ITEM 4 Minute of Meeting of the Performance, Finance and Audit Committee of 18 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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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 18th October 2023 9.30am-11.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director James Muir NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Stacey Connor (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Jacqueline Farmer (Item 7) Senior Auditor Audit Scotland Stephen Forrest (Item 10) Performance Manager Maddy Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director North HSCP Dr Lucy Munro Medical Director North HSCP Maggs Thomson Head of Health NHSCP Apologies: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Paul Carey Audit Scotland Phillip Couser NHS Lanarkshire Nominated Non Exec Director Diane Fraser Head of Adult Social Work Services Amanda Kilburn Section 95 Finance Officer Cathy McGinty Unison Staff Side Rep (NHSL) Councillor Martin McCulloch North Lanarkshire Council Nominated Councillor
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2 Elizabeth Seaton Partnership for Change User Rep ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA 21st June 2023 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. The committee noted the action log updates which shows the actions are progressing well. 5. PF & A Risk Register The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. Following discussions at the last meeting of PFA on 23rd. June 2023 and the meeting of the IJB on 27th September 2023, the risk register has been updated and additional controls/actions added to: IJB 01/21 – Financial Challenges IJB 04/21 – Set Aside IJB 06/21 – Prescribing IJB 11/21 – Performance IJB 13/21 – Care Homes IJB 14/22 – CAMHS IJB 17/22 – Unscheduled Care IJB 02/22- Ineffective Governance Arrangements There are currently two risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 17/22 – Unscheduled Care There are eight high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges
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3 IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 14/22 – CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service IJB 19/23 – Service sustainability IJB 20/23 – Workforce sustainability A key change has been to the fraud risk this was described as “ineffective governance arrangements” it is now described as “Prevention and Detection of Fraud, Bribery and/or Corruption”. The prescribing risk has also been amended as shown on risk IJB06.A risk session is planned for the IJB Liaison session in November to have a deeper dive into risks. Ross McGuffie advised population health have raised a risk around demographic changes which has led to a working group being established to manage this and using the risk sharing form to share across to NLC and South IJB. So he will consider the implications of this to the North IJB risk register. Brian Moore requested risk IJB10 (Ineffective Governance Arrangements Due to the Covid‐19 Pandemic) be reviewed to ensure the risk is still current. Stacey Anderson replied this is reflective of the risk on the NHS register and it is planned to have a deeper dive into this at the IJB Liaison session. James Muir asked do we look at risks across other Boards to see how we compare. Ross McGuffie advised this is not usually done for IJB but informally we have looked at other boards, this was noted and Ross McGuffie will provide a briefing paper for a future meeting to offer assurance to the committee. The IJB PFA noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. RMcG 6. Integration Scheme The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter known as the “Act”) requires Health Boards and Local Authorities to integrate planning for, and delivery of certain adult health and social care services. The Integration Scheme sets out the agreement through which NHS Lanarkshire Health Board and North Lanarkshire Council do this. On 12th April 2019, the Cabinet Secretary approved the integration scheme changes, namely to remove children, families and justice social work. In order to meet the 5-year review timeline, a review and update of the North Lanarkshire Integration Scheme for 2024 has taken place and an update of the document as discussed by the IJB PFA committee members. The Integration Scheme should be subjected to consultation process which will include the document being published on the relevant public websites,
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4 with letters sent to the prescribed list of standard consultees and then submitted to Scottish Government for final approval. Once approval has been received from Scottish Government, the Integration Scheme will be uploaded to the North Lanarkshire Health and Social Care Partnership Website. Brian Moore requested terms referencing to the IJB PFA be standardised, terms should reflect current voting members and also to ensure language is reflective of current position. It was also pointed out that current version refers to the PFA as a non-decision making forum. Ross McGuffie noted we have given delegated authority to this committee through the terms of reference. Stacey Anderson added have been reviewing governance arrangements going forward to ensure linking with both partners and ensuring we have directions tracker in place. Brian Moore also requested updates come from Support Care and Clinical governance, Stacey Anderson advised 6 monthly HQAIC report from SCCG is being drafted just now so this can come to a future meeting. Maddy Halliday suggested referencing links to community solution, this was noted. Once the changes have been made the integration scheme will come back to the IJB committee for approval. The IJB PFA agreed the following recommendations: The IJB PFA acknowledge the refresh of the IJB Integration Scheme Provide any further comments and feedback regarding the Integration Scheme. 7. External Auditor Report This report provides the outcomes of the annual audit and the proposed management response to the action points detailed in the External Auditor’s Annual Audit Report. Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB have to meet to consider whether to approve the audited IJB Annual Accounts 2022/2023 for signature. The members should therefore consider any report made or advice provided by the External Auditor. The External Auditor’s Annual Audit Report on the IJB Annual Accounts extends across several subjects, as follows: IJB Annual Accounts 2022/2023; Financial management and sustainability; and Governance, transparency, and best value.
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5 The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2022/2023 give a true and fair view of the net expenditure for the year and have therefore issued an unqualified independent report. This report included the key messages at page 3 and an action plan on pages 21 to 23 which have been agreed by both the Chief Officer and the Chief Finance Officer. Ross McGuffie noted special thanks to Amanda Kilburn in helping to produce the report. He also advised that for the internal audit we are still waiting on a final date for the plan, this has been delayed due to staffing challenges leading to a delay in completion of the plan but we are working with the NHS and NLC partners on risks. The IJB PFA committee agreed the following recommendations: (1) Consider the External Auditor’s Annual Audit Report in advance of the approval of the IJB Annual Accounts 2022/2023; and (2) Approve the management response to the action points which is highlighted at pages 21 to 23 of the annual audit report, attached at appendix 2. 8. Audited Annual Accounts The report tabled provides details of the unsigned audited IJB Annual Accounts 2022/2023 for approval by the PFA. The External Auditor has concluded that the 2022/2023 financial statements of the North Lanarkshire IJB give a true and fair view of its net expenditure for the year and have therefore issued an unqualified independent audit report. Ross McGuffie noted there has been no significant change to the paper since it has been previously been reviewed by the IJB committee. Recommendations agreed by the committee: (1) Acknowledge the External Auditor’s opinions; (2) Approve the IJB Annual Accounts 2022/2023 for signature; and (3) Acknowledge that the signed audited IJB Annual Accounts will be available to view electronically on the HSCP website. 9. Progress Report on Agreed Actions The report provides an outline of the actions agreed with the External Auditor, Internal Auditor, and the Senior Management Team to further develop the IJB governance framework. Recommendations to further strengthen the IJB governance framework were made by both external and internal audit. The Senior Management Team
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6 (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements. An update on the progress made to date was reported to the PFA Committee on 19 April 2023. A summary of the current position statement is shown in the table below: Source Total Actions Completed Actions Ongoing Actions External Audit 1 1 - Internal Audit 4 3 1 Senior Management 1 - 1 Total 6 4 2 67% 33% Ross McGuffie advised this work has been an area of focus to manage timescales. The outstanding actions are link to progress of National Care Service; an update will be brought to the committee in due course. There are 6 working groups being established but there has not been an ask of the partnership for a representative yet. There has been work undertaken with COSLA around shared accountability arrangements which is still in a draft stage. Recommendations agreed: (1) Acknowledge the contents of the report; and (2) Agree that further progress reports will be presented to future meetings of the PFA Committee in respect of the ongoing actions. 10. Annual Performance Report North Lanarkshire IJB is required by the Public Bodies (Joint Working) Regulations 2014 to publish an Annual Performance Report by July 31st each year. The content of the Annual Performance Report is focused on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). The purpose of standardising Annual Performance Reports for Integration Authorities in this way is to support Integration Authorities in improving the consistency of reporting for these indicator sets. The Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire describes significant progress made in pursuit of the National Health & Wellbeing Outcomes. This progress has been made against a challenging position of recovery and remobilisation of services following the C19 pandemic, which is reflected in the performance in some of the metrics presented in the report. Performance in North Lanarkshire is broadly
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7 comparable with similar authorities and the Scottish average in many areas and in those areas where performance improvements are required, this is managed through the performance framework in place within the Health and Social Care Partnership. James Muir asked how does this report link to risks on our risk register. Stephen Forrest advised in the new chief executive scorecard this will link. It is planned to have a draft scorecard for the end of this year. Also the new committee reporting template makes direct reference to appropriate risk registers and this is already in use. Cllr Burgess asked from the data does the performance show a relation to staff absences. Ross McGuffie replied it is a challenge to relate fully but to note this data is behind so it will relate to some covid data which overall will have had an impact on service performance. Maddy Halliday suggested we have some additional narrative in the report to help public understanding of the data and to offer some context, this was noted. Morag Dendy added we need to consider national requirements but also how this feels in North Lanarkshire and this report will link to strategic commissioning plan and the Programme of work. Brian Moore noted some of the areas reported in the report are not reported to the committee out with this annual report, so will need to consider this going forward. Also to consider the committee receiving updates on SWISS procurement at a future meeting, this was noted. The IJB PFA committee: (1) Reviewed the content of the draft Annual Performance Report 2022/23 – Health & Social Care North Lanarkshire. (2) Approved for publication the content of the draft Annual Performance Report 2022/23 - Health & Social Care North Lanarkshire. 11. Q1 Performance Report The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or
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8 corrective action. The performance review meetings are used as a means for jointly agreeing these actions. The areas for improvement and corrective action were attached as Appendix 1. of the report. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. Areas for Improvement: Alcohol Brief Interventions- Cervical Screening Child immunisations 6-8 Week Reviews Reablement and Rehabilitation Services Delayed Discharge CAMHS Adult Mental Health Paediatrics- Speech and Language Therapies Cllr Burgess asked is there any regulation around garden pubs. Morag Dendy replied advised we are able to get to a point where this is regulated in future but can consider using community board structures to influence lifestyle choices. Maddy Halliday queried the change in child immunisation and asked if this around change in public views. Trudi Marshall advised of ongoing work with public health colleagues as recognise there has been a cultural change in communities and think the covid vaccine has had an impact. There are some practical impacts around how we deliver vaccines also; considering having evenings and weekend appointment to make it more accessible. Ross McGuffie added pulling together an SBAR around 6-8 weeks screening to get agreement to move forward with an electronic system. For the Planned Date of Discharge (PDD) there is a lot of work on going across sites. North Lanarkshire has significant number of supported discharges in comparison to other areas. The committee note the report and its contents. 12. Drug Related Death in North Lanarkshire & ADP Self-Assessment The National Record of Scotland (NRS) Drug Related Deaths was published in July 2023, this report highlights the information specific to North Lanarkshire. A summary paper is presented at Appendix 1 of the report provided more detail to the summarized information noted below.
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9 There were Sixty-five Drug Related Deaths in North Lanarkshire in 2022, down nineteen percent (15 deaths) on 2021. This reduction is the third fall in three successive years. (Highest number of deaths 95 in 2019) though figures remain high. The figures represent the fifth highest number of Drug Related Deaths on record. Cllr Burgess asked is there data available to show if Naloxone was not administered would the drug deaths be higher, Morag Dendy advised this information will be included in a future report, there is evidence that this does make a difference. The committee: (1) Noted the content of the report; (2) Acknowledged the content of the National Record of Scotland (NRS) Drug Related Deaths in North Lanarkshire report, setting out the detail of the confirmed drug related health data from 2022, published by NRS in July 2023. (3) Recognised that there are a range of current arrangements in place to reduce harms. (4) Recognised a more detailed report on the impact of commissioned services and progress will follow in March 2024. This will include a financial overview of spend and forecast arrangements. 13. Resilience Response This paper sets out the actions being taken in response to current whole system service pressures. Intensive work continues to embed best practice accountability and leadership to deliver our plan. However, it is recognised that new ways of working and the resource additionally required will take some time to implement the changes and see the sustained unscheduled care performance that is required to improve patient safety and well-being, across our system. It was disappointing that our performance against the 4-hour standard did not meet our August 2023 trajectory of 70% (65%) despite significant efforts. It should, however, be recognised that many of the additional resources identified through the plan will take some time to get in place, not least due to the current challenges around recruitment. The recovery actions agreed to be progressed through September include: Enhanced duty manager support across our sites to support flow during our vulnerable times which includes the OOHs period and Monday mornings
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10 Increased Senior Clinical Decision Makers within the FNC to support direction of patients to the right service and reduce demand where appropriate Expansion of Hospital at Home capacity to increase admission avoidance Focused improvement work to embed the flow foundation bundles across acute and off site areas Focused communications by the FNC service team outlining the role and function to ensure shared understanding of the opportunities of this service across our system Ross McGuffie drew the committee’s attention to section 5.2 and 5.3 within the report which updates on the progress of operation flow. He advised Cumbernauld care home was previously closing but now we will have 15 interim care beds to assist the flow from Acute beds. Brian Moore asked what stage of development are the interface teams for frailty at. Ross McGuffie stated been pulling together a bid with HIS around peace plus funding relating to frailty which is on-going. Trudi Marshall added the frailty strategy GIFE work is coming to the next IJB committee. Post are out for advert and interviews are being planning, there has been a challenge with 1 post so reviewing how to manage this. He also requested update regarding the off-site beds in terms of having specialist areas and current progress. Ross McGuffie stated we are working towards this for the winter period and working on this as part of the bed modelling with each of the Acute sites to get the right model going forward. Trudi Marshall advised doing an audit to look at why patients are in beds, the audits and data pulled is going to help some focused work to get better outcomes for patients. The PFA: (1) Recognised the whole system Operation Flow 2 plans and implementation structures set out in the report; (2) Requested future updates on progress. 14. Analogue to Digital Telecare Transition This report provides an update on the analogue to digital telecare transition within North Lanarkshire Health and Social Care Partnership. Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout is scheduled to be completed by 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. North Lanarkshire Council currently provides Community Alarm telecare services to around 6500 service users using Analogue Dispersed Alarm
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11 Units (DAU). North Lanarkshire also provides a telecare service to around 800 users within sheltered accommodation. This service receives alerts into an Alarm Receiving Centre, which co-ordinates appropriate response e.g., Emergency Services or Community Alarm Home Support Workers to attend someone in their own home. The analogue to digital transition in North Lanarkshire is still currently on track with work already underway in several key areas. • Digital devices roll out plan – 2890 devices of 6500 have been migrated to date. • Data cleanse of current system- all live records now have a SWIS identifier. • National Shared ARC due for award October 2023 but full implementation not anticipated until at least September 2024 • Interim Software as a Solution (SaaS) purchase agreed to replace current on-site PNC system- to go live in Feb 2024 to provide service continuity to the Community Alarm Service The next step is to identify the project team to support transfer of records to the new system. Cllr Barclay noted thanks for the work of the team which has offered assurance in communities, particularly when this was an external factor that has impacted on HSCP services. The committee noted the progress of the project to date. 15. Risk There was no new risk identified by the committee. 16. Date of Next Meeting TBC