ITEM 3 Minute of Meeting of the IJB held on 27 September 2023
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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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