Item 3 (M) IJB Pfa 21.6.23
North Lanarkshire Council · 18 October 2023
Back to IJB Performance, Finance and Audit Committee — 18 October 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 ITEM 3 Integration Joint Board 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