Combined IJB PFA Pack 18th October 2023
North Lanarkshire Council · 18 October 2023
Back to IJB Performance, Finance and Audit Committee — 18 October 2023 and its agenda
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A meeting of the Performance Finance & Audit Committee will be held on Wednesday 18th October 2023 at 9.30am-12pm via Microsoft Teams If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. AGENDA CHAIR: Brian Moore No Time Item Action Attachment Reporting 1. Welcome and Apologies B Moore 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes Performance, Finance & Audit Committee (21st June 2023) For Approval Attachment B Moore 4. Matters Arising - Action Log For Approval Attachment R McGuffie GOVERNANCE 5. PFA Risk Management Report For Approval Attachment S Anderson 6. Integration Scheme For Approval Attachment S Anderson FINANCE & AUDIT 7. External Auditor Report To Follow Attachment Audit Scotland 8. Audited Annual Accounts To Follow Attachment Audit Scotland 9. Progress Report on Agreed Actions For Endorsement Attachment A Kilburn PERFORMANCE 10. Annual Performance Report For Approval Attachment M Dendy 11. Q1 Performance Report For Noting Attachment M Dendy
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12. Drug related deaths in North Lanarkshire and ADP Self- Assessment For Noting Attachment M Dendy 13. Resilience Response For Noting Attachment R McGuffie 14. Analogue to Digital Telecare Transition For Noting Attachment R McGuffie 15. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls B Moore 16. Date of Next Meeting: TBC
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st June 2023 9.30am-11.30am Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Phillip Couser (Left 10.40am) NHS Lanarkshire Nominated Non Exec Director Councillor Ayeshah Khan North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together In Attendance: Stacey Anderson Support Services, Project Manager Stacey Connor (Minutes) Minute Secretary Mark Dell Communications Manager Dr Lucy Munro Medical Director North HSCP Elizabeth Seaton Partnership for Change User Rep Maria William (Deputy for Morag Dendy) 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 Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddy Halliday Chief Exec, VANL Third Sector Rep Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Trudi Marshall Nurse Director North HSCP Cathy McGinty Unison Staff Side Rep (NHSL) James Muir NHS Lanarkshire Nominated Non Exec Director Maggs Thomson Head of Health NHSCP John Watson Unison Rep
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2 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 were no declaration of interest made. 3. Minutes (19th April 2013) The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising and the action log was noted. 5. PF & A Risk Register The purpose of this report is to provide a summary to the PFA committee on risk management activity, noting any amendments or additions to the current risk register. The PFA committee considered the finance and performance risks at its last minute on 19th April 2023. The register was also reviewed at the IJB on 17th May 2023. Following discussions at the last meeting of PFA on 19th April 2023, the risk register has been updated and additional controls/actions added to: IJB 01/21 – Financial Challenges IJB 04/21 – Set Aside IJB 06/21 – Prescribing IJB 11/21 – Performance IJB 13/21 – Care Homes IJB 14/22 – CAMHS IJB 17/22 – Unscheduled Care 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
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3 IJB 19/23 – Service sustainability IJB 20/23 – Workforce sustainability Brian Moore noted the committee would like to review the prescribing risk in more detail. Ross McGuffie advised it was planned to discuss at a future liaison session, there is a paper being drafted for the next IJB committee to provide a fuller update. Cllr Barclay proposed having an elected members briefing session to raise awareness on the prescribing agenda, this was noted and also Cllr Khan noted community solutions is looking at our lives work which could be linked to this. Decision 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. 6. Unaudited Annual Accounts This report provided an overview of the unaudited North Lanarkshire IJB Annual Accounts for the financial year 2022/2023, in line with the legislative requirements and was presented for approval. Thereafter the accounts will go to Audit Scotland for them to carry out their own external audit. By 12th September should have a draft letter of recommendation from auditors. Then on 27th September final accounts will come to IJB committee for sign off. Phillip Courser noted on p6 of the narrative cost of living is mentioned but we haven’t got details in relation to applying to the IJB directly. Amanda Kilburn advised the challenges have been lifted from the strategic commissioning plan and are as they appear within the plan but consideration will be given if the wording needs to change to be more inclusive. Ross McGuffie added a suite of documents have been created to read across for NHS Lanarkshire as a whole. He will check if there is scope to include some additional wording within the strategic commissioning plan. Brian Moore noted on pages 23-24 the detail around committee governance. It is clear that reasonable assurance can be placed on the adequacy and effectiveness of the IJB governance arrangements. The PFA Committee: (1) Approved the Annual Governance Statement and associated reports for inclusion in the statutory accounts; (2) Approved the unaudited North Lanarkshire IJB Annual Accounts 2022/2023 at Appendix 1; (3) Approved the submission of the unaudited annual accounts to Audit Scotland; and RMcG
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4 (4) Acknowledge the arrangements for publications of the North Lanarkshire IJB Annual Accounts 2022/2023 in line with the legislative requirements. 7. Internal Audit The report provided an update on the results of the planned Internal Audit assignment to follow-up the status of the recommendations agreed in respect of previous internal and external audit reports. It presented the results of the recently completed internal audit work undertaken by North Lanarkshire Council (NLC) and provided an update on the results of follow-up work which reviewed the extent to which management have implemented those actions previously committed to in response to recommendations contained in previous internal and external audit reports. Brian Moore asked on behalf of Phillip Couser in relation to the SLA for hosting children and families and justice services; is there a timeline to provide an update to the IJB. Ross McGuffie advised this has been paused largely due to the development of the National Care Service. The outcome of the follow-up audit concluded the following: (1) 19 agreed actions have been completed. (2) 8 agreed actions are partially implemented (4 of these actions being the same risk) (3) 1 agreed action is not yet due. (4) 3 agreed actions are no longer relevant. The PFA acknowledge the contents of the report. 8. Financial Monitoring The report provided a summary of the year-end position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the financial year 2022/2023 and to seek approval for the transfer of funds to reserves. Budget monitoring throughout 2022/23 has shown the IJB projecting an underspend, prior to the transfer of year-end balances to General Reserves at the financial year-end. As detailed in the table at para 6.4, the IJB final outturn was an underspend of £35.495m. Once all ring-fenced balances have been transferred to the relevant reserve in line with Scottish Government guidance, the revised outturn was an underspend of £14.084m. Subject to IJB approval, this underspend 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 is highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023- 2026.
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5 The reasons for the operational underspend of £14.084m (excluding ring- fenced funding), were detailed as : Employee Costs net underspend of £9.107m: as previously highlighted there are ongoing challenges in terms of recruitment and retention issues across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. These are issues that are being faced by IJBs across Scotland. Payments to Other Bodies net underspend of £1.511m: the underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the self-directed support commissioning framework. There is also an underspend in package costs due to slippage in Self-Directed Support (SDS) start dates. It is anticipated these are in-year underspends only and the full budget will be required in future years. Admin Costs net underspend of £1.431m: within the carers funding there is currently an unallocated budget of £1.8m. Work is continuing to allocate this is relevant carers package in 2022/23. This has been transferred to a dedicated earmark reserve to fund carers pressures in 2023/24. Income over recovery of £6.031m: for social care is due to the drawdown of earmark reserves to offset expenditure relating to winter planning, adaptations, digital and IT and staffing costs associated with services within Muirpark. Supplies and Services net overspend of £2.531m: the overspend is due to additional purchases of PPE and staff uniform due to the increase in home support staff and costs associated with winter planning. There has also been additional expenditure in relation to aids and adaptations to meet current demand. £1.550m additional income was drawn down from earmarked reserves to offset some of this overspend and is showing in the over recovery of income. Prescribing net overspend of £1.750m: activity and cost per item within prescribing is 3.19% higher compared to 2021/2022. Due to the uncertainty around costs and prescribing activity and the three-month time lag in receiving the data, the volatility experienced within prescribing is likely to continue for the foreseeable future. Amanda Kilburn noted under 7.3 asking the PFA to approve 2 new additional earmarked reserves. The first was for the replacement of mental health windows that's due to Health and Safety Notice that we received from health and safety executive and the second one is due to the re grading of social work posts.
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6 Phillip Couser asked if we should have something in the risk register to keep an eye on the spend in relation to the re-grading of social work posts. Ross McGuffie replied we should be reviewing this as part of the broader financial plan; although this will be picked up with the team to consider how best to include on the risk register. Brian Moore noted the committee would welcome an annual update in terms of progress regarding the financial implications of the regrading as the IJB funding is time limited. The PFA Committee agreed the following recommendations: (1) Acknowledge the year-end financial position for 2022/23; and (2) Approve the proposed transfers to General Reserves at para 7.2 and 7.3 of this report. RMcG 9. Resilience Update The IJB received an update on Operation Flow at its meeting on 22nd March 2023 and again at the PFA meeting on 19th April 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. Following two further face to face planning sessions that brought together leaders from across the whole system, a Task and Finish structure has now been developed to take forward the key actions agreed for Operation Flow 2, this is included within appendix 1 of the report. There are 5 work streams progressing the work which are meeting weekly. Brian Moore noted future version of the report should be focusing on the progression and the benefits of each of the initiatives. Ross McGuffie confirmed pulling together a scorecard against each of the work streams aligned to the key matrix’s in place. There is a whole system national group to benchmark against other Boards and looking at other models which have worked well, this information will feed into future progress reports. The PFA: (1) Recognise the whole system Operation Flow 2 plans and implementation structures set out in the report; (2) Request future updates on progress. 10. Prisoner Healthcare
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7 This paper sets out an overview of the Prisoner Healthcare service within North Lanarkshire. Responsibility for the provision of healthcare in prisons transferred from the Scottish Prison Service (SPS) to the NHS in November 2011 and for HMP Shotts in Lanarkshire, it is now the responsibility of the North Lanarkshire H&SCP. HMP Shotts, a 538 place, maximum security prison for convicted adult males serving a sentence of four years or longer has a healthcare team that comprises of three sub-team’s teams of Primary Care team, Addictions Team and Mental Health Team. Over the last 24 months the healthcare team has experienced significant and sustained staff shortages across all disciplines. This has impacted on the team’s ability to provide adequate staffing and maintain a safe skill mix. This included the lack of GP cover from 1:30pm onwards. Due to the apparent challenges, the Nurse Director commissioned a ‘deep dive Service Review to be undertaken. This was completed in March 2022 and an action plan was developed identifying planned improvement actions. There were 12 examples of good practice and 22 recommendations for improvement which include 6 priority recommendations identified; the Inspection Report is listed in Section 8 of the report. Ross McGuffie advised we have recruited a fixed term service improvement manager to oversee and coordinate the improvement work; there is a programme boards in place to support that. Dr Lucy Munro advised there is 0.6 GP resource within the service to manage approximately 500 patients in comparison to general practices in the community who manage roughly 2000 patients. Cllr Barclay asked whether having the enhanced nursing role on site reduces the need for GP call outs. Dr Lucy Munro advised there is some area of cross over but overall it does reduce the call outs. Phillip Couser noted the report states we are at the end of quarter 1 and HIS are due to review in quarter 3. To seek a degree of assurance, do HIS review the rating at quarter 3 and produce a new report or a statement of assurance at this point. Dr Lucy Munro replied that inspectors are understating of the environmental challenges the service faces. We are moving away from the poor rating and progressing the actions required. There are mitigations in place for the urgent care pathways to assist this. Unsure that another report will be issued or if HIS will note the progress. Brian Moore noted the PFA would welcome a further update of the HIS feedback and update of the work; this was noted. Recommendations supported by the PFA committee are:
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8 (1) The creation of a Project Board, overseeing the implementation of improvement plans relating to HIS recommendations, internal Service Review actions and MATS Standards. (2) The ongoing funding and support for the Fixed Term Senior Improvement Manager position. (3) The work associated with locally identified Milestones for the service, as noted in the Annual Delivery Plan for 2023/24 as per summary table in the report. 11. Alcohol & Drug Partnership Annual Report The North Lanarkshire Alcohol & Drug partnership (NLADP) Strategic Lead has been working closely with key partners through the five ADP sub- groups (below) to develop key actions and support in keeping with national evidence, regional scoping work and learning from commissioned services including the voices of lived experience. The ADP sub-groups oversee and support decision making on local investments linked to delivering on the National Mission priorities. 1. Prevention, Early Intervention, & Education 2. Treatment, Care & Recovery 3. Whole Family Approach 4. Public Health Approach to Justice 5. Reducing Alcohol Harms Group All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. The purpose of the Annual Report Survey to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. The Annual report survey sets out the range of work in place to scope strengths and challenges in current arrangements. NLADP place the experience of people with lived experience and families at the centre of developments and engagement with all stakeholders. This approach has significantly reshaped the commissioning intentions, created a robust response to the challenge of preventable drug deaths in North Lanarkshire and informed the ADP Investment Plans. Ross McGuffie advised received positive feedback from Scottish Government around our progress for MAT standards; moving at pace over the last 6 months working with South Lanarkshire in tandem. Cllr Khan asked for question 29a it talks about treatment and support services within the list it mentions employability support for 13-15year older would that be more career advice. Ross McGuffie confirmed it will link to existing programmes in place. Cllr Khan added we need reassurance that they're working with other third sector partners to link in particularly with
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9 those with lived experience and the families through carers organisations or the disability forums; this was noted. Phillip Couser noted on question 16 this is blank was there a reason for this. Ross McGuffie noted this is an area where we have identified a work plan so not sure why blank. Brian Moore there are 50 WTE listed is this number correct as it seems low, Ross McGuffie confirmed this is a mainstream service though additional staff are working within commissioned services. The PFA committee: (1) Note the content of the report; (2) Note the content of the Annual Reporting Survey to the Scottish Government and approved submission to the Scottish Government. (3) Note the arrangements in place across each priority area; • Prevention, Early Intervention and Education • Residential Rehab • Assertive Outreach and Crisis support • Harm reduction – including Naloxone provision • Whole Family Approach and Family Inclusive Practice • Lived and Living Experience (4) Approve NLADP Annual report completion setting out the appropriate supports and governance is in place to deliver the National Mission priorities and The Partnership Delivery Framework objectives. 12. Equality Outcomes & Mainstreaming Report Update The paper was presented to the PFA committee to provide a progress update on the actions set out in the Equality Outcomes and Mainstreaming Report 2022-24 reported to IJB in June 2022. A mainstreaming report was submitted to IJB in June 22 (see appendix 1), with equality outcomes based on the commissioning intentions of the 2020- 23strategic commissioning plan. At that time participation and engagement work had already commencing around the next 2023-26 Strategic Commissioning Plan. Progress against the equality outcomes and the action plan was agreed to be monitored via the Performance, Finance and Audit sub-committee. An update has been added to appendix 2 from the Mainstream report. North Lanarkshire Council has established an Equalities Delivery Board, with engagement from all council services including Adult Health & Social Care. The council is reviewing its EQIA arrangements and a revised and improved approach will be co-ordinated and progressed via the Equalities Delivery
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10 Board. The service has identified an Equalities lead (Senior Manager, Strategy & Performance), responsible for ensuring the effectiveness of EQIA use within the service. A revised programme of EQIA training is being developed to support the roll out of the new process. Working with the council’s Equalities Manager, the Equalities lead will develop a process for the periodical review of compliance. NHS Lanarkshire continues to ensure the ongoing importance of embedding equalities into the organisation through the use of equality impact assessment, with the EQIA tool recently being adapted to incorporate socioeconomic impact in line with the Fairer Scotland Duty and to give consideration to the articles of the United Nations on the Convention of the Rights of the Child (UNCRC). With the Equality and Diversity Steering Group continuing to provide Bi-annual reports on the delivery of Equality strategy actions. Phillip Couser noted the report showed high level information. He asked as a committee do we need to see information sitting underneath this work to offer assurance. Maria Williamson stated we have a whole programme of work to link to for the engagement and participation agenda which will develop more within future reports shared. The PFA committee note the progress update to the actions set out in the Equality Outcomes and Mainstreaming Report 2022-24. 13. Q4 Performance Report The report provided an update to the Committee on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 January 2023 to 31 March 2023 (Quarter 4). The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. For the areas listed for improvement they are all rated as either red or amber and have programme boards supporting progressing the work. Area for improvement are: Alcohol Brief Interventions Cervical Screening Immunisations 6-8 week reviews Delayed discharge, home support, reablement
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11 Reablement / Integrated Equipment & Adaptation Service / Home Assessment Team CAMHS Psychological Therapies Adult mental health Waiting Times Performance - Medical Children & Young People (Consultant Led) Waiting Times Performance – AHP and Community Services Stop Smoking Service Sickness Absence Brian Moore asked for more information on Alcohol Brief intervention. Ross McGuffie noted it’s an area which has been well invested in. Since we have moved across to Morse not getting the same amount of referral forms through. Previously had a process in place to review nursing caseloads as referrals came through, going back to this at a local level to check. The Committee note the contents of the report and its appendix. 14. Risk Ross McGuffie will consider how to include the cost of living risk linking to strategic commissioning plan and the risk relating to the re grading of social work posts discussed today. 15. Date of Next Meeting 18th October 2023 9.30am-12.30pm
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Complete Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IJB PFA Further update on October PFA agenda
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2 6. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB March 2022 – draft guidance shared with NLC and awaiting comment December 2021 December 2022 Ongoing –update planned for sept 23 IJB Complete 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update to be provided after year- end figures 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 On agenda Tabled at June PFA 18. 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 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie Reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute and also review current risk register Update planned for March 2023 IJB Liaison session planned to review Complete 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda Update on October agenda Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT paediatrics and speech and language On April 2023 agenda Complete 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion
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3 Discuss wider thematic work with Brian Moore and Cllr Ayeshah Khan ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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4
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5 CLOSED ACTIONS 1. NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 2. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 3. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete
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6 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care Community Alarms (Analogue to digital) National Care Service September 2022 Complete 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy June 2021 November 2021 – deferred to IJB December 2021 deferred to March 2023. Complete Reserve strategy presented to IJB PFA on 16th Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete
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7 but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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8 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. March 2021 September 2021 December 2021 Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23- Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. June 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS
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9 22.3.22 – Update provided on progress on engagement and development of business case September 2022 around engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete. 15. 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 –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete
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1 REPORT Item No: 5 SUBJECT: Risk Management Report TO: IJB, Performance, Finance and Audit Lead Officer for Report: Ross McGuffie , Chief Officer North HSCP Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 18th October 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 PFA 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 is currently in progress as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. These developments will include review of how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session has been scheduled for the next IJB Liaison Session. 5.4 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
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3 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) 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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4 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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5 □ 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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6 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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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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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 31.10.23 Reviewed and Updated May 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 30.10.23 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 31.11.23 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 30.09.23 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 31.08.23 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 31.09.23 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 31.10.23 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 31.10.23 Reviewed and Updated May 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 31.10.23 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 30.11.2023 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 contionus 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 31.08.23 Reviewed and Updated May 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 ‐ availability of acute beds due to delays experienced for onwards movement of patients 'fit for transfer' to care homes, those Very High
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requiring care at home, exacerbated by rising cases of Covid and high demand 2085 ‐ Capacity within NHSL to respond to ongoing challenges due to Covid 19 and associated variants Very High 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: 6 SUBJECT: IJB Integration Scheme 2024 TO: IJB Performance, Finance and Audit Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Stacey Anderson, Service Support Project Manager DATE: 18 October 2023 1. PURPOSE OF REPORT This paper is coming to the IJB PFA 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 PFA 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. 6. CONCLUSIONS 6.1. Once the Integration Scheme has been approved by the IJB PFA, the Integration Scheme 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.
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4 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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5 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 Integration Scheme. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes Yes ☐ No ☐ N/A ☒
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6 ☐ 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
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7 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 9. APPENDICES Appendix 1NL IJB Integration Scheme 2024 Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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8 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
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2 Contents 1. Introduction .............................................................................................................................. 4 2. The Parties................................................................................................................................ 8 3. Integration Model ..................................................................................................................... 9 4. Local Governance Arrangements .......................................................................................... 9 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............................................................................................................................ 41 18.Claims Handling, Liability and Indemnity ........................................................................... 44 19.Risk Management ................................................................................................................. 46 20.Dispute Resolution Mechanism ........................................................................................... 47 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.
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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. “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 established by Order under section 9 of the Act. 4. Local Governance Arrangements
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10 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; • The Chief Officer of the Integration Joint Board;
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11 • 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. 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: • General medicine;
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15 • 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; • Health Visiting;
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16 • 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 • Respite provision
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18 • 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.
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19 6. Local Operational Delivery Arrangements 6.1 The Integration Joint Board meets up to 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 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 operation and performance management perspective, the Integration Joint Board 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 intent 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 Performance and Audit Sub Committee which is accountable to the Integration Joint Board has been established as a non-decision making body to provide further
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24 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 being met through these existing arrangements and that safe, effective person
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25 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 clinical governance statement.
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26 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 and as the accountable officer to the Integration Joint Board.
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28 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 Medical Director and the Nurse Director as appropriate.
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29 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. 12.3 The Chief Officer will be operationally responsible with regards to the delivery of
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30 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 the request of the Integration Joint Board the Heads of Service will carry out the
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31 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 around Third Sector and Independent Sector capacity. The Workforce
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32 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 and many joint policies already exist which will assist in the process of integration.
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33 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. 14.4 The method for determining the amount set aside for hospital services will follow
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34 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. 14.8 It will be the responsibility of the Local Authority Section 95 Officer and the NHS
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35 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. 14.13 The process for managing any in-year financial variations will be detailed within
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36 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; • the relevant partner makes additional one-off adjustment to the resources that it is
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37 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 UK will be the applicable guidance for their interpretation.
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38 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 Parties. The Chief Officer will consult with the Parties to make best use of existing
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39 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. 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 and seek the views of 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 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
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41 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 has joined 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. 17. Complaints 17.1 The Parties agree the following arrangements in respect of complaints by service
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42 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 no immediate change will be made to the way in which complaints are dealt with in each of the Parties and 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 lead organisation these are the Statutory Social Work Complaints process; and NHS Lanarkshire’s complaints process.
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43 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 remains unresolved, they have the right to go to the Scottish Public Services Ombudsman for services provided by the Local Authority.
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44 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 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
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45 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 with by the Parties through the procedures that were in place prior to Integration.
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46 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; • 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; • The process for agreeing changes with the Integration Joint Board; • Protocols for communication and sharing risk information between the Parties.
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47 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 its Performance and Audit Sub Committee providing an additional layer of scrutiny. 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. 20. Dispute Resolution Mechanism 20.1 In the event of a failure by the Parties to reach agreement between themselves
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48 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. 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.
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49 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: 7 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 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. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 PFA Committee: (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. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 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. SUBJECT: External Auditor’s Annual Audit Report 2022/2023 TO: IJB Performance, Finance and Audit Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 18 October 2023 Yes No N/A
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2 5.2 The IJB’s appointed External Auditor, Audit Scotland, is required to supply an audit certificate outlining the findings of the audit process undertaken in relation to the IJB Annual Accounts 2022/2023. 5.3 Attached at appendix 1 is a letter setting out their responsibilities together with a letter of representation from the Chief Finance Officer. The findings are detailed in the External Auditor’s Annual Audit Report at appendix 2. 6. CONCLUSIONS 6.1 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. 6.2 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. 6.3 This report, attached at appendix 2 includes 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. 7. IMPLICATIONS 7.1 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 ☒ 7.2 ASSOCIATED MEASURE(S) The IJB, the Performance, Finance and Audit Committee and both partners are required to ensure effective governance arrangements are in place. 7.3 FINANCIAL This paper has been reviewed by Finance:
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3 Yes No N/A 7.4 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 Ineffective Governance Arrangements Low Ross McGuffie Notional Set-Aside Budget High Ross McGuffie Hosted Services Medium Ross McGuffie Prescribing Activity and Costs Very High Ross McGuffie Third and Voluntary Sector Low Ross McGuffie Ineffective Governance Arrangements due to Covid-19 Pandemic Medium Ross McGuffie 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 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 ☐ 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.
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4 7.6 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 8. BACKGROUND PAPERS PFA 21 June 2023 Unaudited IJB Annual Accounts 2022/2023 9. APPENDICES Appendix 1– External Auditor’s Letter to the IJB 2022/2023 Appendix 2– External Auditor’s Annual Audit Report 2022/2023 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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1 Appendix 1 Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2023 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2022/23 (the 2022/23 Code). In my opinion the accompanying financial statements: give a true and fair view of the state of affairs of North Lanarkshire Integration Joint Board as at 31 March 2023 and of its income and expenditure for the year then ended; have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2022/23 Code; and have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 2 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of North Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion.
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2 Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on Noth Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on the North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue North Lanarkshire Integration Joint Board’s operations. North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements.
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3 Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer concerning North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report.
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4 Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: adequate accounting records have not been kept; or
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5 the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd Audit Scotland 8 Nelson Mandela Place Glasgow G1 2BT
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1 Appendix 2 North Lanarkshire Integration Joint Board 2022/23 Annual Audit Report – DRAFT Prepared for North Lanarkshire Integration Joint Board and the Controller of Audit October 2023 North Lanarkshire Integration Joint Board 2022/23 Annual Audit Report – DRAFT
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2 Contents Key messages 2 Introduction 4 1. Audit of 2022/23 annual accounts 6 2. Financial management 11 3. Financial sustainability 14 4. Vision, leadership and governance 17 5. Use of resources to improve outcomes 19 Appendix 1. Action plan 2022/23 20 Key messages Key messages 2022/23 annual accounts 1 Audit opinions on the annual accounts of the North Lanarkshire Integration Joint Board are unmodified. The financial statements give a true and fair view and were properly prepared in accordance with the financial reporting framework. Financial management and sustainability 2 North Lanarkshire IJB report a deficit on the provision of services of £21.506 million in 2022/23. The outturn position includes planned use of reserves in year. The underlying operational performance was an underspend of £35.495 million primarily driven through underspends in employee costs and funding earmarked for initiatives in future years.
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3 3 The IJB has appropriate and effective financial management arrangements in place. However, there are opportunities to further enhance financial management reports to provide an overarching position of the IJB. 4 The IJB’s underlying financial position is reflected in the movement in General Fund Reserves. During 2022/23 General Fund Reserves decreased by £21.5 million to £97.4 million – this included the transfer of the underspend into reserves, as well as drawdown of reserves and the Scottish Government’s “reclaim” of unspent Covid-19 funding. Vision, leadership and governance, and use of resources to improve outcome 5 The governance arrangements are appropriate and operate effectively. There is effective scrutiny, challenge and informed decision making 6 The Integration Scheme which outlines the services which North Lanarkshire IJB will deliver and the roles and responsibilities for the partnership was revised in October 2023. Use of resources to improve outcome 7 North Lanarkshire IJB has appropriate arrangements in place for securing Best Value and these continue to be developed reflecting the financial and operational challenges faced. Key messages 8 IJB performance has been mixed with an increase in unscheduled bed days and delayed discharge in 2022/23, while A&E attendance has decreased.
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4 Introduction Introduction 1. This report summarises the findings from the 2022/23 annual audit of North Lanarkshire Integration Joint Board (North Lanarkshire IJB). The scope of the audit was set out in an annual audit plan presented to the 22 March 2023 meeting of the Board. This Annual Audit Report comprises: • significant matters arising from an audit of North Lanarkshire IJB’s annual accounts • conclusions on the following wider scope areas that frame public audit as set out in the Code of Audit Practice 2021: o Financial Management o Financial Sustainability o Vision, Leadership, and Governance o Use of Resources to Improve Outcomes. • conclusions on North Lanarkshire IJB’s arrangements for meeting its Best Value duties 2. This report is addressed to the board of North Lanarkshire IJB and the Controller of Audit and will be published on Audit Scotland's website www.auditscotland.gov.uk in due course. Audit appointment from 2022/23 3. I, John Boyd, have been appointed by the Accounts Commission as auditor of North Lanarkshire IJB for the period from 2022/23 until 2026/27. The 2022/23 financial year was the first of my five-year appointment. My appointment coincides with the new Code of Audit Practice which was introduced for financial years commencing on or after 1 April 2022. 4. My team and I would like to thank board members, senior management, and other staff, particularly those in finance, for their cooperation and assistance this year and we look forward to working together constructively over the course of the five- year appointment.
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5 Responsibilities and reporting 5. North Lanarkshire IJB has primary responsibility for ensuring the proper financial stewardship of public funds. This includes preparing annual accounts that are in accordance with proper accounting practices. North Lanarkshire IJB is also responsible for compliance with legislation, and putting arrangements in Introduction place for governance and propriety that enable it to successfully deliver its objectives. 6. The responsibilities of the independent auditor are established by the Local Government (Scotland) Act 1973 and the Code of Audit Practice 2021, and supplementary guidance and International Standards on Auditing in the UK. 7. Weaknesses or risks identified are only those which have come to our attention during our normal audit work and may not be all that exist. Communicating these does not absolve management of North Lanarkshire IJB from its responsibility to address the issues we raise and to maintain adequate systems of control. 8. This report contains an agreed action plan at Appendix 1. It sets out specific recommendations, the responsible officers, and dates for implementation. Auditor Independence 9. We can confirm that we comply with the Financial Reporting Council’s Ethical Standard. We can also confirm that we have not undertaken any non-audit related services and therefore the 2022/23 audit fee of £31,470 as set out in our 2022/23 Annual Audit Plan remains unchanged. We are not aware of any relationships that could compromise our objectivity and independence. 10. We add value to North Lanarkshire IJB by: • identifying and providing insight on significant risks, and making clear and relevant recommendations • providing clear and focused conclusions on the appropriateness, effectiveness and impact of corporate governance, arrangements to ensure the best use of resources and financial sustainability. • sharing intelligence and good practice identified.
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1. Audit of 2022/23 annual accounts | 6 1. Audit of 2022/23 annual accounts Public bodies are required to prepare annual accounts comprising financial statements and other related reports. These are principal means of accounting for the stewardship public funds. Main judgements Audit opinions on the annual accounts of the IJB are unmodified. The unaudited accounts were of a good quality and there were no material changes to the accounts. Audit opinions on the annual accounts are unmodified 11. The Performance, Finance and Audit Committee approved the annual accounts for North Lanarkshire IJB for the year ended 31 March 2023 on 21 June 2023. As reported in the independent auditor’s report, in my opinion as the appointed auditor: • the financial statements give a true and fair view and were properly prepared in accordance with the financial reporting framework • the audited part of the remuneration report was prepared in accordance with the financial reporting framework • the management commentary and annual governance statement were consistent with the financial statements and properly prepared in accordance with the applicable requirements. Overall materiality was assessed as £14.7 million 12. Broadly, the concept of materiality is applied by auditors to determine whether misstatements identified during the audit could reasonably be expected to influence the economic decisions of users of the financial statements, and hence impact their opinion set out in the independent auditor’s report. Auditors set a monetary threshold when considering materiality, although some issues may be considered material by their nature. It is ultimately a matter of the auditor’s professional judgement.
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1. Audit of 2022/23 annual accounts | 7 7 13. Our initial assessment of materiality was carried out during the risk assessment and planning phase of the audit. This was reviewed and revised on receipt of the unaudited annual accounts and is summarised in Exhibit 1. Exhibit 1 Materiality values Materiality level Amount Overall materiality £14.7 million Performance materiality £11.0 million Reporting threshold £250 thousand 14. The overall materiality threshold for the audit of the annual accounts of North Lanarkshire IJB was set with reference to gross expenditure, which we judged as the figure most relevant to the users of the financial statements. 15. Performance materiality is used by auditors when undertaking work on individual areas of the financial statements. It is a lower materiality threshold, set to reduce the probability of aggregated misstatements exceeding overall materiality. Performance materiality was set at 75% of overall materiality, reflecting a history of minimal errors and no significant issues noted during planning or from the previous audit team. 16. It is our responsibility to request that all misstatements, other than those below our reporting threshold, are corrected, although the final decision on making the correction lies with those charged with governance. Significant findings and key audit matters 17. Under International Standard on Auditing (UK) 260 we communicate significant findings from the audit to the board, including our view about the qualitative aspects of the body’s accounting practices. 18. The Code of Audit Practice also requires all audits to communicate key audit matters within the annual audit report under International Standard on Auditing (UK) 701. These are matters that we judged to be of most significance in our audit of the financial statements. 19. We have no issues to report from the audit.
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1. Audit of 2022/23 annual accounts | 8 8 Our audit work responded to the risks of material misstatement we identified in the annual accounts 20. We have obtained audit assurances over the identified significant risks of material misstatement in the annual accounts. Exhibit 2 sets out the significant risks of material misstatement to the financial statements we identified in our 2022/23 Annual Audit Plan. It also summarises the further audit procedures we performed during the year to obtain assurances over these risks and the conclusions from the work completed. Exhibit 2 Significant risks of material misstatement in the annual accounts Audit risk Assurance procedure Results and conclusions 1. Risk of management override of controls International Auditing Standards require that audits are planned to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes the risk of fraud due to the management override of controls. • • • • Agreement of balances and transactions of North Lanarkshire Council and NHS Lanarkshire financial reports / ledger / correspondence. Assurances will be obtained from the auditors of NHS Lanarkshire and North Lanarkshire Council over the completeness, accuracy and allocation of income and expenditure. Review of significant adjustments at year-end where we consider there to be greatest risk of material misstatement through management override of controls. Review of financial monitoring reports during the year. We undertook agreement of balances and transactions. We obtained assurances from the auditors of NHS Lanarkshire and North Lanarkshire Council. We also reviewed significant adjustments of year-end and financial monitoring reports during the year. Conclusion: We did not identify any incidents of management override of controls or indications of fraud or error. Source: Audit Scotland 21. In addition, we identified “areas of audit focus” in our 2022/23 Annual Audit Plan where we considered there to be risks of material misstatement to the financial statements. These areas of specific audit focus were: • IJB funding – The Scottish Government wrote to all IJBs in September 2022 indicating that, due to changes in public health policy, it intended to reclaim and re-
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1. Audit of 2022/23 annual accounts | 9 9 distribute some IJB reserves which relate to Covid-19 funding to meet current Covid- 19 priorities. It is anticipated that this will be achieved through a reduction in NHS funding allocations, ultimately reducing NHS Lanarkshire’s funding contribution to the IJB.
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| 10 1. Audit of 2022/23 annual accounts 22. We reviewed the disclosures relating to Covid-19 funding as part of our audit. Based on the findings of the audit procedures performed, there are no matters which we need to bring to your attention. There were no identified misstatements to the primary financial statements 23. Our audit identified no misstatements to the primary financial statements above our reporting threshold. We identified a number of presentational adjustments to the accounts including related party disclosures and amendments to the notes to the accounts to enhance disclosures. The unaudited annual accounts were received in line with the agreed audit timetable 24. The unaudited annual accounts were received in line with our agreed audit timetable on 22 June 2023. The accounts and supporting working papers were of a good quality. Good progress was made on prior year recommendations 25. North Lanarkshire IJB has made good progress in implementing the audit recommendations identified by Audit Scotland, their previous external auditor. For actions not yet implemented, revised responses and timescales have been agreed with management, and are set out in Appendix 1.
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2. Financial management | 11 11 2. Financial management Financial management means having sound budgetary processes, and the ability to understand the financial environment and whether internal controls are operating effectively. Conclusion North Lanarkshire IJB report a deficit on the provision of services of £21.506 million in 2022/23. The outturn position includes planned use of reserves in year. The underlying operational performance was an underspend of £35.495 million primarily driven through underspends in employee costs and funding earmarked for initiatives in future years. The IJB has appropriate and effective financial management arrangements in place. However, there are opportunities to further enhance financial management reports to provide an overarching position of the IJB. The IJB’s underlying financial position is reflected in the movement in General Fund Reserves. During 2022/23 General Fund Reserves decreased by £21.5 million to £97.4 million – this included the transfer of the underspend into reserves, as well as drawdown of reserves and the Scottish Government’s “reclaim” of unspent Covid-19 funding. North Lanarkshire IJB report a deficit on the provision of services of £21.506 million in 2022/23. The outturn position includes planned use of reserves in year. The underlying operational performance was an underspend of £35.495 million primarily driven through underspends in employee costs and funding earmarked for initiatives in future years. 26. The IJB does not have any assets, nor does it directly incur expenditure or employ staff, other than the Chief Officer and Chief Finance Officer. All funding and expenditure for the IJB is incurred by partner bodies and processed in their accounting records. 27. The IJB have reported a deficit on the provision of services of £21.506 million. The IJB original budget had included planned use of reserves of £31.193m million. However, the
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2. Financial management | 12 12 outturn position reflected an underlying operational underspend of £35.495 million against budget. This was primarily through underspends of £17.377 million in employee costs due to ongoing recruitment and retention challenges across all service areas. There was also additional funding for Mental Health, Alcohol and Drug Partnership, and HSCP Planning, which will be carried forward to 2023/24 and allocated against new spending plans. 28. North Lanarkshire IJB’s underlying financial position is reflected in the movement in General Fund Reserves. During 2022/23 General Fund Reserves decreased by £21.5 million to £97.4 million. This movement included the transfer of the underspend into reserves, the Scottish Government’s “reclaim” of unspent Covid-19 funding of £25.9 million which was transferred through a reduction in IJB contributions from NHS Lanarkshire. Reserves have been allocated to meet future ring-fenced commitments, including those in the strategic commissioning plan and support the IJB in addressing future forecast funding gaps. Budget monitoring arrangements are appropriate but there is scope to improve the reports to provide greater clarity over the overarching financial position of the IJB 29. Detailed budget monitoring reports were submitted to the IJB Board throughout the year. The outturn to date and projected year-end outturn position were stated in these reports while the actual year-end outturn position was in line with expectations. There is considerable detail in the reports, including operational details provided by the partners NHS Lanarkshire and North Lanarkshire Council. There is an opportunity to provide a summary position for the overall IJB to provide greater linkage between the detailed budget information, the overall holistic position of the IJB and how this aligns to the IJB’s financial strategy and reserves strategy. We are satisfied that the information provided is complete and accurate just presented in different formats. Recommendation 1 The IJB performance monitoring reports provide detailed operational financial performance information over IJB activity at North Lanarkshire Council and NHS Lanarkshire. However, there is an opportunity to enhance the current financial reporting to provide an overview of the overarching IJB performance. 30. We observed that senior management and members receive regular and accurate financial information on the IJB’s financial position and have concluded the IJB has appropriate budget monitoring arrangements. North Lanarkshire IJB has appropriate financial control arrangements in place 31. North Lanarkshire IJB does not have its own financial systems and instead relies on partner bodies’ financial systems. All financial transactions are therefore processed under the partner bodies’ internal controls. 32. As part of our audit approach, we sought assurances from the external auditor of NHS Lanarkshire and North Lanarkshire Council. Neither the health board nor council auditors
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2. Financial management | 13 13 reported any significant weaknesses that could result in a risk to the annual accounts of the IJB. Internal audit provided a reasonable level of assurance over the adequacy and effectiveness of the partnership’s framework of governance, risk management and internal control arrangements for the year ending 31 March 2023. 33. Internal audit provides the Joint Board with independent assurance on risk management, internal control and corporate governance processes. North Lanarkshire IJB’s internal audit function is carried out on a joint basis by the Chief Auditors of NHS Lanarkshire and North Lanarkshire Council, who have now completed their 2022/23 audit work. 34. The Annual Assurance Report for 2022/23 was taken to the Joint Board in June 2023. The report included the opinion that. Overall, reasonable assurance can be placed on the adequacy and effectiveness of the partnership’s framework of governance, risk management and control arrangements for the year ending 31 March 2023. Standards of conduct and arrangements for the prevention and detection of fraud and error were appropriate 35. In the public sector there are specific fraud risks, including those relating to tax receipts, welfare benefits, grants and other claims made by individuals and organisations. Public sector bodies are responsible for implementing effective systems of internal control, including internal audit, which safeguard public assets and prevent and detect fraud, error and irregularities, bribery and corruption. 36. North Lanarkshire IJB has adequate arrangements in place to prevent and detect fraud or other irregularities. 37. Appropriate arrangements are in place for the prevention and detection of fraud and error. We are not aware of any specific issues we require to bring to your attention.
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3. Financial sustainability | 14 14 3. Financial sustainability Financial Sustainability means being able to meet the needs of the present without compromising the ability of future generations to meet their own needs. Conclusion The IJB has established a reserves strategy. However, the IJB should develop longer term financial plans to demonstrate the longer term sustainability of the IJB and the delivery of services. 38. The IJB’s medium term plan is aligned to the Strategic Commissioning Plan 2023/26. The plan reflects the impact of recovery from Covid-19 and the wider challenges facing the entity. Financial sustainability looks forward to the medium and longer term to consider whether the body is planning effectively to continue to deliver its services or the way in which they should be delivered. 39. North Lanarkshire IJB approved the Medium-Term Financial Plan 2023- 2026 and the Reserves Strategy at the Joint Board meeting on 22 March 2023. 40. It was important for the IJB to prioritise having a refreshed Medium Term Financial Plan in place which takes account of the impact of Covid-19 and other challenging factors including cost pressures and service demands. The plan is aligned to wider strategies and plans as defined in Exhibit 3 below to ensure that financial and operational plans are aligned. Exhibit 3 Medium Term Financial Plan and wider financial and operational plans
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3. Financial sustainability | 15 15 Source: 2021/22 North Lanarkshire IJB Annual Accounts The IJB has established a reserves strategy. However, the IJB should develop longer term financial plans to demonstrate the longer term sustainability of the IJB and the delivery of services. 41. The IJB has developed a reserves strategy to demonstrate how the entity protects against unexpected costs pressures and to aid financial sustainability. The Reserves Strategy aims at holding contingency reserves of 3% of annual budget. 42. As at 31 March 2022/23 the IJB held contingency reserves of £7.885 million, representing 3% of budget and in accordance with this strategy. The IJB has committed actions attached to the Strategic Commissioning plan and reserves are held that are earmarked to these commitments. 43. The IJB recognises that it faces significant financial challenges over the coming years. This includes the impact of inflationary pressures on pay and non-pay costs, demographic growth and demand pressures and uncertainty around future funding. The IJB recognises that transformational change is required to allow the IJB to deliver health and social care services in a sustainable way. 44. The IJB has developed a medium-term financial plan into a a three-year plan as opposed to a longer term strategy. This reflected the pending formation of the National Care Service and the continued uncertainty surrounding future funding.
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3. Financial sustainability | 16 16 45. While we recognise the uncertainty facing the IJB, it is important that there is a clear strategic focus to ensure that transformational activity is and decision making is taken in the context of the IJB’s longer term financial outlook so that health and social care services are financially sustainable over the longer term. Recommendation 2 A medium term financial plan has been developed which reflects the impact of Covid-19 and the Strategic Commissioning Plan 2023/26. However, a longer term financial strategy should be developed to demonstrate the IJBs longer-term financial sustainability and resilience.
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| 17 17 4. Vision, leadership and governance 4. Vision, leadership and governance Public sector bodies must have a clear vision and strategy and set priorities for improvement within this vision and strategy. They work together with partners and communities to improve outcomes and foster a culture of innovation. Conclusion The governance arrangements are appropriate and operate effectively. There is effective scrutiny, challenge and informed decision making The Integration Scheme which outlines the services which North Lanarkshire IJB will deliver and the roles and responsibilities for the partnership was revised in October 2023. Governance arrangements are appropriate and operate effectively and there is effective scrutiny, challenge and informed decision making 46. The IJB has well established governance arrangements with the IJB Board supported through the Finance, Performance and Audit Committee. 47. From review of committee and Board papers and through attendance at committee meetings throughout the year we have found that these are conducted in a professional manner and there is a good degree of scrutiny and challenge by members. 48. We consider that governance arrangements are appropriate and support effective scrutiny, challenge and decision making. The IJBs Strategic Plan defines it vision and the Strategic Commissioning Plan clearly outlines its priorities and strategy for delivering this over the next three years.
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| 18 18 49. The long-term vision for North Lanarkshire HSCP was set out in the original Strategic Plan 2016/2026. While this remains relevant, the IJB’s Strategic Commissioning Plan 2023/26 compliments this, setting out the IJB’s commitment to achieve long-term ambitions. The Strategic Commissioning 4. Vision, leadership and governance Plan recognising the importance of partnership working to support the transformational change to improve health and wellbeing in the area. 50. The Commissioning Plan is underpinned by the IJB’s Medium Term Financial Plan 2023/26. These form the basis of annual planning process and budgets. Finance capacity has been increased with the appointment of a new Chief Finance Officer for the IJB 51. There was a change in senior officers in year as a Chief Finance Officer (CFO) was appointed to be the full-time CFO for North Lanarkshire IJB. The previous CFO had responsibility for North and South Lanarkshire IJBs until a decision was taken by the Joint Boards to create a full-time CFO position for each of the IJBs. Climate change arrangements 52. The Scottish Parliament has set a legally binding target of becoming net zero by 2045 and has interim targets including a 75% reduction in greenhouse gas emissions by 2030. The public sector in Scotland has a key role to play in ensuring these targets are met and in adapting to the impacts of climate change. 53. North Lanarkshire IJB are required to comply with the Climate Change (Scotland) Act 2009. Climate change is considered through key decision making as being a standard item for consideration on documents to the IJB Board committees to ensure climate change implications are subject to evaluation. As part of our audit work over NHS Lanarkshire and North Lanarkshire Council we consider the arrangements in place over climate change. 54. The Auditor General and Accounts Commission are developing a programme of work on climate change. This involves a blend of climate changespecific outputs that focus on key issues and challenges as well as moving towards integrating climate change considerations into all aspects of audit work. 5. Use of resources to improve outcomes
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| 19 19 5. Use of resources to improve outcomes Public sector bodies need to make best use of their resources to meet stated outcomes and improvement objectives, through effective planning and working with strategic partners and communities. Conclusion North Lanarkshire IJB has appropriate arrangements in place for securing Best Value Performance reporting was of an acceptable standard 55. Management Commentaries included in the annual accounts should provide information on a body, its main objectives and the principal risks faced. It should provide a fair, balanced and understandable analysis of a body’s performance as well as helping stakeholders understand the financial statements. 56. The management commentary reported the financial performance of the IJB including the financial outturn and the impact on reserves. North Lanarkshire IJB has appropriate arrangements in place for securing Best Value 57. Integration Joint Boards have a statutory duty to have arrangements to secure Best Value. To achieve this, IJBs should have effective processes for scrutinising performance, monitoring progress towards their strategic objectives and holding partners to account. 58. North Lanarkshire IJB carried out a self-assessment exercise in 2021, with the results reported to the Joint Board on 31 August 2022. While good practice areas were identified by the exercise, it also identified three areas for improvement: • Evidencing how health and social care spending contribute to prevention and early intervention • Embedding learning and new ways of working in the IJB from the response to the pandemic to ensure plans and governance are fit for purpose 5. Use of resources to improve outcomes
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| 20 20 • Reviewing how performance information is used by the IJB to ensure it is timely, relevant and provides a good measure of progress. 59. There has been ongoing monitoring of each of these three areas against an improvement plan throughout 2022/23. All proposed improvement actions were deemed to be complete as at the Performance, Finance and Audit Committee meeting on 19 April 2023. IJB performance has been mixed with an increase in unscheduled bed days and delayed discharge in 2022/23, while A&E attendance has decreased. 60. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to produce an annual performance report covering areas such as assessing performance in relation to national health and wellbeing outcomes, financial performance and best value, reporting on localities, and the inspection of services. 61. The Board has continued to monitor key performance targets throughout the year, with the 2022/23 Annual Performance Report having been taken to the October meeting of the Performance, Finance and Audit Committee. 62. Performance reports cover the six ministerial steering group performance measures. Performance in 2022/23 against these measures has been mixed. There was a reduction in the number of A&E attendances, however there was a deterioration in the number of unscheduled hospital bed days and acute bed days lost to delayed discharges. Appendix 1. Action plan 2022/23 Appendix 1. Action plan 2022/23 2022/23 recommendations Issue/risk Recommendation Agreed management action/timing
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| 21 21 1. Financial performance reports The IJB performance monitoring reports provide detailed operational financial performance information over IJB activity at North Lanarkshire Council and NHS Lanarkshire. However, there is an opportunity to enhance the current financial reporting to provide an overview of the overarching IJB performance. Risk – There is a risk that budget monitoring reports focus on operational financial challenges and lose focus on wider overarching financial performance of the IJB. As a Strategic commissioning body the IJB should ensure that its financial performance reports retain a holistic view of the IJBs financial performance as a whole and continue to align to the reserves strategy and financial strategy. Paragraph 30 The financial reports will be further defined to give an overview in the delivery of services against the overall funding aligned to the Strategic Commissioning Plan and Medium Term Financial Plan/Long Term Financial Plan including earmarked reserves. It will also include progress in respect of any future saving plans. Individual detailed reports including priorities and outcomes will also be presented to the IJB as agreed within the programme of works. Responsible officer: Chief Finance Officer Agreed date: March 2024 2. Longer Term Financial Plan A medium term financial plan has been developed which reflects the impact of Covid-19 and the Strategic Commissioning Plan 2023/26. However, the IJB does not have a longer term financial plan in place. The IJB should develop a longer term financial plan to demonstrate the longer term financial sustainability and help support longer term strategic planning and decision making. Paragraph 46 Chief Finance Officer will work towards producing a longer term financial plan which will be reflective of the information known to date. Future amendments will be necessary to align the long term plan to the pending formation of the National Care Service and the Appendix 1. Action plan 2022/23 Issue/risk Recommendation Agreed management action/timing
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| 22 22 Risk – There is a risk that as the IJB faces significant financial and operational challenges and services are transformed, that decisions around these are not aligned to longer term financial plans to support financial sustainability. continuing uncertainty around future funding. Responsible officer: Chief Finance Officer Agreed date: March 2024 PY3. Review of Financial Regulations The financial regulations were approved on 8 March 2016. They require to be updated to reflect the budget disaggregation of Children, Families and Justice Services and to also note the arrangements for the management of financial The financial regulations should be reviewed to ensure they remain up-to-date and fit for purpose. Complete The financial regulations have been updated in line with recommendations, and were approved by the Performance, Finance and Audit Committee on 15 February 2023. Follow-up of prior year recommendations Issue/risk Recommendation Agreed management action/timing PY1. Accounts inspection advert The notice of inspection should state the objection end date and the advert should be posted on the IJB website in addition to the North Lanarkshire Council website. The IJB should ensure it has procedures in place to ensure the accounts inspection advert is published in line with criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. Complete The advert and timing of the notice of publication of the unaudited accounts for 22/23 were reviewed, and they were worded and published in line with the criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. PY2. Reserves Strategy There are significant reserves held at 31 March 2022. A reserves strategy for 2022/23 which sets out how and when monies will be spent, has not yet been developed. The IJB should develop a reserves strategy for 2022/23 which sets out how and when monies will be spent. Complete The 2022/23 Reserves Strategy was approved by the Board on 22 March 2023.
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| 23 23 Appendix 1. Action plan 2022/23 Issue/risk Recommendation Agreed management action/timing resources for hosted services. PY4. Website refresh (b/f from 2020/21) Sections of the North Lanarkshire IJB website are outdated. Children’s, families and justice social work services are still noted as being devolved services. There is scope for improved transparency through the website. It should be clear who has ownership for the website and responsibility for maintaining it. The website should be refreshed to reflect the IJB’s current operating model. Complete Can this be marked as complete? The refreshed website was launched at the end of February 2023. PY5. Medium to long term financial plan (b/f from 2019/20) The IJB has a medium to long term financial plan that spans the period 2020/21 to 2029/30 but this will need to b updated to reflect the impact of Covid-19 and EU withdrawal. The IJB’s medium to long term financial plan should be reviewed due to the impact of Covid-19 and EU withdrawal. Complete The IJB now have a Medium Term Financial Plan 20232026 which was approved by the Board on 22 March 2023.
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| 24 Appendix 1. Action plan 2022/23 | 24 North Lanarkshire Integration Joint Board Draft 2022/23 Annual Audit Report Audit Scotland’s published material is available for download on the website in a number of formats. For information on our accessibility principles, please visit: www.audit-scotland.gov.uk/accessibility For the latest news follow us on social media or subscribe to our email alerts.
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| 25 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit-scotland.gov.uk www.audit-scotland.gov.uk AS.4.0
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1 REPORT Item No: 8 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides details of the unsigned audited IJB Annual Accounts 2022/2023 for approval by the PFA. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 PFA: (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. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 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. 6. CONCLUSIONS 6.1 This report provides an overview of the unsigned audited IJB Annual Accounts for the financial year 2022/2023 in line with legislative requirements. SUBJECT: IJB Audited Annual Accounts 2022/2023 TO: IJB Performance, Finance and Audit Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda, Kilburn, Chief Finance Officer DATE: 18 October 2023 Yes No N/A
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2 7. IJB ANNUAL ACCOUNTS 2022/2023 7.1 The IJB Annual Accounts 2022/2023 were prepared in accordance with the requirements of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable, and prudent judgement were made, and proper accounting records were maintained. The preparation of the unaudited annual accounts also met the statutory deadline of 30 June 2023. 7.2 The unsigned audited IJB Annual Accounts 2022/2023 are attached at appendix 1. 7.3 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. 8. IMPLICATIONS 8.1 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 ☒ 8.2 ASSOCIATED MEASURE(S) The IJB, the Performance, Finance and Audit Committee and both partners are required to ensure effective governance arrangements are in place. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 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 Ineffective Governance Arrangements Low Ross McGuffie Notional Set-Aside Budget High Ross McGuffie
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3 Hosted Services Medium Ross McGuffie Prescribing Activity and Costs Very High Ross McGuffie Third and Voluntary Sector Low Ross McGuffie Ineffective Governance Arrangements due to Covid-19 Pandemic Medium Ross McGuffie 8.5 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 ☐ 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. 8.6 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 9. BACKGROUND PAPERS PFA 21 June 2023 Unaudited IJB Annual Accounts 2022/2023
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4 10. APPENDICES Appendix 1– Unsigned North Lanarkshire Audited IJB Annual Accounts 22/23 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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5 Appendix 1 NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2022/2023 AUDITED
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6 CONTENTS Page Management Commentary Purpose 3 The Role and Remit of North Lanarkshire Integration Joint Board 3 A Profile of North Lanarkshire 4 North Lanarkshire IJB Outcomes for the Year 5 o Achievements 5 o Challenges 6 Our Priorities and Ambitions for 2023/2026 7 Medium Term Financial Plan 8 Financial Performance 10 Resources Available to the IJB 10 Summary of Financial Position 2022/2023 11 Reserves Strategy 12 Risk Management 13 Acknowledgements 14 Statement of Responsibilities 15 Remuneration Report 17 Annual Governance Statement 20 Comprehensive Income and Expenditure Statement 26 Movement in Reserves Statement 27 Balance Sheet 28 Notes to the Financial Statements Note 1: Significant Accounting Policies 29 Note 2: Critical Judgements and Estimation Uncertainty 31 Note 3: Events after Balance Sheet Date 31 Note 4: Expenditure and Funding Analysis by Nature 32 Note 5: Taxation and Non-Specific Grant Income 32 Note 6: IJB Operating Costs 33 Note 7: Short Term Debtors and Creditors 33 Note 8: Usable Reserves 33 Note 9: Related Party Transactions 34 Note 10: Hosted Services 35 Note 11: Additional Council Services Delegated to the IJB 37 Note 12: VAT 37 Note 13: External Audit Costs 37 Note 14: New Standards Issued but not yet Adopted 37 Independent Auditor’s Report 38
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7 MANAGEMENT COMMENTARY Purpose This publication contains the financial statements of North Lanarkshire Integration Joint Board (IJB) for the year ending 31 March 2023. The management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year 2022/23 and looks forward, outlining our future financial plans and the challenges and risks that we will face as we strive to meet the needs of the people of North Lanarkshire. Faced with the unprecedented challenges of Covid-19, followed by the continued cost of living crisis, the IJB entered into a phase of recovery and remobilisation. By working with our partners, staff and communities, our services have responded effectively to this ongoing crisis by protecting lives and keeping people safe but also recognising that the future will require new and innovative solutions to support continued recovery and increased levels of demand created by the pandemic. The IJB and Health and Social Care Partnership (HSCP) Senior Management Team would like to extend our gratitude for the magnificent work our staff continue to undertake despite the challenges they face on a daily basis, ensuring that services to those in need continue to be delivered safely and effectively. The Role and Remit of North Lanarkshire Integration Joint Board North Lanarkshire IJB, formally established on 1 April 2016, has responsibility for the strategic planning and commissioning of a wide range of health and social care services within North Lanarkshire. These functions delegated to the IJB, under the Public Bodies (Joint Working) (Scotland) Act 2014, are detailed in the formal partnership agreement between the two partner organisations, North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) referred to as the Integration Scheme1. The IJBs primary purpose is to set the strategic direction for the delegated functions through its Strategic Commissioning Plan and the HSCP is responsible for the operational delivery of these strategic directions. These includes: accident and emergency services provided in a hospital; inpatient services related to general, geriatric, rehabilitation, and respiratory medicine; palliative care services; community health services; and social care services. The IJB comprises of eight voting members, made up of four Elected Members appointed by NLC and four Non-Executive Directors appointed by NHSL. Non-voting members include the Chief Officer, Chief Finance Officer, service professionals, third sector, service users, carers, and staff representatives. 1 NLHSCP Integration Scheme Our Purpose People of North Lanarkshire will achieve their full potential through: living safe, healthy, and independent lives in their communities; and receiving the information, support and care they need, efficiently and effectively, at the right time and in the right way.
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8 A Profile of North Lanarkshire A full profile of North Lanarkshire IJB is set out in the Strategic Commissioning Plan 2023/2026. Some of the key population characteristics include the following: By mid-2043, the 0 to 15 age group is projected to see the largest decrease (-11%). 75 and over age group is projected to see the largest percentage increase (+53.5%). In 2021/22, 13.5% of Lanarkshire residents were living with three or more long term health conditions. North Lanarkshire has a higher rate per 1,000 population compared to Scotland for several health indicators including A&E attendances, acute emergency hospital admissions, readmissions, NHS24 calls and alcohol and drug related hospital admissions. 10% of North Lanarkshire population is identified as being in a caring role with early indication that this number is set to rise. In North Lanarkshire, life expectancy at birth was higher for females (79.2 years) then for males (74.5 years) in 2018-2020, however both male and female remains below that of the Scottish average. North Lanarkshire Population is 341,400. There are 24,796 working-age people in North Lanarkshire experiencing employment deprivation. This is 11% of the working-age population. Across North Lanarkshire 15% of people are income deprived. The Scottish average is 12%.
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9 North Lanarkshire IJB Outcomes for the Year The achievements and challenges highlighted below represent some of the common themes which emerged in our engagement activities with staff and our stakeholders. Achievements Resilience Within the System – staff, carers, and service users A common thread through all our engagement activity was the recognition of the efforts and resilience of members of staff from across the health and social care sector, volunteers, carers, service users and family members in dealing with the many challenges of the pandemic. Focus on Staff Health, Wellbeing, and Connectedness Training, practical, and psychological supports have been developed for staff wellbeing across the Health and Social Care Partnership (HSCP) over the past two to three years. These initiatives are now aligned and incorporated within the major strategic workplans of both the partnership, NLC and NHSL which will inform and shape the way we work going forward by engaging with staff, embedding good practise in our ways of working and improving our methods of supporting staff in the longer term. Care Academy The Health and Social Care Academy provides curriculum opportunities linked to the health and social care sector. These are targeted at young people in the senior phase of learning from the nine secondary schools in North Lanarkshire. It is focused on assisting pupils to gain qualifications as well as work related learning experiences which will help them in gaining employment and assist in meeting the workforce requirements of the sector. The main areas are health and social care, general nursing, and allied health professions. Community Solutions – community capacity building Community Solutions is the community led, health and social care investment programme operating across North Lanarkshire, focused on building communities where people can have full, independent lives. The programme, which has been in place since 2013, is a partnership between HSCP, Voluntary Action North Lanarkshire (VANL), the community and the voluntary sector of North Lanarkshire. Its latest Strategy and Investment Plan 2022/2025 was agreed in March 2022, setting out investment plans within the programme to strengthen community capacity and resilience and deliver person-centred, community-based support and services to priority groups. Enhanced Capacity and Resilience In February 2022, the IJB approved a £20m business case utilising both recurring and non- recurring funding to transform the whole health and social care system by building capacity and resilience within it. Building on the wider approach to recovery and renewal across the sector, investment has started to be made in supports and approaches which: maximise capacity through new staffing, resources, and services; ensure staff wellbeing; ensure system flow by improving planned discharge from hospital and increasing access to care in a range of community settings; and improve outcomes through collective investment in people, systems, services and supports which deliver the right care in the right setting.
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10 Use of Technology – within a variety of settings The use of technology has expanded considerably over the past three years, and the experience of the Covid-19 restrictions resulted in the acceleration of our plans to use technology more in relation to online appointments and consultations, technology enabled care and also as a key element of our communication and day-to-day management. Mental Health Renewal and Recovery The recovery and renewal of our mental health services continues to progress and the importance of linking these efforts with our new priorities was reflected in engagement discussions and feedback. Challenges Demographic Growth and Demand Health and social care services are experiencing increasing demand due to demographic growth, an ageing population, complexity of care needs, and deprivation. It remains to be seen how detrimental the lasting impacts of Covid-19 will have on our communities, but we project this will result in negative impacts on the health of our residents in the future and subsequently as a direct result, an increase in pressures on our services. Cost of Living Crisis and Widening Inequalities Given the current challenges in relation to the cost-of-living crisis, the wider issues of poverty and income deprivation were highly prevalent in discussions which emerged in our engagement activities. There are significant and persistent inequalities in outcomes across the North Lanarkshire population that have a significant impact on people’s life opportunities and life chances. There is strong evidence to suggest the experience of the pandemic has widened inequalities with some sectors of society disproportionately affected by the disruption and restrictions. The current cost of living crisis will also disproportionately affect those with lower incomes. The volatility of the UK inflation, impacted by the record global energy costs, will present a considerable challenge to the IJB over the short to medium term. Currently at 8.4%, inflation is at one of its highest levels in 30 years far exceeding the Bank of England 2% target. Such pressures will impact on the sustainability of our external providers who will struggle to cope with the rising cost of goods and services, our service users as they battle with the concept of ‘heat’ or ‘eat’ and the IJB directly due to rising costs from providers and increased demand on all services as we continue to help those most in need. Staff Recruitment and Retention The wider health and social care sector have experienced challenges related to the recruitment and retention of staff for some time, with the recent experiences of the pandemic and the withdrawal from the European Union placing further pressure on an already challenging situation. There is a need to invest in the workforce through training and development with clear career pathways, to ensure we make employment within the sector as attractive as possible. Through a values-based approach the HSCP need to offer flexible and positive working environments with an embedded culture of staff wellbeing.
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11 National Care Service The independent review of Adult Social Care recommended the creation of a National Care Service (NCS) and a system of care which took a human right based approach with a focus on incorporating the views of those with lived experience about what needs to change to make real and lasting improvements. The aspirations of the NCS represent a progression from the Scottish Government’s Health and Social Care Delivery Plan and supports their long-standing desire to shift the balance of care and support from hospital to a community care setting. The outcome of this review is currently subject to ongoing consultation and will be used to shape and develop the new legislation, with the intention that the NCS will be fully functioning by the end of the Parliamentary term in 2026. This will impact on the delivery of services and over the next 2 – 3 years, proposed changes will have a direct impact on colleagues working in health and social care resulting in uncertainty and increased work challenges as we prepare for the implementation of the NCS. Our Priorities and Ambitions for 2023/2026 The long-term vision for North Lanarkshire HSCP which was set out in the original Strategic Plan 2016/20262 remains relevant and will continue as our over-arching vision. Our Strategic Commissioning Plan 2023/20263 sets out our commitment to achieve our long-term ambitions. Only by working together, can we bring about real change to improve the overall health and wellbeing for the people of North Lanarkshire. We continue to experience the long-term and lasting impact of the Covid-19 pandemic, whilst working with people to ensure they can access the support and treatment they require following a sustained period of disruption and restriction. This new plan will help to inform financial planning and how we allocate our resources to the programme of work 2023/2026. To enable us to measure how well we are doing, our achievements will be measured and reported against a range of national and local performance measures including the nine national health and wellbeing outcomes below. NATIONAL HEALTH & 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 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 their dignity respected. 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. 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. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Resources are used effectively and efficiently in the provision of health and social care services. Health and social care services contribute to reducing health inequalities. People using health and social care services are safe from harm. 2 Strategic Plan 2016-2026 3 Strategic Commissioning Plan 2023-2026
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12 Following our engagement with stakeholders, taking into account the experience of the past three years and the current and future challenges facing the partnership, we have revised our ambitions to the following: Clearly, these priorities are interlinked, and we expect them to influence and shape each other as we progress our implementation. Under each priority area we will develop an agreed set of medium-term goals that we plan to address between 2023 and 2026. The Programme of Work will set out in detail the programmes that will be progressed over the next three years and will be annually updated to ensure that we stay on track, and at the same time, be able to respond to any new or emerging issues that we need to address. We will closely monitor our progress and continue to seek feedback from service users, carers, and families on the impact we are making. Medium Term Financial Plan 2023/2026 The North Lanarkshire IJB Medium to Long Term Financial Plan 2020/2030, outlined the anticipated financial challenges and opportunities that the partnership expected over the ten- year period and provided a framework which would support the partnership to remain financially sustainable. The impact of Covid-19 on health and social care services and the economy created considerable unanticipated pressures, and therefore the partnerships governance arrangements were reviewed and adapted to support the response, and redesign of services. Whilst many of the elements in the previous financial plan remain, the pandemic and ensuing cost of living crisis has accelerated the delivery of some of our objectives, made others increasingly important and lowered the priority of some of our previously agreed actions. Alongside the development of the new Strategic Commissioning Plan 2023/2026, it is consequently necessary to update our supporting plan to a Medium-Term Financial Plan (MTFP). The new MTFP 2023/20264 reflects the impact of recovering from Covid-19 and other challenging factors facing the IJB. It has been condensed to a three-year plan rather than the original ten- year plan due to the pending formation of the National Care Service and the continuing uncertainty around future funding. 4 Medium Term Financial Plan 2023-2026 Strategic Commissioning Plan 2023/2026 Do the right thing first time Increased focus on prevention, early intervention and tackling inequalities Improve mental health and wellbeing Develop and support a workforce for the future Support people through a whole family approach
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13 By linking the MTFP to the plans and actions below, we ensure that consideration is given to all areas of our business, rather than concentrating on standalone objectives: As was the case prior to the pandemic, the IJB’s financial planning arrangements remain subject to active review, to enable us to continue to plan for a range of potential outcomes and scenarios. This helps us to manage emerging financial risks and challenges and the likely impact these could have on the financial position of the IJB. The financial position for public services continues to be challenging and it is therefore important that the IJB’s ambitions are set within the content of the funding available. The aspiration to prepare a balanced budget covering a longer term will support the development of strategic savings plans and ensure the available resources are allocated effectively across competing priorities. This aspiration however is dependent on the certainty of the financial settlement from the Scottish Government. Both partners have a proven track record of managing budgets effectively over many years. A clear strategy is required to ensure the IJB continue to remain financially sustainable over the medium term. The limited financial and workforce resources will require to be focussed on services which are sustainable and are targeted to those with the greatest need. In preparing the financial plan, a co-ordinated and strategic approach across the partnership has been adopted with both partners including the cost pressures in relation to their delegated functions. A range of outcomes will continue to be analysed and the financial planning assumptions updated as the most likely scenarios emerge for future years. The Scottish Government aspiration to move to multi-year settlements in the future is welcome and would reduce the uncertainty which is currently impacting on strategic commissioning activity across the health and social care partnership. Medium Term Financial Plan Reserves Strategy Engaging with Partner Bodies Supporting Transformation Workforce Planning Strategic Commissioning Plan Financial Management and Planning Budget Setting Process
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14 Financial Performance The financial year 2022/2023 has brought a fresh set of challenges including continued recovery from the pandemic, the current cost of living crisis, a changing demographic profile, staffing shortages and increased demand for services. Through regular updates to the IJB from the Chief Finance Officer (CFO) and by ensuring decisions made throughout 2022/2023 were taken to support financial sustainability, the HSCP has successfully managed to deliver year on year financial balance. This has been achieved through a combination of: Flexible use of recurring and non-recurring resources. Creation and use of reserves for specific commitments. Delivery of approved savings through service redesign and removing duplication. Workforce planning and focusing on services that are sustainable in line with our Strategic Commissioning Plan. Implementing a co-ordinated and strategic approach across the partnership. Effective governance and audit controls. Resources Available to the IJB North Lanarkshire IJB delivers and commissions a range of health and social care services to our local population. This is funded through budgets delegated from both NHS Lanarkshire and North Lanarkshire Council. The level of funding available to the IJB is therefore heavily influenced by these organisations grant settlement from Scottish Government. The Scottish Government allocated funding in March 2022 for Covid-19 costs incurred in 2021/2022 and for future years. The balance of the Covid-19 funding at the end of March 2022 was £31.686m which was transferred to a ring-fenced reserve to fund Covid-19 costs in 2022/2023. In September 2022, due to significant changes to Public Health policies in relation to Covid-19, the Scottish Government advised that surplus Covid-19 reserves funding would be reclaimed and redistributed across the sector to meet revised Covid-19 priorities. The Scottish Government reclaimed the Covid-19 reserve balance of £25.916m. This was achieved through a reduction in the Scottish Government funding allocation to the NHSL Health Board in 2022/2023 of £25.916m which was subsequently transferred through to the IJB. The combined recurring and non-recurring budgets available to the IJB in 2022/2023 to take forward the commissioning intention in line with the Strategic Commissioning Plan, is circa £764m. Included within the resources available is a ‘Large Hospital Services’ (Set Aside) budget totalling £69.120m. This budget is in respect of the functions delegated by the Health Board which are carried out in a hospital setting. The Set Aside budget for delegated services provided in acute hospitals is determined by apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJB based on postcode.
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15 Summary of Financial Position 2022/2023 Throughout 2022/2023 the CFO financial monitoring report to the IJB projected an underspend, prior to the transfer of year end balances to reserves. The year end underspend totalled £35.495m. Adjustments incurred against reserves in 2022/2023 totalled £57.001m leaving a deficit on the provision of services of £21.506m as shown in the Comprehensive Income and Expenditure Statement on page 26 and Movement in Reserves on page 27. North Lanarkshire HSCP Final Outturn 2022/2023 £m HSCP Underspend as at 31 March 2023 (35.495) Adjustments to Reserves: Drawdown of Reserves for IJB Use COVID-19 Funding Reduction by Scottish Government In Year Adjustment 31.193 25.916 (0.108) Deficit on Provision of Services (Page 25) Movement in Reserves (Page 26) 21.506 The following provides a high-level summary of the key pressures and the main reasons why the IJB’s final outturn resulted in an underspend against its budget in 2022/2023: 25% 9%66% NORTH LANARKSHIRE IJB RESOURCES AVAILABLE 2022/2023 North Lanarkshire Council £188.180m National Set Aside £69.120m NHS North Lanarkshire 506.968m Employee Costs net underspend of £17.377m is in relation to ongoing challenges in terms of recruitment and retention of staff across all service areas. This underspend also includes Scottish Government funding of £8.270m allocated to help address the current staffing pressures. This funding will be carried forward into 2023/2024 within specific ring-fenced reserves to be used in 2023/2024. Payments to Other Bodies net underspend of £1.511m is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the self-directed support commissioning framework. Admin Costs net underspend of £1.431m. This is ring-fenced carers funding that will be transferred to a dedicated earmarked reserve to fund carers pressures in 2023/2024. Mental Health, Alcohol and Drug Partnership and HSCP Planning combined net underspend in non-pays totalling £13.330m. This is due to additional funding received from Scottish Government (£13.141m) which will be carried forward into 23/24 and allocated against new spending plans. Supplies and Services net overspend of £2.531m is due to additional purchases of PPE and staff uniform due to the increase in home support staff and costs associated with winter planning. There has also been additional expenditure in relation to aids and adaptations to meet current demand. £1.550m additional income was drawn down from earmarked reserves to offset some of this overspend and is showing in the over recovery of income.
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16 The cost of services incurred in 2022/2023 is compared to the previous two years in the table below: Reserves Strategy The IJB has the same legal status as a local authority and is therefore able to hold reserves under section 106 of the Local Government (Scotland) Act 1973. A reserve strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The IJB Reserves Strategy 2022/2023 allows for flexibility in terms of potential fluctuations. This allows for the IJB to increase contingency reserve balances significantly where resources permit providing future financial resilience for those years where the level of resources available to the IJB may be significantly constrained and will require a draw down from these reserves in order to deliver financial balance. To protect the financial resilience of the IJB in the context of an increased financial risk profile, the IJB transferred £7.885m from the 2022/2023 in year underspend to contingency reserves. This provides a total contingency reserve of 3% of our financial envelope and aligns to the recommendation in our IJB Reserve Strategy of holding a 3% contingency reserve where possible. The IJB also has committed actions attached to the Strategic Commissioning Plan and funding is therefore earmarked to specific projects to allow spend to be managed in a way that represents best value for the IJB to achieve its national outcomes. It is also important that in year funding available for government priorities are able to be ring-fenced and carried forward into the following financial year. As these funding allocations are to meet specific commitments, they must be carried forward to meet the conditions attached to their receipt. The table below shows the breakdown of the underspend transferred to reserves at year end: 2020/2021 2021/2022 2022/2023 £m £m £m Social Care Services 189.048 202.610 236.972 Health Care Services 65.557 74.073 74.527 Family Health Services 105.773 109.652 115.625 Delegated Services 1.281 2.207 2.437 Hosted Services 141.034 149.126 159.642 IJB Operating Costs 0.212 0.214 0.247 Prescribing Costs 69.088 68.739 71.332 Covid-19 Costs 21.342 13.412 7.072 Set Aside 63.066 65.164 69.120 Income (2.507) (3.800) (4.717) COST OF SERVICES 653.894 681.397 732.256 North Lanarkshire HSCP Services Prescribing net overspend of £1.750m is due to activity and cost per item being 3.19% higher compared to 2021/2022. Due to the uncertainty around costs and prescribing activity, the volatility experienced within prescribing is likely to continue for the foreseeable future. Income over-recovery of £6.031m for Social Care is due to the drawdown of earmarked reserves to offset expenditure relating to winter planning, adaptations, digital and IT and staffing costs.
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17 Risk Management The IJB Risk Management Strategy, which was updated and approved by the IJB in March 2023, complements the existing risk management processes within each partner by ensuring risk reports form a substantial item of business at all IJB meetings. There are three main risk registers across the partnership: IJB risk register outlining the strategic risks to the IJB; Health operational risk register, hosted within the NHS Lanarkshire system; and Social Work operational risk register, hosted within North Lanarkshire Council system. Strong ties have been maintained with the corporate risk managers in both partner organisations and the IJB Risk Management Strategy, has been developed in conjunction with these leads, linking closely to both the North Lanarkshire Council and NHS Lanarkshire Risk Management Strategies. At time of writing, there are currently seventeen open risks identified within our North Lanarkshire IJB Risk Register with two of these risks rated as very high and eight rated as high. The table below shows a summary of these: Category Description of Risk Summary Current Risk Level Financial Financial Challenges: There are a range of financial challenges which will impact on the IJB’s ability to deliver the Strategic Commissioning Plan with the financial envelope available. High Financial Ineffective Governance Arrangements: There is a risk that the IJB is unable to prevent and detect fraud and corruptions within services due to inadequate governance arrangements and internal controls. Low Financial Set-Aside Budget: There is a risk that the resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care. High Financial Hosted Services: There is a risk of dispute between the North and South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services budget. Medium Financial Prescribing: Prescribing costs may escalate due to the increases in activity and price volatility, new drugs becoming available, the response to Covid-19 and the impact of the EU withdrawal. Very High Financial Third and Voluntary Sector: There is a risk our third sector organisations are vulnerable because of lack of certainty in respect of long-term funding, leading to instability and recruitment and retention challenges. Low Financial Ineffective Governance Arrangements Due to Covid-19 Pandemic: There is a risk that the intensity of the required response to Covid-19 could result in a failure of governance. Medium Performance Oversight of Performance Activity: There is a risk the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role. Low Performance 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 pressures, sickness, and redeployment. High Performance Care Homes: Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. Medium Analysis of Transfer to IJB Reserves £m Ring-Fenced Reserves 21.411 Earmarked Reserves 6.199 Contingency Reserves 7.885 Total 35.495
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18 Performance Service Sustainability: There is a risk that the IJB will be unable to implement the strategic plan. Failure to achieve the desired IJB strategic aims poses a risk on operational service delivery. High Performance Workforce Sustainability: It is becoming increasing 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. High Category Description of Risk Summary (Continued) Current Risk Level Strategic & Performance Children and Adolescent Mental Health Services: There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of staff vacancies and recruitment challenges. High Strategic & Performance Cost of Living: There is a risk that the Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost-of-living increases being faced by residents. High Strategic & Performance 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 and HSCP workforce capacity. Very High Strategic & Performance Community Alarms: There is a risk the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025. Medium Strategic National Care Service: The ongoing work around the NCS could destabilise current service delivery due to significant change activity, time demands and staff uncertainty. High Acknowledgements We would like to acknowledge the significant effort required to both produce the annual accounts and successfully manage the finances of the IJB and to record our thanks to the Finance teams in both North Lanarkshire Council and NHS Lanarkshire and colleagues in other services within the Partnership for their continued hard work and support. Brian Moore Vice Chair, North Lanarkshire Integration Joint Board and Chair, North Lanarkshire Integration Joint Board Performance, Finance and Audit. Date: Ross McGuffie Chief Officer Date: Amanda Kilburn FCCA Chief Finance Officer Date:
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19 STATEMENT OF RESPONSIBILITIES Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire Integration Joint Board is required to: Make arrangements for the proper administration of its financial affairs and to ensure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Finance Officer. Manage its affairs to secure economic, efficient, and effective use of resources and safeguard its assets. Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). Approve the Annual Accounts. I confirm that these Annual Accounts were approved for signature at a meeting of the North Lanarkshire Integration Joint Board on 18 October 2023. Signed on behalf of the North Lanarkshire Integration Joint Board Brian Moore Date: Vice Chair, North Lanarkshire Integration Joint Board and Chair, North Lanarkshire Integration Joint Board Performance, Finance and Audit.
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20 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the Integration Joint Board’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: Selected suitable accounting policies and then applied them consistently. Made judgements and estimates that were reasonable and prudent. Complied with legislation. Complied with the Local Authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: Kept proper accounting records which were up-to date. Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that these Annual Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2023 and the transactions for the year then ended. Amanda Kilburn FCCA Date: Chief Finance Officer
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21 REMUNERATION REPORT The Local Authority Accounts (Scotland) Regulations 2014 (SSI No. 201/200) require local authorities and IJBs in Scotland to prepare a Remuneration Report as part of the annual statutory accounts. The information in the tables below is subject to external audit. The explanatory text in the Remuneration Report is reviewed by Audit Scotland to ensure it is consistent with the financial statements. Voting Board Members Voting IJB members constitute councillors nominated as board members by constituent authorities and NHS representatives nominated by the NHS Board. The voting members of North Lanarkshire IJB were appointed through nomination by North Lanarkshire Council and NHS Lanarkshire. The regulations require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant’ person in relation to the Remuneration Report includes a senior officer holding office with associated authority, whether on a permanent or temporary basis, in the financial year to which that Remuneration Report relates. The Board Members do not receive remuneration or expenses directly from the IJB. Any remuneration or reimbursement of expenses for voting board members is governed by the relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs by the partner. Vice Chair vacant from 1 April 2022 to 21 June 2022. Councillor Ayeshah Khan vacated the position of IJB Chair on 30th June 2023. As Vice Chair, Brian Moore is currently Chairing the IJB until the new Chair can uptake post. Taxable Expenses 2021/2022 £ Name Post Held* Nominated by Taxable Expenses 2022/2023 £ IJB Chair (1 April 2021 to 31 March 2022) IJB Chair (1 April 2022 to 21 June 2022) IJB Chair (22 June 2022 to 24 August 2022) IJB Chair (25 August 2022 to 31 March 2023) IJB Vice Chair (1 April 2021 to 31 March 2022) IJB Vice Chair (22 June 2022 to 31 March 2023) - -Cllr Paul Kelly North Lanarkshire Council - Cllr Paul Kelly North Lanarkshire Council - - - - - - - - - Cllr Ayeshah Khan North Lanarkshire Council Brian Moore NHS Lanarkshire Cllr Tracy Carragher North Lanarkshire Council Dr A Osborne NHS Lanarkshire
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22 The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or the Vice Chair. There were no exit packages payable during the financial year. Officers of the IJB The IJB does not directly employ any staff in its own right however specific post-holding officers are non-voting members of the Board. The Chief Officer and the Chief Finance Officer are appointed by the North Lanarkshire IJB and employed by North Lanarkshire Council. Both posts are seconded to the IJB in line with the local arrangements. The senior officers received the following remuneration in the period: M Moy, Chief Finance Officer was also appointed to the South Lanarkshire IJB from 1 April 2021 to 6 May 2022. Therefore, the remuneration disclosed above for this post, is the proportion of remuneration received solely in relation to the activity of the North Lanarkshire IJB. FYE: Full Year Estimate includes an estimate of the full year salary from 1 April 2022 for Amanda Kilburn who started as Chief Finance Officer on 22 August 2022 and a proportion of full year salary to 31 March 2023 for Marie Moy who left as Chief Finance Officer on 6 May 2022. Pay band information is not separately provided as all staff pay information has been disclosed in the information above. Pension Benefits In respect of officers’ pension benefits the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pension liability reflected on the IJB balance sheet for the Chief Officer or the Chief Finance Officer. Total Earnings Total Earnings * 2021/2022 2022/2023 £ £ Ross McGuffie Chief Officer 1 April 2022 to 31 March 2023 Marie Moy Chief Finance Officer 1 April 2022 to 6 May 2022 Amanda Kilburn Chief Finance Officer 22 August 2022 to 31 March 2023 - 45,844 (FYE 74,370) Name and Post Title* 102,352 112,098 36,631 3,645 (FYE 38,004)
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23 The IJB however, has responsibility for funding the employee contributions for the current year in respect of the officer time spent fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The table also shows the total value of the accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. The pension contribution and benefits for M Moy, Chief Finance Officer relate to the proportion attributable to the activity of the North Lanarkshire IJB based on a pro-rata approach. Brian Moore Vice Chair, North Lanarkshire Integration Joint Board and Chair, North Lanarkshire Integration Joint Board Performance, Finance and Audit. Date: Ross McGuffie Chief Officer Date: For Year to 31/03/2022 For Year to 31/03/2023 As at 31/03/2022 As at 31/03/2023 £ £ £000 £000 Pension 10 12 Lump Sum - - Pension 16 - Lump Sum 22 - Pension - 15 Lump Sum - - Amanda Kilburn Chief Finance Officer - 8,848 Name and Post Title In Year Pension Contribution* Accrued Pension Benefits* Marie Moy Chief Finance Officer Ross McGuffie Chief Officer 21,291 21,635 7,058 365 Description
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24 ANNUAL GOVERNANCE STATEMENT The Annual Governance Statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance and meets the requirements of the ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE in 2016. Scope of Responsibility The IJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. The IJB also aims to foster a culture of continuous improvement in the performance of the IJB’s functions and to make arrangements to secure best value. To meet this responsibility, the IJB has established arrangements for governance which includes a system of internal controls. The system is intended to manage risk to support the achievement of the IJB’s policies, aims and objectives. Reliance is also placed on the North Lanarkshire Council and NHS Lanarkshire systems of internal control which support compliance with both organisations’ policies and promotes achievement of each organisations aims and objectives, as well as those of the IJB. This system can only provide reasonable and not absolute assurance of effectiveness. Purpose of the Governance Framework The governance framework comprises the systems and processes, and culture and values, by which the IJB is directed and controlled. It enables the IJB to monitor the achievement of the objectives set out in the IJB’s Strategic Commissioning Plan. The governance framework is continually updated to reflect best practises, new legislative requirements, and the expectations of stakeholders. The system of internal control is based on an ongoing process designed to identify and prioritise the risks in the achievement of the IJB’s objectives, to evaluate the likelihood of those risks being realised, the impact should they be realised, and to manage them effectively. Governance Framework and Internal Control System The IJB comprises of eight voting members, with one from each partner organisation assuming the role of Chair and Vice Chair. Four are Council Members nominated by North Lanarkshire Council and four are Non-Executive Members appointed by NHS Lanarkshire. The term of office is for a period of three years. There are also a number of non-voting professional and stakeholder members on the IJB board. Stakeholder members currently include third sector, carers, staff representatives, service users and professional members including the Chief Officer and Chief Finance Officer. The IJB, via a process of delegation from NHS Lanarkshire and North Lanarkshire Council, has responsibility for the planning, resourcing and operational delivery of all delegated health and social care within its geographical area. The main features of the governance framework are: Principles The IJB follows the principles set out in the Convention of Scottish Local Authorities (COSLA) and the Accounts Commission in 1996 Code of Guidance on Funding External Bodies and
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25 Following the Public Pound for both resources delegated to the IJB, and resources paid to its Local Authority and Health Service partners. Formal Frameworks The IJB is formally constituted through the Integration Scheme agreed by North Lanarkshire Council and NHS Lanarkshire and approved by Scottish Ministers. The IJB operates within an established procedural framework. The roles and responsibilities of board members and officers are defined within standing orders, scheme of delegation and financial governance arrangements which are subject to regular review. The IJB Code of Corporate Governance5 was approved by the IJB on 18 July 2017 which is subject to ongoing updates as required. Board members adhere to an established Code of Conduct and are supported by induction and ongoing training and development. Staff ‘Personal Development Plan’ (PDP) schemes are also in place, the aim of which is to focus on performance and development that contributes towards achieving service objectives. The HSCP has robust structures which are based on service delivery, care and interventions that are person centred, timely, outcome focused, equitable, safe, efficient, and effective. Reports are presented to the IJB throughout the year which provides evidence to demonstrate the delivery of our core components within our frameworks and the Clinical and Care Governance principles specified by Scottish Government. Strategic Planning The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic Commissioning Plan which sets out the key outcomes the IJB is committed to delivering with its partners. The Strategic Planning Group sets out the IJB’s approach to engage with stakeholders. Consultation on the future vision and activities of the IJB is undertaken with its Health Services and Local Authority partners. The IJB regularly publishes information regarding its performance. The Medium-Term Financial Plan 2023/2026 outlines the financial challenges and opportunities the HSCP faces over the next three years and provides a framework which will support the HSCP to remain financially sustainable. It complements the IJB Strategic Commissioning Plan 2023/2026, highlighting how the financial plan will support the delivery of the IJB’s strategic objectives and priorities. Oversight Effective scrutiny and service improvement activities are supported by the formal submission of reports, findings and recommendations by Inspectorates and the appointed Internal Audit Service to the IJB’s Senior Management Team, the main IJB board and the Performance, Finance and Audit Committee, as appropriate. Performance management, monitoring of service delivery and financial governance is provided by the HSCP to the IJB, who are accountable to both the Health Board and Local Authority. It reviews reports on the effectiveness of the integrated arrangements including the financial management of the integrated budget. This ensures there is a regular scrutiny at senior management, committee, and board level. Information on performance can be found in the Annual Performance Report published on our North Lanarkshire HSCP website6. 5 IJB Code of Corporate Governance 6 Health & Social Care North Lanarkshire Website
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26 Risk Management In line with the continued and ongoing review of the IJB Risk Register, new and emerging risks or changes in risk level are agreed at each Senior Management Team, IJB and PFA meeting as appropriate. The current risks at time of writing are summarised in the Management Commentary on pages 12-13. Financial Control Responsibility for maintaining and operating an effective system of internal financial control rests with the Chief Finance Officer. The system of internal financial control is based on a framework of regular management information, Financial Regulations and Standing Financial Instructions, administrative procedures, including segregation of duties, and management and supervision including delegation and accountability. Development and maintenance of these systems is undertaken by managers within the HSCP supported by North Lanarkshire Council and NHS Lanarkshire in relation to the operational delivery of health and social care services. Transformational Change The Medium-Term Financial Plan and the Strategic Commissioning Plan recognises the need to transform the way in which the HSCP delivers services to ensure the sustainability of health and social care services going forward. Together with the IJB Reserves Strategy, both plans are regularly reviewed over their lifespan, and amended as necessary to reflect the current challenges and pressures the partnership face. Review of Adequacy and Effectiveness Due to the nature of the IJB membership, a conflict of interest can arise between individual board and committee members and the responsibilities they have to the IJB. It is the responsibility of board and committee members to declare any potential conflicts of interest, and it is the responsibility of the Chair of the relevant board or committee to ensure such declarations are appropriately considered and acted upon. The IJB has responsibility for conducting, an annual review of the effectiveness of the system of internal control and the quality of data used throughout the organisation. The review is informed by the work of the Senior Management Team who have the responsibility for the development and maintenance of the internal control framework, the work of the internal and external audit teams and other independent inspectorates. Internal Audit undertake an annual programme following an assessment of risk completed during the strategic audit planning process. The appointed NHS Lanarkshire Chief Internal Auditor in conjunction with the North Lanarkshire Council Chief Officer (Audit and Risk), provide an annual report to the IJB PFA giving an independent opinion of the adequacy and effectiveness of the governance framework, risk management and internal controls. Based on the audit work undertaken directly on behalf of the IJB and being informed by internal audit, work undertaken independently by each respective internal audit function within North Lanarkshire Council and NHS Lanarkshire, the NHS Lanarkshire Chief Internal Auditor and the North Lanarkshire Council Chief Officer of Audit and Risk are able to conclude that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls. Roles and Responsibilities
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27 The Chief Officer is the Accountable Officer for the IJB and has day-to-day operational responsibility to monitor delivery of integrated services, with oversight from the IJB. The IJB complies with the CIPFA statement on ‘The Role of the Chief Finance Officer in Local Government 2014’. The IJB Chief Finance Officer has responsibility for North Lanarkshire HSCP financial arrangements and is professionally qualified and suitably experienced to lead and advise the IJB finance function. The IJB complies with the requirements of the Public Internal Audit Standards (PSIAS) and the approved Internal Audit Charter for the IJB. The appointed North Lanarkshire IJB Chief Internal Auditor has responsibility for the IJB internal audit function and is professionally qualified and suitably experienced to lead and direct internal audit staff. The Internal Audit service operates in accordance with the CIPFA ‘Public Sector Internal Audit Standards 2017’. Board members and officers of the IJB are committed to the concept of sound internal control and the effective delivery of health and social care services. The IJB Performance, Finance and Audit Committee operates in accordance with CIPFA Audit Committee Principles in Local Authorities in Scotland and Audit Committees ‘Practical Guidance for Local Authorities’. The Committee core function is to provide the IJB with independent assurance on the adequacy of the risk management framework, the internal control environment, the integrity of the financial reporting and governance arrangements. In March 2023, the IJB approved a revision to the IJB Performance, Finance and Audit Committee Terms of Reference, delegating the power to approve the IJB Annual Accounts effective from the financial year 2022/2023 and each year thereafter. The PFA Terms of Reference have been revised to account for this change. An update to the North Lanarkshire IJB Governance Document was approved by the IJB on 17 May 2023 which includes IJB Programme of Reports, Equality Impact Assessment, Code of Conduct and Declaration of Interest, Directions, IJB Risk Reporting Process and Risk Reporting Template7. Action Plan To ensure continual improvement of the IJB’s governance arrangements, the following action plan has been agreed. Also included are improvement areas identified by Audit Scotland within their Annual Audit Report. Regular updates on progress of the agreed actions will be presented to and monitored by the IJB Performance, Finance and Audit Committee. 2021/2022 Ref Improvement Area Agreed Action Responsible Person Date 1 Review of Set-Aside Concept Due to the complexity of the data surrounding this area, it has been reviewed and agreed with the partner that the current process will remain as described in note 2 Critical Judgments and Estimation Uncertainty, until a decision is taken at a national level. Chief Finance Officer Complete 7 North Lanarkshire IJB Governance Document 2023
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28 2 Website Refresh HSCP working group have completed the development of the new IJB website which reflects the current operating model. There is a dedicated team who will take ownership and responsibility for maintaining and updating it. The new website launched at the end of February 2023 with endorsement by the IJB on 22 March 2023. IJB Chief Officer Complete 3 Medium Term Financial Plan The new Medium Term Financial Plan 2023/ 2026 reflects the impact of recovering from Covid-19 and other challenging factors facing the IJB. The plan was approved by the IJB on 22 March 2023 and aligns to the new Strategic Commissioning Plan 2023/ 2026 and the current IJB Reserves Strategy. Chief Finance Officer Complete 2022/2023 Ref Improvement Area Agreed Action Responsible Person Date 1 Completion of previous internal and external audit actions. All external and internal audit actions have been completed apart from the Service Level Agreement (SLA) with Children, Families and Justice. This SLA will be revisited once further clarity has been obtained around what services will be part of the new National Care Service. Progress was reported to the PFA Committee in November 2022 and April 2023. Chief Finance Officer Complete (Pending National Care Service) 2 National Care Service To develop a sound understanding of the impact for the NLHSCP of the outputs of the National Care Service legislation. Due to the uncertainty and lack of detail currently available, the revised date of completion has been moved to March 2024. Chief Officer Updated timescale: March 24 3 Implementation of improvement actions identified in the Best Value Self-Assessment exercise. Both the Strategic Commissioning Plan 2023/2026 and the Medium-Term Financial Plan 2023/2026, approved at the IJB on 22 March 2023, align to strengthen outcomes against resources. By ensuring good practise and lessons learned, both plans have aligned to future funding and reserves to link with outcomes around the improvement actions in the Best Value Self-Assessment exercise. Head of Planning, Performance and Quality Assurance Complete 4 Review the IJBs progress in becoming a Category 1 Responder as set out within the Civil Contingencies Act In conjunction with the Local Resilience Partnership, undertake a self-assessment review against the seven duties, reporting progress to the West of Scotland Regional Resilience Partnership. Report submitted and reviewed by the IJB on 22 March 2023. Chief Officer Complete 5 Accounts Inspection The IJB should ensure it has procedures in place to ensure the accounts inspection advert is published in line with criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. Chief Finance Officer June 2023
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29 6 2022/23 Reserves Strategy The IJB 2022/23 Reserves Strategy was presented and approved by the IJB Committee on 22 March 2023. The Reserves Strategy will continue to be updated in line with the new Strategic Commissioning Plan 2023/2026 and the new Medium Term Financial Plan 2023/2026. Chief Finance Officer Complete 7 Review of Financial Regulations Revised Financial Regulations were approved at the Performance, Finance and Audit Committee on 15 February 2023 and include the services currently delegated by each partner to the IJB and the principal method of accounting for Hosted Services. Chief Finance Officer Complete Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the partnership conducts its business in a manner that has due regard to the principles of good governance. Overall, the results of the work undertaken to provide assurance include reports produced by External Audit and a range of governance reports undertaken jointly with the partner organisations, to help to inform an opinion on whether the internal controls the North Lanarkshire HSCP has in place are adequate. The joint internal audit opinion is that reasonable assurance can be placed upon the adequacy and effectiveness of the North Lanarkshire IJB’s framework of governance, risk management and internal control. Conclusion and Opinion on Assurance It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements. The IJB has adhered to the stated principles of good governance, acted in the public interest, and been committed to continuous improvement. The scrutiny and oversight of the IJB Performance, Finance and Audit Committee contributes effectively to these arrangements. There were no significant control weaknesses, issues, or failures in the expected standards for good governance, risk management and internal control. We consider that the internal control environment provides reasonable and objective assurance that any significant risks impacting on the IJB’s principal objectives will be identified and actions taken to avoid or mitigate their impact and are consistent with the recommendations of the CIPFA/SOLACE Framework (2016). Brian Moore Vice Chair, North Lanarkshire Integration Joint Board and Chair, North Lanarkshire Integration Joint Board Performance, Finance and Audit. Date: Ross McGuffie Chief Officer Date:
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30 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2023 This statement shows the actual cost of providing services in accordance with generally accepted accounting practices. It includes, on an accrual basis, all expenses and related income. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Gross Expenditure Gross Income Net Expenditure Gross Expenditure Gross Income Net Expenditure £m £m £m £m £m £m 202.610 (1.593) 201.017 Social Care Services 236.972 (2.280) 234.692 74.073 74.073 Health Care Services 74.527 74.527 109.652 109.652 Family Health Services 115.625 115.625 149.126 149.126 Hosted Services 10 159.642 159.642 1.668 (1.668) 0.000 Housing Services 1.886 (1.886) 0.000 0.539 (0.539) 0.000 Transport Services 0.551 (0.551) 0.000 0.214 0.214 Corporate Services 6 0.247 0.247 68.739 68.739 Prescribing 71.332 71.332 65.164 65.164 Set Aside for Hospital Acute Services 69.120 69.120 13.412 13.412 Covid-19 Costs 7.072 7.072 685.197 (3.800) 681.397 Total Cost of Services 736.974 (4.717) 732.256 (747.731) (747.731) Taxation and Non-Specific Grant Income 5 (710.750) (710.750) 685.197 (751.531) (66.334) (Surplus) or Deficit on Provisions of Services (Movement in Reserves) 736.974 (715.467) 21.506 2021/2022 2022/2023 North Lanarkshire Health & Social Care Partnership Integration Joint Board Note
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31 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. General Fund Balance Total Reserves £m £m Opening Balance at 1 April 2021 (53.118) (53.118) Total Comprehensive Income and Expendiutre (Increase) or decrease in 2021/22 (66.334) (66.334) Closing Balance at 31 March 2022 (119.452) (119.452) Opening Balance at 1 April 2022 (119.452) (119.452) Total Comprehensive Income and Expendiutre (Increase) or decrease in 2022/23 21.506 21.506 Closing Balance at 31 March 2023 (97.946) (97.946) Movement in Reserves during 2021/2022: Movement in Reserves during 2022/2023: North Lanarkshire Health & Social Care Partnership Integration Joint Board
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32 BALANCE SHEET AS AT 31 MARCH 2023 The balance sheet shows the value of the IJB’s assets and liabilities as at 31 March 2023. The net assets of the IJB (assets less liabilities) are matched by the reserves held by the IJB. The Statement of Accounts presents a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2023 and its income and expenditure for the year then ended. Notes to the Financial Statements numbers 1 to 14 found on pages 29 – 37, form part of the financial statements. The unaudited accounts were authorised for issue on 21 June 2023. These audited accounts certified by the Chief Finance Officer on 18 October 2023 replace the unaudited accounts. Balance Sheet signed by: Amanda Kilburn FCCA Chief Finance Officer Date: 31 March 2022 31 March 2023 £m £m 119.452 Current Assets Short Term Debtors 7 97.946 - Current Liabilities Short Term Creditors 7 - 119.452 Net Assets 97.946 119.452 Usable Reserves: General Fund 8 97.946 119.452 Total Reserves 97.946 North Lanarkshire Health & Social Care Partnership Integration Joint Board Notes
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33 NOTES TO THE FINANCIAL STATEMENTS Note 1. Significant Accounting Policies General Principles The financial statements summarise the transactions of the IJB for the financial year 2022/2023 and its position at 31 March 2023. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between North Lanarkshire Council and NHS Lanarkshire. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2022/2023, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. Each partner complies with their accounting policies as appropriate. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: Expenditure is recognised when goods or services are received, and their benefits are used by the IJB. Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income and receipt of the income is probable. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. Where debts may not be received, the balance of debtors is written down. Funding The IJB is primarily funded through funding contributions from its statutory funding partners, North Lanarkshire Council and NHS Lanarkshire. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Lanarkshire and service recipients in South Lanarkshire, for services that are delivered under hosted arrangements and on a pan-Lanarkshire basis. The funding relating to the year under review is recognised as income in the Comprehensive Income and Expenditure Statement and will normally be income added to the General Fund. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by partners. The movement in General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Cash and Cash Equivalents
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34 The IJB does not operate a bank account or hold cash. All transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. There is therefore no requirement for the IJB to produce a cash flow statement. The funding balance due to or from each funding partner as at 31 March 2023 is represented as a debtor or creditor on the IJB’s balance sheet. Employee Benefit The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its balance sheet. The IJB has a legal responsibility to appoint a Chief Officer. A Chief Finance Officer has also been appointed to the IJB. More details on these arrangements are provided in the remuneration report. The charges for the employing partners are treated as employee costs. Where material, the absence entitlement at 31 March is accrued, for example in relation to annual leave earned but not yet taken. In the case of North Lanarkshire IJB any annual leave earned by the Chief Officer and Chief Finance Officer, but not yet taken is not considered to be material. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation on 31 March due to a past event, settlement of the obligation is probable, and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31 March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s balance sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31 March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s balance sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. Indemnity Insurance / Clinical and Medical Negligence The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). North Lanarkshire Council and NHS Lanarkshire have responsibility for claims in respect of the services for which they are statutorily responsible for and that they provide. Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material, the overall expected value of known claims taking probability of settlement into consideration, is provided for in the IJB balance sheet.
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35 The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and where material, presented as either a debtor or disclosed as a contingent asset. Debtors and Creditors Financial instruments are recognised in the balance sheet when an obligation is identified and released as that obligation is fulfilled. Debtors are held at fair value and represent funding due from partner bodies that was not utilised in year. There are no creditor balances. Reserves A reserve is the accumulation of surpluses, deficits, and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2023, the usable reserve balance totals £97.946m. There are no unusable reserves. Specific Service Income Income may be received from individuals as a contribution towards the cost of their social care service. The amount collected is allocated to the relevant expenditure category and the net cost is reported in the Comprehensive Income and Expenditure Statement. This is the basis upon which the 2022/2023 annual accounts have been prepared. Note 2. Critical Judgements and Estimation Uncertainty In preparing the 2022/2023 financial statements, the IJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. The critical judgments made in the annual accounts are: Hosted Services Within Lanarkshire, each IJB has operational responsibility for the services which it hosts on behalf of the other IJB. In delivering these services each IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such the IJB is considered to be acting as ‘principle’, and the full costs are reflected within the annual accounts for the services which it hosts. This is the basis on which North Lanarkshire IJB accounts have been prepared. The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the North Lanarkshire IJB on the basis of 51% of the total expenditure. 49% of the services relating to the South Lanarkshire IJB are also included as the North Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the Annual Accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service. Note 3. Events After the Balance Sheet Date The Chief Finance Officer authorised the unaudited annual accounts for issue on 21 June 2023. Events after the balance sheet date are those events that occur between the end of the reporting period and the date when the statements are authorised for issue. Where events take place before the date of authorisation and provide information about conditions existing as at 31 March 2023, the figures in the financial statements and notes would be adjusted in all material aspects to reflect the impact of this information. There have been no
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36 material events since the date of the balance sheet which require revision to the figures in the annual accounts. Note 4. Expenditure and Funding Analysis by Nature The following table shows the gross expenditure and funding for North Lanarkshire IJB against subjective headings: Note 5. Taxation and Non-Specific Grant Income The following table shows the funding contribution from the two partner organisations: The funding contribution from the NHS Board shown above includes £69.120m in respect of ‘Set Aside’ resources relating to acute hospital services. These are provided by NHS Lanarkshire which retains responsibility for managing the costs of providing these services. The IJB however has responsibility for the consumption and level of demand placed on these resources. Funding to meet the cost of the emergency response to the Covid-19 pandemic was nil in 2022/2023 (2021/2022: £45.098m). Excluded from the funding contribution from the partners above is any specific service income contributions from clients towards the cost of their social care services. In 2022/2023 this 2021/2022 2022/2023 £m £m Social Care Services 202.610 236.972 Health Care Services - Localities 58.073 58.422 Health Care Services - Area Wide 11.010 11.189 Health Care Services - Out of Area 4.990 4.917 Family Health Services 109.652 115.625 Housing Services 1.668 1.886 Transport Services 0.539 0.551 Hosted Services - Led by North IJB 114.573 125.402 Hosted Services - Led by South IJB 34.553 34.240 IJB Operating Costs 0.214 0.247 Prescribing Costs 68.739 71.332 Covid-19 Costs 13.412 7.072 Set Aside 65.164 69.120 Income (3.800) (4.717) Total Cost of Services 681.397 732.256 Partners Funding Contributions and Non-Specific Grant Income (747.731) (710.750) (Surplus)/Deficit on Provision of Services (66.334) 21.506 Expenditure and Funding Analysis by Nature 2021/2022 2022/2023 £m £m Funding Contribution from NHS Lanarkshire (582.943) (523.649) Funding Contribution from North Lanarkshire Council (164.788) (187.101) Total (747.731) (710.750) Taxation and Non-Specific Grant Income
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37 income totalled £2.280m and is presented as gross income in the Cost of Services within the Comprehensive Income and Expenditure Statement on page 26. Note 6. IJB Operating Costs North Lanarkshire Council and NHS Lanarkshire provide a range of support services for the IJB including finance, personnel, planning, audit, payroll, debtor, and creditor services. There is no charge to the IJB for these support services. The costs associated with running the IJB are shown in the following table: Note 7. Short Term Debtors and Creditors At 31 March 2023, North Lanarkshire IJB had short term debtors of £97.946m relating to the reserves held in the Balance Sheet. There were no short-term creditors. Amounts owed by funding partners are stated on a net basis and are classified as short-term debtors on the basis that these reserves could be utilised at any time. Note 8. Usable Reserves: General Fund The purposes of the General Fund are detailed in the IJB Reserves Policy8 and summarised below: Funding received for a specific purpose and not yet spent will be allocated to a ring-fences reserve. Funding for future expenditure needs and key financial risks will be allocated to earmarked reserves. A contingency reserve is required to cushion the impact of unexpected events or emergencies. At 31 March 2023 the IJB created earmarked reserves to support the delivery of projects which span financial years and ring-fenced reserves to enable the IJB to deliver on specific Scottish 8 North Lanarkshire IJB Reserves Policy 2021/2022 2022/2023 £m £m Staff Costs 0.183 0.213 Audit Fees 0.028 0.031 Administration Costs 0.003 0.003 Total 0.214 0.247 IJB Operating Costs (Corporate Services) 2021/2022 2022/2023 £m £m NHS Lanarkshire 87.533 62.180 North Lanarkshire Council 31.919 35.766 Total 119.452 97.946 2021/2022 2022/2023 £m £m NHS Lanarkshire - - North Lanarkshire Council - - Total - - Short Term Debtors Short Term Creditors
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38 Government funded programmes. In addition, the contingency reserve has been increased as part of the financial strategy of the IJB. This will be used to manage the risk of any future unanticipated events and support service provision that may materially impact on the financial position of the IJB in later years. The following table shows how reserves are allocated: Note 9. Related Party Transactions The IJB has related party transactions with North Lanarkshire Council and NHS Lanarkshire. In particular the nature of the partnership means that the IJB may influence and be influenced by its partners. Scottish Government Ring-Fenced Reserves £m £m £m Adult Social Care Winter Preparedness Fund 1.941 -1.941 - Alcohol and Drug Partnership Funding 1.142 2.206 3.348 Blood-Borne Viruses Services - 0.171 0.171 Children and Adolescent Mental Health Services 0.900 3.201 4.101 Community Living Change Fund 1.298 - 1.298 Covid-19 Funding 31.686 -30.915 0.771 District Nursing - Scottish Government Funded - 0.376 0.376 Hospital at Home Services - Support Development - 0.621 0.621 Integrated Authority Support 6.076 -6.076 - Mental Health and Learning Disability Services 0.111 11.179 11.290 North Planning Band 2-4 Posts & Pharmacy Training - 1.106 1.106 Ring-Fenced Reserves - Other Services 2.564 1.931 4.495 Scottish Government Ring-Fenced Reserves Total 45.718 -18.141 27.577 Adult Social Care Winter Preparedness Fund - 1.941 1.941 Carers Act Support 0.580 2.063 2.643 Children and Adolescent Mental Health Services 0.717 -0.371 0.346 Digital and IT Strategy 0.566 5.064 5.630 Earmarked Reserves - Other Services 48.072 -42.809 5.263 Home Support Resilience - 3.498 3.498 Integrated Authority Support - 4.926 4.926 IJB Financial Plan 2023/2026 6.572 2.375 8.947 Long Covid Contingency 3.000 -1.051 1.949 Minor Repair and Replacement Programme of Works 1.387 2.003 3.390 Prescribing Fund 4.361 - 4.361 Social Care Services 3.988 1.228 5.216 Speech, Language and Therapy Services 0.807 -0.807 - Winter Funding Business Case - 5.608 5.608 Earmarked Reserves Total 70.050 -16.332 53.718 Contingency Reserve Total 3.684 12.967 16.651 Total North Lanarkshire IJB Reserves 119.452 -21.506 97.946 Earmarked Reserves USEABLE RESERVES Net Transfers during 2022/2023 Balance as at 31 March 2023 Balance as at 31 March 2022
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39 Non-voting board members are not directly employed by NHS Lanarkshire however, a contribution of 50% of the cost of the Chief Officer is made by NHS Lanarkshire along with the full cost of the Chief Finance Officer. This payment is included in the IJB Operating Costs (Corporate Services) in the Comprehensive Income and Expenditure Statement and detailed at Note 6. The financial information contained in the IJB annual accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double counting. The following transactions and balances included in the IJB annual accounts are presented to provide additional information on related party relationships. There are elements of expenditure which are shown against North Lanarkshire Council but where the resource is provided by NHS Lanarkshire. Resource Transfer which includes the Social Care Fund are therefore part of the NHS Lanarkshire budget but are used to deliver social care services supplied by North Lanarkshire Council. Note 10. Hosted Services North Lanarkshire IJB act as the lead for a number of delegated services on behalf of South Lanarkshire IJB. It therefore commissions services on behalf of South Lanarkshire IJB and 2021/2022 2022/2023 £m £m NHS Lanarkshire - - North Lanarkshire Council (3.800) (4.717) Total (3.800) (4.717) 2021/2022 2022/2023 £m £m NHS Lanarkshire 472.132 496.010 Resource Transfer to North Lanarkshire Council 59.679 52.993 NHS Lanarkshire Total 531.811 549.003 North Lanarkshire Council 213.065 240.964 Resource Transfer from NHS Lanarkshire (59.679) (52.993) North Lanarkshire Council Total 153.386 187.971 2021/2022 2022/2023 £m £m NHS Lanarkshire (582.943) (523.649) North Lanarkshire Council (164.788) (187.101) Total (747.731) (710.750) 2021/2022 2022/2023 £m £m NHS Lanarkshire 87.533 62.180 North Lanarkshire Council 31.919 35.766 Total 119.452 97.946 Income Received Expenditure on Services Provided Funding Contributions Received Debtors
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40 reclaims the costs involved. Since North Lanarkshire IJB is acting as ‘principle’ in these transactions, the total gross expenditure and the consequential reimbursement is included in the Comprehensive Income and Expenditure Statement even though 49% of the hosted budget is consumed by South Lanarkshire. Similarly, South Lanarkshire IJB acts as the lead for a number of delegated services on behalf of North Lanarkshire IJB. The value consumed by North Lanarkshire equates to 51% of South Lanarkshire IJB hosted budget. As this expenditure is incurred for the residents of North Lanarkshire, it is included in the Comprehensive Income and Expenditure Statement. North Lanarkshire Services 2021/2022 Consumed by South Lanarkshire 2021/2022 North Lanarkshire Services 2022/2023 Consumed by South Lanarkshire 2022/2023 £m £m £m £m 1.364 0.739 Blood Borne Virus Services 1.535 0.764 7.157 6.097 Children and Adolescents Mental Health Services 11.127 7.193 11.513 5.619 Childrens Services 12.220 6.035 2.216 1.099 Continence Services 2.452 1.177 3.519 1.864 Dietetics Services 3.753 1.996 2.178 1.264 Hospital at Home 2.166 1.277 3.564 1.077 Immunisation Services 2.473 0.940 - 0.278 Integrated Equipment and Adaptation Store - 0.278 68.844 38.312 Mental Health and Learning Disability Services 74.366 41.490 4.045 2.118 Podiatry Services 4.434 2.250 1.724 0.984 Prisoner Healthcare Services 1.908 0.874 2.809 1.442 Sexual Health Services 2.974 1.541 5.640 2.962 Speech and Language Therapy Services 5.994 3.195 114.573 63.855 Total Services Hosted by North Lanarkshire IJB 125.402 69.010 Host: North Lanarkshire Service Consumed by North Lanarkshire 2021/2022 South Lanarkshire Services 2021/2022 Consumed by North Lanarkshire 2022/2023 South Lanarkshire Services 2022/2023 £m £m £m £m 3.758 6.508 Community Dental Services 4.007 7.081 - - Brain Injury Unit 1.396 1.856 2.929 3.960 Diabetic Services 2.649 5.113 - - Improving Cancer Journey 0.024 0.047 5.180 9.057 Occupational Therapy Services 4.350 7.909 4.509 8.126 Out of Hours Services 4.806 9.003 3.770 7.541 Palliative Care Services 3.738 7.412 5.148 9.632 Physiotherapy Services 5.536 10.427 - - Telehealth 0.362 0.319 0.389 0.657 Primary Care Services 0.452 0.810 8.656 7.177 Primary Care Improvement Fund 6.920 10.973 0.214 0.420 Primary Care Transformation Fund - - 34.553 53.078 Total Services Hosted by South Lanarkshire IJB 34.240 60.950 Host: South Lanarkshire Service
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41 The table below shows the total of hosted services included in the Comprehensive Income and Expenditure Statement: 2021/2022 £m Hosted Services 2022/2023 £m 114.573 Total Services Hosted by North Lanarkshire IJB 125.402 34.553 Total Services Hosted by South Lanarkshire IJB 34.240 149.126 Total Included in Comprehensive Income and Expenditure Statement 159.642 Note 11. Additional Council Services Delegated to the IJB The following table shows the costs of North Lanarkshire Council services delegated to the IJB. Under the Public Bodies (Joint Working) (Scotland) Act 2014, the IJB is accountable for these services however, they continue to be delivered by North Lanarkshire Council. HSCP monitor the delivery of these services on behalf of the IJB. Note 12. VAT The IJB is not VAT registered and does not charge or recover VAT on its functions. The VAT treatment of expenditure and income within the accounts depends on which of the partner is providing the service as these bodies are treated differently for VAT purposes: Where North Lanarkshire Council is the provider, income and expenditure exclude any amounts related to VAT, as collected VAT is payable to HM Revenue & Customs and all VAT paid is recoverable from it. On a very limited number of items that North Lanarkshire Council are not entitled to fully recover VAT, expenditure for these specific items will include the full cost to the IJB. Where NHS Lanarkshire is the provider, expenditure will include the full cost to the IJB as generally, NHS Lanarkshire cannot recover VAT. The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime. Note 13. External Audit Costs Fees payable to Audit Scotland in respect of external audit services undertaken in accordance with Audit Scotland’s Code of Audit Practice in 2022/23 are £31,470. Audit Scotland did not undertake any non-audit services. Note 14. New Standard Issued but Not Yet Adopted 2021/2022 2022/2023 £m £m 1.668 Housing Services 1.886 0.539 Transport Services 0.551 2.207 Gross Expenditure 2.437 (2.207) Income (2.437) - Net Expenditure - Council Services
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42 The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts.
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43 Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2023 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2022/23 (the 2022/23 Code). In my opinion the accompanying financial statements: give a true and fair view of the state of affairs of North Lanarkshire Integration Joint Board as at 31 March 2023 and of its income and expenditure for the year then ended; have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2022/23 Code; and have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 2 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of North Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion.
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44 Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on Noth Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on the North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue North Lanarkshire Integration Joint Board’s operations. North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to
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45 influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer concerning North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report.
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46 Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016).
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47 Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: adequate accounting records have not been kept; or the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd Audit Scotland 8 Nelson Mandela Place Glasgow G1 2BT
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1 REPORT Item No: 9 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee: For approval For endorsement For noting 1.2 This 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. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 PFA Committee: (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. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Recommendations to further strengthen the IJB governance framework were made by both external and internal audit. The Senior Management Team (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements. 5.2 The original reports from external and internal audit and the SMT were previously reported in full to the IJB and PFA Committee as appropriate. This report summarises the agreed recommendations and provides an update on the progress made to date against each action. Further details are attached at appendices 1 to 3. 5.3 Any actions which are reported as complete will be removed from the next progress report to the PFA Committee. SUBJECT: Progress Report on Agreed Actions TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 18 October 2023 Yes No N/A
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2 6. CONCLUSIONS 6.1 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% 6.2 The ongoing actions are measured against the revised timeline set out in appendices 1 to 3. 7. IMPLICATIONS 7.1 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 ☒ 7.2 ASSOCIATED MEASURE(S) The implementation of agreed actions will contribute to the ongoing development of the internal control framework and will also inform the Annual Governance Statement for 2023/24. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 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 Ineffective Governance Arrangements Low Ross McGuffie
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3 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 This report includes all engagement and participation objectives as effective governance arrangements ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. ☒ 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 Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 - External Audit Actions Appendix 2 - Internal Audit Actions Appendix 3 - Senior Management Actions 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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4 Update on External Audit Actions Appendix 1 Ref Finding Recommendation Management Response Current Position 1 Accounts inspection advert The notice of inspection should state the objection end date and the advert should be posted on the IJB website in addition to the North Lanarkshire Council website. Original The IJB should ensure it has procedures in place to ensure the accounts inspection advert is published in line with criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. Agreed The IJB will ensure future adverts are posted on the IJB website in addition to the North Lanarkshire Council website. IJB Chief Financial Officer Original Timeline: June 2023 COMPLETE – advert placed on IJB website 05 June 2023: https://hscnl.org.uk/2023/06/north-lanarkshire-integration-joint-board-annual-accounts-2022-2023/
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5 Update on Internal Audit Actions Appendix 2 Ref Performance Management (August 2019) Current Position Per Management Update Internal Audit Comment 2 Risk: The IJB may not provide adequate performance information to key stakeholders to enable them to make informed decisions and recommend remedial actions to address concerns arising. The Performance, Finance and Audit Committee may not be in a position to fulfil its remit which includes the requirement to ‘review quarterly performance and recommend remedial action to address concerns’ and to ‘ensure effective arrangements are in place to register all performance and operational risks’. Recommendation: Management should undertake a formal review of the current arrangements for monitoring and reporting performance to reflect on whether reports are fit for purpose and contain relevant comprehensive information useful to stakeholders. This could include comparison with other IJB published reports. Particular consideration should be given to the areas identified in the finding: An overview of all indicators on the performance scorecard including a mechanism to provide an update on indicators previously reported but now considered satisfactory; Areas for improvement listed should include proposed actions with timescales, progress with these and how effective they are; Greater use of benchmarking with other IJBs and trend information and Incorporating reporting by locality. Category: Amber Original Timeline: October 2019 Revised Timeline: March 2022 September 2023 Original Responsible Officer: Performance Manager The Performance Framework for the HSCP is well defines, although not always referenced in those terms. A clear link exists between the National Health and Wellbeing Outcomes, nationally agreed performance indicators and frameworks, and local indicators, including those presented at HSCP level, Chief Executive/Organisational level, and service/directorate level. A session was held in June 2023 to discuss the framework and to review the scorecard. As a result, it was agreed: A refreshed CE Scorecard would be produced including new indicators. A similar workshop would be held with locality managers to improve quarterly performance reviews. This was held in August 2023. The development of the Strategic Commissioning Plan and the associated Programme of Work provides another core element of the performance framework. The relevant performance indicators, data and information will be developed and reported on as the work progresses. This will inform improvement planning and provide rich content for performance reviews carried out within the performance framework. The IJB will be provided with both quarterly and annual performance reporting within this framework. The draft 22/23 Annual Performance Report will be presented to the September IJB which follows a similar format to prior years as due to the timescale for publication there is little flexibility to deviate from the agreed North Lanarkshire format. A quarterly performance report is also provided to the IJB which is based around the Chief Executive’s Scorecard and quarterly performance reviews. Internal Audit are pleased to note that significant action has been taken in this area or is planned for the coming months to fully implement the recommendations made. Internal Audit acknowledge that delays in implementation were initially due to the pandemic but were further impacted by the Performance Manager post being vacant for approximately 18 months. This post has now been filled, with the post holder taking up their position mid-April 2023 and work is progressing to meet the revised timescales. Given that the action is required to further improve the control environment, Internal Audit assess the residual risk as ‘Medium’ and consider it important that the agreed revised timescale of September 2023 is achieved. COMPLETE - Email received from internal audit to confirm the actions taken appears to be sufficient to enable the recommendation to be closed. As part of internal audit follow-up and in line with audit process, internal audit will undertake testing to ensure that the expected actions are being complied with. Ref Performance Management (August 2019) Current Position Per Management Update Internal Audit Comment 3 Risk: There is no formal documented record or clear rationale for the targets and trajectories set. Recommendation: Management should ensure that a formal record is retained detailing the rationale for, and approval of, the targets and trajectories set for the indicators on the performance scorecard and this information should be shared with the Performance, Finance and Audit Committee. Category: Amber Original Timeline: October 2019 Revised Timeline: March 2022 September 2023 Original Responsible Officer: Performance Manager The rationale for all indictors appearing in the scorecard will be agreed and documented in the scorecard and reporting. The narrative explanation for the rationale may not be displayed next to the visualisation of the data but will be held within a version-controlled document. Internal Audit are pleased to note that there has been some action taken in this area and acknowledge that implementation of the recommendation was delayed as a result of the pandemic in the first instance and thereafter due to the Performance Manager post being vacant for approximately 18 months. This post has now been filled, with the post holder taking up their position mid-April 2023 and work is progressing to meet the revised timescales. Given that action is required to further improve the control environment, Internal Audit assess the residual risk as ‘Medium’ and consider it important that the agreed revised timescale of September 2023 is achieved. COMPLETE - Email received from internal audit to confirm the actions taken appears to be sufficient to enable the recommendation to be closed. As part of internal audit follow-up and in line with audit process, internal audit will undertake
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6 testing to ensure that the expected actions are being complied with. Ref Financial Due Diligence Audit Report (May 2020) Current Position Per Management Update Internal Audit Comment 4 Risk: A lack of formally documented arrangements may increase the risk that the resources transferred from the IJB to the Council do not reflect the cost of the relevant services in terms of delegated and non-delegated functions. Recommendation: Each of the reports listed contained similar recommendations in respect of the disaggregation of Children, Families and Justice Social Work Services and need for hosting arrangements to be finalised for cross-cutting services. Reports: Internal Audit – Financial due diligence (May 2020) – 2 actions External Audit – Annual Audit Report 2019/20 – 1 action Annual Governance Statement – Continuous improvement 2019/20 – 1 action Original Timeline: March 2021 Revised Timeline: September 2021 June 2022 Revised timescale to be determined once further clarity obtained regarding National Care Service proposals. Original Responsible Officer: Chief Officer Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance The budget disaggregation exercise has been concluded and the revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Management recognises that the finalisation of the Service Level Agreement (SLA) for future hosting arrangements and associated budgets is overdue. Once finalised, the SLA will be presented to a future meeting of the IJB and NLC Education and Families Committee for approval. The SLA between Children, Families and Justice Services will be revised once further clarity has been obtained around what services will be part of the new National Care Service. Updated Timeline for NCS: STAGE 1 – General Principles Bill introduced on 20 June 2022 Financial Memorandum posted 20 June 2022 Statement of Legislative Competence posted 20 June 2022 Delegated Powers Memorandum posted 27 June 2022 Public submit view on Stage 1 – closed 02 September 2022 and posted 03 November 2022 National Care Service Forum held 03 October 2022 7 June 2023 Parliament agreed a motion to further extend the deadline for the completion of Stage 1 of the National Care Service (Scotland) Bill to 31 January 2024. The deadline for MSPs to debate the Bill and agree its general principles has now been delayed almost a year later than originally planned. Internal Audit are pleased to note the budget disaggregation exercise has been concluded and acknowledge that Covid has had a significant impact on the HSCP which has in turn impacted on the prioritisation of resources. In addition, it is acknowledged that further clarity around the services which will be part of the National Care Service is required before the SLA between Children, Families and Justice Services can sensibly be finalised. Given the delays in implementation of the remaining actions, Internal Audit assess the residual risk as ‘High’. Ref Risk Maturity Assessment (August 2019) Current Position Per Management Update Internal Audit Comment 5 Risk: Decisions may not fully reflect risk management considerations. The Risk Register may not reflect issues highlighted within performance management and other assurance reports. Recommendation: IJB and PFA Committee papers should contain a section on risk which considers whether issues raised should be included within the risk register and overtly reflect the impact on any existing strategic risks. Performance reports should reference relevant strategic risks and assess whether scores are accurate and whether actions intended to reduce risk to target level are on track. Category: Amber Original Timeline: March 2020 Revised Timeline: June 2021 June 2022 September 2023 Revised Responsible Officer: Service Support Project Manager A new IJB reporting template has been developed as part of the IJB Governance Documents update and this template has a greater focus on EQIAs, Risk, Participation and Engagement, National Outcomes and Directions. IJB reporting template guidance has also been developed to support authors when completing the reporting template. Additional work associated with internal audit comment includes: New IJB reporting template which includes the risk level of the report, which risks is held on the risk register and the mitigation in place. As per the new guidance, reports will be returned to authors if they are not completed on the new template. Risks are reviewed at each IJB and PFA board. New risk reporting structure in place which includes a risk dashboard, level of risk, risk movement and SMART actions aligned to each risk. Risk sharing document in place. Internal Audit are pleased to note that there is now a higher percentage of reports presented to the IJB and PFA Committee which contain a section of risk. Internal Audit acknowledge that further steps are planned to increase compliance and fully address this recommendation. Internal Audit consider the revised timescale to be reasonable and have assessed the residual risk for this recommendation as ‘Low’. COMPLETE - Email received from internal audit to confirm the actions taken appears to be sufficient to enable the recommendation to be closed. As part of internal audit follow-up and in line with audit process, internal audit will undertake testing to ensure that the expected actions are being complied with.
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7 Update on Senior Management Actions Appendix 3 Ref Annual Governance Statement Continuous Improvement Actions (2021/2022) Current Position Per Management Update Internal Audit Comment 4 Risk: N/A Recommendation: To develop a sound understanding of the impact for the North Lanarkshire Health & Social Care Partnership of the outputs of the National Care Service legislation. Original Timeline: March 2023 Revised Timeline: To be determined once further clarity obtained regarding National Care Service proposals. Due to the uncertainty and lack of detail currently available, this will be revisited once further clarity has been obtained. The Scottish Government has delayed further discussion and consultation in respect of the National Care Service legislation until after the summer recess. Updated Timeline: STAGE 1 – General Principles Bill introduced on 20 June 2022 Financial Memorandum posted 20 June 2022 Statement of Legislative Competence posted 20 June 2022 Delegated Powers Memorandum posted 27 June 2022 Public submit view on Stage 1 – closed 02 September 2022 and posted 03 November 2022 National Care Service Forum held 03 October 2022 7 June 2023 Parliament agreed a motion to further extend the deadline for the completion of Stage 1 of the National Care Service (Scotland) Bill to 31 January 2024. The deadline for MSPs to debate the Bill and agree its general principles has now been delayed almost a year later than originally planned. Internal Audit acknowledge that implementation of the recommendation has been delayed as a result of the uncertainty and lack of detail available in respect of the new National Care Service. Given the delay in implementation and that action is required to further improve the control environment, Internal Audit have assessed the residual risk as ‘Medium’ and consider it important that, once further clarity has been obtained, management consider and agree an appropriate revised timescale.
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1 REPORT Item No: 10 SUBJECT: Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire TO: IJB Performance, Finance & Audit Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest – Performance Manager, Graeme Cowan – Senior Manager, Strategy & Performance DATE: 18th October 2023 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Review the content of the draft Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire, which is appended to this report. (2) Approve for publication the content of the draft Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 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 presents the performance in relation to these metrics, alongside performance information relating to inspections carried out by the Care Inspectorate and additional local performance information in the form of the Chief Executive’s scorecard. Progress against the National Health & Wellbeing Outcomes is also described in the report. A section has been dedicated to presenting and describing financial performance for 2022/23. In order to comply with the requirements to publish the APR by 31st July 2023, a draft version has been available on the IJB website since that date, pending approval by the IJB. This was required due to the timescales imposed on the partnership to produce and publish an Annual Performance Report by 31st July using Public Health Scotland data that is not published on their website until 04th July 2023, as previous publications of the data set are provided to the Integration Authorities for management use only. Members should note the most up-to-date available has been used in the report, however for many indicators this relates to previous years; NI1 – NI9 are based on
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3 the results of the Health and Care Experience Survey, which was last carried out in 2021/22 and for others, 2022/23 data is not yet available. For indicators NI12 – NI16, the performance for calendar year 2022 is presented per the instructions of Public Health Scotland as the 2022/23 data for these indicators has not been validated for publication. 6. CONCLUSIONS 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 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. 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 ☒
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4 7.2 ASSOCIATED MEASURE(S) The content of the Annual Performance Report is focused on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). A framework is in place within the North HSCP to ensure the continual monitoring of performance data and information, and any improvement actions associated with the performance monitoring. 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 11.21 - Oversight of Performance Activity Low Ross McGuffie NHSL 2014 - Recovery of Performance 2021/22 Very High NHSL Corporate NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 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 The APR provides information on community stakeholders and how they are involved in our services.
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5 ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery The APR provides information on engagement with community stakeholders. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings The APR provides performance information that will enable stakeholder representatives to participate in wider discussion about performance. □ 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 The performance information included in the APR supports locality planning. 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 N/A 9. APPENDICES Appendix 1- Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire
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6 CHIEF ACCOUNTABLE OFFICER (or Depute) Morag Dendy, Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk Graeme Cowan – Senior Manager, Strategy & Performance cowang@northlan.gov.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 Annual Performance Report 2022/23 Health & Social Care North Lanarkshire Contents 1. Introduction Welcome to the Annual Performance Report of the North Lanarkshire Health and Care Partnership (HSCP) for the period from April 2022 to March 2023. This report presents a range of both qualitative and quantitative information, demonstrating our performance in relation to the National Health & Wellbeing Outcomes, National Core Integration Indicators, Ministerial Strategic Group indicators, and local performance measures. The Integration Joint Board receives regular progress reports on performance, and you can find these reports, along with our previous Annual Performance Reports on our website: https://www.hscnorthlan.scot/. The Annual Performance Report provides an opportunity to reflect on the past year and celebrate the accomplishments of North Lanarkshire Health and Social Care services, employees, and partners.
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9 It acknowledges the ongoing collaborative work undertaken with service users, carers, families, and communities to improve on performance. Moreover, it recognises and acknowledges the existing and future challenges that the partnership faces, many of which are influenced by the long-lasting effects of the COVID-19 pandemic. The report presents data and information on performance and describes significant developments in 2022/23. The report presents data and information on performance and describes significant developments in 2022/23. The initial section of the report focuses on statutory reporting of performance information showing a comparison with the Scottish position and a trend analysis is provided to understand the local context for these performance indicators. Regrettably, due to circumstances beyond the partnership's control, we are unable to present a complete picture for some of the indicators and where this is the case, the reasons for this limitation are explained within the corresponding section of the report. The remaining part of the report provides more information for each of the National Outcomes, highlighting the various advancements and achievements throughout the year 2022/23. 2. Measuring Performance Under Integration Since 2016/17, Integration Authorities have been required by legislation to report on the Core Suite of Integration Indicators within their Annual Performance Reports. These indicators were developed to help Integration Authorities review their progress towards achieving each of the National Health and Wellbeing Outcomes1, which focus on improving how services are provided and the difference that integrated health and social care services should make for people. The indicators were developed in consultation with a wide range of stakeholders and are intended for consideration within the wider context of health and social care. They help the HSCP identify areas for improvement and assist with strategic planning. Indicator values are derived from national data sources for each of the 23 indicators to enable comparability between local areas and with Scotland. There are 23 indicators in total, comprising of nine indicators based on the Health and Care Experience Survey and ten other measures mainly using health activity, community and deaths information. The remaining four indicators cannot be reported on as national data is not available or there is not yet a nationally agreed definition. The nine indicators based on the Health and Care Experience Survey, which has been run every two years since 2009 detail people's experiences of accessing and using various services. The Health and Care Experience Survey (successor to the GP and Local NHS Services Patient Experience Survey) asks about people’s experiences of accessing and using their GP practice and Out of Hours services, aspects of care and support provided by local authorities and other organisations and caring responsibilities and related support: 1https://www.gov.scot/publications/national-health-wellbeing-outcomes-framework/
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10 N.B. Results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are not directly comparable to figures in previous years due to changes in survey wording and methodology. National Outcome Indicators – Benchmarking – 2021/22 The table above provides a comparison for 2021/22 with North Lanarkshire’s ‘Family Group’ of Integration Authorities for those National Outcome Indicators that are sourced from the Health and Care Experience Survey. The results highlight some areas where improvement might be made, including supporting people to live as independently as possible, health and social care services being well co-ordinated, improving or maintaining quality of life, people having a positive experience of care at their GP practice and carers feeling supported to continue in their caring role. Use of 2021 calendar year data instead of 2021/22 financial year data for indicators 12, 13, 14, 15 and 16 The primary source of data for these indicators are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital records. Following recommendations made by Public
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11 Health Scotland (PHS) and communicated to all Health and Social Care Partnerships, the most recent reporting period available is calendar year 2021; this ensures that these indicators are based on the most complete and robust data currently available. Figures presented may not fully reflect activity during 2021/22 due to the varying impact of COVID-19 at different points of the pandemic. Indicator 20 NHS Boards were not able to provide detailed cost information for 2020/21 due to changes in service delivery during the pandemic. As a result, PHS have not provided information for indicator 20 beyond 2019/20. PHS previously published information to calendar year 2020 using costs from 2019/20 as a proxy but, given the impact of the COVID-19 pandemic on activity and expenditure, PHS no longer consider this appropriate. The data for Indicator NI – 20, Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency is no longer available from Public Health Scotland and has been excluded from this report. National Integration Indicators – Benchmarking – 2022
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12 Measuring Performance Under Integration (MPUI) Emergency Admissions Based on agreed trajectories, our objective for 2022/23 was to manage the anticipated admissions at the same level as 2021/22. The actual position for 2022/23 was 45,724 emergency admissions which represents an increase of 0.6% from 2021/22. Unscheduled Bed Days Based on agreed trajectories, our objective for 2022/23 was to achieve a reduction in the number of unscheduled bed days across acute specialties from 254,828 in 2021/22 to 219,249 in 2022/23, a reduction of 14%. The actual position for 2022[1] was 266,609 bed days. [1] Full financial year figures are not available at time of publication A&E Attendances Based on agreed trajectories, our objective for 2022/23 was to maintain the same level of attendances as 2021/22. The actual position for 2022/23 was 117,378 A&E attendances which was 5.7% lower than our planned trajectory.
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13 Delayed Discharge Based on agreed trajectories, our objective for 2021/22 was to continue our agreed trajectory for reducing the number of occupied bed days due to standard delays, from 26,744 in 2021/22 to 23,725 in 2022/23. The actual position for 2022/23 was 30,839 occupied bed days which represents an increase of 15% from the previous year. The continued pressure on health and social care services continued throughout 2022/23 resulting in the number of bed days due to standard delays remaining beyond our planned trajectory. End of Life Care The percentage of the last six months of life spent at home or in community settings has gradually increased since 2015/16, however 2021/22 witnessed a very small reduction. Balance of Care The percentage of people aged 65+ who live at home in North Lanarkshire remains high at 96.9% in 2021/22. Using benchmarked data from the Local Benchmarking Framework for 2021/22, approximately 68% of older people with long term needs are supported at home. This compares well with the Scottish average and other similar Health & Social Care Partnerships. North Lanarkshire has the fifth highest percentage of all mainland council areas in Scotland.
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14 Performance Dashboard 3. Our Progress Against the National Health & Wellbeing Outcomes Prevention and Early Intervention The HSCP believe that our available funding is directed to best effect when it has regard to early intervention and prevention. In 2022/23, the HSCP delivered a range of prevention and early intervention Programmes with a focus on reducing inequalities. Early and preventative interventions – Right Support, Right Time Improving Access to Services Healthy Schools Developed by NHS Lanarkshire’s Healthy Lifestyle and Weight Management Service in conjunction with North Lanarkshire Council, as well as input from practitioners and learners, Healthy Schools is an example of health and education services working in partnership to support the future generations of Lanarkshire. The interactive website, which has been in circulation since 2014 to support education staff and nursery, primary and secondary pupils, was written by teachers from North and South Lanarkshire in conjunction with local NHS and Health & Social Care staff. In September 2022, the website was re-launched with a new look and design, with updated materials for all levels and now has new resources specifically aimed at S5 and S6 pupils. To mark this, NHS Lanarkshire held an event to showcase it to various stakeholders within Lanarkshire. To mark this, NHS Lanarkshire held an event to showcase it to various stakeholders within Lanarkshire. The Healthy Schools framework supports practitioners across establishments in North and South Lanarkshire to co-design and co-create relevant, appropriate Health & Wellbeing curricula with their children and young people. The Healthy Schools framework provides a ‘one stop shop’ for practitioners that includes suggested Health & Wellbeing Experiences and Outcomes. Working with this framework will support the delivery of Health & Wellbeing for children and young people across Lanarkshire. This is further supported by additional CLPL, training and support sessions to enhance provision in educational establishments. The website is available to support children and their families to look after and improve their health and wellbeing by providing a health education framework which can be used by practitioners and teachers. The structured framework contains all the learning & teaching resources and materials
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15 needed to support the delivery of health & wellbeing and helps education staff to plan and deliver individualised health and wellbeing education which compliments existing teaching resources. Breastfeeding The HSCP aim is to make North Lanarkshire a place where breastfeeding is the norm and build a supportive community and environment to encourage more women to feel comfortable breastfeeding for as long as they want, recognising both the short and long-term health benefits of breastfeeding for both mother and baby. The HSCP support breastfeeding as the optimal infant feeding choice for all parents. NLC continue with work to become the first breastfeeding-friendly council in Scotland; this includes work with schools and designing new community buildings to include breastfeeding facilities. In addition, each Community Board area in North Lanarkshire has a breastfeeding champion in place to support our commitment to improving breastfeeding rates. In October 2022, Health Visitor and Family Nurse services were again awarded ‘Baby Friendly’ accreditation from the UNICEF Baby Friendly Initiative. The re-accreditation recognises the high standard of their work supporting breastfeeding and helping parents form close, loving relationships with their children during the critical early years. Health visiting teams work with mothers and fathers, their families and community groups across Lanarkshire to promote the health and wellbeing of children and reduce inequalities from the antenatal period until children start school. The process of accreditation includes feedback from mothers about their experience of the health visitor service, staff training assessments, and an audit and evaluation of the service. In awarding the accreditation UNICEF commented on the very high standards of care, the extremely knowledgeable staff and their excellent and sensitive communication skills. Newmains and St Brigid's Community Hub The Newmains and St Brigid's Community Hub is a shared campus development that accommodates three independent establishments: Newmains Primary school, St Brigid's Primary school and Newmains Family Learning Centre. The facility was handed over in February 2023 and provides an inclusive learning environment where state-of-the-art facilities are provided for children, young people and members of the community. The Community Hub, which is the first community hub of its kind in North Lanarkshire Council provides for a focus on health and wellbeing, and links with the wider Newmains community. Families and local groups can enjoy the benefits of the site including the outdoor facilities, which provide enhanced leisure and recreational facilities for all members of the community. Engagement & Participation Community boards are the foundation of the community planning process in North Lanarkshire. In North Lanarkshire nine Community Boards have been established and embedded to support community leadership, involvement and capacity building within their geographical area, focussing activity through a local outcome and improvement plan (LOIP).
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16 The Chief Social Work Officer undertakes the role of Community Co-ordinator for one of the local boards and the Head of Adult Social Work, and the Head of Planning Performance and Quality Assurance provide a link to the Health and Social Care Partnership and its strategic commissioning activity across all Community Boards. Senior Social Work Managers also participate in area-based teams and the sub-groups which support the delivery of the LOIPs The multi-agency Local Partnership teams were launched to support the development of the community planning agenda within these community partnership areas. The Managers from each of the localities within the Health & Social Care Partnership are key members of these forums, and this offers opportunities to co-ordinate our locality improvement activities across the wider Community Planning Partnership. Community boards are the foundation of the community planning process in North Lanarkshire. A review of participation and engagement was commissioned during 2021/222 and the outputs and recommendations were presented to the IJB in April 2022 as HSCNL Review of engagement and participation structures. Aligned to North Lanarkshire Council’s Delivering for Communities report, the HSCP has finalised structural changes, which ensure robust and proactive systems and processes that maximise the use of the Community Boards as the key vehicle for participation and engagement. The Strategic Commissioning Plan and the associated Programme of Work are closely aligned with the Local Outcome Improvement Plans for each of the Community Board areas. Our overall structure for delivery remains with six localities, with three each aligned to a sector (North East and North West), which allows for closer relationship with the two acute hospitals located within North Lanarkshire. Living Well in the Community Living Well in the Community is a multi-professional, cross-sector collaboration of Support Staff, Community Rehabilitation, Nursing, Health Visiting, Mental Health, Care at Home Teams, Equals Advocacy (Third Sector Advocacy Organisation), Frailty Specialists (Secondary Care), Information Technology, Pharmacy, Primary Care and Public Health Scotland. The team has a preventative approach for older adults in the community who are at high risk of deterioration. The overall aim of the approach is to improve outcomes and move away from crisis intervention as the only option for this cohort of patients. This approach is deployed across three Lanarkshire GP practices; despite the constraints resulting from the C19 pandemic, 62 older adults at high risk of deterioration have been identified and have had person-centred outcomes realised, including supported frailty self-assessments. The Coatbridge Living Well in the Community team at Coathill Hospital won the ‘Integrated Care Award’ category at the Scottish Health Awards ceremony in November 2022 in recognition of their work to put the patient voice at the heart of their practice, and the early intervention and prevention work they carry to allow people wanted to spend as much time as possible in the homeliest setting and where possible, to support people to remain at home.
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17 Discharge Without Delay (DWD) Discharge Without Delay is a whole system approach which supports people to be cared for at home (or as close to home as possible), prevents avoidable admissions to hospital and, where hospital admission is necessary, supports timely discharge. This programme was introduced towards the end of 2021/22 and has continued into 2022/23 and beyond as a priority for the partnership. The Home Assessment Team (HAT) was developed as a new team within North Lanarkshire and was launched in early 2022. The team works collaboratively with hospital discharge hubs and clinical teams to support timely discharge from hospital to enable an assessment of each person’s immediate and longer-term needs in their own home. This can include anything from signposting to support from a statutory service and community care assessment. The Home Assessment Team take a multi-disciplinary approach to person centred care and consists of Home Support staff, AHP’s, Clinical Responders and Social Work staff to embed Home First principles to enable people to be supported to return home for a period of assessment. The HAT is receiving an increasingly greater volume of referrals and a Home Assessment Team Development Plan is in place to streamline and reduce duplication of service from the teams working in this area. The dynamic between Integrated Rehabilitation, Hospital Social Work, Home Assessment Team and Reablement has been recognised as allowing an opportunity to provide one seamless combined service. The development plan is currently focussed on services to support discharge, however a second phase is planned looking at the interaction with Hospital at Home and other services placed to support admission prevention and avoidance. Multi-disciplinary and multi-agency focus groups are planned to look at the available resources and patient/client pathways, which will inform the implementation of the development plan. A governance framework has been developed to support this work, which is overseen by a Programme Board. Technology Enabled Care Additional funding has been allocated directly to Health and Social Care Partnerships to support an increase in the use of Community Equipment and Technology Enabled Care (TEC). In North Lanarkshire, a dedicated TEC Team has been formed to support the use of technology within the HSCP to support individuals within their homes and communities. The focus is on embedding technology into assessment and planning processes; providing training to all staff groups on technology and its use in care and support; supporting with risk assessments; ensuring technology support advice is embedded in SDS; and providing high level data on the technology being used within our communities. Our approach is aligned to the national guidance on the promotion of technology that can be both an early intervention and prevent the need for supporting services to be put in place where a suitable TEC alternative exists.
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18 The HSCP is actively promoting Technology Enabled Care through the TEC Team and the TEC Flat, which is a demonstrator property for those interested in the potential solutions to meet their needs. The TEC Team supports Locality Teams to maximise the use of innovative technology enabled care and to review the support arrangements for existing clients, considering the potential use of technology enabled care solutions to support better and more independent living. Other initiatives support the wider TEC agenda. Partnership initiatives with carer support organisations have been undertaken to raise awareness of the possibilities that assistive technology can bring; including risk mitigation, remote support, medication prompts, personal locators, and a diverse range of other technology-based solutions. Most items are available, free of charge to the end -user. This enhances our existing Making Life Easier (MLE) initiative, whereby people can self- refer and self-access smaller enabling pieces of equipment. Operation Flow and Operation Flow 2: A New Model of Care 2022/23 and in particular, the winter period, was a challenging time for HSCP services, patients and staff. The continued impact of the COVID-19 pandemic resulted in service pressures and ongoing disruption in some service areas. In response to this, the HSCP and partners developed a clear plan to help redesign and rebuild services with the aim of increasing resilience within the service and the wider system, and also to provide a framework for whole system improvement programme. Operation Flow was deployed, including the successful short term Firebreak in February to March 2023. This realised significant improvement across the Health and Social Care system, including improved opportunities to support people to remain well at home, a reduction in hospital occupancy and length of stay and a very significant improvement in 4 Hour A&E access, and an important reduction in ambulance waits, including 8 and 12 hour delays. The best practice and lessons learned from Operation Flow have been recorded and shared, however the improvements in flow across the whole system realised during the firebreak were not sustained beyond that phase. The second phase of this work has since been designed and launched in June 2023 as Operation Flow 2, which is a plan for a sustainable and resilient way forward with a clear focus on improving patient and staff experience as well as key performance improvements. The new programme is focused at improving the system across the full patient pathway from avoiding hospital admission through to discharge and beyond. It is structured in five operational Task & Finish Groups who are responsible for developing and implementing the key changes. These groups are: The Programme includes three key steps:
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19 Operation Flow 1 involved considerable whole-system development work undertaken jointly by NHS Lanarkshire, Health and Social Care North Lanarkshire, South Lanarkshire Health and Social Care Partnership and Scottish Ambulance Service and this will continue through the duration of Operation Flow 2. Community Solutions Established in 2012, Community Solutions is a successful, HSCNL cross-sector health and social care investment and improvement programme for North Lanarkshire that is improving people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources, with a focus on prevention and early intervention. Community Solutions ensures a co-ordinated approach throughout North Lanarkshire, promoting local opportunities and solutions for and with people, avoiding the need for more formal services for longer periods of time. In March 2022, the IJB approved the Community Solutions Strategy and Investment Plan 2022-25. The Community Solutions Programme involves all HSCNL partners and also links to the North Lanarkshire community planning partnership – North Lanarkshire Partnership (NLP) and the Children’s Services Partnership. Community Solutions is an effective and active example of co- production: a true partnership between people, communities and services. The range of achievements via the Community Solutions Programme Approach include significant development through local anchor organisations; Support in the Right Direction, Community Connectors and Improving Cancer Journeys. Community Solutions builds capacity in the wider Health and Social Care System by facilitating the allocation of funding to enable Community and Voluntary sector organisations to deliver support to priority groups, providing information and guidance on key issues such as governance, planning, training, accreditation, finance and evaluation. The Community Solutions programme also supports development and facilitation of the “first point of contact,” “three conversations” and “social prescribing” approaches to help people express their needs; feel empowered; and access community supports and services as quickly as possible. This
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20 approach is supplemented by supporting digital inclusion to enhance public access to health and social care information and services. The Community Solutions model has been used in Children’s Services to test out new models of support to address distress and promote positive mental health with a significant portion of new Scottish Government funding targeted at early intervention and community support through the Children and Young People’s Mental Health and Wellbeing Framework allocated to organisations though VANL to develop new supports in partnership with school clusters, children, young people and their families. Future investment will be used to continue the community capacity building work already well embedded in the Community Solutions Programme through Voluntary Action North Lanarkshire. The new Improving Lives work stream will see development across a number of key priorities for the Partnership in line with the Strategic Commissioning Plan, and ensure there is sufficient capacity within the community and voluntary sector to respond to demand. Self-Directed Support - Transformational SDS Agenda A notable change during the period is the impact of the transformational SDS agenda, which has an emphasis on building greater community capacity to support earlier preventative approaches and proactive planning so that people can be supported at home as independently as possible, for as long as is appropriate to support better lives. Self-directed support was introduced in Scotland on the 1 April 2014 following the Social Care Self- directed Support Scotland Act 2013. Its introduction means that people receiving social care support in Scotland have the right of choice, control and flexibility to meet their personal outcomes. Health and Social Care Partnerships are required to ensure that people are offered a range of choices on how they receive their social care support. The self-directed support options available are: Option 1: Taken as a Direct Payment. Option 2: Allocated to an organisation that the person chooses and the person is in charge of how it is spent. Option 3: The person chooses to allow the council to arrange and determine their services. Over the last 4 years, the number of SDS users and their average budget has been steadily increasing. This is reflected in the rate per 1,000 population of North Lanarkshire SDS users, which has steadily increased each year over the last 4 years. A corresponding decrease in the the number of care at home users has been observed in 2021/22 and this is likely to be linked to the transition from “traditional” care at home towards Self-Directed Support. SDS 2 (allocated to an organisation that the person chooses and the person is in charge of how it is spent) accounts for over 70% of the North Lanarkshire SDS budget; there has been little change in the percentage breakdowns of SDS option over the last 4 years. Key priorities for the continued implementation of SDS include enhancing partnership working across the spectrum of community solutions, universal services, third and voluntary sectors and statutory sector. An enhanced focus on Technology Enabled Care, through the dedicated TEC team in the deployment of assistive technology so that people can be supported at home as independently as possible, for as long as is appropriate, whilst minimising risk and reducing reliance on statutory
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21 services. Several posts and initiatives are part funded through Scottish Government monies to enhance SDS. Alcohol & Drugs Partnership (ADP) North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership established in 2019 focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives, including agencies that provide treatment and intervention for people experiencing problem alcohol and drug use. In September 2022, the IJB approved the North Lanarkshire ADP Strategy 2021 – 2024, which draws on the successes, challenges and learning from previous activity. The Strategy was informed by extensive consultation and engagement with service users, representative groups and other key stakeholders to understand the needs, challenges and innovative ideas for change from those living in North Lanarkshire, including many who have been in contact with services for support with substance-related issues. Supporting Unpaid Carers In 2022/23, North Lanarkshire HSCP has continued to support unpaid carers and develop work with our partners, including Lanarkshire Carers. To develop an alternative to traditional respite or a cash grant, which often had restricted eligibility criteria, a consultation was carried out with carers to put them at the heart of service design when considering alternative and creative ways to provide a short break. Carers fed back that service providers needed to think creatively and address the need for a break that didn’t only take the form of an annual short break, but that was easily accessible in the community, available on a regular basis and more flexible in terms of availability throughout the day. From these insights, the concept of the Carer Breather was established and funded projects were set up to offer activities such as art therapy, health and wellness activities, holistic support, and groups supporting people caring for loved ones with learning disabilities or living with long term conditions. This service is now supported by NLCT as Carer Support Network Leads within Community Solutions. Carers can now access new services across North Lanarkshire that provide breaks from their caring roles and allow them to take some quality time out for themselves. The Carer Breather projects and pilot Sitter Services were developed directly through listening to the views of carers, and will be
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22 utilising the Carer Pathway Toolkit to engage carers in conversation as part of a light touch early intervention within the local community. To support this work, the Community Solutions Programme invests in activities in each locality in North Lanarkshire to support the needs of local people and their carers. These activities enable short breaks for carers through a range of local activities. Lanarkshire Carers, North Lanarkshire Carers Together and the Short Break Carer Information Service all provide pathways and support for this work. Care Inspectorate Reporting on North Lanarkshire Carers Independent reporting and evaluation by the Care Inspectorate that took place in June 2022 concluded that Carer satisfaction levels within North Lanarkshire were consistently better than the national average, and in many areas were significantly better than the national average. The evaluation involved conversations/focus group discussion with carers provided rich data for the HSCP and further data and information was provided by the results of a survey that was commissioned to support the Care Inspectorate’s evaluation. When looking at carer satisfaction in relation to Adult Carer Support Plans in North Lanarkshire: • 69% of carers in North Lanarkshire said their ACSP helped them do things that are important to them compared with 42% in Scotland. • 74% of carers in North Lanarkshire said their ACSP helps make sure that they get the right support to keep caring compared with 54% in Scotland. There are approximately 14,000 unpaid carers known to carer support services and/or Health and Social Care North Lanarkshire (HSC NL) locally. However, the estimated true figure of unpaid carers locally is in the region of 50,000 to 60,000. This means that only around 1 in 4 or 1 in 5 carers are actually known to us. The needs of cared for people being supported at home have become increasingly complex over the years. People who may in the past have been supported in institutional or residential care previous, are now, rightly, being supported at home, however this can have an impact on unpaid care givers. Following implementation of the Carers (Scotland) Act in 2018, we are now seeing an increased Adult Carer Support Plans (ACSP’s) by HSCP staff and Young Carer Statements (YCS). A wide range of carer support options have been implemented recently. These include: • Enhanced funding and extended contracts to the three commissioned local carer organisations • Enhanced funding for PAMIS family support service., a service which supports families caring for a loved one where there are significant and profound multiple impairments. • The development of an extended and enhanced Carer Breather programme administered by North Lanarkshire Carers Together • The development of a Dementia Carers initiative, in recognition of the range of challenges in supporting a family member with Dementia • The introduction of a Hospital Discharge payment for carers in lieu of services, to mitigate the risk of delayed discharge, and/or delay of support services. Whilst this originally ran as a pilot scheme from January – March 2023, this has recently been reintroduced as of June 2023 to run until December 2023
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23 The HSCP is working with Lanarkshire Carers to look at ways in which individual budgets can be used to help meet caring-related needs that have been identified as low or moderate. Our shared aim is to streamline processes and ensure that carers with this level of need, who may require a budget rather than the range of existing other support options, can access a budget in the easiest way possible. This will help reinforce preventative and/or anticipatory planning. Adult Support and Protection (ASP) A joint inspection of adult support and protection in the North Lanarkshire partnership led by the Care Inspectorate in collaboration with Healthcare Improvement Scotland and Her Majesty’s Inspectorate of Constabulary in Scotland was conducted between August and November 2022. The inspection scrutinised the records of adults at risk of harm for a two-year period, August 2020 to August 2022. The focus of this inspection was on whether adults at risk of harm in the North Lanarkshire area were safe, protected and supported and evaluates the partnership’s key processes for adult support and protection, and strategic leadership for adult support and protection. The inspection identified many strengths in the North Lanarkshire approach, stating that adults at risk of harm had improved safety, health and wellbeing because of the diligent work of partnership staff who conducted their enquiries into the circumstances of adults at risk efficiently and effectively. Independent advocacy for adults at risk of harm was identified as a key strength for the partnership. The partnership’s strategic leaders were noted as enabling a culture of strong, credible, strategic partnership working for adult support and protection, with rigorous, multi-agency quality assurance and audit work in place for adult support and protection. Some areas for improvement were identified, including some improvements to chronologies for adults at risk of harm, improvements to the management of case conferences and representation for adults at risk of harm and their unpaid carers. Action plans are in place to manage the improvements identified from these recommendations. Suicide Prevention and Distress Brief Intervention (DBI) The work undertaken through the Suicide Prevention Partnership Group, which a collective of multi- agency staff that aims to collaborate in the promotion of the national and local suicide prevention strategies, is a key area where the HSCP is working to provide Early Intervention and Prevention. This takes place via a range of activities including awareness raising and training across services and local communities. This group includes representation from NHSL, Education and Justice, Police Scotland, CAMHS, NL Leisure, VANL and the Independent Sector. The group oversees and supports suicide prevention work in North Lanarkshire, working with partners to develop specific activities around suicide prevention activity and evaluates the impact of suicide prevention work for purposes of quality assurance and review.
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24 Staff Health & Wellbeing Work has continued in 2022/23 with the Health & Social Care North Lanarkshire Health & Wellbeing Group providing leadership and embedding a co-ordinated approach to staff health and wellbeing across the partnership. Care Academy The Health & Social Care Academy is now a mature and established partnership with South Lanarkshire HSCP, New College Lanarkshire and the University of the West of Scotland. The newly published website Prepare to care (carecareersnl.co.uk)2 provides information on care career pathways and Social Care Training opportunities. The Programme is continuing work against the three priority areas; the younger workforce, adult recruitment and employability, and building capacity and resilience by supporting wellbeing, training, and development across the existing workforce. The links with our education partners at New College Lanarkshire provide pathways to careers in care and The Health and Social Care Academy, based within the Coltness High School campus provides opportunities to learn about health and social care for pupils in S4 to S6, no matter what high school in North Lanarkshire they attend as pupils remain on the roll of their own school however, for any subjects and opportunities relating to health and social care they are transported to Coltness High School. Young people have the opportunity to access health and social care vocational learning pathways, such as Foundation Apprenticeships and Skills for Work courses, all under one roof allowing pupils to gain qualifications as well as work related learning experiences which will assist them in gaining employment in health and social care professions. Areas covered include Health and Social Care, General Nursing and Allied Health Professions at Levels 4/5 and Foundation Apprenticeship. iMatter staff experience survey. The iMatter staff experience survey allows HSCP staff the chance to give feedback on, and be involved in, influencing change and improvement in their workplace. The questionnaire, which is available online and in hard-copy takes just 10 minutes to fill in anonymously, is totally confidential and provides staff and line managers to understand what it is like as an individual at work, in teams and in the wider HSCP and the partner organisations. The information generated by the survey allows the necessary support required to enable employees feel motivated, supported and cared for at work. 2https://www.carecareersnl.co.uk/index.html
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25 Financial Year 2022/2023 Financial information is part of our performance management framework with regular reporting of financial performance to the IJB. National Health and Wellbeing Outcome 9 also requires resources to be used effectively and efficiently in the provision of health and social care services. The resources available to the IJB to deliver the delegated functions set out in the Integration Scheme and the Strategic Commissioning Plan are comprised of the financial contributions from North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL). The financial position for public services continues to be challenging, particularly in recovering from the Covid-19 pandemic, the inflationary cost pressures and cost of living crisis and the uncertainty around future funding. Notwithstanding these pressures, in March 2023 the IJB agreed a Medium- Term Financial Plan 2023/2026[2] to outline challenges and opportunities that the partnership expects over the next three years and to provide a framework which would support the partnership to remain financially sustainable. [2] Medium-Term Financial Plan 2023/20263 Partner Contributions 2022/2023 The delegated funds for the IJB come from NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. The total funding for the IJB in 2022/2023 was £738m. Included in the funding is a ‘Large Hospital Service’ (Notional Set Aside) budget totalling £66.858m. This budget is in respect of those functions delegated by the Health Board which are carried out in a hospital within the Health Board area. The Set Aside resource for delegated services provided in acute hospitals is determined by apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not, and assigning these to the relevant IJB based on postcode. The IJB is responsible for the strategic planning of these services but not their operation delivery. The comparison of funding contributions from the partners over the last three years is illustrated in the table as follows: Partner Expenditure 2022/2023 The total cost of services for the IJB in 2022/2023 was £732m. The comparison over the last three years is summarised in the table below: 3https://mars.northlanarkshire.gov.uk/egenda/images/att100330.pdf
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26 Summary of Financial Position 2022/2023 Throughout 2022/2023 the Chief Finance Officer’s financial monitoring report to the IJB projected an underspend, prior to the transfer of year end balances to reserves. The year end underspend totalled £35.495m. Adjustments incurred against reserves in 2022/2023 totalled £57.001m leaving a deficit on the provision of services of £21.506m as shown in the table below: The following provides a high-level summary of the key pressures and the main reasons why the IJB’s final outturn resulted in an underspend against its budget in 2022/2023:
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27 Reserves Strategy The IJB Reserves Strategy 2022/2023 allows for flexibility in terms of potential fluctuations. This allows the IJB to increase contingency reserve balances significantly where resources permit providing future financial resilience for those years where the level of resources available to the IJB may be significantly constrained and will require a draw down from these reserves in order to deliver financial balance. To protect the financial resilience of the IJB in the context of an increased financial risk profile, the IJB transferred £7.885m from the 2022/2023 in year underspend to contingency reserves. This provides a total contingency reserve of 3% of our financial envelope and aligns to the recommendation in our IJB Reserves Strategy of holding a 3% contingency reserve where possible. The IJB also has committed actions attached to the Strategic Commissioning Plan and funding is therefore earmarked to specific projects to allow spend to be managed in a way that represents best value for the IJB to achieve its national outcomes. It is also important that in year funding available for government priorities are able to be ring-fenced and carried forward into the following financial
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28 year. As these funding allocations are to meet specific commitments, they must be carried forward to meet the conditions attached to their receipt. The table below shows the breakdown of the underspend transferred to reserves at year end and approved by the IJB PFA Committee on 21 June 2023: Further details of the ring-fenced, earmarked, and contingency reserves totalling £97.946m is available at Note 8 of the North Lanarkshire Annual Accounts Unaudited 2022-2023[3] . Risk Management In line with the continued and ongoing review of the IJB Risk Register, new and emerging risks or changes in risk level are agreed at each Senior Management Team, IJB and PFA meeting as appropriate. Throughout the year, risk reports provide updates on the management of the key financial risks. Strategic Planning The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic Commissioning Plan 2023/2026[4] which sets out the key outcomes the IJB is committed to delivering with its partners. The Strategic Planning Group sets out the IJB’s approach to engage with stakeholders. Consultation on the future vision and activities of the IJB is undertaken with its Health Services and Local Authority partners with a Programme of Work setting out in detail the commitments that will be progressed over the next three years. The Medium-Term Financial Plan 2023/2026 outlines the financial challenges and opportunities the HSCP faces over the next three years and provides a framework which will support the HSCP to remain financially sustainable. It complements the IJB Strategic Commissioning Plan, highlighting how the financial plan will support the delivery of the IJB’s strategic objectives and priorities. Our joint focus with all our partners and stakeholders will continue to be ensuring that all resources in scope are maximised to their full potential and health and social care services are efficient, effective, and sustainable for the future. [3] North Lanarkshire IJB Unaudited Annual Accounts 2022/20234 [4] IJB Strategic Commissioning Plan 2023/20265 4https://mars.northlanarkshire.gov.uk/egenda/images/att100904.pdf 5https://mars.northlanarkshire.gov.uk/egenda/images/att100339.pdf
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29 4. Looking Forward – Our Next Steps The North Lanarkshire HSCP draft Strategic Commissioning Plan 2023 – 2026 was approved by the IJB in March 2023 following a final consultation period during the months of December, January, and February 2023. A Programme of work is set out in detail within the plan outlining the key work Programmes that will be undertaken over the three-year period to meet the key priorities within the Strategic Commissioning Plan. The Programme and the key deliverables will be monitored with regular reports on progress to be made to the Board the relevant Committees. It will be updated on an annual basis to ensure progress with the work and to respond to any new or emerging issues. The Programme of Work is aligned to the transformational change priorities for the partnership and a whole system approach to delivery of the projects and workstreams reflect the requirement to manage the interconnections and dependencies in a complex system, as well as give clarity and structure to wider partners and stakeholders. The Plan sets out revised ambitions for the HSCP, which were agreed following consultation with the public and other stakeholders: Do the right thing first time Increased focus on prevention, early intervention and tackling inequalities by working with communities and people Develop and support a workforce for the future Improve mental health and wellbeing Support people through a whole family approach A project management and data-driven approach will be adopted to ensure progress with the Programme and in order that informed decisions can be made regarding any dynamic changes to the work plan to assist with managing the extraordinary pressures on existing services as a result of demographic growth, the lasting implications of the Covid-19 pandemic and wider financial challenges to the HSCP and the partner organisations. The data collected to support the Programme of work will inform future resource planning and support the work of locality planning groups. Appendix 1 – Summary of Performance against Core Suite of Integration Indicators
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31 Appendix 2 – HSCP Performance Dashboard
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33 Appendix 3 – Inspection Findings 2022/23 Further information on 2022/23 inspection activity can be found in the HSCP Quality Assurance Annual Report, or more detailed information is available at the Care Inspectorate website: Publications & Statistics (careinspectorate.com)6. Glossary of Terms 6https://www.careinspectorate.com/index.php/publications-statistics
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1 REPORT Item No: 11 SUBJECT: Performance Update – Quarter 1 (April – June 2023) TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 18th October 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: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance 3. RECOMMENDATIONS It is recommended that the IJB/IJB PFA Committee: (1) Note the contents of the report and the appendix.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 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 corrective action. The performance review meetings are used as a means for jointly agreeing these actions. 6. CONCLUSIONS The areas for improvement and corrective action are attached as Appendix 1. 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. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ Yes ☐ No ☐ N/A ☒
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3 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low Ross McGuffie NHSL 2014 - Recovery of Performance 2021/22 Very High NHSL Corporate NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 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 The performance information, with the corresponding improvement and corrective actions will enable stakeholder representatives to participate in wider discussion about performance. ☐ Develop participation guidelines to ensure a common understanding and set of Yes ☐ No ☐ N/A ☒
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4 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 The performance information, with the corresponding improvement and corrective actions supports locality planning. 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 OneAreas for Improvement (Quarter 1, April – June 2023) CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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5 Appendix One Appendix One– Areas for Improvement (Quarter 1, April – June 2023) 1. Alcohol Brief Interventions Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 4072 292 718 Alcohol Brief Interventions (all settings) NHSL 7381 647 1098 Narrative & Corrective Action The Scottish Government (SG) and Public Health Scotland (PHS) have confirmed that the NHS Lanarkshire annual ABI target is to remain at 7381 for 2023/24. To reflect structural and organisational changes, the Information Services team have completed a mapping exercise detailing the teams in their localities, which allows for the provision of agreed trajectories for each locality and the many teams who contribute toward achieving the overall target number of ABI. This will allow for local scrutiny of performance by service managers at their team meetings. A SOP for recording ABIs on each of the recording systems has been finalised and will be disseminated to localities and teams by Service Managers. An evaluation of the training provided to community staff has been shared with the Steering Group and the recommendations are now being considered as it will not be possible to implement them fully within the current level of resource available. 2. Cervical Screening Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 72.5% 72.3% Narrative & Corrective Action Analysis was carried out using MiLan data to understand the cervical screening uptake across Lanarkshire. The chart below shows the uptake for North Lanarkshire Council by locality for quarter 1. No locality achieved the recommended target of 80%.
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6 Data analysed from MiLan for the time period 1st April 2023 – June 2023 – Quarter 1 Data for cervical screening is available at a practice level. Of the 50 GP practices in North Lanarkshire, only 3 GP practices achieved the national target of 80% in Quarter 1. The breakdown by locality is provided below. Airdrie (6 practices) – no practices achieved the 80% uptake target Bellshill (9 practices) – no practices achieved the 80% uptake target Coatbridge (6 practices) – no practices achieved 80% uptake target Motherwell (6 practices) – 1 practice achieved above 80% uptake target North (12 practices) – 2 practices achieved 80% or above Wishaw (11 practices) – no practices achieved the 80% uptake target Health Improvement Activity Information Provision/Communications 62.0% 64.0% 66.0% 68.0% 70.0% 72.0% 74.0% 76.0% 78.0% 80.0% 82.0% Airdrie Bellshill Coatbridge Motherwell North Wishaw 2023 Locality Uptake by Quarter 2023 Quarter 1 Jan - March 2023 Target
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7 Information was circulated to partners as part of Cervical Screening Awareness Week (19th-24th Jun) to support awareness raising and informed choices. Two Cancer and Screening Inequalities Workshops were delivered by Health Improvement. This includes cervical cancer and screening information; these sessions are available to staff and organisations across North Lanarkshire. Community Engagement. o Two community projects were appointed through the VANL commission process in June 2023. These were appointed to deliver a 12-month programme of activity in North Lanarkshire, specifically Airdrie and Bellshill, using a community development approach to improve awareness and engagement with the national cervical and breast screening programme. Airdrie – Bear Necessities: A project manager will work with local women’s community groups and settings where women already attend to explore barriers to attending screening, and to raise awareness around cervical and breast screening. Engagement with primary care to support women attend cervical screening will be offered. Existing links with Airdrie Action Partnership and Airdrie Consortium will be used to extend the reach of the work. Bellshill – Culture Junction: A community arts approach delivering workshops and pop up events, empowering women to discuss their thoughts around their bodies, to address any fears, shame or stigmas they may face when accessing cancer screening, or fears, shame or stigma more generally. Using creative engagement approaches e.g., creative writing, arts and craft, to engage women on the topic, and to provide a safe, relaxed environment to share stories, learn from one another and gain confidence to access their screening. In addition, a focus group will be supported to create a resource for women. 3. Child Immunisations Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 92.2% 91.4% Narrative & Corrective Action The Community Nursing Management Team are carrying out further analysis of DNA at a locality level to try and determine whether there are patterns, or trends at the level of localities that might increase the organisational intelligence around non-attendance. It should be noted that regardless, in each instance of DNA, there is an appropriate and proportionate action plan for each child following up on that non-attendance. The intelligence gained through previous analysis has identified that more novel and focussed approaches may be desirable, and the team is looking at how home immunisations and “pop-up” immunisation clinics might improve performance in the areas of highest non-attendance. This is supported by the findings of a self-assessment by the Immunisation Inclusivity Group and Dr Henry Prempeh, who conducted a session around nine thematic areas (local insights, eligible population, reminders/recall, catch-up activity, declines/opt-outs, delivery models, inclusion activity, marketing and
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8 communications and workforce education) to better understand the performance and what improvements might be found. The findings of this review will inform future improvement activity. It should be noted that there are known anomalous aspects of the data held regarding childhood immunisations; for example, where a child has had all immunisations except MMR due to choice, the calculation for this metric may return that case as the child having had no immunisations. Work is ongoing to address these issues, with further development of SIRS and Morse recording practices to ensure accurate performance data is produced and published. 4. 6-8 Week Reviews Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6-8 week review 90% 71.1% Quarterly/ 1 quarter behind Narrative & Corrective Action An SBAR has been prepared detailing recommendations for improvements to the Universal Health Visiting Pathway (UHVP) and the Child Health Surveillance Programme Pre-School system (CHSP-PS). One of the drivers for this work is the level of performance in this area; the PHS monthly reporting indicates that completion of the 6 to 8-week assessment by 10 weeks of age is consistently below 75% across North Lanarkshire. 6-8 week assessments are not being undertaken in the required timescales and are not being delivered consistently across NHS Lanarkshire. UHVP is a minimum standard for core home visiting offered to all families consisting of 11 home visits; 8 within the first year of life and 5 Child Health Reviews between birth and starting school. CHSP-PS supports the delivery of the child health programme by facilitating the automated call and recall of children for the agreed schedule of child health reviews for pre-school children. Both programmes are evidence based and agreed best practice. The visit at 6 to 8-week review is a home visit that is in addition but complimentary to the review undertaken by General Practitioners (GP) at 8 weeks in the surgery or clinic. Completion and return of the Child Health Surveillance Programme form is the joint responsibility of the GP and Health Visitor (depending on local arrangements) and the review form should be completed fully and accurately then promptly returned to the local child health department for timely data entry into the CHSP-PS. Quality control and validation is in place to ensure the accuracy of data, however this does result in situations where records or forms identified as requiring further attention not being captured in reporting, therefore there is often incomplete reporting for this metric, or misleading performance information. An in-depth review was carried out by each Health Visiting Team Leader for children born within their localities between October 2022 and December 2022; the review used a case-study approach for 6-8 week reviews that were thought either not to have taken place, or information had not been received by the Child Health Department for recording into the CHSP-PS. These cases were reviewed for accuracy and any trends or common themes for
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9 those cases. The results are summarised in the table below; 82% of babies identified within the time frame did receive a full HV/GP assessment, of those 39% were out with the timeframe: The overall findings highlighted that the paper-based system that is in place is not easy to navigate, nor does it allow for ease of monitoring at a local level. The review found that implementing an electronic system would reduce the risk of lost information, avoid confusion and provide a clear monitoring system. The SCAR concludes with the following recommendations: The implementation of a CHSP forms as part of an electronic system would reduce dependency on paper assessment sheets and reduce the duplication of forms, provide assurance that assessments were being completed and ensure prompt return. It would allow for easier monitoring of what was completed/outstanding. Develop a Standard Operating Procedure to ensure 6-8 week assessments are completed within agreed timescales and completed forms are promptly returned to the local child health department for timely data entry into the Child Health Surveillance Programme Pre-School system (CHSP-PS). Wishaw Motherwell Bellshill North Coatbridge Airdrie Total % No. on List 21 24 22 45 13 27 152 No. completed by HV 21 22 21 45 12 27 148 97% No. with full HV and GP review within timescales 14 10 7 21 4 9 65 43% No who had a late review/or no full GP/HV Review Late: 4 No: 3 Late: 9 No: 5 Late: 8 No: 7* *1 child not discharged from hospital Late: 24 No: 0 Late: 6 No: 3 Late: 8 No: 10 Late:59 No: 28 39% 18%
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10 Remind Health Visitors and GP’s/CHS clinics of the tight timescales for completion to ensure assessments are completed timeously. Ensure outcome of assessments shared – GP should be returning HV part of form to the Health Visitor for information. Health Visiting Teams to follow the journey of the 6 to 8-week Assessment form to ensure process is followed. Ensure GP Practices and CHS clinics have enough appointments to accommodate demand for assessments so that there is assurance that they will be completed within approved timescales. Once both HV and GP assessments are completed this should be recorded as a significant event in the child’s Health Visiting record. The SBAR is being considered through the service’s internal governance before proceeding to implementation of the recommendations. 5. Reablement and rehabilitation services Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 1418 376 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 61.20% 64.00% Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 28.80% 21.30% Balance Of Care - % Of People (Age 65+) 45% 42.60% 40.20% IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 51.50% 47.50% Narrative & Corrective Action It is widely acknowledged that Reablement support provided within North Lanarkshire produces good outcomes for service users completing the Reablement process, however further consideration of performance in this area has highlighted clear recording issues in some localities and teams. In essence, Reablement demand and support is not always being recorded appropriately, with both Cumbernauld and Airdrie identified as not accurately reporting Reablement progress, and there is an undoubted subsequent impact on the data for these performance metrics. The service is now experiencing a delay in Home Support Teams moving service users off of Reablement if it has been identified that a provider may be required for ongoing support should the locality teams not have the resource required. This is mainly due to the directive that an indicative budget requires to be approved and agreed before a service user can be allocated to a provider via the SDS model of support. This is impacting on locality teams taking on additional cases for Reablement.
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11 All Reablement teams are highlighting the lack of Occupational Therapy support to Reablement received from each of the locality teams; prior to the creation of IRT, Occupational Therapists worked in partnership with Home Support Reablement teams, with joint screening meetings and home visits accepted practice. All locality teams are reporting that this support is now limited due to the demands on IRT. Locality SDM’s have highlighted the significant and sustained vacancies in Reablement teams that are unable to be filled, particularly Home Support Worker vacancies. This is in part due to the current cap on recruitment, which is restricting the number of service users who can be supported at any given time via the Reablement process. The expansion of the Home Assessment Team (HAT) and the HAT approach continues to impact on the wider system. The number of referrals per month to HAT continued to increase until March 2023, where it appears to have plateaued and then subsequently reduced in July 2023. The largest input service for HAT is Home Support (65% of referrals received), followed by O.T. (49%). Both of these figures have remained constant since the start of the service.
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12 846 people were noted as completing HAT, 85% of the total referrals. The locality with the largest number of people recorded at completion stage was Wishaw. Of the 304 showing further service being required, the service with the highest number was C.A.S. with 131 (15% of total completing). With regard to IEAS, a Programme of improvement works is still in progress, with improvements to premises and focussed recruitment activity in progress at the time of reporting. Sustained workforce challenges, specifically recruitment and retention of suitably skilled and experienced IEAS staff have resulted in challenges with the delivery and uplift of equipment. 6. Delayed Discharges Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Delayed discharge bed days - standard delays 31,796 8,178 8,438 Narrative & Corrective Action For 2023/24, North Lanarkshire HSCP has set a target to reduce the 2022/23 target for number of delayed discharge bed days for standard delays by 5%. This is on top of the 10% reduction target in the previous year. During April – July 2022/23, cumulatively, there were 1527 more delayed discharge standard bed days than trajectory – 11,234 against the target of 9,797. Input SW 4% OT 49% Physio 17% AHP Support Staff 9% Home Support 65% CAS 24% Technology 4% Pharmacy 3% Com. Nursing Team 10% Med. Realignment 2% Service at Completion HS - Reablement 9% HS - Mainstream 13% IRT - Physio 7% IRT - OT 11% Rehabilitation - Other 1% CAS 15% Locality SW Referral 1% IDS 1% LSS 1% District Nurse 7% NL Leisure 1% Third Sector 4%
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13 Standard Bed Days against trajectory Figures 6 and 7 show that North Lanarkshire performance has improved on the July census date and was below the national average for the rate of delayed discharge for the entire adult population and >75. Lower is better
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14 Rate Per 100,000 Over 18s Rate Per 100,000 Over 75s* The work initially being undertaken as part of the ‘Discharge Without Delay’ programme is now being subsumed within Operation Flow and should see improvement across a number of areas which will assist in improving patient flow through the hospital which, in turn, will assist significantly in reducing delayed discharges. Through the use of accurate Planned Date of Discharge (PDD), early involvement of social work staff in discharge planning and an associated reduction in ‘unplanned referrals’, so the number and time associated with delayed discharges should improve.
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15 Recently reported work associated with ‘Discharge without Delay’ and associated developments to support earlier discharge and potential admission avoidance are anticipated to assist in bringing further improvements in this position. Throughout July, above 94% of all patients from North Lanarkshire were discharged without delay (target 98%). All inpatient discharges In the middle of the month of July patients aged 65+ with a Planned Date of Discharge (PDD) was 61%. Unplanned referrals peaked at 41% in the first week of July. Discussion is ongoing with acute colleagues in seeking to support improvements in these areas such that there is sufficient time to plan discharges and therefore reduce the level of subsequent delay. Work includes the provision of dedicated social work support to ward-based Multidisciplinary Team reviews with an aim of improving the number of people with PDDs and accuracy of same.
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16 Current Inpatients (at time of census) with a Planned Date of Discharge
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17 Current Inpatients (at time of census) with a SW referral that is unplanned Factors affecting performance include: Recent challenges with increases in sickness absence levels in in-house Home Support services Continued reduced capacity of Reablement services Recruitment and retention to posts at all grades in Home Support has been challenging and there has been a higher than usual turnover. In particular Home Support Worker, Support Officer and Service Delivery Coordinators have been difficult to recruit and retain. Highest referral rates on record – w/b 16th January, the North partnership received 158 referrals (peak winter pre-pandemic average was 77) A wide range of activity is underway, both locally and nationally, to drive further improvement in performance, these include: Whole system improvement work on the PDD process, including development of PDD metrics for inclusion in future reports Home Support recruitment
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18 Lanarkshire is a demonstrator site for Home First/Discharge without delay. Staff involved in the development of the Discharge without delay measurement plan Rapid response, focused on supporting people at home, is having an impact. Home Assessment Teams are now up and running with over 660 individuals now supported home since May 2022. 60% of individuals the Home Assessment Team has worked with required no further support or service at the end of the process. Further work is ongoing to accelerate the implementation of Home Assessment Teams across all localities. Expanding Hospital at Home service and considering expanding to under 65s Additional CSWs are being recruited so that District Nursing Teams can enhance the care offering to those on both Home Support and District Nursing caseloads, freeing up further Home Support capacity to concentrate on other cases New approach to interim care home placements introduced in December 2022. Establishment of additional review capacity to free up mainstream Home Support service Efforts continue to ensure Reablement capacity within the service is protected with Reablement and rehabilitation key priorities for the future of the operating model. 7. CAMHS Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 28.7% 28.1% Narrative & Corrective Action The Waiting List Initiative has continued to evidence a steady downward trajectory in children and young people who are waiting to be seen. This, in collaboration with the delivery of increased capacity for initial assessment (Choice Appointment), is evidencing regular incremental monthly reductions in the waiting list and the longest waits. A regular weekly meeting is in place that will continue to focus on longest waits, as well as the distribution of choice and partnership appointments being offered. The service has currently paused the additional capacity being offered for Choice appointments (initial assessment). The service has assured itself that Choice appointment capacity is embedded in the CAPA booking process and this will continue to be scrutinised to ensure it is maintaining capacity against demand.
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19 It is likely that the WLI will need to flex to provide the additional capacity required to address ongoing challenges around the RTT target. Work is ongoing with CAMHS Clinical Managers and Team Coordinators to ensure CAPA partnership appointment capacity is maximised across the whole system. There has been a drop off in RTT performance in Q1; this was anticipated due to the increased activity through waiting list initiative and it expected that there will not be significant improvement in RTT in Q2. This is due to a culmination of higher levels of DNA due to school holidays and staff annual leave; however, the weekly focus on longest waits, CAPA appointments and additional out-of-hours capacity should start to realise a consistent positive trajectory in future quarters. 8. Adult Mental Health Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 63.5% 57.4% Narrative & Corrective Action Psychiatry performance continues to be impacted by significant challenges around the recruitment and retention of Consultants, which is a national issue. Performance in this area is subject of the MH & LD Risk Register. Sustained levels of high demand and recovery works focussed on those patients waiting the longest have seen improvements in the longest waits.
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20 The service continues to focus improvement activity on improving current staffing levels and retaining staff through personal development and training opportunities. 9. Medical Paediatrics Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90% 49.2% 49.5% Narrative & Corrective Action The Paediatric Modernisation Board has been established. A preliminary workshop followed by the first meeting of new Board has taken place. It is chaired by AMD for NLHSP and reports directly to Head of Health who has responsibility for delivery of the ongoing improvements required to assure future service models. Membership and agreed TOR now in place. Programme of work identified. A Horizon 1- 3 approach is being taken. Initial Work Streams have now been established. These include: - Care Assurance Work Stream- Chaired by AND for Children and Young People Services. Rota Sustainability Continence Service Model review (which has a big impact on community paediatric waiting times) There continues to be robust vetting of all referrals into General and Paediatric services and some recovery of waiting time is being achieved. However, there are increasing numbers of referrals being sent to the department so impact of what is being delivered has not yet balanced and will require further scope of capacity and demand to evidence the growth ask beyond current resource. This will be a focus of Paediatric Modernisation Board as we consider and progress new sustainable models of working. Performance for July shows 45.3% with 802 children waiting over 12 weeks. Longest wait is 51 weeks.
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21 10. Paediatrics – Speech and Language Therapies Target 2022/23 2022/23 Q4 2023/24 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90% 39.4% 25.1% Narrative & Corrective Action Speech and Language Therapy continues to face significant challenges to meet the waiting times target. A service improvement plan is in progress and the management team have been provided with additional support to implement the improvements. A service improvement workshop and subsequent process mapping session was facilitated by a project lead and service improvement colleague; these colleagues are providing ongoing dedicated support for the improvement work. There are now six discreet areas of improvement work: - 1. Communication and Engagement - SLT colleagues already have a dedicated website and share many support materials via YouTube. This work stream will be led by NHS Communications Team and supported by the SCHSU Engagement Officer to ensure voices of children, young people and family are considered within this process. 2. Waiting List - The Team are not consistently using Trakcare across their full system. This makes it difficult for them to apply consistent waiting time measurement processes across the service. Service Improvement and Waiting List Management colleagues have been involved in supporting improvement work in this area. 3. Accommodation - The Team are based across several community bases and are also on acute sites. A review will be undertaken of currently allocated space with a particular focus on appropriate capacity of clinical rooms to meet clinical demand. 4. HR and Workforce - The team are similar to many areas within healthcare; recruitment and retention is an important area of focus due to difficulties recruiting, training and retaining suitable skilled and experienced staff. This work will be supported by NHS Lanarkshire HR and workforce colleagues. Scoping will be undertaken of the workforce demography to ensure we are building a sustainable future model for workforce and service delivery. This will include considered expansion of non-registered roles with the input of further education partners, who
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22 are involved in supporting the work; it is hoped that their inclusion in workforce planning will support increased partnership working and sharing of experience that will be mutually beneficial. 5. Administration - Currently the OSM workforce is managed across 2 separate OSP portfolios. The administration group will focus on scoping of tasks against current capacity and demand, as well as insuring that both OSM’s are kept informed of developments that may affect their teams. eHealth - eHealth colleagues will lead this group and develop a plan of improvement. The initial focus will be testing the current Trakcare build and expanding this to all parts of service. Thereafter, the focus will be on ensuring all people being seen by SLT will have their care and interventions documented on Morse, so that they can inform shared working with other colleagues involved in direct care.
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23 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
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24 11 Date direction will be reviewed
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1 REPORT Item No:12 SUBJECT: North Lanarkshire ADP – Drug Related Deaths TO: IJB Performance, Finance & Audit Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 18th October 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTES TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: (1) Note the content of the report; (2) Acknowledge 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) Recognise that there are a range of current arrangements in place to reduce harms. (4) Recognise 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.
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2 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The National Record of Scotland (NRS) Drug Related Deaths was published in July 2023, this report highlights the information specific to North Lanarkshire. 5.2 A summary paper is presented at Appendix 1 providing more detail to the summarized information noted below. 5.3 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. 5.4 The five-year average rate for North Lanarkshire is very similar to that seen nationally across the reporting period. 5.5 Drug related deaths are more prevalent in males than females in North Lanarkshire in 2022. 5.6 Opiates/opioids were the most common group of drugs implicated in DRD in north Lanarkshire in 2022. 5.7 Four of the six localities in North Lanarkshire had a reduction in DRD in 2022 compared to the previous year. o Airdrie Locality had largest reduction in DRD in 2022 compared to the previous year with ten less reported deaths. The only Locality with an increase in DRD (+5) in 2022 was Motherwell Locality. 5.8 Over seventy percent (71%) of DRD in North Lanarkshire in 2022 had two or more substances implicated in the cause of death. 5.9 Alcohol was implicated in almost double the proportion (20%) of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (11%). 5.10 The NLADP support team worked closely with key partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence- base, regional scoping work and learning from commissioned services to target the right responses to reduce harms. 5.11The following ADP sub-groups oversee and support decision making on local investments linked to delivering the National Mission priorities. (1) Prevention, Early Intervention, & Education (2) Treatment, Care & Recovery (3) Whole Family Approach (4) Public Health Approach to Justice
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3 (5) Reducing Alcohol Harms Group (pan – Lanarkshire) (6) Drug Death Prevention Group (pan – Lanarkshire) 5.12 The work led by the NLADP will continue to engage wider stakeholders in analysing the impact of current services, supports and models of intervention, as well as consider the priorities and design into the future. A stakeholder conference in November 2023 will bring together people with lived and living experience, frontline practitioners, managers and strategic leads to reflect on local and national performance. Outcomes from this event will be incorporated into a fuller report to committee in March 2024. 6. CONCLUSIONS 6.1 Deaths from drugs in 2022 reduced, as did the numbers across Scotland. The numbers for North Lanarkshire remain high. 6.2 Poly-substance use is an ongoing concern, including alcohol prevalence in confirmed deaths from drugs. More work is required to understand the right approach needed for North Lanarkshire. This will be explore thought the Drug Death Review processes in place and the Reducing Alcohol Harms group. 6.3 NLADP now has the appropriate processes and measures in place to offer assurances that everything possible, to reduce harms and deaths from substances, is being considered. This is set out in the ADP Annual Survey. 6.4 NLADP increased investments across key priority areas for the past 3 years and is working closely with key stakeholders to review data and local intelligence to target the most appropriate interventions in areas of concern. 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 ☒
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4 7.2 ASSOCIATED MEASURE(S) Drug Death prevention - The Pan-Lanarkshire Drug Death Prevention group (DDPG), a function of North and South ADP’s has been in place since 2019. The work of the group is guided by an action plan aligned to the national approach set out in Staying Alive and the Drug Deaths Task Force Changing lives report. NHSL, Director of Public Health will take on the Role of Chair for the DDPG strategic group from December 2023. North and South ADPs share a Drug Deaths Information Officer post providing a supporting role in gathering data any information relating to suspected drug related deaths. This allows the wider partnership to identify trends and patterns to target the right responses required to reduce deaths and harms from drugs. Quarterly reports are produces and shared by the groups. The drug trends monitoring group is a quarterly meeting attended by police/ADP stakeholders and is Chaired Public Health colleagues. The purpose of this group is to identify and share relevant information appropriately to inform and safe lives. This group is linked to Public Health Scotland’s RADAR alerts system to ensure our local response is well informed and efficient. A seminar to examine the challenges in relation to drug-related deaths and suicides has been scheduled for 4th October, on behalf of the Public Protection Chief Officers Groups (PPCOGs) for North and South Lanarkshire. PPCOGs have a responsibility to ensure suicide prevention and drug related deaths are a priority. The seminar will ensure all are cited on the local issues and that the responses both individually and collectively are effective. • Medication Assisted Treatment (MAT) standards – 1-5 implemented and embedded by March 2024 (6-10 beyond). Work continues to fully embed all standards by March 2025. A dedicated North working group meets monthly to guide this work with links to a Pan-Lanarkshire oversight group. • Residential rehab – assessment and access is now offered to anyone who chooses/where appropriate to access rehab, as part of their care and treatment. NLADP published the rehab pathways online in 2023, setting out how people can access rehab. There has been an increase in referrals and placements following training being delivered to frontline staff in 2023. • Harm reduction and Assertive Outreach – A new crisis response team has been commissioned via NLADP, in collaboration with housing and treatment service colleagues. The new service will deliver vital support to reach people in crisis sooner and will connect people to support following a near fatal overdose. A steering group has been established to lead this work to ensure we offer a consistent approach and make the most of the increased workforce capacity to deliver Harm Reduction measures. This includes Naloxone provision, Blood-Bourne Virus testing and wound care.
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5 • Whole Family Approach – integrated authorities are tasked with increasing and widening Family Inclusive Practice (FIP) across all treatment and care settings. NLADP commissioned a new family support service, independent of treatment services, to meet the needs of families. Workforce training is underway with frontline staff to improve family involvement in treatment and care planning, where appropriate. This is being led by Scottish Families Affected by Alcohol and Drugs who developed the national framework. • Lived and Living Experience (LLE) and those in recovery are involved in design, delivery and evaluation of services. LLE Panels are to be established with a dedicated post within the ADP support team out to advert to lead this work. NLADP has a very strong focus on listening to LLE via ADP commissioned services, there are visible and active Recovery Communities and Tier 2 treatment services operating across all six localities in the North. – LLE involvement in ADP recruitment and commissioning processes – LLE Representation embedded across all ADP sub-group structures – NLADP is establishing lived experience panels by March 2024. Young people’s voices are included in the planning, delivery and evaluation of services with NLADP commissioning services to support young people to engage in this process. – Peer-awareness and education initiatives recommissioned with youth lived- experience panels to be established. Healthcare Improvement Scotland have been leading a review of mental health and substance use support (North) this includes lived and living experience. Final recommendations and actions for consideration to be reported in October 2023. 7.3 FINANCIAL NLADP has increased investment across the sector, targeting the most appropriate and evidence-based interventions to deliver on the Nation Mission Priorities. This is intended to reduce harms and prevent deaths with spending decisions made via the ADP sub-groups with approval by the ADP Board and finance groups. The year-end position for NLADP spending is set out below: 2020/21 Year end £2,410,584 2021/22 Year end £2,290,611 2022/23 Year end £4,219,447 2023/24 Spend forecast £4,988,194 This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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6 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes □ Provide stakeholders with information on how to get involved □ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings □ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff □ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒
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7 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 National Record of Scotland (NRS) Drug Related Deaths in North Lanarkshire report, 2023. This report sets out a more detailed breakdown of NRS data for confirmed Drug Related Death in North Lanarkshire for 2022. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; John Holleran on 01698 753651 john.holleran@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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[Type here] [Type here] [Type here] Appendix 1 P a g e NATIONAL RECORDS OF SCOTLAND (NRS) REPORTED DRUG RELATED DEATHS (DRD) IN NORTH LANARKSHIRE IN 2022 A NORTH LANARKSHIRE FOCUSSED SUMMARY OF THE NRS DATA AND PUBLICATION North Lanarkshire Alcohol and Drug Partnership 28 August 2023
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1 | P a g e Summary ...................................................................................................................................................................................... 2 Headlines ................................................................................................................................................................................. 3 Sex ............................................................................................................................................................................................. 3 Age ............................................................................................................................................................................................ 4 Deprivation ............................................................................................................................................................................. 5 Geography ................................................................................................................................................................................... 6 Substances .................................................................................................................................................................................... 7 Opiates or Opioids .......................................................................................................................................................................... 8 Benzodiazepines ...................................................................................................................................................................... 9 Other substances ................................................................................................................................................................... 10 Annotation ..................................................................................................................................................................................... 11 CONTENTS
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2 | P a g e THERE WERE SIXTY FIVE DRUG RELATED DEATHS IN NORTH LANARKSHIRE IN 2022. This is fifteen less than 2021 and the third successive year showing a reduction. Deaths are still high however with almost thirty more deaths in North Lanarkshire in 2022 compared to ten years ago. DRUG RELATED DEATHS ARE MORE PREVELENT IN MALES THAN FEMALES IN NORTH LANARKSHIRE IN 2022. In North Lanarkshire in 2022 there were one and a half times more DRD reported for males than females. Whilst this is a considerable difference and both male and female DRD have shown a decrease from 2021 the proportional fall is much more marked in males. Ten years ago, in 2012, there were over four and a half more DRD reported for males in North Lanarkshire than females. OPIATES/ OPIODS ARE THE MOST COMMON GROUP OF DRUGS IMPLICATED IN DRD IN NORTH LANARKSHIRE IN 2022. Whilst Opiates/Opioids are the most common drug implicated in DRD in North Lanarkshire, in 2022, the proportion is considerably less than that reported nationally (82% Scotland, 74% North Lanarkshire). The most commonly implicated Opiate/Opioid for DRD in 2022 in North Lanarkshire differs from what is seen nationally with Heroin/ Morphine being the most commonly implicated in North Lanarkshire and Methadone the most commonly implicated nationally. SUMMARY
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3 | P a g e Drug Related Deaths in North Lanarkshire remain high but have fallen in three successive years. • Sixty five Drug Related Deaths in North Lanarkshire in 2022. • Down nineteen percent (15 deaths) on 2021. • Third fall in three successive years. (Highest number of deaths 95 in 2019). • Fifth highest number of Drug Related Deaths on record. • Five year average rate very similar to that seen nationally across the reporting period. HEADLINES
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3 | P a g e Reduction in deaths over six times greater in males than females. There were one and a half times the number of drug related deaths for males (39, 60%) compared to females (26, 40%) in 2022. The gap has narrowed, for the second consecutive year, with one point nine times the number of drug related deaths for males (52, 65%) compared to females (28, 35%) in 2021. Reduction in deaths over six times greater in males (13 less deaths) than females (2 less deaths). SEX
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4 | P a g e Thirty eight percent of DRD in 2022 in North Lanarkshire occurred within the thirty five to forty four age group. The age profile in North Lanarkshire is broadly similar to the national profile for 2018-2022 averages per 100,000 population deaths. Deaths per 100,000 population in the 25-34 age group in North Lanarkshire is considerably higher than what is seen nationally for 2018-2022 averages (41.3 North Lanarkshire, 27.9 Scotland). In 2022 the age group with the largest proportion of deaths was the 35-44 age group (38%) followed by the 45-54 (32%) age group. This differs from 2021 where the this was reversed i.e. most deaths in 45-54 age group followed by 35-44 age group. AGE
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5 | P a g e More than half (58%) of the DRD reported in 2022 in North Lanarkshire were for individuals living in the most deprived area (Scottish Index of Multiple Deprivation (SIMD) quintile 1). Almost ninety percent (86%) of DRD in North Lanarkshire in 2022 were for individuals in the two most deprived areas (SIMD 1 and 2). In North Lanarkshire in 2022 there were ten percent more (86%) DRD in the two most deprived areas compared to Scotland as a whole (76%). Less than four percent of DRD in North Lanarkshire in 2022 were for individuals in the two least deprived areas (SIMD 4 and 5). DEPRIVATION
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6 | P a g e All localities in North Lanarkshire had five or more DRD in 2022. Four of the six localities in North Lanarkshire had a reduction in DRD in 2022 compared to the previous year. Airdrie Locality had largest reduction in DRD in 2022 compared to the previous year with ten less reported deaths. The only Locality with an increase in DRD (+5) in 2022 was Motherwell Locality. GEOGRAPHY
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7 | P a g e Opiates/Opioids are the most common drug implicated in DRD in 2022 in North Lanarkshire. Whilst Opiates/Opioids are the most common drug implicated in DRD in North Lanarkshire in 2022 the proportion is considerably less than that reported nationally (82% Scotland, 74% North Lanarkshire). A similar relationship can be seen for benzodiazepines and Gabapentin and/or Pregabalin (Benzodiazepines 57% Scotland, 49% North Lanarkshire, Gabapentin and/or Pregabalin 35% Scotland, 28% North Lanarkshire). Alcohol was implicated in a considerably larger proportion of DRD in 2022 in North Lanarkshire compared to Scotland (20% North Lanarkshire, 11% Scotland). Over seventy percent (71%) of DRD in North Lanarkshire in 2022 had two or more substances implicated in the cause of death. SUBSTANCES
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8 | P a g e Methadone was implicated in almost half the proportion of DRD in North Lanarkshire (23%) compared to Scotland (45%) in 2022. Buprenorphine was implicated in more than double the proportion of DRD in North Lanarkshire (14%) compared to Scotland (6%) in 2022. Every DRD in North Lanarkshire in 2022 where Buprenorphine has been implicated was a poly drug death; on average there were 4 drugs implicated in every DRD where Buprenorphine was implicated. In North Lanarkshire in 2022 the most commonly implicated Opiate/ Opioid for DRD was Heroin/ Morphine (40%). This differs from Scotland were Methadone was the most commonly implicated Opiate/ Opioid (45%); Methadone was implicated in twenty-three percent of DRD in North Lanarkshire. OPIATES OR OPIOIDS
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9 | P a g e With the exception of Etizolam all categories of Benzodiazepines are implicated in a smaller proportion of DRD in North Lanarkshire in 2022 than across Scotland. Any "Prescribable" benzodiazepine were implicated in half (9%) the proportion of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (18%). Diazepam was implicated in five times the proportion (15%) of DRD in 2022 across Scotland compared to North Lanarkshire (3%). BENZODIAZEPINES
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10 | P a g e Alcohol was implicated in almost double the proportion (20%) of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (11%). Cocaine was implicated in more than one in three (35%) of DRD in North Lanarkshire in 2022, which is identical to the proportion across Scotland. In 2021 Cocaine was implicated in twenty-seven percent of DRD in North Lanarkshire. Although this (35% reported in 2022) is a proportional increase of seven percent it equates to just one more DRD were Cocaine was implicated in 2022 (23 deaths) compared to 2021 (22 deaths). Gabapentin and/or Pregabalin was less commonly implicated (7% less) for DRD in 2022 in North Lanarkshire (28%) compared to Scotland as a whole (35%). OTHER SUBSTANCES
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11 | P a g e Pages 3 and 4 1) Populations for 2022 are not available at the time of publication so 2021 populations are used to calculate rates for 2022. Page 4 2) Some age groups have been aggregated to protect anonymity. Pages 7,8, 9 and 10 1) More than one drug may be reported per death. These are mentions of each drug, and will not add up to give total deaths. ANNOTATION
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1 REPORT Item No: 13 SUBJECT: Resilience Response TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Kirsty Orr, Head of Planning and Development, NHSL Ross McGuffie ,Chief Officer North HSCP DATE: 18th October 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Performance, Finance and Audit Committee: For approval For endorsement To note 1.2 This paper sets out the actions being taken in response to current whole system service pressures. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The PFA is asked to: (1) Recognise the whole system Operation Flow 2 plans and implementation structures set out in the report; (2) Request future updates on progress. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. 5.1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 The IJB PFA received an update on Operation Flow at its meeting on 21st June 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 5.2.2 In the June update, officers set out the Operation Flow 2 plan and implementation structure for members, with the aim of having all elements completed by the end of October 2023, ahead of winter. 5.3 Operation Flow 2 Progress Update 5.3.1 Intensive work continues to embed best practice accountability and leadership to deliver our plan. However, we know 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. 5.3.2 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. 5.3.3 Consequently, in early September operational and clinical colleagues, from across the system, worked together to develop a recovery plan for with the objective of improving performance against some or indeed all of our metrics which are: Weekly 4-hour access performance Weekly number 8 hour waits Weekly number of 12 hour waits Acute site occupancy levels, Ward beat rate achieved / week Discharge lunge use Pre-noon discharge rate Delayed discharges / week (Acute and Community sites) 5.3.4 The recovery actions agreed to be progressed through September include:
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3 Enhanced duty manager support across our sites to support flow during our vulnerable times which includes the OOHs period and Monday mornings 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 5.3.5 Daily performance metrics for each site have also been implemented which will ensure that we can track day to day improvements or deterioration in performance and the required actions to sustain or improve our metrics. 5.3.6 Within the HSCP, significant progress has been made in creating a more efficient entry point to social care, with Reablement teams now fully ring-fenced to ensure their capacity and Home Assessment Teams expected to be at full capacity by the end of October. 5.3.7 Home Assessment Team capacity has been steadily improving, with the service supporting its 1000th discharge in August, with still over 60% of service users requiring no ongoing package of care after 2 weeks of wrap around support and assessment at home. 5.3.8 A test of change around Locality Response has commenced in Wishaw Locality, supporting a multi-disciplinary urgent response to individuals at risk of admission, with the aim of supporting them to remain at home. This has included tie ins with both the Emergency Department and Flow Navigation Centre. The aim is to continue to test the model before gradually rolling out across the five remaining Localities. 5.3.9 Hospital at Home service expansion continues ahead of winter, with the service roll out into Clydesdale Locality taking place in August 2023 and additional capacity being recruited to support extended working hours and increased capacity in the North Lanarkshire service. 5.3.10 Work continues with the development of a Frailty Strategy and the recruitment of Frailty interface teams on each of the three acute sites with the aim of supporting admission avoidance, improved pathways and earlier discharge for frail patients. 5.4 System Readiness – Operation Flow 2 Power Up 5.4.1 The primary objective of the task and finish groups in relation to scoping and developing proposals has now been achieved and we a transitioning to our delivery structures to support this work. Some task and finish groups will continue to operate until all our new models of care are developed. However, the majority of the work will be delivered through a hospital sector based structure to ensure that we maintain a whole system approach. However, we also recognise that there are some elements of our plan that are pan-Lanarkshire e.g. FNC development and Frailty Clinical Network which will require some flexibility in our approach to support delivery.
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4 5.4.2 We remain committed to launch and implement our Operation Flow 2 Winter Plan from the 1 November 2023. However, we know that creating the right conditions for launch is essential. Consequently, our preparation will include finalising our new care models and ensuring that our workforce is engaged in all elements of the plan and understand their role in its implementation. System readiness is also underpinned by the delivery and implementation of the detail of the site and sector level improvement plans. This focused preparation period - Power up - will run through the month of October. 5.4.3 As a system we agreed a number of actions that would support testing of new models as well as decompression during the duration of the Power up period, which includes: Testing of the Rapid Emergency Assessment Care Team (REACT) processes as part of our new Front Door Target Operating Model (see appendix 1) to increase streaming of patients to the right part of our system in UHH and UHW which will help to ensure that processes are tested and staff increase their confidence in initial assessment at the front door (REACT is a model already in place in Monklands and being rolled out across the other two acute sites) Maximise the availability of a senior clinical decision maker in the Flow Navigation Centre as part of our new care model to support direction of patients the right place and at the right time to ensure new care model is ready for launch on 1 November 2023 (see appendix 2) Increase Near me consultation and Call before you Convey between Hospital @ Home and the Scottish Ambulance Service to increase efficiency and capacity within the service Complete the bed base modelling for UHW and UHH sites to inform future planning and consideration of reconfiguration of our bed base to manage demand Undertake focused improvement work within Medicine for Older Adults – UHW to maximise flow across the acute site and off site beds Fast track access to interim care beds at Cumbernauld Care Home to create acute capacity Undertake a review of all inpatients categorised as Hospital Based Complex Clinical Care (HBCCC) to determine if appropriately coded and placed or if another care location is more appropriate to meet their needs 5.4.4 The actions outlined in section 3.1 and above are aligned to the site and sector based improvement delivery plans and the remaining actions being progressed through the task and finish group structures. 5.5 Learning from our NHS Tayside Colleagues 5.5.1 Throughout Operation Flow we have embraced learning from across our system to help inform our new models. We were delighted that colleagues from NHS Tayside provided a peer support visit to NHS Lanarkshire to review our new target operating models and winter plans to help determine if there are any further opportunities for improvement and shared learning. The visit took place over the 7 and 8 September 2023 and colleagues spent time on our sites and with teams from across our system. 5.5.2 We await a formal feedback report however the team provided some initial reflections during the visit and a high level summary is noted below:
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5 Extremely supportive of the Senior Clinical Decision Maker workforce model for Flow Navigation Centre to maximise increase direction of patients to the right place, first time. Opportunities exist to maximise the use of Near Me to reduce footfall to our front doors Investment in our Frailty Strategy is essential to respond to current and future demand Reconfiguration of our off site bed estate to maximise system flow for this Winter and beyond 5.5.3 We have a whole system Operation Flow – Pause Event scheduled for Friday 29 September where will use the time to reflect on what will be at risk to deliver for Winter 2023/24 and how as a system will be respond to this and what elements of our plan do we need to change based on the learning from the peer review visit by NHS Tayside colleagues. Therefore, further detail of this this learning will be available for a future report. 5.6 Evaluating Patient Experience and Staff Well-being 5.6.1 Understanding the impact of Operation Flow from a patient experience and staff welling-being perspective is key for NHS Lanarkshire’s learning. Therefore, formal evaluation of Operation Flow 2 will commence from the 1 November 2023 in collaboration with colleagues from Strathclyde University. Our findings will be shared with the committee as soon as they are available. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan and prepare for implementation Operation Flow 2 at scale and pace. 6.2 Performance remains challenged, however, a range of the identified supports including additional staffing capacity will take time to implement. 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 ☒
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6 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) A weekly performance framework has been developed to track progress. 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 IJB Risk 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. Very High Chief Officer 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 Yes ☒ No ☐ N/A ☐
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7 ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: An EQIA for Operation Flow has been completed by NHS Lanarkshire. EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1: target operating model Appendix 2: Flow Navigation Centre changes ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591. Yes ☒ No ☒ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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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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9 Appendix 1: Target Operating Model
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10 Appendix 2: Flow Navigation Centre
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1 REPORT Item No: 14 SUBJECT: Analogue to Digital Telecare Transition TO: IJB Performance, Finance & Audit Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Hugh Holt, Senior Officer Assistive Technology + Analogue to Digital Project Lead DATE: 18 October 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 1.1. This report provides an update on the analogue to digital telecare transition within North Lanarkshire Health and Social Care Partnership. 2. ROUTE TO THE BOARD This paper has been: Prepared by the analogue to digital project team and reviewed by senior management. Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1. The PFA committee is asked to: a) Note the progress of the project to date. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background to Analogue to Digital Transition 5.1. 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. 5.1.1 North Lanarkshire Council currently provides Community Alarm telecare services to around 6500 service users using Analogue Dispersed Alarm 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. 5.1.2 The Digital Office for Local Government is currently supporting North Lanarkshire through the transition with subject experts and through a defined support network. 5.1.3. A project board has been established within the organisation with membership from all areas with a direct or linked connection to the community alarm service alongside representatives from senior management, Digital NL Procurement finance, joint equipment store, NHS and enterprise and communities. Alarm Receiving Centre 5.2. In 2022-23 North Lanarkshire’s community alarm service facilitated 429,534 telephone calls into the service. 5.2.1. Tunstall Healthcare currently provides the software used within the community alarm receiving centre which is known as Tunstall PNC 8.1. This software currently processes call through an analogue means. Yes ☐ No ☒ N/A ☐
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3 5.2.2. The requirement of a digital alarm receiving centre to allow for the transition has allowed North Lanarkshire to work with the Digital Office for Local Government to build a tender for national shared digital alarm receiving centre. This work has included 19 other local authorities/Housing Associations to ensure that a robust and secure solution can be found. The tender for this solution was due for release on October 28th, 2022, with an implementation scheduled for Spring 2023, however this has slipped significantly, and the award has yet to be made, this is now anticipated to awarded in October 2023. Dispersed Alarm Equipment 5.3. North Lanarkshire had predominantly used Tunstall Lifeline Vi analogue alarms within a person’s home to allow them to contact the alarm receiving centre. There are still currently around 3500 of these alarms within the community. 5.3.1. North Lanarkshire has procured 3200 digital /hybrid alarms from Careium UK. These alarms do not connect over a land line but operates over the mobile network through a provided roaming SIM card that is inbuilt into the device. These alarms allowed North Lanarkshire to provide a working solution to those without a phone line or who’s phone line was migrated to a digital equivalent. Tunstall did not have any Digital/Hybrid Alarms available. There are currently 2890 of these devices within the community. 5.3.2. Further procurement will be undertaken this financial year to purchase approximately 1500 additional Digital/Hybrid units to replace existing analogue units. Funding for this is already in place from a previous Capital Bid allocation. Analogue Telecare Peripherals 5.4. There is currently a number of analogue telecare peripherals linked to the community alarm service within the community, such as linked smoke, heat and fire alarms, bed sensors, epilepsy sensors and door contacts. Key Issues 5.5. Telephone lines in the UK are being upgraded to digital technology at pace by the major telephone service providers including BT and Virgin Media. Currently North Lanarkshire is working with Telecom Service Providers to identify telecare users within the Authority who will be affected by the migration of analogue services to a digital equivalent, and replacing analogue alarms based on the provided change over dates. 5.5.1. The national shared alarm receiving centre solution was initially planned to be awarded in June 2022, however significant delays were encountered in progressing the project and the final award is now due in October 2023. This has significantly impacted on North Lanarkshire’s timescale to deliver a working digital solution for the Community Alarm Service. The existing infrastructure is an on-premise system, which will become unsupported in 2023, therefore an interim solution to move to a cloud-based software as a service (SaaS) has been agreed with our current supplier (Tunstall) which will provide ongoing service continuity until the new Shared ARC is procured and installed. The timescale for this Shared ARC installation will be known
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4 once the procurement exercise concludes and we engage with the successful supplier. 5.5.2. Current equipment supplies chains are still affected by shortages of microchips which has led to long delays for peripheral supplies, and this has been forecasted to remain an issue until late 2023/early 2024. 5.5.3. We were unable to secure Digital /Hybrid Alarm units from our incumbent supplier due mainly to chip shortages in their supply chain and had to go to market to procure a supply of compatible units to allow the immediate exchange of alarms to service users that were being migrated to a digital telephone network. 5.5.4. Initially we supplied the Hybrid Alarms to service users that only required the Alarm and a pendant; however, we are now required to supply additional peripherals – smoke CO heat etc to meet the needs of our service users. This has highlighted an issue with some incompatibility and at times considerable delays in connection. Additional work is being undertaken to improve the connection issues and work around solutions have been identified to allow the peripheral devices to be correctly identified at the Alarm Receiving Centre. This presents a considerable risk to both Service Users and the Community Alarm Service 5.5.5. A key recommendation from the Digital Telecare Workgroups regarding this transition is the cleansing of current data held within the ARC to meet the new “Telecare Information Framework” that the new shared ARC will have as part of its standard configuration. The current data held on the Tunstall PNC system has over 25,000 records, of which approximately only 7000 are current users. With the current PNC system there is no facility to “batch” delete the 18,000 archived records. Records should be deleted after 5 years (or 3 years if deceased). The post of system administrator was removed from the staff structure within community alarms. This has resulted in deletion not routinely taking place. There may be an option to identify and then delete in batches when the service moves to Software as a Service. (SaaS) 5.5.6 An assessment of the work required to oversee and complete the Data Migration, and then then the Shared ARC migration has been undertaken, this report made some key recommendations which are included in an SBAR agreed at the Analogue to Digital Board. These were. A Service Manager requires to take the lead and oversee the data cleanse ensuring representation from relevant departments attend regular meetings and work on action points to keep the programme on time. Resources require to be identified and dedicated out with The Community Alarm Service to prepare the data records for the shared ARC. Resources need to be identified e.g., a System Administrator moving forward to keep the data cleansing updated.
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5 There needs to be resource and time commitment from IT, Admin and Corporate Comms to support this programme. This same group needs to be part of the Project Team delivering the transition to the new ARC. The current PNC records are checked and updated in line with the Digital Office recommendations -based on the Telecare Information Framework that will be required to migrate to the Shared Arc when it is implemented. A template for this Telecare Information Framework is designed to capture this information on a single consistent working document, and this template is used for information gathering for any new Service Users being added to our PNC going forward to maintain the data integrity before migration. Peer quality checking any updated information for service users across SWIS and PNC to maintain accuracy of contact /keysafe number changes on both systems. If possible, the SWIS record should also be updated with any changes or amendments the PNC update identifies. 6. CONCLUSIONS 6.1. The analogue to digital transition requires to be completed by 2025 to ensure that North Lanarkshire can provide a working and reliable community alarm service. This will require the system used within the community alarm service to be a digital receiving software and for all equipment in the community to work through a digital means of signalling. 6.1.2 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 6.1.3. The Data cleansing exercise required in preparation for the implementation of the Shared ARC and the implementation of the shared ARC will require dedicated resources from various Service areas. A Project team to ensure the process concludes successfully tasks and responsibilities for both areas have been initially scoped with the assistance of the Digital Office subject matter experts and will be brought to the next Analogue to Digital Board meeting for discussion.
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6 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: 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. 7.3.1. The analogue to digital transition currently has capital funding of £2 million to support with the replacement of the alarm receiving centre, dispersed community alarms and peripherals associated with the community alarms. 7.3.2. There will be a revenue cost to the organisation for the subscription to the national shared alarm receiving centre. Yes ☐ No ☒ N/A ☐
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7 7.3.3 There will be a revenue cost associated with the SIM cards placed within the analogue/digital hybrid and then fully digital devices. 7.3.2. Indicative costs for the transition have been scoped alongside the Digital Office for Scotland and are noted below: Costs: Cost Element Capital Revenue 3 Year Cost Notes Telecare solution setup and recurring contract costs: £10,000 (First year) £35,000 per year Disaster Recovery - £0 £ 105,000 Disaster Recovery - £0 Indicative costs supplied by the Digital Office New in-home digital alarm equipment: £1,193,500 (alarms only, no peripherals) £312,000 per annum if not within bundle (costed at £4 per month per sim) £2,129,500+ (Cost of devices over first year and then sim charge over 3 years) £312,000 sim card cost is for the further 5500 alarms that we will require to buy for this. Total £1,203,500 £ 347,000 £ 2,234,500 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.4.1. All risks around the analogue to digital transition are managed by the analogue to digital project board. 7.4.2. The analogue to digital transition is also on the organisational risk register with updates on a 6 monthly basis. 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
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8 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 7.5.1. The communities of North Lanarkshire will continue to be informed of the analogue to digital telecare transition and users of the service will be contacted directly to allow the instillation of new equipment. 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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9 8. BACKGROUND PAPERS Scotland Digital Health and Care Strategy - Digital health and care strategy - gov.scot (www.gov.scot) Digital Office National Telecare Briefing Document - Digital Telecare Playbook · LAUNCH OF THE NATIONAL BRIEFING DOCUMENT (digitaloffice.scot) 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@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