouse gas protocol. A corporate accounting and reporting standard (revised edition)”, World Business Council for Sustainable Development, Geneva, Switzerland / World Resources Institute, Washington DC, USA (2004), ISBN: 1-56973-568-9. Complete the following table with the breakdown of emission sources from the body’s most recent carbon footprint (greenhouse gas inventory); this should correspond to the last entry in the table in 3(a) above. Use the ‘Comments’ column to explain what is included within each category of emission source entered in the first column. If there is no data consumption available for an emission source enter the emissions in kgCO2e in the ‘Consumption’ column of one of the “Other” rows and assign the scope and an emission factor of 1. ENSURE QUESTION 1f IS COMPLETED BEFORE STARTING THIS SECTION, THEN SELECT APPROPRIATE BASELINE YEAR. TOTAL EMISSIONS IN THE MOST RECENT FOOTPRINT YEAR IN THIS QUESTION SHOULD EQUAL TOTAL EMISSIONS IN Q3B Land Use & Land Use Change emissions can be included where data/estimates are available. (a) Emissions factors are published annually by the UK Department for Business, Energy & Industrial Strategy
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13 Provide a summary of the body’s annual renewable generation (if any), and whether it is used or exported by the body. Total consumed by the body (kWh) Total exported (kWh) Total consumed by the body (kWh) Total exported (kWh) Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Targets 3d Organisational targets Name of target Type of target Target Units Boundary/scope of target Year used as baseline Baseline figure Units of baseline Target completion year Progress against target Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please 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down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Total - How will the body publish, or otherwise make available, it's progress towards achieving its emissions reduction targets? Provide any other relevant supporting information. In the event that the body wishes to refer to information already publshed, provide information about where the publication can be accessed. Simply referencing this report or it's availabilty on the SSN website is insufficient information. Technology Renewable Electricty Renewable Heat List all of the body’s targets of relevance to its climate change duties. Where applicable, targets for reducing indirect emissions of greenhouse gases, overall carbon targets and any separate land use, energy efficiency, waste, water, information and communication technology, transport, travel and heat targets should be included. Where applicable, you should also provide the body’s target date for achieving zero direct emissions of greenhouse gases, or such other targets that demonstrate how the body is contributing to Scotland achieving its emissions reduction targets. Estimated total annual carbon savings from all projects implemented by the body in the report year If no projects were implemented against an emissions source, enter "0". If the body does not have any information for an emissions source, enter “Unknown”. If the body does not include the emissions source in its carbon footprint, enter “N/A”. How will the body align its spending plans and use of resources to contribute to reducing emissions and delivering its emission reduction targets? Provide any relevant supporting information that is not already included elsewhere in this report.
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3f
Project name Funding source First full year of CO2e savings Are these savings figures estimated or actual? Capital cost (£) Operational cost (£/annum) Project lifetime (years) Primary fuel/emission source saved
Estimated carbon savings per year
(tCO2e/annum)
Estimated costs
savings (£/annum) Behaviour Change Comments
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3g
Emissions source Total estimated annual emissions (tCO2e) Increase or decrease in emissions Comments
Estate changes Please select from drop down box
Service provision Please select from drop down box
Staff numbers Please select from drop down box
Other (please specify in comments) Please select from drop down box
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Total -
3h Anticipated annual carbon savings from all projects implemented by the body in the year ahead
Emissions source Total estimated annual carbon savings (tCO2e) Comments
Electricity
Natural gas
Other heating fuels
Waste
Water and sewerage
Travel
Fleet Transport
Other (please specify in comments)
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3i
Emissions source Total estimated annual emissions (tCO2e) Increase or decrease in emissions Comments
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3j
Total savings Total estimated emissions savings (tCO2e) Comments
Total project savings since baseline year
Further information
3k
If no projects are expected to be implemented against an emissions source, enter “0”.
If the organisation does not have any information for an emissions source, enter “Unknown”.
If the organisation does not include the emissions source in its carbon footprint, enter “N/A”.
Detail the top 10 carbon reduction projects to be carried out by the body in the report year
Provide details of the 10 projects which are estimated to achieve the highest carbon savings during report year.
Estimated decrease or increase in the body’s emissions attributed to factors (not reported elsewhere in this form) in the report year
If the emissions increased or decreased due to any such factor in the report year, provide an estimate of the amount and direction
The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner
statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Through our Strategic
Commissioning Plan our main focus is working together to improve health and wellbeing in the community, however there are also co-benefits which improve the environment and contribute to meeting climate change duties delivering our
Commissioning Intentions.
Estimated decrease or increase in emissions from other sources in the year ahead
If the body’s corporate emissions are likely to increase or decrease for any other reason in the year ahead, provide an estimate of the amount and direction.
Total carbon reduction project savings since the start of the year which the body used as a baseline for its carbon footprint
If the body has data available, estimate the total emissions savings made from projects since the start of that year ("the baseline year").
Supporting information and best practice
Provide any other relevant supporting information and any examples of best practice by the body in relation to corporate emissions, targets and projects.Page 310
15 Scope Level 1 Level 3 UOM GHG Conversion Factor 2022 (kgCO2e/unit) GHG Conversion Factor 2023 (kgCO2e/unit) Scope 1 Bioenergy Biogas kWh 0.00022 0.00022 Scope 1 Bioenergy Biogas tonnes 1.21919 1.23595 Scope 1 Bioenergy Landfill gas kWh 0.00020 0.00020 Scope 1 Bioenergy Wood chips kWh 0.01053 0.01074 Scope 1 Bioenergy Wood chips tonnes 39.78833 40.58114 Scope 1 Bioenergy Wood pellets kWh 0.01053 0.01074 Scope 1 Bioenergy Wood pellets tonnes 50.55459 51.56192 Scope 2 Electricity Electricity: UK kWh 0.19338 0.20707 Scope 3 Electricity Transmission and distribution - Electricity: UK kWh 0.01769 0.01792 Scope 1 Fuels Aviation spirit kWh 0.24375 0.24382 Scope 1 Fuels Aviation spirit litres 2.33048 2.33116 Scope 1 Fuels Aviation turbine fuel kWh 0.24782 0.24758 Scope 1 Fuels Aviation turbine fuel litres 2.54514 2.54269 Scope 1 Fuels Burning oil (Kerosene) kWh 0.24677 0.24677 Scope 1 Fuels Burning oil (Kerosene) litres 2.54013 2.54016 Scope 1 Fuels Burning oil (Kerosene) tonnes 3165.01000 3165.04181 Scope 1 Fuels Coal (industrial) tonnes 2411.43000 2396.47994 Scope 1 Fuels Diesel (100% mineral diesel) litres 2.69880 2.65937 Scope 1 Fuels Diesel (average biofuel blend) litres 2.55784 2.51206 Scope 1 Fuels Fuel oil kWh 0.26816 0.26813 Scope 1 Fuels Fuel oil litres 3.17523 3.17492 Scope 1 Fuels Fuel oil tonnes 3229.20000 3228.89019 Scope 1 Fuels Gas oil kWh 0.25679 0.25650 Scope 1 Fuels Gas oil litres 2.75857 2.75541 Scope 1 Fuels Gas oil tonnes 3230.28000 3226.57859 Scope 1 Fuels LPG kWh 0.21449 0.21450 Scope 1 Fuels LPG litres 1.55709 1.55713 Scope 1 Fuels Marine fuel oil litres 3.10669 3.10202 Scope 1 Fuels Marine gas oil litres 2.77539 2.77139 Scope 1 Fuels Natural gas kWh 0.18254 0.18293 Scope 1 Fuels Petrol (100% mineral diesel) litres 2.33970 2.34503 Scope 1 Fuels Petrol (average biofuel blend) litres 2.16185 2.09747 Scope 1 Fuels Propane kWh 0.21411 0.21410 Scope 1 Fuels Propane litres 1.54354 1.54358 Scope 1 Fuels Waste oils kWh 0.25682 0.25641 Scope 1 Fuels Waste oils litres 2.75367 2.74924 Scope 1 Fuels Waste oils tonnes 3224.57000 3219.37916 Scope 2 Heat and steam District heat and steam kWh 0.17073 0.17965 Scope 2 Heat and steam Onsite heat and steam kWh 0.17073 0.17965 Scope 3 Heat and steam Transmission and distribution - district heat & steam, 5% loss kWh 0.00899 0.00945 Scope 3 Homeworking Homeworking (office equipment + heating) FTE Working Hour 0.34075 0.33378 Scope 3 Hotel stay Hotel stay - UK Room per night 10.40000 10.40000 Scope 3 Hotel stay Hotel stay - UK (London) Room per night 11.50000 11.50000 Scope 3 Material use Aggregates - Primary material production tonnes 7.75102 7.75138 Scope 3 Material use Aggregates - Recycled source tonnes 3.19471 3.19491 Scope 3 Material use Aggregates - Re-used tonnes 2.21000 2.21000 Scope 3 Material use Asbestos - Primary material production tonnes 27.00000 27.00000 Scope 3 Material use Asphalt - Primary material production tonnes 39.21249 39.21249 Scope 3 Material use Asphalt - Recycled source tonnes 28.65471 28.65491 Scope 3 Material use Asphalt - Re-used tonnes 1.73826 1.73826 Scope 3 Material use Average construction - Primary material production tonnes 80.33777 80.21282 Scope 3 Material use Batteries - Alkaline - Primary material production tonnes 4633.47826 4633.47826 Scope 3 Material use Batteries - Li ion - Primary material production tonnes 6308.00000 6308.00000 Scope 3 Material use Batteries - NiMh - Primary material production tonnes 28380.00000 28380.00000 Scope 3 Material use Bricks - Primary material production tonnes 241.75102 241.75138 Scope 3 Material use Clothing - Primary material production tonnes 22310.00000 22310.00000 Scope 3 Material use Clothing - Re-used tonnes 152.25000 152.25000 Scope 3 Material use Compost derived from food and garden waste - Primary material production tonnes 114.83221 114.83405 Scope 3 Material use Compost derived from garden waste - Primary material production tonnes 112.01558 112.01742 Scope 3 Material use Concrete - Primary material production tonnes 131.75102 131.75138 Based on UK Government GHG Conversion Factors published annually, with the exception of water supply/treatment factors which use Scottish Water's reported emission intensities. Emission Factors by Scope/Category - for reference only, not editable. Category
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16 Scope 1 Refrigerants R504 kg 4143.00000 4299.00000 Scope 1 Refrigerants R505 kg 8502.00000 7956.00000 Scope 1 Refrigerants R506 kg 4490.00000 3857.00000 Scope 1 Refrigerants R507A kg 3985.00000 3985.00000 Scope 1 Refrigerants R508A kg 13214.00000 11607.00000 Scope 1 Refrigerants R508B kg 13396.00000 11698.00000 Scope 1 Refrigerants R509A kg 5741.00000 5758.00000 Scope 1 Refrigerants R510A kg 1.00000 1.00000 Scope 1 Refrigerants R511A kg 9.00000 7.00000 Scope 1 Refrigerants R512A kg 189.00000 196.00000 Scope 1 Refrigerants R600 = butane kg 4.00000 4.00000 Scope 1 Refrigerants R600A = isobutane kg 3.00000 3.00000 Scope 1 Refrigerants R601 = pentane kg 5.00000 2.00000 Scope 1 Refrigerants R601A = isopentane kg 5.00000 2.00000 Scope 2 Renewables Renewable Elec Purchase Direct Supply kWh 0.00000 0.00000 Scope 2 Renewables Renewable Heat Purchase Direct Supply kWh 0.00000 0.00000 Scope 2&3 Transport - car Average business travel car - Battery Electric Vehicle km 0.05140 0.05480 Scope 2&3 Transport - car Average business travel car - Battery Electric Vehicle miles 0.08272 0.08819 Scope 2&3 Transport - car Average business travel car - Plug-in Hybrid Electric Vehicle km 0.09349 0.09392 Scope 2&3 Transport - car Average business travel car - Plug-in Hybrid Electric Vehicle miles 0.15046 0.15113 Scope 3 Transport - car Average car - Diesel km 0.17082 0.16983 Scope 3 Transport - car Average car - Diesel miles 0.27492 0.27332 Scope 3 Transport - car Average car - Hybrid km 0.12004 0.11898 Scope 3 Transport - car Average car - Hybrid miles 0.19318 0.19147 Scope 3 Transport - car Average car - Petrol km 0.17048 0.16391 Scope 3 Transport - car Average car - Petrol miles 0.27436 0.26379 Scope 3 Transport - car Average car - Unknown km 0.17067 0.16664 Scope 3 Transport - car Average car - Unknown miles 0.27465 0.26817 Scope 1 Transport - car Average fleet car - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - car Average fleet car - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - car Average fleet car - Plug-in Hybrid Electric Vehicle km 0.06840 0.06588 Scope 1 Transport - car Average fleet car - Plug-in Hybrid Electric Vehicle miles 0.11007 0.10601 Scope 2&3 Transport - car Large business travel car - Battery Electric Vehicle km 0.05550 0.05797 Scope 2&3 Transport - car Large business travel car - Battery Electric Vehicle miles 0.08932 0.09330 Scope 2&3 Transport - car Large business travel car - Plug-in Hybrid Electric Vehicle km 0.10148 0.10158 Scope 2&3 Transport - car Large business travel car - Plug-in Hybrid Electric Vehicle miles 0.16332 0.16349 Scope 3 Transport - car Large car - Diesel km 0.20953 0.20859 Scope 3 Transport - car Large car - Diesel miles 0.33722 0.33570 Scope 3 Transport - car Large car - Hybrid km 0.15491 0.15244 Scope 3 Transport - car Large car - Hybrid miles 0.24929 0.24530 Scope 3 Transport - car Large car - Petrol km 0.27639 0.27224 Scope 3 Transport - car Large car - Petrol miles 0.44480 0.43812 Scope 3 Transport - car Large car - Unknown km 0.22733 0.22612 Scope 3 Transport - car Large car - Unknown miles 0.36584 0.36389 Scope 1 Transport - car Large fleet car - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - car Large fleet car - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - car Large fleet car - Plug-in Hybrid Electric Vehicle km 0.07410 0.07082 Scope 1 Transport - car Large fleet car - Plug-in Hybrid Electric Vehicle miles 0.11924 0.11397 Scope 2&3 Transport - car Medium business travel car - Battery Electric Vehicle km 0.04878 0.05257 Scope 2&3 Transport - car Medium business travel car - Battery Electric Vehicle miles 0.07850 0.08458 Scope 2&3 Transport - car Medium business travel car - Plug-in Hybrid Electric Vehicle km 0.08597 0.08501 Scope 2&3 Transport - car Medium business travel car - Plug-in Hybrid Electric Vehicle miles 0.13834 0.13680 Scope 3 Transport - car Medium car - Diesel km 0.16800 0.16716 Scope 3 Transport - car Medium car - Diesel miles 0.27039 0.26902 Scope 3 Transport - car Medium car - Hybrid km 0.10999 0.10904
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17 Scope 3 Material use Concrete - Primary material production tonnes 131.75102 131.75138 Scope 3 Material use Concrete - Recycled source tonnes 3.19471 3.19491 Scope 3 Material use Electrical items - fridges and freezers - Primary material production tonnes 4363.33333 4363.33333 Scope 3 Material use Electrical items - IT - Primary material production tonnes 24865.47556 24865.47556 Scope 3 Material use Electrical items - large - Primary material production tonnes 3267.00000 3267.00000 Scope 3 Material use Electrical items - small - Primary material production tonnes 5647.94563 5647.94563 Scope 3 Material use Food and drink - Primary material production tonnes 3701.40359 3701.40359 Scope 3 Material use Glass - Primary material production tonnes 1402.76667 1402.76667 Scope 3 Material use Glass - Recycled source tonnes 823.18954 823.18954 Scope 3 Material use Insulation - Primary material production tonnes 1861.75102 1861.75138 Scope 3 Material use Insulation - Recycled source tonnes 1852.08089 1852.08125 Scope 3 Material use Metal: aluminium cans and foil (excl. forming) - Primary material production tonnes 9122.63640 9108.72731 Scope 3 Material use Metal: aluminium cans and foil (excl. forming) - Recycled source tonnes 999.39628 990.47810 Scope 3 Material use Metal: mixed cans - Primary material production tonnes 5268.55640 5254.64731 Scope 3 Material use Metal: mixed cans - Recycled source tonnes 1473.78996 1461.67759 Scope 3 Material use Metal: scrap metal - Primary material production tonnes 3682.68290 3669.43615 Scope 3 Material use Metal: scrap metal - Recycled source tonnes 1633.17782 1620.27606 Scope 3 Material use Metal: steel cans - Primary material production tonnes 3100.63640 3086.72731 Scope 3 Material use Metal: steel cans - Recycled source tonnes 1740.63640 1726.72731 Scope 3 Material use Metals - Primary material production tonnes 4018.00295 4005.13777 Scope 3 Material use Metals - Recycled source tonnes 1571.27037 1558.94894 Scope 3 Material use Mineral oil - Primary material production tonnes 1401.00000 1401.00000 Scope 3 Material use Mineral oil - Recycled source tonnes 676.00000 676.00000 Scope 3 Material use Paper and board: board - Primary material production tonnes 828.86816 801.52177 Scope 3 Material use Paper and board: board - Recycled source tonnes 719.55532 699.88184 Scope 3 Material use Paper and board: mixed - Primary material production tonnes 884.16078 868.06994 Scope 3 Material use Paper and board: mixed - Recycled source tonnes 731.67375 718.56937 Scope 3 Material use Paper and board: paper - Primary material production tonnes 919.39628 910.47810 Scope 3 Material use Paper and board: paper - Recycled source tonnes 739.39628 730.47810 Scope 3 Material use Plasterboard - Primary material production tonnes 120.05000 120.05000 Scope 3 Material use Plasterboard - Recycled source tonnes 32.17000 32.17000 Scope 3 Material use Plastics: average plastic film - Primary material production tonnes 2574.16475 2560.25566 Scope 3 Material use Plastics: average plastic film - Recycled source tonnes 1894.62863 1890.70135 Scope 3 Material use Plastics: average plastic rigid - Primary material production tonnes 3276.70693 3263.92202 Scope 3 Material use Plastics: average plastic rigid - Recycled source tonnes 2748.83298 2744.09248 Scope 3 Material use Plastics: average plastics - Primary material production tonnes 3116.29156 3102.44851 Scope 3 Material use Plastics: average plastics - Recycled source tonnes 2326.53028 2322.22425 Scope 3 Material use Plastics: HDPE (incl. forming) - Primary material production tonnes 3269.83889 3255.92980 Scope 3 Material use Plastics: HDPE (incl. forming) - Recycled source tonnes 2350.61634 2346.68907 Scope 3 Material use Plastics: LDPE and LLDPE (incl. forming) - Primary material production tonnes 2600.63640 2586.72731 Scope 3 Material use Plastics: LDPE and LLDPE (incl. forming) - Recycled source tonnes 1797.22268 1793.29541 Scope 3 Material use Plastics: PET (incl. forming) - Primary material production tonnes 4032.39250 4018.48341 Scope 3 Material use Plastics: PET (incl. forming) - Recycled source tonnes 3125.27157 3121.34429 Scope 3 Material use Plastics: PP (incl. forming) - Primary material production tonnes 3104.72699 3090.81790 Scope 3 Material use Plastics: PP (incl. forming) - Recycled source tonnes 2541.31327 2537.38600 Scope 3 Material use Plastics: PS (incl. forming) - Primary material production tonnes 3777.94890 3764.03981 Scope 3 Material use Plastics: PS (incl. forming) - Recycled source tonnes 3198.95732 3187.08199 Scope 3 Material use Plastics: PVC (incl. forming) - Primary material production tonnes 3413.08416 3399.17507 Scope 3 Material use Plastics: PVC (incl. forming) - Recycled source tonnes 2489.67044 2485.74317 Scope 3 Material use Soils - Recycled source tonnes 0.98471 0.98491 Scope 3 Material use Tyres - Primary material production tonnes 3335.57190 3335.57190 Scope 3 Material use Tyres - Re-used tonnes 731.21789 731.21789 Scope 3 Material use Wood - Primary material production tonnes 312.61178 312.61178 Scope 3 Material use Wood - Recycled source tonnes 112.96968 112.96968 Scope 3 Material use Wood - Re-used tonnes 38.54288 38.54288 Scope 1 Process Desflurane kg 2540.00000 2540.00000 Scope 1 Process Sevoflurane kg 130.00000 130.00000 Scope 1 Process Isoflurane kg 510.00000 510.00000 Scope 1 Process Anaesthetic Nitrous Oxide kg 298.00000 298.00000 Scope 1 Refrigerants HFC-134a kg 1430.00000 1300.00000 Scope 1 Refrigerants HFC-32 kg 675.00000 677.00000 Scope 1 Refrigerants R404A kg 3922.00000 3943.00000 Scope 1 Refrigerants R407C kg 1774.00000 1624.00000 Scope 1 Refrigerants R410A kg 2088.00000 1924.00000 Scope 1 Refrigerants R422D kg 2729.00000 2473.00000 Scope 1 Refrigerants R422E kg 2592.00000 2350.00000 Scope 1 Refrigerants R423A kg 2280.00000 2274.00000 Scope 1 Refrigerants R424A kg 2440.00000 2212.00000 Scope 1 Refrigerants R425A kg 1505.00000 1431.00000 Scope 1 Refrigerants R426A kg 1508.00000 1371.00000 Scope 1 Refrigerants R427A kg 2138.00000 2024.00000 Scope 1 Refrigerants R428A kg 3607.00000 3417.00000 Scope 1 Refrigerants R429A kg 14.00000 15.00000 Scope 1 Refrigerants R430A kg 95.00000 106.00000 Scope 1 Refrigerants R431A kg 38.00000 40.00000 Scope 1 Refrigerants R432A kg 2.00000 1.50000 Scope 1 Refrigerants R433A kg 3.00000 3.00000 Scope 1 Refrigerants R433B kg 3.00000 3.00000 Scope 1 Refrigerants R433C kg 3.00000 3.00000 Scope 1 Refrigerants R434A kg 3245.00000 3075.00000 Scope 1 Refrigerants R435A kg 26.00000 28.40000 Scope 1 Refrigerants R436A kg 3.00000 3.00000 Scope 1 Refrigerants R436B kg 3.00000 3.00000 Scope 1 Refrigerants R437A kg 1805.00000 1639.00000 Scope 1 Refrigerants R438A kg 2265.00000 2059.00000 Scope 1 Refrigerants R439A kg 1983.00000 1828.00000 Scope 1 Refrigerants R440A kg 144.00000 156.00000 Scope 1 Refrigerants R441A kg 3.00000 3.00000 Scope 1 Refrigerants R442A kg 1888.00000 1754.00000 Scope 1 Refrigerants R443A kg 2.00000 1.50000 Scope 1 Refrigerants R444A kg 88.00000 89.00000 Scope 1 Refrigerants R445A kg 130.00000 118.00000 Scope 1 Refrigerants R500 kg 8077.00000 7564.00000 Scope 1 Refrigerants R501 kg 4083.00000 3870.00000 Scope 1 Refrigerants R502 kg 4657.00000 4786.00000 Scope 1 Refrigerants R503 kg 14560.00000 13299.00000
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18 Scope 3 Transport - car Medium car - Hybrid miles 0.17702 0.17549 Scope 3 Transport - car Medium car - Petrol km 0.18470 0.17819 Scope 3 Transport - car Medium car - Petrol miles 0.29724 0.28676 Scope 3 Transport - car Medium car - Unknown km 0.17588 0.17246 Scope 3 Transport - car Medium car - Unknown miles 0.28306 0.27754 Scope 1 Transport - car Medium fleet car - Battery Electric Vehicle km 0.00410 0.00419 Scope 1 Transport - car Medium fleet car - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - car Medium fleet car - Plug-in Hybrid Electric Vehicle km 0.06473 0.06144 Scope 1 Transport - car Medium fleet car - Plug-in Hybrid Electric Vehicle miles 0.10421 0.09887 Scope 3 Transport - car Motorbike - Average km 0.11355 0.11367 Scope 3 Transport - car Motorbike - Average miles 0.18274 0.18294 Scope 2&3 Transport - car Small business travel car - Battery Electric Vehicle km 0.04416 0.04823 Scope 2&3 Transport - car Small business travel car - Battery Electric Vehicle miles 0.07107 0.07763 Scope 2&3 Transport - car Small business travel car - Plug-in Hybrid Electric Vehicle km 0.05255 0.05402 Scope 2&3 Transport - car Small business travel car - Plug-in Hybrid Electric Vehicle miles 0.08458 0.08694 Scope 3 Transport - car Small car - Diesel km 0.13989 0.13931 Scope 3 Transport - car Small car - Diesel miles 0.22514 0.22420 Scope 3 Transport - car Small car - Hybrid km 0.10332 0.10150 Scope 3 Transport - car Small car - Hybrid miles 0.16628 0.16336 Scope 3 Transport - car Small car - Petrol km 0.14652 0.14080 Scope 3 Transport - car Small car - Petrol miles 0.23580 0.22660 Scope 3 Transport - car Small car - Unknown km 0.14440 0.14037 Scope 3 Transport - car Small car - Unknown miles 0.23239 0.22591 Scope 1 Transport - car Small fleet car - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - car Small fleet car - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - car Small fleet car - Plug-in Hybrid Electric Vehicle km 0.02216 0.02163 Scope 1 Transport - car Small fleet car - Plug-in Hybrid Electric Vehicle miles 0.03567 0.03481 Scope 3 Transport - public Average local bus passenger.km 0.09650 0.10215 Scope 3 Transport - public Black cab km 0.30624 0.30604 Scope 3 Transport - public Black cab passenger.km 0.20416 0.20402 Scope 3 Transport - public Coach passenger.km 0.02733 0.02718 Scope 3 Transport - public Ferry - Average (all passenger) passenger.km 0.11286 0.11270 Scope 3 Transport - public Ferry - Car passenger passenger.km 0.12952 0.12933 Scope 3 Transport - public Ferry - Foot passenger passenger.km 0.01874 0.01871 Scope 3 Transport - public Flights - Domestic, to/from UK - Average passenger passenger.km 0.24587 0.27258 Scope 3 Transport - public Flights - International, to/from non-UK - Average passenger passenger.km 0.18362 0.18395 Scope 3 Transport - public Flights - International, to/from non-UK - Business class passenger.km 0.40781 0.39044 Scope 3 Transport - public Flights - International, to/from non-UK - Economy class passenger.km 0.14063 0.13464 Scope 3 Transport - public Flights - International, to/from non-UK - First class passenger.km 0.56251 0.53854 Scope 3 Transport - public Flights - International, to/from non-UK - Premium economy class passenger.km 0.22500 0.21542 Scope 3 Transport - public Flights - Long-haul, to/from UK - Average passenger passenger.km 0.19309 0.26128 Scope 3 Transport - public Flights - Long-haul, to/from UK - Business class passenger.km 0.42882 0.58029 Scope 3 Transport - public Flights - Long-haul, to/from UK - Economy class passenger.km 0.14787 0.20011 Scope 3 Transport - public Flights - Long-haul, to/from UK - First class passenger.km 0.59147 0.80040 Scope 3 Transport - public Flights - Long-haul, to/from UK - Premium economy class passenger.km 0.23659 0.32016
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19 Scope 3 Transport - public Flights - Short-haul, to/from UK - Average passenger passenger.km 0.15353 0.18592 Scope 3 Transport - public Flights - Short-haul, to/from UK - Business class passenger.km 0.22652 0.27430 Scope 3 Transport - public Flights - Short-haul, to/from UK - Economy class passenger.km 0.15102 0.18287 Scope 3 Transport - public International rail passenger.km 0.00446 0.00446 Scope 3 Transport - public Light rail and tram passenger.km 0.02861 0.02860 Scope 3 Transport - public Local bus (not London) passenger.km 0.10778 0.11836 Scope 3 Transport - public Local London bus passenger.km 0.07936 0.07832 Scope 3 Transport - public London Underground passenger.km 0.02781 0.02780 Scope 3 Transport - public National rail passenger.km 0.03549 0.03546 Scope 3 Transport - public Regular taxi km 0.20826 0.20806 Scope 3 Transport - public Regular taxi passenger.km 0.14876 0.14861 Scope 2&3 Transport - van/HGV Business Travel Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle km 0.06225 0.07346 Scope 2&3 Transport - van/HGV Business Travel Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle miles 0.10019 0.11824 Scope 2&3 Transport - van/HGV Business Travel Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle km 0.03612 0.03850 Scope 2&3 Transport - van/HGV Business Travel Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle miles 0.05814 0.06197 Scope 2&3 Transport - van/HGV Business Travel Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle km 0.05640 0.05932 Scope 2&3 Transport - van/HGV Business Travel Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle miles 0.09079 0.09547 Scope 2&3 Transport - van/HGV Business Travel Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle km 0.09327 0.08967 Scope 2&3 Transport - van/HGV Business Travel Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle miles 0.15009 0.14430 Scope 1 Transport - van/HGV Fleet Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle km 0.00000 0.00000 Scope 1 Transport - van/HGV Fleet Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle miles 0.00000 0.00000 Scope 1 Transport - van/HGV HGV (all diesel) - All artics - Average laden km 0.92391 0.90644 Scope 1 Transport - van/HGV HGV (all diesel) - All artics - Average laden miles 1.48688 1.45877 Scope 1 Transport - van/HGV HGV (all diesel) - All HGVs - Average laden km 0.89061 0.87205 Scope 1 Transport - van/HGV HGV (all diesel) - All HGVs - Average laden miles 1.43329 1.40341 Scope 1 Transport - van/HGV HGV (all diesel) - All rigids - Average laden km 0.84061 0.82313 Scope 1 Transport - van/HGV HGV (all diesel) - All rigids - Average laden miles 1.35282 1.32470 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All artics - Average laden km 1.06854 1.04867 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All artics - Average laden miles 1.71964 1.68766 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All HGVs - Average laden km 1.04208 1.02098 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All HGVs - Average laden miles 1.67706 1.64310 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All rigids - Average laden km 1.00090 0.98025 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) - All rigids - Average laden miles 1.61079 1.57754 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Diesel km 0.23156 0.23128
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20 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Diesel miles 0.37268 0.37224 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Petrol km 0.21332 0.20132 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Petrol miles 0.34330 0.32400 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Unknown km 0.23099 0.23037 Scope 1 Transport - van/HGV Vans - Average (up to 3.5 tonnes) - Unknown miles 0.37174 0.37075 Scope 1 Transport - van/HGV Vans - Class I (up to 1.305 tonnes) - Diesel km 0.14189 0.14212 Scope 1 Transport - van/HGV Vans - Class I (up to 1.305 tonnes) - Diesel miles 0.22836 0.22875 Scope 1 Transport - van/HGV Vans - Class I (up to 1.305 tonnes) - Petrol km 0.19687 0.18217 Scope 1 Transport - van/HGV Vans - Class I (up to 1.305 tonnes) - Petrol miles 0.31683 0.29318 Scope 1 Transport - van/HGV Vans - Class II (1.305 to 1.74 tonnes) - Diesel km 0.17513 0.17405 Scope 1 Transport - van/HGV Vans - Class II (1.305 to 1.74 tonnes) - Diesel miles 0.28186 0.28013 Scope 1 Transport - van/HGV Vans - Class II (1.305 to 1.74 tonnes) - Petrol km 0.20461 0.19594 Scope 1 Transport - van/HGV Vans - Class II (1.305 to 1.74 tonnes) - Petrol miles 0.32928 0.31534 Scope 1 Transport - van/HGV Vans - Class III (1.74 to 3.5 tonnes) - Diesel km 0.25481 0.25346 Scope 1 Transport - van/HGV Vans - Class III (1.74 to 3.5 tonnes) - Diesel miles 0.41010 0.40792 Scope 1 Transport - van/HGV Vans - Class III (1.74 to 3.5 tonnes) - Petrol km 0.32607 0.31444 Scope 1 Transport - van/HGV Vans - Class III (1.74 to 3.5 tonnes) - Petrol miles 0.52475 0.50605 Scope 3 Waste Aggregates - Landfill tonnes 1.23376 1.23401 Scope 3 Waste Aggregates - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Asbestos - Landfill tonnes 5.91308 5.91332 Scope 3 Waste Asphalt - Landfill tonnes 1.23376 1.23401 Scope 3 Waste Asphalt - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Average construction - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Average construction - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Batteries - Recycled tonnes 21.28000 21.28100 Scope 3 Waste Books - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Books - Landfill tonnes 1041.78497 1164.09963 Scope 3 Waste Books - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Bricks - Landfill tonnes 1.23376 1.23401 Scope 3 Waste Clinical Waste - Orange Stream tonnes 273.00000 273.00000 Scope 3 Waste Clinical Waste - Other tonnes 1000.00000 1000.00000 Scope 3 Waste Clinical Waste - Red Stream tonnes 1000.00000 1000.00000 Scope 3 Waste Clinical Waste - Yellow Stream tonnes 297.00000 297.00000 Scope 3 Waste Clothing - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Clothing - Landfill tonnes 444.92469 496.68331 Scope 3 Waste Clothing - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Commercial and industrial waste - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Commercial and industrial waste - Landfill tonnes 467.00838 520.33474 Scope 3 Waste Concrete - Landfill tonnes 1.23376 1.23401 Scope 3 Waste Concrete - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Glass - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Glass - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Glass - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Household/Municipal/Domestic waste - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Household/Municipal/Domestic waste - Landfill tonnes 446.20411 497.04471 Scope 3 Waste Insulation - Landfill tonnes 1.23376 1.23401 Scope 3 Waste Insulation - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Metal: aluminium cans and foil (excl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Metal: aluminium cans and foil (excl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Metal: aluminium cans and foil (excl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Metal: mixed cans - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Metal: mixed cans - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Metal: mixed cans - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Metal: scrap metal - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Metal: scrap metal - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Metal: scrap metal - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Metal: steel cans - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Metal: steel cans - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Metal: steel cans - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Metals - Landfill tonnes 1.26435 1.26435 Scope 3 Waste Metals - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Mineral oil - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Mineral oil - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Organic: food and drink waste - Anaerobic digestion tonnes 8.91058 8.91242 Scope 3 Waste Organic: food and drink waste - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Organic: food and drink waste - Composting tonnes 8.91058 8.91242 Scope 3 Waste Organic: food and drink waste - Landfill tonnes 626.85615 700.20988 Scope 3 Waste Organic: garden waste - Anaerobic digestion tonnes 8.91058 8.91242 Scope 3 Waste Organic: garden waste - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Organic: garden waste - Composting tonnes 8.91058 8.91242 Scope 3 Waste Organic: garden waste - Landfill tonnes 578.94041 646.60659 Scope 3 Waste Organic: mixed food and garden waste - Anaerobic digestion tonnes 8.91058 8.91242 Scope 3 Waste Organic: mixed food and garden waste - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Organic: mixed food and garden waste - Composting tonnes 8.91058 8.91242 Scope 3 Waste Organic: mixed food and garden waste - Landfill tonnes 587.32567 655.98717 Scope 3 Waste Paper and board: board - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Paper and board: board - Composting tonnes 8.91058 8.91242 Scope 3 Waste Paper and board: board - Landfill tonnes 1041.78497 1164.09963 Scope 3 Waste Paper and board: board - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Paper and board: mixed - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Paper and board: mixed - Composting tonnes 8.91058 8.91242 Scope 3 Waste Paper and board: mixed - Landfill tonnes 1041.78497 1164.09963 Scope 3 Waste Paper and board: mixed - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Paper and board: paper - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Paper and board: paper - Composting tonnes 8.91058 8.91242 Scope 3 Waste Paper and board: paper - Landfill tonnes 1041.78497 1164.09963 Scope 3 Waste Paper and board: paper - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plasterboard - Landfill tonnes 71.95000 71.95000 Scope 3 Waste Plasterboard - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastic film - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastic film - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: average plastic film - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastic rigid - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastic rigid - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: average plastic rigid - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastics - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: average plastics - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: average plastics - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: HDPE (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: HDPE (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: HDPE (incl. forming) - Recycled tonnes 21.28019 21.28081
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21 Scope 3 Waste Plastics: LDPE and LLDPE (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: LDPE and LLDPE (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: LDPE and LLDPE (incl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PET (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PET (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: PET (incl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PP (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PP (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: PP (incl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PS (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PS (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: PS (incl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PVC (incl. forming) - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Plastics: PVC (incl. forming) - Landfill tonnes 8.88327 8.88413 Scope 3 Waste Plastics: PVC (incl. forming) - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Soils - Landfill tonnes 17.57714 19.51734 Scope 3 Waste Soils - Recycled tonnes 0.98471 0.98491 Scope 3 Waste Tyres - Recycled tonnes 21.28019 21.28081 Scope 3 Waste WEEE - fridges and freezers - Landfill tonnes 8.88327 8.88413 Scope 3 Waste WEEE - large - Landfill tonnes 8.88327 8.88413 Scope 3 Waste WEEE - large -Recycled tonnes 21.28019 21.28081 Scope 3 Waste WEEE - mixed - Landfill tonnes 8.88327 8.88413 Scope 3 Waste WEEE - mixed - Recycled tonnes 21.28019 21.28081 Scope 3 Waste WEEE - small - Landfill tonnes 8.88327 8.88413 Scope 3 Waste WEEE - small - Recycled tonnes 21.28019 21.28081 Scope 3 Waste Wood - Combustion tonnes 21.28019 21.28081 Scope 3 Waste Wood - Composting tonnes 8.91058 8.91242 Scope 3 Waste Wood - Landfill tonnes 828.01354 925.24450 Scope 3 Waste Wood - Recycled tonnes 21.28019 21.28081 Scope 3 Water Water supply (mains) cubic metres 0.10000 0.10000 Scope 3 Water Water supply (mains) million litres 100.00000 110.00000 Scope 3 Water Wastewater cubic metres 0.19000 0.19000 Scope 3 Water Wastewater million litres 190.00000 190.00000
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22 PART 4 Adaptation - please do not include information in this part on measures that solely reduce emissions with no implications for climate adaptation. These are climate mitigation measures which should be reported in the Emissions tab. Assessing and managing risk 4a Has the body assessed current and future climate-related risks? 4b Taking action 4c What action has the body taken to adapt to climate change? 4d Where applicable, what contribution has the body made to helping deliver the Programme? Provide any other relevant supporting information Review, monitoring and evaluation 4e What arrangements does the body have in place to review current and future climate risks? 4f What arrangements does the body have in place to monitor and evaluate the impact of the adaptation actions? Future priorities for adaptation 4g Further information 4h The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Include details of work to increase awareness of the need to adapt to climate change and build the capacity of staff and stakeholders to assess risk and implement action. The body may wish to make reference to the Scottish Climate Change Adaptation Programme (“the Programme”). The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Public Sector Report on Compliance with Climate Change Duties 2023 Template If yes, provide a reference or link to any such risk assessment(s). The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. What arrangements does the body have in place to manage climate-related risks? Provide details of any climate change adaptation strategies, action plans and risk management procedures, and any climate change adaptation policies which apply across the body. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to adaption. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Please provide details of monitoring and evaluation criteria and adaptation indicators used to assess the effectiveness of actions detailed under Question 4(c) and Question 4(d). The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. What are the body’s top 5 climate change adaptation priorities for the year ahead? Provide a summary of the areas and activities of focus for the year ahead. The accountability and responsibility for climate change governance, management and strategy in relation to the delivery of Council and Health Board services (including community health and social care) lies with North Lanarkshire IJB's partner statutory bodies, North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail how this is managed. Provide details of arrangements to review current and future climate risks, for example, what timescales are in place to review the climate change risk assessments referred to in Question 4(a) and adaptation strategies, action plans, procedures and policies in Question 4(b).
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23 PART 5Procurement 5a How have procurement policies contributed to compliance with climate change duties? 5b How has procurement activity contributed to compliance with climate change duties? Further information 5c Supporting information and best practice Public Sector Report on Compliance with Climate Change Duties 2023 Template North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements. Provide any other relevant supporting information and any examples of best practice by the body in relation to procurement. North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements. Provide information relating to how the procurement policies of the body have contributed to its compliance with climate changes duties. North Lanarkshire IJB has no legal basis on which to procure community health and social care services. This is a function of North Lanarkshire Council and NHS Lanarkshire. Both North Lanarkshire Council and NHS Lanarkshire submit a Public Bodies Climate Change Duties Report that will detail their arrangements. Provide information relating to how procurement activity by the body has contributed to its compliance with climate changes duties.
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24 PART 6Validation and Declaration 6a Internal validation process Briefly describe the body’s internal validation process, if any, of the data or information contained within this report. 6b Peer validation process Briefly describe the body’s peer validation process, if any, of the data or information contained within this report. 6c External validation process Briefly describe the body’s external validation process, if any, of the data or information contained within this report. 6d No Validation Process If any information provided in this report has not been validated, identify the information in question and explain why it has not been validated. 6e Declaration Name: Role in the body: Date: Public Sector Report on Compliance with Climate Change Duties 2023 Template I confirm that the information in this report is accurate and provides a fair representation of the body’s performance in relation to climate change. The data in this report is reviewed internally by the Health and Social Care Partnership Senior Management Team and the report being presented to the Integration Joint Board (IJB).
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25 Recommended Reporting: Reporting on Wider Influence Wider Impact and Influence on GHG Emissions Q1) Historic Emissions (Local Authorities Only) Please indicate emission amounts and unit of measurement (e.g. tCO2e) and years. Please provide information on the following components using data from the links provided below. Please use (1) as the default unless targets and actions relate to (2). Please note : territorial emissions of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) are provided, but not fluorinated gases, which are also included in the UK territorial greenhouse gas emissions statistics. Prior to the 2005 to 2020 publication the statistics covered emissions of carbon dioxide only (1) UK local and regional CO2e emissions: subset dataset (emissions within the scope of influence of local authorities): (2) UK local and regional CO2e emissions: full dataset: https://data.gov.uk/dataset/723c243d-2f1a-4d27-8b61-cdb93e5b10ff/emissions-of-carbon-dioxide-for-local-authority-areas Local Authority:(Please State) Please select from drop down box DESNZ Dataset:(full or sub-set) Please select from drop down box Source Sector 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Units Comments Total Emissions ktCO2e Industry and Commercial ktCO2e Domestic ktCO2e Transport total ktCO2e Per Capita ktCO2e Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2a) Targets Please detail your wider influence targets Sector Type of Target (units) Baseline value Start year Target Target/End year Saving in latest year measured Latest Year Measured Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2b) Does the organisation have an overall mission statement, strategies, plans or policies outlining ambition to influence emissions beyond your corporate boundaries? If so, please detail this in the box below. Description Comments DESNZ Sectors Other Sectors
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26 Q3) Policies and Actions to Reduce Emissions Please detail any of the specific policies and actions which are underway to achieve your emission reduction targets Sector Start year for policy/action implementation Year that the policy/action will be fully implemented Annual CO2 saving once fully implemented (tCO2) Latest Year measured Saving in latest year measured (tCO2) Delivery Role During project/policy design and implementation, has ISM or an equivilent behaviour change tool been used? Please give further details of this behaviour change activity. Value of Investment (£) Ongoing Costs (£/year) Primary Funding Source for Implementation of Policy/Action Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please provide any detail on data sources or limitations relating to the information provided in Table 3 Q4) Partnership Working, Communications and Capacity Building Please detail your Climate Change Partnership, Communication or Capacity Building Initiatives below. Organisation's project role Lead Organisation (if not reporting organisation) Private Partners Public Partners 3rd Sector Partners Outputs Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Q5) Please detail key actions relating to Food and Drink, Biodiversity, Water, Procurement and Resource Use in the table below Key Action Type Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Key Action Description Metric/indicators for monitoring progress Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Other Notable Reportable Activity Organisation's Project Role Please select from drop down box Please select from drop down box Please select from drop down box Status Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Q6) Please use the text box below to detail further climate change related activity that is not noted elsewhere within this reporting template Please select from drop down box Please select from drop down box Please select from drop down box CommentsImpacts Please select from drop down box Comments Key Action Type Description Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box