Combined Pack
North Lanarkshire Council · 21 February 2024
Back to IJB Performance, Finance and Audit Committee — 21 February 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
A meeting of the IJB PFA will be held on Wednesday 21st February 2024 at 2pm-4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB PFA ( 18th October 2023) For Approval Attachment Chair 4. Matters Arising/Rolling Action List For Noting Attachment Chair Strategic Planning & Development 5. Chryston Hub Update For Noting Attachment Ross McGuffie 6. Hospital At Home For Noting Attachment Ross McGuffie 7. Health Care Resettlement for asylum seekers and refugees across Lanarkshire For Noting Attachment Ross McGuffie 8. Care Home Support For Noting Attachment Trudi Marshall 9. Community Nursing Review For Noting Attachment Trudi Marshall 10. Winter Resilience For Noting Attachment Ross McGuffie Performance & Finance 11. 2024/25 Budget Briefing For Noting Presentation Amanda Kilburn 12. Financial Monitoring For Noting Attachment Amanda Kilburn
Page 2
13. IJB Reserves Strategy 2023/24 For Approval Attachment Amanda Kilburn 14. Q2 Performance Report For Noting Attachment Morag Dendy Governance & Policy 15. Risk Register For Approval Attachment Stacey Anderson For Noting 16. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 17. Date of Next Meeting 22nd May 2024 2pm-4.30pm For Noting
Page 3
1 ITEM 3 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 Elizabeth Seaton Partnership for Change User Rep
Page 4
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 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 IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 14/22 – CAMHS IJB 15/22 – Cost of Living
Page 5
3 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, with letters sent to the prescribed list of standard consultees and then submitted to Scottish Government for final approval.
Page 6
4 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. 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.
Page 7
5 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 (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements.
Page 8
6 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 comparable with similar authorities and the Scottish average in many areas and in those areas where performance improvements are required, this is
Page 9
7 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 corrective action. The performance review meetings are used as a means for jointly agreeing these actions.
Page 10
8 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. 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
Page 11
9 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 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
Page 12
10 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 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.
Page 13
11 • 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
Page 14
1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 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 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 23. 18.10.23 Item 5 Risk Register R McGuffie Ross to provide briefing document to offer the committee assurance that risk are reviewed against other boards Paper will be tabled at IJB PFA May 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report
Page 15
2 ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
Page 16
3 CLOSED ACTIONS 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 1. 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 2. 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 March 2022 June 2022 Complete
Page 17
4 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. 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. June 2021 November 2021 – deferred to IJB December 2021 Complete Reserve strategy presented to IJB PFA on 16th
Page 18
5 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 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 deferred to March 2023. Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete 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 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 Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
Page 19
6 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. hosting arrangements. 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 March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action.
Page 20
7 February 2022 – update on progress noted with further updates to be presented 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. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final
Page 21
8 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 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 June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 Complete Ongoing updates on progress scheduled into forward plan for PFA
Page 22
9 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 August 2022 MAT standards update given to Feb IJB PFA Further update on October PFA agenda 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 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 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 On April 2023 agenda
Page 23
10 language Complete 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore Topic at 8th Nov Liaison session Complete
Page 24
1 REPORT Item No: 5 SUBJECT: Progress Update: Development and Delivery of Chryston Community Health Clinic TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Maggs Thomson, Head of Health DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA to provide an update on the development and delivery of Chryston Community Health Clinic For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Reviewed By: Endorsed By: Prepared by Maggs Thomson, Head of Health in consultation with both Chryston Community Health Clinic Mobilisation Group and the Northern Corridor Service Repatriation Group. 3. RECOMMENDATIONS The IJB PFA is asked to: 1) Note the active and ongoing progress with the delivery of this capital programme.
Page 25
2 2) Note the progress with the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and their associated Health and Social Care Partnerships (HSCP’s) 3) Note the previously identified financial gap reported Feb 2023 and reflect on work to date to progress towards final conclusion. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. 5.1.2 This boundary change aimed to facilitate the development of integrated services across all areas of Scotland. The change resulted in the Northern Corridor (covering the areas of Moodiesburn, Muirhead, Chryston, Stepps, Gartcosh and Auchinloch) being transferred into the NHS Lanarkshire (NHSL) boundary. 5.1.3 This geographical area has one health facility located within Muirhead (Muirhead Clinic), which is small and at the time of transfer, dilapidated and not fit for function. The facility required backlog maintenance and asbestos work to be undertaken which was completed. 5.1.4 Despite the upgrade and refurbishment which improved compliance with healthcare standards, the facility could still not support the provision of all services for the local population. 5.1.5 Consideration was given to providing a new build facility on the existing site, however the footprint and parking limitations would not allow for the size of centre required to meet the clinical ask. 5.1.6 Due to the limited capacity of this facility, NHSL was unable to fully repatriate services from NHSGG&C, resulting in northern corridor residents having to travel significant distances across Glasgow to access some health services, with teams and clinics based in a range of areas including Shettleston, Kirkintilloch, Easterhouse and Bridgeton. 5.1.7 The services identified below continue to be delivered via a Service Level Agreement (SLA) with NHSGG&C and the associated HSCP’s. • Community Diabetic Service Yes No N/A
Page 26
3 • Community Mental Health Teams • Dietetics • Physiotherapy • Sexual and Reproductive Health Services • Substance Misuse 5.1.8 An opportunity emerged with the development of North Lanarkshire Council’s (NLC) ‘The Plan for North Lanarkshire’ which set out an ambitious estates strategy that looked to develop Community Hubs / Campuses. Further to consideration of this approach, NHSL working in partnership with NLC, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. 5.1.9 There was extensive engagement with all stakeholders including NLC and NHSL project teams which resulted in the optimum design being developed to the satisfaction of all the stakeholders. The agreed design went through wide- ranging routes of engagement with key stakeholders including NHSL staff, H&SCP staff, teachers, support staff and pupils at Chryston Primary School. This process also included joint engagement with representatives of the Parent Council and elected members, culminating in an online public consultation to inform residents of the design outcome. 5.1.10 The business case for the Development of Chryston Community Health Clinic was considered by the NHSL Board on December 2021 at a cost of £3.65M and signed off with all legal agreements completed in January 2022. 5.1.11 The build programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. 5.1.12 In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. 5.1.13 A Service Level Agreement (SLA) continues to be in place and as of January 2024 a notice of cessation is now formally lodged with GG&C. This exposed H&SCNL to a £392k financial gap if services where to be delivered with the known funded establishment and skill mix of the NHS Lanarkshire service model. 5.1.14 It was also recognised in February 2022 that to support the smooth transition, clinical safety and continuity of care there would be an expectation of double running costs for a period of 3 months, equating to an increased cost of £212k for that quarter. 5.1.15 All work was progressed on the basis of the funding being agreed in February 2022 calculation.
Page 27
4 Update 5.2 Chryston Community Health Clinic 5.2.1 The build programme experienced a delay and handover completed to NLC in late September 2023. To support school term and safe transfer of equipment it was agreed to open the school for business on 25th October 2023 following the mid-term break (see Appendix 1 for visual update). 5.2.2 H&SCNL mobilisation group progressed their operational plan in line with the school timeline and worked towards mid-November transfer of Muirhead clinic. Unfortunately, due to some critical snagging and IT challenges this further delayed to December 2023 with the first patient being received on the 18th. 5.2.3 At time of reporting all Muirhead Clinic services have transferred to Chryston Community Clinic. 5.2.4 Midwifery and CAMHS have also been supported to provide services the new health clinic 5.2.5 The intention was to decommission Muirhead Clinic, however NHSL has offered this accommodation to another service and the site responsibility will transfer to SLH&SCP at the end of January 2024. 5.3 Repatriation of Services 5.3.1 This process has proved challenging due to build delays and agreements with NHSGG&C resulting in the mutual agreement to repatriate services from 1st April 2024. 5.3.2 Finance has now been agreed and recruitment is progressing to repatriate all services identified above (5.1.7). 5.3.3 The finance identified from the SLA exceeds what was previously reported and gives a level of comfort that the shortfall previously reported may be closer to a break even. At time of reporting this has not been confirmed, however a verbal update will be provided. 6. CONCLUSIONS 6.1 In conclusion, this paper confirms that Chryston Community Health Centre has been delivered for service provision from 18th December 2023. 6.2 All services have transferred from Muirhead Clinic and are being delivered in Chryston Community Health Clinic with the addition of Midwifery and CAMHS
Page 28
5 6.3 Muirhead Clinic will not be decommissioned but handed over the SLH&SCP by 31st January 2024. 6.4 The IJB has already approved additional funding (£212K) to support double running costs for one quarter to allow safe transition of repatriated services. There is however some comfort that the £392K funding gap previously identified may not be required. The confirmed finance position will be verbally updated when this report is presented. 7. IMPLICATIONS Noted within the content of the paper 7.1 NATIONAL OUTCOMES The repatriation of services will support improvements in a range of service performance measures, particularly around mental health and substance misuse. 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) None. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
Page 29
6 At this time the £212k non-recurring allocation will still be required to support any potential double running costs. The £392k recurring revenue gap has been reduced with the possibility of a break-even position (yet to be confirmed).. Finance teams are reviewing our known position and will provide contemporary costs by the end of February 2024. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks around the repatriation of services, including the transfer of complex treatment packages, ongoing recruitment challenges and the funding gap already identified and will be built into the operational risk register. Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTCIPATION 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 There was full stakeholder involvement at every level of the development of this new health clinic. This ranged from presentation of project, through design development and delivery of the facility. There were dedicated meetings to progress the project and all updates were provided locally via community board structures. ☒ Provide stakeholders with information on how to get involved a/a ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs a/a ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services a/a ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery a/a
Page 30
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 A significant programme of engagement has taken place as part of the development of the business case. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to previous report as an appendix Developed as part of the business case. EQIA added to website: 8. BACKGROUND PAPERS NHS Lanarkshire Chryston Community Health Clinic Business Case https://www.nhslanarkshire.scot.nhs.uk/download/2021-december-20-board- papers/ 9. APPENDICES Please include a glossary of terms if not already included. Yes ☒ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
Page 31
8 Appendix 1 Photographic views of the completed exterior and internal reception and waiting area December 2023. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Maggs Thomson, maggs.thomson@lanarkshire.scot.nhs.uk
Page 32
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 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
Page 33
10 Appendix 1 1: Main Entrance 2: Reception and Waiting Area
Page 34
1 REPORT Item No: 6 SUBJECT: Hospital at Home TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer, NL HSCP Author(s) of Report Hazel Mitchell, Service Manager, AHSU DATE: 21 st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for noting of the current Hospital at Home service provision, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been prepared by Hazel Mitchell, Service Manager to update the Board on the current H@H service performance, and to update on on-going expansion plans. The paper has been reviewed by Jamie Quin, General Manager, AHSU Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐
Page 35
2 3. RECOMMENDATIONS The IJB PFA are asked to approve the following recommendations: (1) In line with the Scottish Government initiative to implement a Hospital at Home service in every Board in Scotland, that NHS Lanarkshire shall expand their service provision to the Clydesdale locality within South Lanarkshire. (2) In line with the Board’s Unscheduled Care strategy, that Hospital at Home should seek to expand their operating hours to increase virtual bed capacity. (3) To ensure that the service is achieving maximum efficiency and operating in line with the Boards strategic objectives, a Rapid Strategic Review would be undertaken. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1) The Health Board are trying to increase virtual beds and reduce hospital attendances in line with their Unscheduled Care & Winter Planning programmes 5.1) The Scottish Government has a National Objective to double virtual bed capacity by 2025 6. CONCLUSIONS 6.1) Hospital At Home service in NHSL has continuously increased virtual bed capacity every year since 2019 via its expansion programmes and pilots. 6.2) KPIs including increased capacity and reduced LOS have all been achieved (data embedded) 6.3) Risk factors to future expansions include non-recurring finding streams
Page 36
3 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL Substantive Budget £2.79m (inc Clydesdale & Stepdown) = 96 virtual beds One year non-recurring pledge of £1.25m for additional 60 beds (48 H@H & 12 Cardiology) from SG/Unscheduled care. Risk in confirmed recurring funding has made achievement of additional 60 beds challenging and will only be mitigated by permanent funding. This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Non confirmation of recurring funding to substantiate current expansion plans will reduce virtual bed capacity back to 96 substantive virtual beds.
Page 37
4 Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 All staff and relevant management have been involved in service changes and expansion plans ☒ Provide stakeholders with information on how to get involved All staff and community colleagues have been informed on how to engage and onward refer to H@H ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Various working groups and patient forums are on-going ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Community stakeholders are involved in active working groups including patient representation where appropriate □ 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 Always supported and encouraged □ 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
Page 38
5 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 No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1– H@H update January 2024, author Hazel Mitchell Appendix 2– H@H Rapid Strategic Review Recommendations, authors Claire Rae & Maggs Thomson (Head of Health for South & North HSCPS respectively) Appendix 3– H@H Data 2023, author Hazel Mitchell Appendix 4– H@H Funding Application update as at January 2024, author Hazel Mitchell CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Hazel Mitchell, Service Manager, AHSU Hazel.Mitchell@lanarkshire.scot.nhs.uk Jamie Quin General manager, AHSU Jamie.Quin@lanarkshire.scot.nhs.uk
Page 39
6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
Page 40
7 Appendix 1 TITLE & PURPOSE OF PAPER: NHS Lanarkshire Hospital at Home Service; Update for IJB DIRECTORATE: Adult Health Services Unit DATE: 15 January 2023 AUTHOR: Hazel Mitchell 1) BACKGROUND Hospital at Home (H@H) was initially set up as an Admission Avoidance service by NL H&SCP in 2011. The service covers all areas of North Lanarkshire and areas of South Lanarkshire (excluding Camglen) With prior endorsement from the (then recently retired) Cabinet Secretary for Health, all areas of Scotland were to introduce a H@H service. Having created the first H@H Service in 2011, the task for Lanarkshire was to provide full geographical coverage by the service, and expand our virtual bed capacity in already existing localities In 2022 the H@H service undertook a large scale project to introduce the service and provide 12 virtual beds in the Clydesdale locality within South Lanarkshire, and to extend the operating hours of the whole service. In February 2022 the service participated in the organisation’s “Firebreak” process and use the opportunity to test the value in extending their operating hours to later in the evening and weekends. This was evaluated with the learning and outcomes used to inform future decision making and service changes. 2) GENERAL OVERVIEW H@H Operates a service model that consists of 4 Hubs/Teams, 3 located within the Acute Hospitals across Lanarkshire, with the Monklands and Wishaw Hubs covering North Lanarkshire and the Hairmyres Hub covering the Hamilton & EK localities of South Lanarkshire. A new hub has been opened in Carluke Health Centre to cover the Clydesdale locality. The substantive operating budget is £2.1 million for the 3 teams within Acute sites, each team has a staffing structure incorporating: Band 7 Team Leader Band 6 Nurse Practitioners Band 4 APR’s Band 3 Administration Staff The service is currently Medically (Consultant) led and each Hub is supported by Consultant Geriatricians from the associated Acute Hospital Site, for which NL H&SCP meet the funding. The teams above each provide 24 virtual Admission Avoidance beds, 72 in total. While successful, the original operating model described above provided challenges to growth & expansion. The lack of available Consultant Geriatricians within the recruitment market meant a replication of the Consultant led model was not possible, and alternative would need to be devised. In response to this plans to introduce Advanced Practitioners into the H@H model were
Page 41
8 : ANP (B7) 1.00 wte £61,118 RGN (B5) 3.00 wte £123,279 APR (B4) 1.00 wte £33,686 TOTAL Recurring Annual Cost £218,083 initiated. In principle, qualified and experienced Advanced Practitioners could work autonomously as clinical decision makers. It was proposed to implement this role into the service to work in collaboration with the Consultant Geriatricians. HIS under the direction of the Scottish Government have supported expansion plans in NHSL H@H by providing non‐recurring funding to help us implement expansion proposals Over the course of 2022 & 2023 the following expansions were implemented: Confirmed substantive implementation of Stepdown ‐ 12 virtual beds Service coverage into Clydesdale locality – 12 virtual beds Service coverage for identified Cardiology Heat Failure patients requiring infusion – 3 beds Extended hours working via Firebreak programme 3) EXPANSION PROGRAMMES STEPDOWN: Model: Stepdown model was introduced in 2020 as a response to the Covid pandemic. This allowed 12 ring‐fenced virtual beds to assist with hospital flow. Inpatients within the COTE wards who were still acutely ill and met the H@H clinical criteria could be discharged home and vacate an inpatient bed, with the remainder of their care being delivered by H@H. Clinical criteria & referral pathways were developed using the Trakcare Workbench function to accurately record the patient’s movement and transfer the care record. Funding: In 2022/23 the Board permanently funded the Stepdown facility within and the following funding was received: Service Provision: By 2022/23 the Stepdown function were managing over 36 referrals per month, with an average LOS of 5.5 days. By end September 2023 this service had increased capacity to an average of 46 referrals per month and reduced LOS to 3.81 days. The addition of this facility also allowed for the introduction of Band 5 RGN posts into the service, which provides attraction and career progression into the service. Since establishment in 2020, 2 Band 5 RGNs have progressed into Band 6 Nurse Practitioner posts. CLYDESDALE Model: The expansion into Clydesdale was anticipated to increase virtual bed capacity by 12 beds Due to the lack of additional Consultant availability and the rural nature of the region it was agreed to implement an ANP model to this locality. In contrast to the existing H@H model, patients would be reviewed by a Band 7 ANP and discussed virtually with the Consultant to
Page 42
9 confirm the clinical plan. The framework for the ANP roles was established in collaboration with Practice Development. The project was commenced late 2021 with the first actions being to: Confirm funding Recruit Project Manager Recruit clinical staff Compose patient pathways into service Compose SOPs to govern the ANP model Define Patient cohort and demand Establish working relationship with Clydesdale locality Senior management and ICST teams Identify accommodation Plan & endorse electronic patient record keeping Plan & endorse POCT Funding: In 2022/23 the Board provided funding as per below to fund a 12 virtual bedded service: ANP (B7) 2.28 wte £139,349 NP (B6) 1.77 wte £89,790 APR (B4) 1.77 wte £59,736 Admin (B3) 0.50 wte £14,699 Supplies & Equipment £20,500 TOTAL Recurring Annual Cost £324,074 £27,006 TOTAL Recurring Monthly Cost Aim of Service Provision: To ensure the service was providing care to the most appropriate patient cohort, (and not to reroute patients from existing appropriate community services) a demand profile was established as per below using the criteria: patients admitted to hospital via ED Over 65 years of age Registered to a Clydesdale postcode Admitted between 8am and 4pm, Monday‐Friday (H@H operational service hours) This data showed: 1438 hospital admissions during H@H working hours (8am‐4pm, Mon‐Fri) 710 of those were clinically suitable for H@H referral Potential for 13.6 referrals per week. The service therefore aimed to safely prevent 13.6 hospital admissions per week. Process for implementation: A working group was set up to ensure collaborative working between Clydesdale locality teams and H@H. Accommodation was identified within Carluke Health Centre and the team are located with ICST to ensure good communication, collaborative working, and safe and effective patient care.
Page 43
10 Staff recruitment was commenced and concluded. All staff were in post by summer 2023. The Band 7 ANPs were all recruited on an Annex 21 Trainee basis. New patient pathways and SOPs were devised and ratified to ensure patients are referred and managed safely The use of electronic patient records on patient Trak were tested, ratified and implemented to allow for virtual working between ANP/Practitioners and Consultants. POCT and CRP machines were purchased to maximise efficiency in diagnostics and treatment plan initiation. Trainee ANPS were supported by Practice Development and a Senior ANP to ensure their compliance with the ANP framework and academic programme. Robust Communications programme to ensure all GPs and community teams were aware of service, service provision, criteria and referral process. Also patient engagement events were attended by the team. A Band 6 Project manager was recruited and funded by HIS on non‐recurring funding. Achievements to date: The Clydesdale hub began accepting “test” patients in a planned manner in May 2023, with multi‐ disciplinary reviews after each case to assess success and explore any issues. By August 2023 the hub was fully functional in its intended manner and operation from its new base in Carluke Health Centre. The team have increased their live capacity each month, and by December had an average of 10 patients per week and an average LOS of 7.2 days. This is referral rate is expected to have reach a weekly average of 14 patients by end of March 2024, as set out in the main aims of the programme. Associated Risks: ANPs are currently still in Training Programme, and are therefore not fully qualified autonomous practitioners, but are receiving enhanced Consultant support to allow the service to function as expected. It is anticipated that 3 of the 4 Trainee ANPs will be fully signed off by June 2024. CARDIOLOGY HEART FAILURE: Model: As part of HIS non‐recurring funding programmes, they financially supported the recruitment of 2 Band 5 RGNs to administer the infusion of IV Furosemide to identified Heart Failure patients. This was with the intent that these patients, as identified by Heart Failure nurses as being clinically safe to remain at home for infusion, would no longer need to occupy an inpatient bed for up to 5 consecutive days for infusion only purposes. These patients are still clinically responsible to the Heart Failure service and H@H are responsible for the infusion only. Funding: His Funded £105,000 = 2 x band 5 RGN, non‐recurring for 1 year only Service Provision: Due to the fixed term nature of this post, only 1 staff member was successfully recruited. The pilot is live. We have been unable to manage all patients at home as the Heart Failure pathways do not currently allow for management of other medical issues (such as Acute urinary retention). Therefore to develop this more robustly new clinical pathways would need to be developed. A
Page 44
11 0.0 1 separate bid to the Government for an enhanced Cardiology H@H service has been submitted by the Cardiology team which may address this. Risks: Not fully adapted to keep all patients at home as yet Non‐recurring funding made recruitment unsuccessful EXTENDED HOURS VIA FIREBREAK PROGRAMME: In February 2023, the H@H participated in the NHSL Firebreak programme. Aim of Service Provision: To increase virtual bed capacity within the service, and reduce hospital attendances and admissions by extending operating hours to include evenings and weekends. Process for Implementation: Amend opening hours to accept new patient referrals up to 8pm Monday‐Friday (9pm for Care homes), and from 8am until 4pm at weekends (5pm for care homes). Implementing a temporary organisation change to amend shift patterns and off duties for Practitioner and support staff Creating a virtual process for Consultants to review patients Enhanced Communications programmes to GPs, SAS, ERC, Care homes and OOHs to ensure they were aware of our new operating schedule. Recruitment of Locum junior doctors and redeployment of Nursing staff from other services within AHSU Achievements: The service increased the active caseload by 77% over the 9 day period, with referrals totalling 129 compared to the average 73 (compared to an average 9 day period pre firebreak). 14 120.0 H@H FIREBREAK REFERRAL ACTIVITY OVER 9 DAY ROLLING PERIOD 29 100.0 80.0 60.0 40.0 42 45 35 66 31.2 80 41.6 95 52.0 113 62.4 72.8 20.0 20.8 21 21 0.0 Fri 24/02/23 Sat 25/02/23 Sun 26/02/23 Mon 27/02/23 Tue 28/02/23 Wed 01/03/23 Thu 02/03/23 Fri 03/03/23 DURATION OF FIREBREAK Rolling Average of Referrals pre Firebreak Actual Number of Referrals during Firebreak NUMBER OF REFERRALS
Page 45
12 4) ON‐GOING WORKSTREAMS RAPID STRATEGIC REVIEW In 2023, The organisation requested a Rapid Strategic Review be undertaken. This was jointly chaired by the Head of Health from both North & South HSCPs. It was supported by the Planning department. The outcome is shown in appendix 2. UNSCHEDULED CARE/WINTER EXPANSION The Organisation requested via the Unscheduled Care Board that H@H expand their service capacity in response to winter pressures. The initial plan was to replicate the Firebreak programme with the intention of introducing an additional 48 virtual beds to the service. Thus far recruitment has been unsuccessful as the non0recurring budget for 6 months has made the posts unattractive to candidates. The Band 7 ANP posts were funded permanently and they have been filled with candidates taken up post between January & February 2024. The lack of additional staff meant that the service could not sustainably replicate the firebreak programme for a 6 month period, as it was not sustainable with the staffing resource in post. Current achievements include increasing virtual bed capacity by 12 beds by extending operational hours to 6pm instead of 4pm. Future Aims: To substantively provide a 7 day/12 hour operational service to increase capacity permanently Risks: Lack of substantive funding as non‐recurring budget does not allow tests of change or pilots to be tested and proven effectively. Current ANPs are Trainees and will have a year before all are qualified and signed off Lack of new Consultants in recruitment market 5) CURRENT SERVICE DATA Information is included under appendix 3 and 4.
Page 46
13 Appendix 2 HOSPITAL AT HOME RAPID STRATEGIC REVIEW RECOMMENDATIONS 1. Recommendations Over the past 8 months, the Rapid Strategic Review Group have met to review the current service, the immediate plans for expansion and the future vision for Hospital at Home in line with Scotland’s national strategy and the following recommendations are proposed: Horizon 1 – timescale 6 months (as part of Winter funding proposal) Extend operating hours to include evening and weekend working Enhance interfaces between community nursing, hospital based specialities and more understanding of capabilities across the system. Increased reporting of agreed KPIs Increased professional to professional advice via consultant connect Capture learning from Heart Failure Test of Change to inform speciality developments across the service Explore Flow Navigation Centre being the single point of access for escalation and de- escalation Horizon 2 (learning from Winter proposal) – implemented by March 2024 Refocus on service to admission avoidance Clearly define step down criteria for complex cases Move from medical delivered model to a medical oversight model Rapid access to diagnostics Develop and implement recommendations from Heart Failure learning Horizon 3 – implement March 2025 Finalise workforce mode for service Connect Hospital at Home to locality teams (urgent response and nursing) Agree model for multiple Responsible Medical Officers when the service expands into other specialties Clarify system wide governance arrangements Ensure a de-escalation and escalation framework is in place ANPs undertaking differential diagnosis A structure to support the implementation of the recommendations is required and a group will be established to oversee these strategic developments. The work will also continue to be connected into the Operation Flow programme. An MDT approach will be essential to support the implementation of the new model, incorporating disciplines such as pharmacy, physio, mental health and social work.
Page 47
14 Appendix 3 REFERRAL DATA REFERRALS TAKEN TO DATE 2023 = 1590 AVERAGE REFERRALS TAKEN PER MONTH 2023 = 265 Hub Apr May Jun Jul Aug Sep Total Hairmyres 61 70 68 63 67 66 395 Monklands 75 84 94 70 96 90 509 Stepdown 47 54 48 43 43 38 273 Wishaw 69 63 70 73 69 69 413 Grand Total 252 271 280 249 275 263 1590 2022 VS 2023 Patient Increase % Increase 6 10% 8 11% 10 28% 20 40% 44 20% AVERAGE REFERRALS SITE 2022/23 2023/24 Hairmyres 60 66 Monklands 77 85 Stepdown 36 46 Wishaw 49 69 Grand Total 221 265 H@H Referral per Hub, 2023/24 120 100 80 60 40 20 0 Hairmyres Monklands Stepdown Wishaw Apr 61 75 47 69 May 70 84 54 63 Jun 68 94 48 70 Jul 63 70 43 73 Aug 67 96 43 69 Sep 66 90 38 69 NO REFERRALS
Page 48
15 LOS 2023/24 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 AVERAGE LENGTH OF STAY 2023 AVERAGE LOS = 5.99 DAYS 0.00 April May June July August September Grand Total Hairmyres 8.38 5.71 7.79 7.67 8.42 7.18 7.50 Monklands 3.95 3.96 4.51 5.19 4.83 4.87 4.55 Stepdown 4.06 3.37 3.75 3.58 3.40 4.89 3.81 Wishaw 8.83 7.17 8.16 7.01 8.17 7.28 7.77 Grand Total 6.38 5.04 6.09 6.07 6.32 6.08 5.99 AVERAGE LOS PER SITE 2021/22 2022/23 2023/24 Hairmyres 8.02 7.4 7.50 Monklands 6.01 5.7 4.55 Stepdown 5.77 5.5 3.81 Wishaw 10.48 9.3 7.77 Grand Total 7.44 6.91 5.99 2021 VS 2023 Reduction in days % Reduction 0.52 7% 1.46 24% 1.96 34% 2.71 26% 1.45 19% 2022 VS 2023 Reduction in days % Reduction -0.11 -1% 1.10 19% 1.71 31% 1.50 16% 0.91 13% 2021 VS 2022 Reduction in days % Reduction 0.63 8% 0.36 6% 0.25 4% 1.21 12% 0.54 7% DAYS
Page 49
16 REFERRAL SOURCE 2023 Referral Source Apr May Jun Jul Aug Sep Total A&E 32 31 19 21 13 24 140 Clinic 1 1 2 1 5 ConsultantConnect 1 2 1 2 1 3 10 DN 2 1 3 ECU 1 2 1 2 2 1 9 GP 162 166 200 157 191 170 1046 Nurse 1 1 SAS 8 12 7 17 17 23 84 Ward 47 56 50 48 50 41 292 Grand Total 252 271 280 249 275 263 1590 CAREHOME PATIENTS Carehome Patients Apr May Jun Jul Aug Sep Total Hairmyres 12 12 9 11 11 12 67 Monklands 2 4 2 5 8 4 25 Stepdown 2 6 2 10 Wishaw 1 3 2 1 1 6 14 Grand Total 15 19 13 19 26 24 116 BED COMPLEMENT Bed Complement Apr May Jun Jul Aug Sep Hairmyres 24 24 24 24 24 24 Cardiology 3 3 Monklands 24 24 24 24 24 24 Stepdown 12 12 12 12 12 12 Clydesdale 12 Wishaw 24 24 24 24 24 24 Grand Total 84 84 84 84 87 99
Page 50
17 WORKFORCE DATA 2023 Month FE In Post Vacancy Rate Vacancy (WTE) Employee Headcount Total Leaver s WTE Total Leavers 12Mths Rolling 12 Mths Turnover Sick Leave % September 42.44 45.21 (6.53%) (2.77) 48 0.0 0 0.00% 4.79% August 42.44 40.65 4.22% 1.79 43 0.0 0 0.00% 7.29% July 37.93 39.26 (3.51%) (1.33) 42 0.0 0 0.00% 15.88% June 37.93 39.26 (3.51%) (1.33) 42 0.0 0 0.00% 7.80% May 37.93 38.26 (0.87%) (.33) 41 0.0 0 0.00% 7.63% April 37.93 37.26 1.77% .67 40 0.0 0 0.00% 9.62% 2023 39.43 39.98 (1.40%) (.55) 42.67 0.0 0 0.00% 8.83% Average The team have been fully established for the entirety of 2023, with no staff having left the service and a turnover rate of zero. The only vacancy being for the newly developed Cardiology team in August while we awaited a start date. All recruitment campaigns have been highly successful The Clydesdale was formed and began operational activity on 28th August, this data will follow Sickness Absence is managed well within the policy
Page 51
18 Appendix 4 Chief Operating Officer, NHS Scotland Directorate Deputy Chief Operating Officer: Performance and Delivery Division To: Chief Executives IJB Chief Officers CC: COO NHS Scotland 14th November 2023 Dear Jann, ADDITIONAL FUNDING TO SUPPORT HOSPITAL AT HOME EXPANSION 2023-24 Thank you for recent work to identify your Health Board’s ability to mobilise additional virtual capacity to support resilience over winter. This letter sets out additional funding which should be utilised to develop the services set out in your submission with a focus on reducing hospital admissions and maximising capacity. I am pleased to tell you that Scottish Ministers have approved the allocation below which is based on your return which set out the additional capacity which could be created by the end of this financial year. Board Additional beds Indicative Funding 23/24 NHS Lanarkshire 60+ £ 1,274 ,685 Funding will be released at the end of this financial year based on delivery and monthly evidence of the impact it is having to ease system pressures and improve the experience of services users. This funding is provided for the current financial year only. If an underspend is expected to arise as compared to the costs outlined above, this must be notified to us as soon as possible. The funds should be used entirely for the purpose outlined in your submission and should not be top sliced or used for any other purpose. Considering current service pressures NHS Boards, particularly those facing the greatest challenges, should continue to consider what additional initiatives, within the hospital at home programme, can be evidenced and rapidly stood up if support was available. You should notify the Unscheduled Care Policy team where this is the case. Future Arrangements For Hospital at Home to be effective and to ensure Boards progress at pace, we recognise that funding must be provided on a recurring basis at full year costs. This will help ensure the ongoing sustainability of new services in pressurised boards and to reduce the risks of services
Page 52
19 folding or failing to start due to ongoing funding concerns. We will work with you over the coming months to understand the recurring element of your funding. Until the 2024-25 Budget is approved we cannot confirm future year or recurring funding. The biggest risk to expansion of hospital at home services is whether sustainable workforce models can be developed. Mitigation of this risk requires a concurrent focus on developing a sustainable workforce model across all disciplines. The Scottish Government will work organisations including NES and HIS to ensure effective governance and oversight is in place and based on best practice. Governance Expansion of virtual capacity so far has been overseen by the Hospital at Home Expert Working Group chaired by Graham Ellis, Deputy Chief Medical Officer. This group will now cease and will be replaced by a Programme Delivery Board within Scottish Government, supported by operational support within the Centre for Sustainable Delivery (CfSD) as lead agency and in close collaboration with other National and territorial boards. This group will support the delivery of the wider Hospital at Home expansion across a range of specialties, supporting shared learning and collaborative working across Health Boards. As confirmation of receipt and acceptance of this funding envelope, please provide us with the name of the nominated representative for your board to attend the Programme Delivery Board. You may wish to name 2 people to ensure operational and clinical representation. Performance monitoring and Reporting It is essential that early evaluation is in place to assess how well the virtual capacity is delivering and to ensure the funding delivers value for money and services are safe, consistent, efficient, and person-centred. NHS Boards are asked to consider what local service evaluation can be put in place to support this. Reporting will be requested on the first Monday of every month from 4 December and should be sent to the Unscheduled Care Team UnscheduledCareTeam@gov.scot A template has been provided in Annex A. Please contact the Unscheduled Care team if you require any further information. Yours sincerely, The Unscheduled Care Policy Team MONTHLY HOSPITAL AT HOME SUBMISSION HB Named Representative: Submitted by (if different to above): Contact: Hazel Mitchell Board: Lanarkshire Date: 04/12/2023 ANNEX A
Page 53
20 Complete and return by 1st Monday of every month. Trajectory of additional bed numbers by March (as provided to Scottish Government) Hospital at Home pathway Nov Dec Jan Feb Mar Older People 12 24 36 48 48 Heart Failure 12 12 OPAT / / / / / Paeds tbc tbc tbc tbc tbc Other (please specify) / / / / / Total 60+ 60+ Current actual number of additional beds Hospital at Home pathway Nov* Dec* Jan Feb Mar Older People 0 12 12 Heart Failure OPAT Paeds Other (please specify) Total 0 12 12 *Please note November & December has been amended to accurately reflect the additional beds as opposed to total beds previously reported. What progress has been made in the last month in increasing virtual capacity? Include details on whether you remain on trajectory and any issues impacting on agreed deliverables and whether you remain on track to spend funding. Active recruitment process has been on-going since September to help enable us to fulfil this expansion plan. The temporary funding of the posts has deterred candidates from taking up these roles and this has made the expansion challenging. We have failed to recruit the Band 6 Practitioners and Band 4 Assistant Practitioners due to the temporary posts not being an attractive option. Successful recruitment does includes3wte Band 7 Trainee ANPs and a Band 8a Senior ANP.
Page 54
21 This cohort of staff are due to take up post mid-January so will hopefully help bolster capacity into February once the induction programme has been followed. Notwithstanding the issue of not having any additional Practitioner staff in post, utilising additional excess and bank hours for the past 2 months have allowed us to increase capacity by 12 beds. Additional Senior medical staff have been utilised on a sessional basis, although this arrangement is temporary and not a long term sustainable plan. In terms of Junior doctors, 3 locums have been recruited on short term contracts via Agency. How are you ensuring virtual beds are being fully utilised? Please include data that evidences how beds are being utilised? Increased capacity is evidenced below by number of referrals accepted by team: *Please note October & November data has been revised and accurately recorded above, previous submission was inaccurately reported As the table above shows patient referrals accepted by the team have increased since October. The table below shows that December saw a 13% increase in patients accepted into the service. Also as December had less working days due to Public Holidays, this is actually a 25% increase in true terms of daily referrals. The additionality of the Junior Doctors in place to support the Senior clinical decision maker has allowed the service to accept additional patients, and enabled more virtual working, hence allowing the Wishaw & Clydesdale hubs to accept more referrals than previous months. The Acuity of the patients we have managed has increased with patients presenting as much sicker and frailer than the months prior, however this is consistent with the expectation of what we would expect in winter months, when frailty and co- morbidities make patients more vulnerable. Team October* November* December Hairmyres 63 82 70 Monklands 95 100 99 Wishaw 66 58 69 Clydesdale 11 18 30 Stepdown 40 47 44 Total Referrals 275 305 312 Analysis October November December Increase in referrals since expansion ‐ 30 37 Increase in referrals since expansion (%) ‐ 11% 13% Average referrals per day 12.50 13.86 15.60 % Increase daily referrals ‐ 11% 25%
Page 55
22 What impact are you seeing on acute capacity, e.g., admissions, length of stay, occupancy? Increased admission rates have helped support the Acute sites winter plan and helped minimise their challenges wth patient flow and reduce delayed discharges by keeping patients with POC in their own homes. The average LOS in 23/24 for NHSL H@H patients was 6.08 days prior to expansion. As mentioned above the acuity of patients in November/December has increased and this has a consequential impact on the LOS, which has risen to an average of 7.02 days for December 2023. Without additional funding and the additional medical staff and excess/bank nursing hours it would not have been possible to manage these sick patients and increase referral rates. December referrals of 312 x average LOS of 7.02 days = 2190 Acute bed days saved Any further information (please note any further information around concerns or impact such as patient and staff feedback / experience) Patient feedback has been very positive as is the expectation in our service as we strive to give excellent patient centred care at all times.
Page 56
1 REPORT Item No: 7 SUBJECT: Health Care Resettlement for asylum seekers and refugees across Lanarkshire. TO: Integration Joint Board, Performance, Finance & Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health Author(s) of Report Sharon Simpson, Health and Social Work Manager Maureen Burns, Interim Service Manager till December 2023 DATE: 21 February 2024 This paper is coming to the IJB PFA for: For approval ☐ For endorsement ☐ To note ☒ The purpose of the report is to provide an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. This report will also provide an update on the work of the healthcare resettlement team that was developed as a response on an interim basis to support those arrivals. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Maureen Burns Interim Service Manager Health Care Resettlement, NHS Lanarkshire and Sharon Simpson, Health and Social Work Manager. 3. RECOMMENDATIONS It is recommended that the IJB PFA committee: 1) Acknowledge the contents of report. 2) Request future updates when available.
Page 57
2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Since 2015 all Scottish Local Authorities have participated in the Syrian Refugee Resettlement programme. From 2015 until 2019, approximately 300 Syrian refugees were settled in Lanarkshire. The Syrian Refugee Resettlement Programme, in its initial form, came to an end in April 2020. In spring 2020, the UK Government published information and guidance about a replacement programme, the ‘UK Resettlement Scheme’ (UKRS), and sought confirmation from Councils about their willingness to continue to participate in refugee resettlement. The UKRS was established in response to the ongoing refugee crisis across the globe and a number of refugees continue to arrive in Lanarkshire from Syria and other countries such as Sudan, Iraq, Palestine and Afghanistan. The Afghan Relocations and Assistance Policy (ARAP) was launched in April 2021, reflecting the changing situation in Afghanistan and Lanarkshire are continuing to see a small number of arrivals via the ARAP programme. The launch of the revised UK National Transfer Scheme for Unaccompanied Asylum Seeking Children (UASC) August 2023, was built around the concept of a weighted rota to enable the transfer of Unaccompanied Minors from the ‘entry LA’ to another local authority. The scheme is intended to relieve the pressure of southern local authorities which are no longer able to support the increasing numbers of UASC arriving, both to more fairly distribute responsibility for UASC across the UK and to improve support and outcomes for UASC. As a result of this Lanarkshire has seen around 5-6 arrivals of young people every month. In December 2021 the Home Office and Mears established an emergency contingency accommodation for single male asylum seekers at a hotel in East Kilbride. The Scottish Government in conjunction with COSLA committed to support Ukrainian people coming to live in Scotland via the Homes for Ukraine scheme and The Super Sponsor scheme. In May 2022 welcome hubs were set up within 2 hotels in Lanarkshire with a further 4 established in June 2022 with the Scottish Government extending the hotel contracts until March 2024. This report will provide a summary of the refugee and asylum arrivals to interim hotel accommodation, the settled population and recommissioned properties. It will also provide a summary of work completed by the Health Care Resettlement Team and the Health Improvement staff and ongoing work of the Health Improvement Manager for Health and Wellbeing of Asylum Seekers and Refugees. Yes ☐ No ☐ N/A ☒
Page 58
3 5.1 Health Care Resettlement Team Recruitment of an interim Health Care Resettlement team commenced October 2022 and was fully established and recruited to in March 2023 as an initial, short term response to the increasing numbers of asylum seekers and extensive number of Ukrainian refugees arriving in Lanarkshire. The resettlement health care team has supported and contributed to the Lanarkshire Strategic Oversight and Operational Groups and has established strong communication links with the Public Health Department and other healthcare services to ensure managers and staff are kept up to date with national and local matters in relation to asylum seekers and refugees. Regular updates have been provided to CMT. The Health Care Resettlement team consists of Interim Service Manager 37.5hrs (1wte) Left post 01/12/2023 Interim Team Leader 37.5hrs (1wte) Left post 27/10/2023 Interim Specialist Nurse 30 hrs (0.8wte) Leaving post 30/01/2024 Interim Clerical Officer to support above team 15hrs (0.4wte) Left November 2023 The contracts of these staff were extended and agreed until March 2024 as these pays were secured from the monies already drawn down from the programmes that were funded. Daily clinical triage was established to assess any heath needs, with signposting, referral and support to each of the existing hotel sites across Lanarkshire initially on a daily basis. Many of the asylum seekers and refugees attending have presented with mental health concerns associated with trauma and long term conditions such as hypothyroidism, asthma and diabetes requiring support with prescriptions. Those requiring GP registration have been supported in doing so. These contacts have ranged from a minimum 20 minutes up to 1 ½ hours due to the requirement of interpreting services, referrals to other services and the complex sensitive nature of concern. The team’s efforts have been instrumental in addressing the health needs and ensuring the well-being of these vulnerable populations during their resettlement process. Clinical triage has also been provided to those families that have arrived following leaving the cruise ships until they have been registered with a GP and have the ability to access universal services. A Ukrainian Health Needs Assessment has been formulated and offered to all new arrivals and is now available on Morse patient recording system. The team has tried to address the many challenges that asylum seekers and refugees face by providing a person centred service in a trauma informed manner. The programme of work has moved at pace and necessitated a team approach, partnership and multidisciplinary working to ensure connectivity to support a smoother transition and integration into mainstream services.
Page 59
4 Pathways have been developed for direct referrals to Midwifery Services, Mental Health, Sexual Health, Public Dental, Smoking Cessation, Public Health, Mears, wider Vaccination Service and an Unaccompanied Asylum Seeking Children’s pathway. Standard Operating Procedures have been compiled to support the administration of vaccinations to the asylum population within their current accommodation. All pre 5 children who have been residing within hotel accommodation who were outstanding vaccinations have been vaccinated prior to moving to more permanent accommodation. All of those children will also have a non-routine wellbeing assessment carried out in this time and vaccinated as required and communication is in place to the appropriate Health Visiting Team when children have moved to more permanent accommodation within a locality. The wider vaccination service has provided Covid vaccinations to those within the interim hotel accommodation to try and improve uptake rates. To support this, a resettlement health care repository has been set up on a shared drive to ensure knowledge, information, processes and protocols are accessible. A resettlement email has also been developed to share and transfer information with colleagues and partners. One WTE Health Improvement Manager and 0.5wte admin support are currently in post until October 2024 to carry out a training needs assessment of health care staff and undertake a population health needs assessment of asylum and refugee populations resettling in Lanarkshire to inform planning for future support. Connections have been made across all NHS services to improve their understanding of the health needs of refugees and asylum seekers and the rights and entitlements of them to access health services. Information for staff on supporting the healthcare and wellbeing of asylum seekers and refugees living in Lanarkshire has been created and is now available on a landing page on the NHSL intranet, FirstPort. The development of information for the public to access is also underway. 5.2 Hotel Accommodation for Ukrainian refugees Initially there were 6 hotels across Lanarkshire hosting Ukrainian refugees however due to the recommissioning of properties and a reduction in new arrivals from September there is now only 1 hotel in East Kilbride with 72 residents awaiting appropriate matching. 5.3 Recommissioned properties At present there are circa 2000 people from Ukraine now settled in Lanarkshire within recommissioned properties, private arrangements and hosting arrangements. There have been a number of properties recommissioned across Lanarkshire to support Ukrainian refugees and these properties are now at capacity. Birkshaw Tower in Wishaw has 50 properties let with 115 people in total residing there, consisting of 76 adults and 39 children. High Coats in Coatbridge has 143 properties occupied at this time with 296 residents consisting of 224 adults and 72 children. Barrack Street accommodation has 150 adult residents at this time and is at full capacity.
Page 60
5 GP registrations have been supported by the team for all of the above residents in a rotational pro rata basis as requested by GP services within the respective localities. GP registration has generated CHI numbers for all therefore supporting access to other health services. 5.4 Asylum population Currently the Bruce Hotel in East Kilbride is hosting 71 male residents. This has been an increase from the initial capacity of 65 residents. Room sharing within the hotel was implemented on the 1st September 2023 with 31 rooms identified as having the ability to be maximised. Ever since the team has been formed, all new arrivals to the hotel have been offered a full health needs assessment specifically drawn up for the asylum population. These thorough assessments have helped identify any immediate health concerns or underlying medical conditions. The assessments have been crucial in determining the appropriate care and support required. The team have also facilitated GP registrations for these men. Vaccination history has been sought and those with outstanding vaccinations that have consented are being immunised by the team and connections have been made with the wider vaccination service moving forward. At this time the men residing here have originated from 13 countries speaking 15 different languages. Networks of support have been set up and the Health Protection team have offered and carried out TB screening to many of the residents with Blood Borne Virus services currently facilitating BBV screening. 5.5 Unaccompanied Asylum Seeking Children As a result of the revised National Transfer Scheme for Unaccompanied Asylum Seeking Children (UASC), Lanarkshire has been supporting around 5 to 6 young people per month who have been arriving. Demographics of arrivals have been mainly boys aged 16-17yrs with a small number of 15 year olds. The health needs of this population are predominantly supported by the Through Care and School Nursing service. All of these young people are residing with foster placements, children’s houses or supported accommodation. 5.5.1 North Lanarkshire Within North Lanarkshire, 39 young people have been supported (aged between 15 and 20 years). There are currently 21 under the age of 18, and 18 who are over 18 years and supported as care leavers residing here. The Health Care Resettlement team have supported the School Nursing Team in North Lanarkshire to carry out Health Needs Assessments for all UASC not in education until through care support staff take up post. 5.5.2 South Lanarkshire 44 UASC have been supported in South Lanarkshire with currently 34 still residing and being supported here, comprising 1 female and 33 males ranging from 16-19 years of age. The most common countries of origin are Iran and Vietnam with others from Iraq, Syria and Afghanistan.
Page 61
6 5.6 Resettlement Health Care & Wellbeing Improvement Plan 2023-2024 A Resettlement Healthcare & Wellbeing improvement plan has also been developed by the service. Appendix 1. The main high level outcomes of this plan are: 1. Staff and service providers have a sound knowledge and understanding of the rights and health and wellbeing needs of New Scots settling in NHS Lanarkshire area. 2. Appropriate and timely health & social care services and wider wellbeing services, that are sensitive to the needs of New Scots settling in Lanarkshire are established. 3. All staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports the delivery of services for resettled populations. 4. New Scots are thriving and are integrated into their local community & able to access health & wellbeing services and supports. 5.6.1 Support - Strategic & Operational Groups & Third Sector Involvement A Lanarkshire Resettlement Healthcare and Wellbeing Oversight group and an Operational Sub-Group are fully established and the Oversight Group has ratified the Improvement Plan. A community and third sector conference took place on 22nd June 2023 to engage the wider voluntary sector in the development of community based support for people settling in Lanarkshire. An Equality Impact Assessment (EQIA) has been completed for the Resettlement Healthcare & Wellbeing Programme. Work to date has focused on addressing the immediate and longer term health needs of those ethnic minority groups who have recently resettled in Lanarkshire. 5.6.2 Training Needs Assessment A training needs assessment (TNA) has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role. The TNA aimed to identify areas where staff may require further training and knowledge to identify areas where staff may require further training and knowledge to improve the provision of good quality and equitable health care delivery to refugees and asylum seekers resettling in Lanarkshire. An online survey with healthcare staff was carried out with 283 responses. The survey set out to explore their experience of supporting refugees and asylum seekers and the results of the TNA will inform the development of any recommendations on how best to support healthcare staff to provide high quality care for these populations. 5.6.3 Population Health Needs Assessment
Page 62
7 A Population Health Needs Assessment (PHNA) is currently being undertaken. To date there has been little research to understand the challenges faced in accessing healthcare or how health care experiences effect the health and wellbeing of asylum seekers and refugees in Scotland or indeed in the UK. Also, there has been a lack of research on health behaviours and the impact of the social determinants on the health of these populations. Undertaking a health needs assessment on these populations will help ensure that their health needs are addressed, reduce health inequalities but also support future planning and integration to local health care systems. The PHNA aims to find out the following: What do people asylum seekers and refugees know about health services in Lanarkshire? What factors promote and what factors inhibit people’s access and use of health services? What factors promote and what factors inhibit people’s integration into their local community? How aware are health professionals of the welfare and healthcare needs of asylum seekers and refugees? In their view what factors promote and what factors inhibit access and use of health services by refugees and asylum seekers? What is the availability of routinely collected health data on these populations? A more detailed action plan for health improvement and health care will be completed based on the key findings of the population health needs assessment and the staff training needs analysis. 6. CONCLUSIONS The programme of work has moved at pace and necessitated a team approach, partnership and multidisciplinary working to ensure connectivity to support the transition and integration into main stream services. The team’s work has had a profound impact on improving health outcomes and overall wellbeing of asylum seekers and refugees. Through their support and guidance, the team has ensured that that the settling populations can easily access healthcare services, resulting in timely diagnosis, treatment and improved health outcomes. Through the support of the Health Improvement Manager, the wider team have empowered asylum seekers and refugees with the essential knowledge and skills to maintain and improve health, prevent ill health and navigate the health care system independently. The arrival of Ukrainian refugees to Lanarkshire has greatly decreased such that only 1 hotel now hosts families in Lanarkshire from the original six. Additionally, there is currently one hotel hosting asylum seeking males. As part of the Widening Asylum Dispersal Strategy, Lanarkshire is now seeing people seeking asylum moving in to dispersal accommodation. At this time numbers have
Page 63
8 been low however it is difficult to estimate these numbers. MEARS procure accommodation for asylum seekers and they will notify health of any new arrivals in to the area. They will support GP registrations as directed. Those residing with initial hotel accommodation are supported by one GP Practice as a Local Enhanced Service (LES) agreement. The numbers of people seeking asylum and refugees coming to and settling in Lanarkshire will continue. By working together, we can ensure that refugees and asylum seekers in Lanarkshire have access to the health care services they require to live healthy, fulfilling lives and integrate into our community effectively. 7. IMPLICATIONS Workforce – Health Care Resettlement staff have contracts to 31 March 2024 however the Interim Service Manager and the Interim Team Leader in the Resettlement Healthcare Team are moving into new posts by December 2023. The remaining staff within the team will finish the end of January. To ensure a smooth transition of the team, there has been a Service Manager in North and South identified and agreed to oversee any future programmes of work and will attend single and multiagency meetings that are currently in place. All relevant information, processes and pathways have been developed and accessible on the resettlement shared drive and regular meetings have been established to facilitate a seamless transfer of information and responsibilities. There are no new arrivals of Ukrainians to interim hotel accommodation therefore no clinical triage will be required however if there were to be a large number of new refugee or asylum populations arriving in Lanarkshire this would have an impact on universal services. Standard Operating Procedures and pathways have been developed to support this until any new arrivals are fully integrated into mainstream health services. The situation is changing each day regarding arrivals, therefore this report sets out what is known to date. There is no ongoing funding and/or an indication of a predictable volume / flow of people coming to Lanarkshire that would indicate the need for a discrete Resettlement Team. Moving forward the model being proposed is one that creates a sustainable approach and ensures that we can react with a shared pan Lanarkshire deployment of existing staff to support the needs of the emergent population no matter which local area they are placed. This is currently being referred to as the “reserve team” which will consist of an agreed volume of identified staff from each locality overseen by a Health and Social Work Manager (north), coordinated by two Service Managers (N&S) and supported by professional colleagues deployed dependent on the presentation of the new arrivals. At this time the model needs to be finalised and signed off and an implementation plan developed that will identify process, staff and training. The current infrastructure of the Strategic and Operational Resettlement Healthcare Groups will be the vehicle to support the change in model. 7.1 NATIONAL OUTCOMES
Page 64
9 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) Resettlement Healthcare & Wellbeing Improvement Plan 2023-2024 incorporates measures for each action. 7.3 FINANCIAL All refugees and asylum seekers have a right to health care. Funding for health can be accessed for refugees coming via the UKRS. This is funding that can be drawn down by NHSL from the Home Office to cover primary and secondary care costs, in the initial year up to £2,600 per person. Unfortunately, there is no additional funds that health can access to cover the costs of the Ukrainian refugees, asylum seekers or UASC. The Health Care Health Improvement staff and the Health Care Resettlement team was established on a temporary basis from the reserves drawn down from this funding. Funding may be required for public health screening. A refreshed LES agreement was being developed and accepted by the GPs, which has provided them with a payment for each person registered with their practice paid from this current fund. This LES agreement has been agreed until the 31st of March 2024. All refugees have access to public funds, the UASC have become the responsibility of and are cared for by the Local Authority. The asylum population residing in initial hotel accommodation are supported by Mears with accommodation and meals provided however they have no recourse to public funds and those families living and arriving in dispersal properties do not have any recourse to public funds. The details of the proposed capacity have been agreed and approved by Finance. Appendix 2. Yes ☒ No ☐ N/A ☐
Page 65
10 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Stakeholders have been consulted and involved through the development of the Health Care Resettlement oversight and operational groups. Multiagency groups are currently in place across both local authorities. A community and third sector conference took place in June 2023. A training needs assessment has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role aimed to identify areas where staff may require further training and knowledge. A Population Health Needs Assessment is currently being undertaken and a more detailed action plan for health improvement and health care will be completed based on the key findings of this and the staff training needs analysis. 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
Page 66
11 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. Appendix 3 EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1A Resettlement Healthcare & Wellbeing improvement Plan Appendix 2Finance Report Appendix 3 EQIA Completed & Fairer Scotland Impact Assessment Form CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Sharon Simpson Health and Social Work Manager Sharon.Simpson@lanarkshire.scot.nhs.uk Yes ☒ No ☐ N/A ☐ Yes / Date added ☒ No ☐ N/A ☐
Page 67
12 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
Page 68
13 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
Page 69
14 Appendix 1 Lanarkshire Resettlement Healthcare & Wellbeing Improvement Plan 2023-2024 Task not started Task started but delayed Task on schedule Task completed Prepared by: The Resettlement Healthcare & Wellbeing Team for Asylum Seekers & Refugees January 2023 Updated July 2023
Page 70
15 Background The UK Government has made a commitment, to resettle refugees from various countries in the UK. The Scottish Government (SG) in conjunction with COSLA has agreed to support many of these people in Scotland. In response to the crisis in Ukraine, the SG have indicated their commitment to support Ukrainian people coming to settle in Scotland. The indicators are that the numbers of people seeking asylum, and arriving as refugees and coming to settle in Lanarkshire will increase. In summary the current situation is that there are various groups of people coming to settle in Lanarkshire, who will require healthcare and support. Asylum seekers or refugees living in Scotland, have the right to NHS healthcare while staying here. Health is fundamental Human Right for all, including asylum seekers and refugees. According to the 1951 Refugee Convention, refugees should have access to the same or similar healthcare as host populations. According to international law, a refugee is a person who: Owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it. Article 1(A) 1951 UN Convention relating to the Status of Refugees. An asylum seeker is a person who has applied to be recognised as a refugee. There are different forms of humanitarian protection which provide rights and entitlement similar to refugee status. Under current constitutional arrangements, asylum issues are reserved to the UK Government and handled by the Home Office. This includes operation of the asylum system, provision of asylum accommodation and support, and the management and decisions related to UK resettlement programmes. Many of the services which are essential to support the integration of refugees into our communities, including healthcare and education, are however devolved to the Scottish Government.
Page 71
16 The second New Scots Refugee Integration Strategy 2018 – 2022 builds on the first strategy and “aims to be dynamic, so that it can adapt to changing political, policy or international contexts, which have an impact on refugees and asylum seekers living in Scotland.” The latest version of the New Scots Integration Strategy can be found here: New Scots: refugee integration strategy 2018 to 2022 - gov.scot (www.gov.scot) We understand an update is due to be published soon. The Lanarkshire Resettlement Healthcare & Wellbeing Improvement Programme will champion the aspirations of the New Scots Strategy for the improvement and protection of the health and wellbeing of these target populations. It will contribute to a concerted, consistent approach to the delivery of healthcare, health improvement and integration plans for these populations and will develop to encompass a variety of community based projects, staff training & healthcare programmes that are adapted to the needs of refugees and asylum seekers. The resettlement healthcare team will support and contribute to the Lanarkshire Strategic Oversight and Operational Groups and establish strong communication links with the Public Health Department and other healthcare services to ensure managers and staff are kept up to date with national and local matters in relation to asylum seekers and refugees. The team will also support the development of and contribute to the aims and objectives of the soon to be established National Network of staff who support the resettlement of asylum seekers and refugees in Scotland. The overall aim is to improve the health of individuals and their families who have via a variety of routes, resettled in Lanarkshire. This will be done in partnership with our community planning & Health & Social Care colleagues through the provision of healthcare services and prevention and awareness raising initiatives, particularly targeting those living in areas of deprivation. The main high level outcomes of this plan are: 1. Staff and service providers have a sound knowledge and understanding of the rights and health and well-being needs of New Scots settling in NHS Lanarkshire area. 2. Appropriate and timely health & social care services and wider well-being services, that are sensitive to the needs of New Scots settling in Lanarkshire are established.
Page 72
17 3. All staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports the delivery of services for resettled populations. 4. New Scots are thriving and are integrated into their local community & able to access health & well-being services and supports.
Page 73
18 High level Outcomes High level Key actions How will we know Timescale Lead Progress 1.Staff and service providers have a sound knowledge and understanding of the rights and health and well- being needs of New Scots settling in NHSL area. 1.1 Undertake a systematic literature review of evidence base for this population to identify gaps in knowledge and in the data. 1.2 Conduct a population health needs assessment and develop a health plan to address need. 1.3 Complete a clinical assessment for 1.1 Systematic literature review completed. 1.2.1 Population HNA completed and health issues identified. Resettlement Health plan developed to meet the health and well- being needs of the target population. 1.2.2 The results of the population HNA should inform the need for the setting up of: a dedicated mental health/trauma service; a Near Me Hub. 1.3 Results from the clinical assessments June 2023. Oct. 2023 On-going Health Improvement Manager (Asylum Seekers & Refugees) Health Improvement Manager (Asylum Seekers & Refugees) Interim Service Manager Completed and to be finalised ready for inclusion in the POP HNA In hand with data collation nearly complete and all stakeholder interviews underway All in hand and early data analysis underway and being collated
Page 74
19 new arrivals from January 2023. 1.4 Identify staff training needs to identify attitudes, values and knowledge regarding target population. recorded on Morse to identify trends/gaps in service provision. 1.4.1 Training needs analysis completed with key staff groups and training courses developed/procured to address staff needs. The TNA should address staff needs in terms of delivering a trauma informed practise. Oct 2023 (Asylum Seekers & Refugees) Health Improvement Manager (Asylum Seekers & Refugees) Underway and surveys out to staff now High level Outcomes High level Key actions How will we know Timescale Lead Progress 2. Appropriate and timely health & social care services and wider well-being 2.1 Ensure decisions, practices & policies are fair and do not 2.1 Conduct an Equality Impact assessment of the Resettlement Programme. Areas for August 2023 Interim Service Manager Completed and submitted for final approval
Page 75
20 services, that are sensitive to the needs of New Scots settling in Lanarkshire are established. discriminate against New Scots. 2.2 Ensure that NHSL has strategies and systems in place to respond to the immediate and ongoing needs of resettling people. 2.3 Recruit and manage the resettlement healthcare team. improvement to be addressed within the health plan. 2.2.1 Develop a high level plan and pathway that puts in place forward planning and contingency measures to respond to the needs of new scots. 2.2.2 Scope out sources of funding and ensure systems in place to identify and claim all funds due to NHSL. 2.2.3 Develop a funding profile and spend plan projected for up to 3 years. 2.3 Resettlement healthcare team recruited & established. Jan 2023 May 2023 June 2023 (Asylum Seekers & Refugees) Lead for Coordinating Healthcare for Asylum Seekers & Refugees. Interim SM (Asylum Seekers & Refugees) Interim SM (Asylum Seekers & Refugees) High level plans in place along with a responsive healthcare team recruited and in place All funding applied for and un place to sustain the response team until March 2024 Completed with Finance until March 2024 at which point funds will all be utilised and further decisions will need to be made to address the need for the response team and the LES payments Team all in place All in hand
Page 76
21 2.4 Staff can practice safely, meeting the needs of the target populations. 2.5 Ensure the health & well- being needs of asylum seeking and refugee children are met. 2.4.1 Set out Standard Operating Procedures and pathways for all clinical work, referrals and public health screenings, and immunisations. 2.4.2 Develop and maintain all rotas to support any contingency or interim places where people are accommodated. 2.4.3 Develop and maintain databases as required. 2.4.4 Further develop and agree systems for payments and contracts with GPs and any other providers. 2.5.1 Set out and communicate the pathway and supports for Unaccompanied Asylum Seeking Interim SM (Asylum Seekers & Refugees) Interim SM (Asylum Seekers & Refugees) All in place All in place New LES to be finally approved at July 2023 that is fairer and more sustainable In place In place
Page 77
22 Children and Young people (UASC). 2.5.2 Set out key pathways and agree systems for notification to ensure children are identified if not yet GP registered, and once GP registered ensure known to health visitor or school nurse. High level Outcomes High level Key actions How will we know Timescale Lead Progress 3. Ensure all staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports delivery of services for resettled populations. 3.1 Develop a communications plan around all the key areas of work to ensure that all staff and service users can access the resources and supports that are developed. 3.2 Lead on communications internally and with the Scottish 3.1 Communication plan developed & disseminated. 3.2.1 Establishment of a Pan Lanarkshire oversight group and an operational group for June 2023 June 2023 Lead for Coordinating Healthcare for Asylum Seekers & Refugees. Lead for Coordinating Healthcare for Asylum Seekers & Refugees. Communications to key groups done along with the development of the website Oversight group established with TOR and has met twice and membership agreed.
Page 78
23 Government, the Home Office, COSLA and other National colleagues, ensuring reporting mechanisms to all relevant parties in NHSL and the 2 HSCPs. 3.3 Develop resources in partnership with translation services as appropriate and depending on the gaps identified in the HNA. 3.4 Utilise internal communication channels to healthcare and wellbeing support for people resettling in NHSL area. 3.2.2 Consider reporting structures, data information needs and frequency to ensure that NHSL and the 2 HSCPs receive timeous reports and updates as the plans and supports are established. 3.3 Suite of resources developed & accessible to relevant HSCP staff. 3.4 Develop & publish content on NHSL’s web-site, First Port, The Pulse and weekly staff briefing. On-going On-going On-going Health Improvement Manager (Asylum Seekers & Refugees) Health Improvement Manager (Asylum Seekers & Refugees) Health Improvement Operational group meeting date set for August 2023, TOR proposed and TBA. Agreed to report via the North Core group and copy reports to the respective groups across NHSL area. Collation ongoing and links to key sites and resources done and will be the dedicated website link. Website pages complete and Live and article to follow in the team briefings and Pulse etc.
Page 79
24 regularly update and keep HSCP & community planning staff informed. 3.5 Liaise with partners nationally involved in resettlement programmes to share good practice and research findings and to foster joint working. 3.6 To disseminate information on the resettled populations as appropriate to staff and volunteers in the H&SCP’s. 3.5 Joint partnership projects, research projects, disseminate good practice to staff groups via email, staff briefing etc. 3.6. Contribute to “Our Health Together” report. June 2023 Manager (Asylum Seekers & Refugees) Lead for Coordinating Healthcare for Asylum Seekers & Refugees. Many ongoing such examples underway such as the arts pprojects. It was agreed that as there was a parallel process in terms of the POP HNA learning and outcomes from that will be shared and fed in later, along with encouraging and supporting people from ethnic minority groups to participate in the development of the Our Health Together consultations.
Page 80
25 High Level Outcomes High Level Key actions How will we know Timescale Lead Progress 4. New Scots are thriving and are integrated into their local community & able to access health & well-being services and supports. 4.1 Develop a local network of health improvement, third sector & other HSCP staff to share good practice and foster joint work, to provide a forum to respond to national or local policy developments. 4.2 Promote patient’s rights, access to health services and self- management to refugees and asylum seekers. 4.3 Establish health services and community health and wellbeing 4.1.1 Emails, reports, staff briefing, joint research projects, information on NHSL landing page on First Port, The Pulse. 4.1.2 Work in tandem with the 2 health and equalities officers in VANL and VASLAN respectively to ensure a community capacity and connectedness to support wider wellbeing of these groups of people. 4.2.1 Suite of resources sourced/developed & available in accessible formats which are promoted to the target audience. 4.3.1 Utilise existing communication channels and networks to highlight & promote August 2023 On-going On-going Health Improvement Manager (Asylum Seekers & Refugees) Health Improvement Manager (Asylum Seekers & Refugees) Health Improvement Manager (Asylum Seekers & Refugees) All in hand New Scots 3rd sector event has taken place and the outcomes and outputs are being worked up for dissemination and action. Some in hand and some to be developed after the POP HNA and further consultation with stakeholders. Ongoing and in hand
Page 81
26 initiatives that responds to the health and wellbeing needs of New Scots across a lifespan. community health and wellbeing services to resettled people & to staff & volunteers who support them. 4.3.2 Develop new initiatives as directed by the population HNA in partnership with HSCP staff & volunteers. On-going Health Improvement Manager (Asylum Seekers & Refugees) TBC once the HNA is completed
Page 82
27 Appendix 2 NHS Lanarkshire Resettlment Healthcare(Refugees/Displaced Peoples) Finance Report: 21/22; 22/23; 23/24 2021/22 Spend 73,933 2022/23 Spend 404,032 477,965 2023/24 Spend To September 2023 Pays 170,456 Non Pays 6,058 LES Payments To GP's 80,340 256,854 Total Spend To Date(21/22, 22/23, To Sept 23) 734,819 Anticipated Spend - Remainder of 23/24 171,316 24/25 Spend 76,664 247,980 Total Spend - 21/22, 22/23, 23/24, 24/25 982,800 Funding Received / Anticipated Home Office Claim: 21/22 858,000 Home Office Claim: July 21 to March 22(Received 22-23) 96,200 Home Office Claim - Received March 23 - Afghan Claim Since 2021(Received 22-23) 13,000 Anticipated Funding 23-24 From Home Office - New Claim For Syrians Arrived in Feb 23 15,600 982,800 The funding received from the Home Office has been carried forward via the IJB reserves.
Page 83
28 Appendix 3 This is a legal document stating you have fully considered the impact on the protected characteristics and is open to scrutiny by service users/external partners/Equality and Human Rights Commission If you require advice on the completion of this EQIA, contact hina.sheikh@lanarkshire.scot.nhs.uk ‘Policy’ is used as a generic term covering policies, strategies, functions, service changes, guidance documents, other Name of Policy NHSL healthcare and wellbeing resettlement programme (Health Care Resettlement Team) (Population Health Needs Assessment) Names and role of Review Team: Maureen Burns (Interim Service Manager) Maria Reid (Senior Manager Health Improvement) Susan Lyttle Cheryl Martin (Interim Team Leader) Date(s) of assessment: commenced 24.04.2023 SECTION ONE AIMS OF THE POLICY 1.1. Is this a new or existing Policy : _New_________________ Please state which: Policy Strategy Function Service Change Guidance Other New service 1.2 What is the scope of this EQIA? NHS Lanarkshire wide Service specific Discipline specific Other (please detail)
Page 84
29 ______________________________ 1.3a. What is the aim? To set up a health care and wellbeing service in response to the global situation focussing on the most vulnerable population of asylum seekers and refugees coming to Lanarkshire. An interim Health Care Resettlement team has now been established and recruited to within NHSL in response to the current situation. Clinical triage has been established to assess any heath needs, with signposting, referral and support to each of the existing hotel sites daily. The nursing team works closely with our multiagency partners, particularly the council resettlement teams in North and South, completing Health Needs Assessments (HNAs) and offering an initial triage system to identify more urgent health needs, which includes symptomatic TB screening and immunisation status when living in temporary accommodation. The team ensures these needs are met through referral to the appropriate services as required. When a more settled status is achieved, GP registration is facilitated with independence encouraged and universal services involvement. 1.3b. What is the objectives? Key areas of work required which will be rights based and trauma informed to provide a service to the growing population of refugees and asylum seekers arriving in Scotland and the sudden arrivals following the war in Ukraine. 1. Staff and service providers have a sound knowledge and understanding of the rights and health and well-being needs of New Scots settling in NHS Lanarkshire area. 2. Appropriate and timely health & social care services and wider well-being services, that are sensitive to the needs of New Scots settling in Lanarkshire are established. 3. All staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports the delivery of services for resettled populations. 4. New Scots are thriving and are integrated into their local community & able to access health & well-being services and supports. 1.3c. What is the intended outcomes? Health and wellbeing needs of asylum seekers and refugees are identified and supported with a focus on prevention and early intervention. Healthcare services are continuously improved to ensure accessible, high quality care is delivered in the right place, at the right time and by the right person.
Page 85
30 . 1.4. How have the stakeholders been involved in the development of this policy? Connections are being made across all NHS services to improve their understanding of the health needs of refugees and asylum seekers and the rights and entitlements of refugees and asylum seekers to access health services. GP contracts have been negotiated and agreed via the Lanarkshire Medical Committee. A landing page is currently in development to support staff groups when working with asylum seekers or refugees. An Oversight Group has been established and is chaired by the Head of Health, Health and Social Care North Lanarkshire, and will oversee the planning and governance of all the associated work streams. Views of clients are captured and recorded at every contact. Regular partnerships to share information and recent developments. 1.5 Examination of Available Data and Consultation - Data could include: consultations, surveys, databases, focus groups, in-depth interviews, pilot projects, reviews of complaints made, user feedback, academic or professional publications, reports etc) A database has now set up to gather data on health need assessments, referrals, immunisation status. All clinical contacts by team are recorded on Morse whereby data on contacts can be pulled. Individual Health Needs Assessments are being offered to all new arrivals within the hotels. Refugees and asylum seekers are informed about health services, their rights and how to access services. They are also provided with the information on Scotland’s healthcare system and how to access primary care services. A review of the literature was undertaken initially to look for studies regarding health issues, health needs, risk factors and lifestyle issues as well as healthcare experiences of asylum seekers & refugees in the UK and across Europe. A further review was then undertaken to look specifically at experiences of healthcare of refugees and asylum seekers in primary care, secondary care, maternity care, dental and oral health, screening, immunisation, mental health and sexual and reproductive health services again in the UK and Europe. A Report on data to support planning for the health needs assessment (HNA) of people from various countries, including Syria, Afghanistan and Ukraine that have been settled in Lanarkshire was undertaken and the objective was to collect data for analysis to support health needs assessment (HNA) for people from various countries, including Syria, Afghanistan and Ukraine that have resettled in Lanarkshire or are seeking asylum. Challenges are there is no single source of data that is able to provide an accurate estimate of the number people from various countries seeking refuge in Scotland as immigration is not devolved to Scotland and there are various immigration schemes, and there are constant changes to government policies notably due to changing circumstances on a global level. Data capturing methodology from 2000 till date shows differences to how data were segregated or classified, while some data from same period shows different figures e.g. dependant breakdowns are not available prior to 2002, Unaccompanied Asylum Seeking Child (UASC) breakdowns are not available prior to 2006 and age and sex breakdowns are not available prior to 2009.
Page 86
31 There is also lack of consistency as to how migrant are classified either as asylum, resettled or other names adopted by present government policies on immigration as shown in Box 2 above. The Vulnerable Persons Resettlement Scheme (VPRS) was launched in January 2013 with a commitment to resettling a further 20,000 in refugees in Scotland? under the scheme by 2020. This target was reached in February 2021 but delayed due to the pandemic. Following this, the scheme was replaced by the UK Resettlement Scheme(UKRS). Available figures do not include those resettled to the UK under the ex gratia scheme for Afghan locally engaged civilians. Name any experts or relevant groups / bodies you should approach (or have approached) to explore their views on the issues. Public Health Health Protection colleagues BBV services Public Health Scotland Interpreting Services North and South local authority resettlement teams Hina Sheikh and Chris Kimber VANL and VASLAN Equality and Diversity Officers MEARS Group Terrence Higgins Trust Health Improvement Maternity services Mental Health Sexual Health services Health Visiting services
Page 87
32 Long term conditions Quit your way Public Dental Service Gender Based Violence services A full health needs assessment on arrival What do we know from existing in-house quantitative and qualitative data, research, consultations, focus groups and analysis? A review of literature has been undertaken. Population Health Needs assessment 1.6.2 As part of UNCRC you need to consider what the voices of children and young people in our communities are telling you about this proposal and are there gaps in evidence? The service aims to ensure that childrens rights are respected, protected and fulfilled.The best interests of the child is a primary consideration in all actions and decisions that affect them. All children and young people are offered a Health Needs Assessment on arrival to the area. As part of this assessment, there is an assessment of their wellbeing focussing on all well being indicators. Children have the right to express their opinions freely therefore their perspectives and voices are included throughout the assessment process. Their views are sought and recorded at these contacts and they are encouraged to participate and be heard in decisions that may affect them. As part of the Population Health Needs Assessment depending on age and maturity will have the opportunity to participate in the interviews/focus groups.This service promotes the realisation of childrens rights by promoting equality and non discrimination . 1.7. What resource implications are linked to this policy? This service will be funded initially from existing non-recurring monies however if the need continues to provide the service additional funding will be set out in a separate business case.
Page 88
33 SECTION TWO IMPACT ASSESSMENT Complete the following table, giving reasons or comments where: The Programme could have a positive impact by contributing to the general duty by – Eliminating unlawful discrimination Promoting equal opportunities Promoting relations within the equality group The Programme could have an adverse impact by disadvantaging any of the equality groups. Particular attention should be given to unlawful direct and indirect discrimination. If any potential impact on any of these groups has been identified, please give details - including if impact is anticipated to be positive or negative. If negative impacts are identified, the action plan in appendix 3 form C must be completed Equality Target Groups – please note, this could also refer to staff Positive impact Adverse impact Neutral impact Reason or comment for impact rating By providing triage service helps identify any health needs or supports required. This service is provided on an outreach capacity which helps reduce barriers to access. Information on accessing universal health services is provided and promoted. Staff sign post to routes to work and money matters services as required.
Page 89
34 2.1. Age Children and young people Adults Older People X Age appropriate health care services are provided to all asylum seekers and refugees. All age groups have access to assessment and onward referral as required. - Children & Young People that arrive as unaccompanied asylum seekers will be offered an individualised full health needs assessment in keeping with the Care experienced pathway whilst they are in supported accommodation (childrens houses). - Adults and Older people are offered the assessment on arrival within the contingency arrangements and referred on to age appropriate services as required. 2.2. Disability (incl. physical/ sensory problems, learning difficulties, communication needs; cognitive impairment, mental health) x The health care resettlement team provides the care in the clients own accommodation and would ensure that appropriate adjustments required are supported. Appropriate referrals to Allied Health Professionals would be made and support of partner agencies with transition in to more permanent accommodation. Right Care, right place, right time detail shared. Mental Health - mental health resources shared and pathway in place for any referral required. All staff provide services in a trauma informed manner.
Page 90
35 2.3. Gender Reassignment X There is no differential impact on gender reassignment. When delivering the service, we will continue to advocate the use of gender -neutral language, including provision of information materials and ensure a gender neutral clinical environment that the service users will access. The team would need to be aware of the specific health needs of transgender people and ensure that their needs are being met. 2.4 Marriage and Civil partnership X The health care resettlement team would have no differential impact on the protected characteristics of marital or partnership status 2.5 Pregnancy and Maternity (including breastfeeding) X There should be a positive impact on pregnancy and maternity as pathways have been developed and information regarding antenatal care, vaccination programmes are available in many languages. Midwifery staff have access to language line and language line enabled ipads are available on site within the maternity unit. 2.6 Race/Ethnicity X The service has been developed to support our new Scots settling into Lanarkshire area. The services are provided in a culturally sensitive manner. All staff have access to language line and translated information. NHS Lanarkshires new Digital Plan 2023-28 should also support this as the plan advocates provision of language translation options for the Lanarkshire public as required by the NHS Scotland Interpreting, Communication Support and Translation National Policy (2020) Cultural awareness training is sought and a landing page is under development to support all of NHSL staff.
Page 91
36 2.7 Religion/Faith X There is no differential impact on Religion and/or Faith and the resettlement health care team ensure that health care services are provided in a way that respects the religious and cultural beliefs of refugees and asylum seekers. Religious and cultural beliefs are sought to ensure that the health care provided suits their needs and provided in a culturally sensitive way. 2.8 Sex (male/female) X There is no differential impact on sex. The service is delivered in a manner that is sensitive to the needs of different sexes. As part of the initial assessment we inquire about the patients preference for the gender of staff they would like to work with and will continue to advocate the use of gender appropriate staff to anyone wishing this for religious and cultural reasons 2.9 Sexual Orientation Lesbians Gay men Bisexuals X There is no differential impact on sexual orientation the service will be accessible and appropriate for all people of all sexual orientation. When delivering the service, we will continue to advocate the use of gender - neutral language, including provision of information materials and ensure a gender neutral clinical environment that the service users will access. 2.10 Carers x Implementation will have no differential impact. Those in carers role can be offered carers assessment and referred to appropriate services. 2.10 Homeless x All asylum seekers and refugees within Lanarkshire are provided with interim contingency accommodation and supported to move in to more permanent accommodation.
Page 92
37 2.12 Involved in criminal justice system X There should be no differential impact for those involved in the criminal justice system 2.13 Literacy x All materials and communications are considered in terms of literacy skills and age appropriateness. Materials are Easy Read and can be adapted for individuals with a learning disability if required. Materials have been translated to many languages and staff have access to Interpreting services (Interpreting protocols shared with all services)and translation services. 2.14 Rural Areas X The service is delivered within the clients accommodation therefore should have no differential impact. 2.15 Staff Working conditions Knowledge, skills and learning required Location Any other relevant factors x Staff are aware of Working from home policy and Lone working policy. Risks assessments have been completed for working off site in hotel accommodation Staff are aware of NHS Lanarkshire’s mandatory training requirements, staff aware of NES modules in relation to trauma, bespoke training has been arranged in relation to trauma informed practice, Gender based violence, understanding trafficking and exploitation, Mears (Understanding Asylum process) training. Training needs analysis to be completed for relevant staff. Landing page in development for Firstport 2.16. What is the socio-economic impact of this policy / service change? (The Fairer Scotland Duty places responsibility on Health Boards to actively consider how they can reduce inequalities of outcomes caused by socio-economic disadvantage when making strategic decisions)
Page 93
38 Positive Adverse Neutral Rationale/Evidence Low income / poverty X There should be no differential impact on low income / poverty as the service is accessible and appropriate for people from socioeconomic backgrounds. Living in deprived areas X There should be no differential impact on living in deprived areas Living in deprived communities of interest X There should be no differential impact on living in deprived communities of interest. Employment (paid or unpaid) X There should be no differential impact on employment. SECTION THREE CROSSCUTTING ISSUES What impact will the proposal have on lifestyles? For example, will the changes affect: Positive impact Adverse impact No impact Reason or comment for impact rating 3.1 Diet and nutrition? x Diet, nutrition and lifestyle is discussed as part of the Health Needs Assessment offered to all new arrivals to Lanarkshire. The staff take into account the different foods that people eat and the advice will relate to their diet. 3.2 Exercise and physical activity? X Exercise and physical activity is discussed is discussed as part of the Health Needs Assessment offered to all new arrivals to Lanarkshire
Page 94
39 3.3 Substance use: tobacco, alcohol or drugs? X As part of an individualised health needs and assessment and the offer of clinical triage , information is shared and a direct referral can be made to Quit Your Way (NHS Lanarkshire Stop Smoking Service). Some of the arrivals have came from areas with high prevalence of smokers. The service has translated, materials that have been shared with the team. Alcohol brief interventions are offered to all new arrivals and any history of drug taking is recorded as part of health assessment and onward referral to addiction services if appropriate. 3.4 Risk taking behaviour? X Discussed part of the Health Needs Assessment offered to all new arrivals to Lanarkshire, referral pathways have been compiled for direct referral to sexual health services, mental health services and blood borne virus service. BBV training has been attended by all team members. BBV is risk assessed and screening has been offered to our asylum population. SECTION FOUR CROSSCUTTING ISSUES Will the proposal have an impact on the physical environment? For example, will there be impacts on: Positive impact Adverse impact No impact Reason or comment for impact rating 4.1 Living conditions? X This service should have a positive impact on an individual’s living conditions. Any reasonable adjustments to properties will be considered of required.
Page 95
40 4.2 Working conditions? X There should be no impact on working conditions for refugees. Asylum seekers are unable to work within the first year of seeking asylum and require to apply for work visa after this time. 4.3 Pollution or climate change? X The service is delivered to the interim accommodation therefore should have no negative impact on pollution or climate change. Will the proposal affect access to and experience of services? For example: Positive impact Adverse impact No impact Reason or comment for impact rating Health care X The development of a health care resettlement team aims to provide effective, efficient and safe access to all refugees and asylum seekers. Social Services X The service should have no negative impact on Social services in fact and should be positive due the multiagency working and decision making. Education X The service should have no negative impact on Education and should be positive due the multiagency working. Transport X Not currently applicable as the service is provided on one site. Housing X The service should have no negative impact on Housing and should be positive due to involvement from all agencies. SECTION FIVE MONITORING How will the outcomes be monitored?
Page 96
41 Regular reporting Service evaluation Feedback from service users Population Health Needs Assessment What monitoring arrangements are in place? Morse, SIRS Who will monitor? Strategic Oversight Group Operational Group will report directly to the Strategic Oversight Group What criteria will you use to measure progress towards the outcomes? A high level plan based on the New Scot Strategy has been developed and has a range of proposed measures and objectives for the service and the oversight group will monitor the progress of the outcomes. PUBLICATION Public bodies covered by equalities legislation must be able to show that they have paid due regard to meeting the Public Sector Equality Duty (PSED). This should be set out clearly and accessibly, and signed off by an appropriate member of the organisation. Once completed, send this completed EQIA to the Equality & Diversity Manager
Page 97
42 Authorised by Title Signature Date Appendi x 3: Form C Identified Negative Impact Assessment Action Plan Name of EQIA: Date Issue Action Required Lead (Name, title, and contact details) Timescale Resource Implications Comments Further Notes:
Page 98
43 Signed: Date:
Page 99
1 REPORT Item No: 8 SUBJECT: Care Home Support TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Trudi Marshall, Nurse Director, Health & Social Care North Lanarkshire Author(s) of Report Sharon Murray, Associate Nurse Director DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: To update members on the progress on the support provided to care homes across Lanarkshire. For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This report was prepared by Sharon Murray, Associate Director of Nursing who is leading on the Care Home Support team across Lanarkshire. The report has been reviewed by North Lanarkshire HSCP CORE Management Team. This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐
Page 100
2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Consider the professional oversight and clinical leadership that is provided to the care home sector. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND/SUMMARY OF KEY ISSUES Following communication from the Cabinet Secretary on 17th May 2020 there were additional requirements for the Executive Director of Nursing, Midwifery and Allied Health Professionals within NHS Lanarkshire (NMAHP) which included: Providing professional oversight and clinical leadership and support ensuring health needs of care home residents are met. Outbreak management Oversight of testing and review of test results, and supporting the development and implementation of a range of testing approaches for care homes. Conduct assurance visits and monitor information trends from safety huddle providing professional and clinical advice on provision of health care needs. Support compliance with IPC whilst monitoring trends and escalations via safety huddle. Support education and training in care homes in IPC measures. There are 86 care homes across Lanarkshire, 28 within North Lanarkshire and 58 within South Lanarkshire. There are approximately 3600 residents and 3200 staff working with in the care home sector. In 2021-22, My Health, My Care, My Home (Healthcare Framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for adults living in care homes across Scotland. The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes. Yes ☐ No ☒ N/A ☐
Page 101
3 The framework’s recommendations highlighted a need for a strong partnership approach, recognising the knowledge and experience of care home staff. This was reinforced by the letter received in March 2023 which outlined the new arrangements for Enhanced Clinical and Care Support for Care Homes describing the role of the Executive Nurse Director in supporting the implementation of the framework in alignment with Excellence of Care, HIS IPC standards/IPC national requirements and the National Care Home Contract. To ensure a collaborative approach with implementation of the Healthcare Framework an engagement session took place in April 23 with all key stakeholders including care home staff, care home managers, care home providers, Care Inspectorate, Scottish Care, Health, Social Work and Social Care Staff. 5.2 Objectives and Process Work collaboratively with care home sector to develop internal assurance processes in the context of Excellence in Care, including IPC standards and embedding the National Infection Prevention and Control Manual. Develop collaborative improvement models across sector. Review and develop support to care homes to improve health and wellbeing of adults living in care homes through implementation of My Health, My Care, My Home – healthcare framework for adults living in care homes and Health and Social Care Standards in Scotland. Support development and review of clinical protocols and pathway Work in Collaboration with other professionals & multi agencies to ensure optimum support & timely access to healthcare services.
Page 102
4 To achieve the objectives a Project Plan was developed and agreed with key stakeholders. Short Life Working Groups (SLWGs) were established covering all six core elements: o Nurturing Environment o Multi-Disciplinary Team (MDT) o Prevention o Anticipatory and Future Care Planning o Palliative and End of Life Care o Urgent and Emergency Care The Short Life Working Groups meet monthly and have undertaken a self-assessment to identify and prioritise actions that can be taken forward by all partners to support the implementation of the framework. These arrangements are in addition to the support and governance provided by the Chief Social Work Officer (CSWO), through the Adult Social Work team who lead on Adult Support and Protection and the Quality Assurance team, who oversee all aspects of contract monitoring in relation to the NCHC. Overall governance is provided by the Care Home Assurance & Support Board that meets quarterly. 5.3 Current Progress Lanarkshire HSCPs have already began evolving their arrangements in collaboration with care homes, focusing on improvement, sustainability and viability, considering the learning and experience of the pandemic and the strong, positive relationships built between our local partners and the care home staff, residents and their families. 5.3.2 Nurturing Environment Much progress has been made with recognising and valuing the important role care home staff have in improving the health and wellbeing of residents. The collaborative visit programme undertaken by the HSCP were seen by many care home staff as similar to an inspection and lacking the support it was designed to offer. Since its completion there has been a shift from “doing to” to “doing with” and new initiatives such as the MDT and Hand Hygiene Improvement projects have been built using a collaborative approach. There have been improvements in encouraging and listening to feedback. An example of this has been in working together to address the needs of care home staff training, which resulted in the development of the recently completed 6-month training programme. The newly appointed Practice Development Educator for care homes is currently engaging with staff to collaboratively develop the next programme based on the care homes identified needs and the HSCP’s priorities. This includes enabling routes for care home staff to access planned NHS training has begun.
Page 103
5 5.3.3 Multi- Disciplinary Team In February 2022, NHS Lanarkshire began a Care Home MDT pilot. Initially staff working in the care homes and GP practices identified patients new to living in the care home who were deteriorating or had complex needs. The care home liaison nurse and pharmacist reviewed the patient in collaboration with care home staff, completing a comprehensive geriatric assessment, accessing GP records and clinical portal with support as required from a Care of the Elderly Consultant. They also reviewed the individual’s assessments and care plans to produce a summary for the MDT to consider. As of September 2023, this has resulted in 40% of residents reviewed having one or more medications that are linked to increased falls risk stopped. In June 2023 the pilot began to roll out to all new residents admitted to care homes in three localities. The MDT has continued to work collaboratively with the care home staff, assisting with care planning and introducing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). The team have now joined up with Social Work to attend the residents’ 4–6-week review in the care home. The MDT work is currently working across 22 care homes in Lanarkshire, the current process will be evaluated and then further roll out as agreed with Social Work. General Practitioners are an important part of the MDT, and the framework highlighted the benefits of close relationships between individual GP practices and care homes. The framework highlighted that care home staff can encounter difficulties when working with several different GP practices, as they each have different ways for requesting advice, visits, and prescriptions. ‘Local enhanced services’ (LES) in relation to care homes provide additional funding to supplement services already offered within the core GP contract. In Lanarkshire where a LES has helped to align most care homes with a specific GP practice. 78% of care homes in Lanarkshire are currently linked with a single GP practice, providing care for all the people living in the care home; and only 11% of Lanarkshire care homes are required to engage with 3 or more different GP practices. This compares with the national figures of 45% and 36% respectively. 5.3. 4 Prevention There has been good uptake of COVID-19 and other vaccines by care homes; however, the SLWG identified that care home residents are often missed from public health screening programmes such as bowel and breast. Access to these programmes as appropriate to the individual must be available. Likewise, the group highlighted that routine hearing, sight and hearing reviews are not always being carried out the extent of this is not known. Social Work teams are now ensuring that these are being completed when carrying out reviews. The application of IPC standards in care homes is being well supported. The dedicated IPC team is available for advice, education and guidance. IPC are working with the
Page 104
6 care homes to promote and embed the NIPCM and have commenced on coproduced work to improve hand hygiene. Lack of care plan reviews were a recurrent theme highlighted by the collaborative visit programme and Care Inspectorate visits. There is ongoing training sessions for all Care home staff with Social Work Quality Assurance maintaining an overview as part of the NCHC monitoring arrangements. Care plans and risk assessment tools are not standardised with each home/ care home group choosing the care records that suit them best. The MDT approach will however support the contents of care plans to be reflective of the individuals care needs taking into account health needs, which is often a role that carers complete. The support from CHL will therefore ensure the best start for residents entering care homes ensuring a more comprehensive proactive, preventative approach. Progress is being made with ensuring proactive approaches in many other areas, for example continence with the relaunch of continence bundles, to promote continence and with promotion and training in the Swallowing Matters guidance by Speech and Language therapists4Prevention. 5.3.5 Anticipatory and Future Care Planning The framework advocates that all residents should have the opportunity to develop an ACP using a robust approach such as ReSPECT. The Collaborative visits, CI and audits completed by the team all highlighted that not all residents have meaningful ACPs in place, there is a lack of a standardised approach to documenting them and ACP information is not always shared with GPs to be added to eKIS. The SLWG group highlighted that care home staff are not equipped with appropriate ACP communication training to support having these often-difficult conversations nor made aware of their importance. There is therefore a need to raise awareness of ACP’s and to provide education and training for care home staff. A training package is currently being developed by palliative care consultants and the Care Home Practice Development Educator. 5.3.6 Palliative and End of Life Care This group found that care homes were not aware of nor were they using LPCAT or RELIC as tools to aid resident’s palliative/ end of life care needs. DNs provide the documents; however, there is a need to promote these tools and to provide training to support their use as recommended by the framework. Project ECHO has been endorsed as a means of working together to explore shared learning and peer support. A trial of the project is being planned for August 2023 involving 6 care homes across Lanarkshire.
Page 105
7 5.3.7 Urgent and Emergency Care Practice development have agreed to prioritise the deteriorating patient and the Practice Development Educator is to conduct a training needs assessment to establish the number of staff trained in vital sign observations. These tools are needed to support and empower care home staff as it is often carers who escalate concerns. The Flow Navigation Centre (FNC) appropriately refer care home residents to Hospital at Home from 09:00hrs- 17:00hrs. This approach has successfully supported care home residents to remain in the care homes. These hours will be extended over the next few months. To reduce hospital waiting times for residents requiring non-emergency radiology tests a Radiology pathway has been developed to allow direct access to care home residents. Poor discharge communication has led to DATIX regarding pressure ulcers, medication issues, lack of dressings and poor palliative care provisions. A transfer of care document has therefore been developed in collaboration with the care homes, hospital staff and CHL to address these issues. Discussions have taken place to scope the possibility of an electronic version however to date engagement with the document has been poor. 6. CONCLUSIONS This report provides an update to IJB committee members on work underway as part of the Care Home Support team in Lanarkshire. It highlights some of the complexities to the review and also some of the innovative approached being taken. Social Work staff and the Scottish Care Independent sector leads, commissioned by the HSCPs, continue to work closely with the Care Home Support team to ensure that there is a joined-up approach that promotes good outcomes for people. 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 ☒
Page 106
8 Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Associated measures include: ED attendances Emergency admissions Re-admissions Improved assessment/planning outcomes Co design evidence People dying in place of choice 7.3 FINANCIAL Any financial impact will be highlighted at the end of the review 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 Medium 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.
Page 107
9 Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Ongoing engagement with sector. Further engagement session scheduled February 24 ☒ Provide stakeholders with information on how to get involved As above ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ 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 Communication strategy will ensure regular feedback. ☐ 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 No N/A
Page 108
10 8. BACKGROUND PAPERS None. 9. APPENDICES None. Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact the following; Trudi Marshall, Nurse Director Trudi.Marshall@lanarkshire.scot.nhs.uk
Page 109
11 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
Page 110
12
Page 111
REPORT Item No: 9 SUBJECT: Community Nursing Review TO: Integration Joint Board Performance Finance & Audit Committee Lead Officer for Report: Trudi Marshall, Nurse Director, Health & Social Care North Lanarkshire Author(s) of Report Sharon Murray, Associate Nurse Director DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: To update members on progress of Community Nursing Review For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This report was prepared by Sharon Murray, Associate Director of Nursing who is leading the community nursing review. The report has been reviewed by Community Nursing Review Programme Board and Strategic Commissioning Plan Board. This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐
Page 112
2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Consider progress of Community Nursing review 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Community Nursing is a planned service that is delivered in all six localities and provides nursing care to people that cannot leave their homes to access nursing care within health centres. It provides this service to all age ranges and people can have a one off intervention or be on caseloads for a significant period of time. Anyone can refer into community nursing services including patients and carers. It operates over 7 days between the hours of 8 am and 10 pm. There is a separate overnight nursing service which operates between 10 pm and 7 am which predominately provides palliative care pain relief and unscheduled care. There is currently 320 staff (234.84 whole time equivalent) working with in this service providing assessment care and treatment to approximately 3,700 people. This service was last reviewed in 2006 therefore a review of community nursing within North Lanarkshire HSCP was commissioned by Nurse Director, Health & Social Care North Lanarkshire on 20 August 2023 with the aim to develop a model which meets the needs of our changing demographics and also to support improved workforce planning with clear career progression pathways. Demand for our health and social care services is ever increasing as people live longer but are often now living with multiple long term conditions and increasingly complex needs for health care and social support. The COVID-19 pandemic came at a time when there had already been a stalling in life expectancy and a widening of inequalities. The pandemic has compounded pre- existing health inequalities with evidence showing that COVID-19 has had greater direct and indirect effects on people living in more deprived localities and those who are most vulnerable. The impact of the Covid-19 pandemic has been a strong Yes ☐ No ☒ N/A ☐
Page 113
3 reminder that health and wellbeing outcomes are influenced by wider determinants in terms of the life circumstances and opportunities and fundamentally the control people have over their lives. Health inequalities are driven by wider socioeconomic determinants such as poverty, employment, education and place thus actions that can be taken to positively influence these wider determinants through maximising our role as an inclusive anchor organisation will support our overarching ambition to reduce health inequalities. The community nursing review will ensure the following: service develops to meet the needs of the local population, demography and economy be appropriate and responsive to the changing needs of patients, be proactive (not reactive), anticipate need and prevent illness be at the centre of the delivery of coordinated joint service 5.2 Objectives and Process Develop a Vision for Community Nursing in Lanarkshire. Map demography, local need and current service provision Develop a stakeholder engagement to ensure that we engage the community, staff and service users Develop a revised clinical model To develop a workforce plan – utilising the 6-step methodology of workforce planning To develop a training and development plan to support the new staffing model Review Governance for Community Nursing Implement recommendations of review and monitor impact on patient outcomes To achieve the objectives a Project Plan was developed and agreed with key stakeholders. Short Life Working Groups (SLWGs) were established covering o Vision & Model o Caseload Complexity o Care Management & Referral Criteria, o Roles, Responsibilities and Training o Boundaries The Short Life Working Groups meet fortnightly and provide Flash Reports on progress 4 weekly. Overall governance Is provided by the CNR Project Board which meets 12 weekly.
Page 114
4 5.3 Current Progress 5.3.1 Vision & Model. There have been engagement sessions with community nursing staff and feedback requested from service users and GP’s. This has shaped the vision: Our population is changing, it’s growing in diversity and people are living longer. Our services therefore need to be equipped to care for the increasingly complex health and social care needs which are a result of poorer health in older age. Our vision is to transform Community Nursing to ensure it is appropriate and responsive to meet patient’s future care needs. (Appendix 1) This includes a shift from what is often a reactive to a more proactive, preventative approach. It involves working with patients, unpaid carers, families and other agencies, as necessary, with a focus on; direct nursing care, health promotion and education, future care planning and supporting self-care for patients or for those who look after them.’ At the stakeholder’s session staff recruitment and shift pattern was a recurring challenge raised. A review of the service needs which includes evening and overnight nursing demand, against current staffing has been agreed and is being supported by the workforce team. A feedback event has been scheduled during February 24 to provide feedback to all key stakeholders around the future vision of community nursing. A communication strategy has been developed (Appendix 2). 5.3.2 Caseload Complexity Work is underway with the teams to develop a consistent approach as to how we measure and describe complexity of cases within a caseload. A number of audits have now been undertaken to help understand how our current complexity tools are
Page 115
5 being used and assess their reliability and sensitivity in action. This is essential in allowing us to be able to describe and monitor demand in the future. This work has identified that there is care being provided by registered nursing staff that in other areas in Scotland is now being facilitated by other members of the health and social care team with appropriate training. Work is now underway to explore the potential for this in North Lanarkshire. This would require facilitation of education sessions, relationship building and robust communication across the Health and Social Care partnership. Safe staffing levels in nursing is currently monitored daily via real time risk assessment tool known as PRAG (Purple, Red, Amber, Green). This tool records the professional judgement of staff in relation to the complexity and volume of care to be delivered against staff available to provide this care however, this can be subjective at times and not applied consistently across all teams. Work to align the complexity tool and PRAG whilst also adding more objectivity is underway and being tested. 5.3.3 Care Management & Referral criteria. Care Management was introduced to community nursing teams in xxxx. This is where people have high complexity of needs requiring a more senior nurse to be allocated to the case and take the role of lead professional. This is often those with complex palliative care needs or fluctuating needs with high risk of hospital admission. It has been agreed that following approval of the vision the care management approach will be reviewed to ensure that we are able to respond to rising unscheduled complex demand, altering frailty levels and requirements for coordinated locality response. The introduction of a single point of access for patients, carers and professionals would ensure that patients are assessed and signposted to the most appropriate service to meet their individual needs in a timeous manner, allowing for prioritising of care and reducing waste visits. Right care, at the right time, by the right people, in the right place. This would provide an opportunity to discuss planned care and to attend discharge planning meetings in cases when complex health needs are identified or specialised equipment, i.e. hoists or mattresses are needed therefore when these referrals are highlighted this can be timely captured and dates put into diaries for the nurses to attend these meetings. Having a single point of access for all, which is consistent and efficient to support early access will allow for prioritisation and appropriateness of referrals which will free up clinical staff to see more face to face patients. This will allow patients and carers easier access to Community Nursing teams and improve the patient journey. A test of this model commenced on 15/01/24 within Houldsworth Health Centre and take calls for Wishaw, Motherwell and Bellshill
Page 116
6 5.3.4 Roles, Responsibilities and Training Within community nursing teams there is a specific role related to District Nurses (DN) that required staff to leave their role and undertake a 1 year course at university that would allow a separate registration onto the nursing and midwifery register. A number of years ago it was identified that this was creating a bottle neck in staff development with significant unfilled DN post. An internal DN trainee pathway was developed and has been successfully supporting the training and registration of staff. A review of this training pathway to ensure it reflects the new NES Nursing Midwifery Allied Health Professional (NMAHP) Competency Framework and Queens Nurse Institute Scotland (QNIS) standards. Over recent years the number of Newly Qualified Nurses (NQN) joining the teams has gradually increased. A welcome Induction pack for new staff has been developed that will be tested with newly qualified practitioners in November 23. This will be evaluated on an ongoing basis. 5.3.5 Boundary Work It is recognised that we have seen demographic shifts and profile changes within our localities over recent years. It has been recognised that this means workforce numbers and skill mix originally allocated to localities may now not meet demand. Work has commenced with Lanarkshire Principal Information Analyst to review how we could develop a resource allocation tool based on demographics rather than geographical boundaries to allocate workforce and resources. 6. CONCLUSIONS This report provides an update to IJB committee members on work underway as part of the community nursing review in North Lanarkshire . It highlights some of the complexities to the review and also some of the innovative approached being taken. 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 ☒
Page 117
7 Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Associated measures include: A&E attendances Unscheduled bed days Delayed discharges Emergency admissions Re-admissions Improved assessment/planning outcomes Co design evidence People dying in place of choice 7.3 FINANCIAL Any financial impact will be highlighted at the end of the review 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 Project Risk Register There is a risk that due to current service demands staff are unable to participate fully in the review Medium Sharon Murray
Page 118
8 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 Questionnaires to stakeholders – GPs/Service users – June- August 2023 ☒ Provide stakeholders with information on how to get involved As above ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ 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 Report from Stakeholder Event 30.8.23 Feedback event arranged for February 2024 ☐ 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 No N/A
Page 119
9 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 Community Nursing Vision Model Appendix 2 Communication Matrix Stakeholder CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact the following; Trudi Marshall, Nurse Director
Page 120
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
Page 121
11 Appendix 1 North Lanarkshire Community Nursing Review Vision and Model Our new Vision and Model has been created through stakeholder engagement and sets out the areas we will focus on over the coming years to ensure the service meets the needs of North Lanarkshire’s population. We will see a shift in focus to ensure an appropriate and responsive service for patients that is proactive, anticipates need and prevents illness. We will do this by supporting the development of our nursing staff to ensure patients receive the right care, at the right time, by the right people, in the right place. Our vision is in line with Getting It Right for Everyone (GIRFE) a multi-agency approach to health and social care support and services from young adulthood to end of life care. It recommends working collaboratively to shape the design and delivery of services, ensuring that people’s needs are met. GIRFE is about providing a more personalised way to access help and support when it is needed. It aims to place the person at the centre of all the decision making that affects them, with a joined-up consistent approach regardless of the support needed at any stage of life.
Page 122
12 Right Care Know your population To ensure we can provide the right care and allocate resources effectively it is important that we understand the profiles of our localities, long term condition and frailty prevalence. This will highlight key areas where we need to increase our health promotion and education efforts. Capacity mapping of services, including those in the third sector will be used to support patients and reduce reliance of NHS and Social Care. Caseload profiling to measure and manage the increasingly complex community nursing caseloads will also be completed at set regular intervals to ensure capacity and capability within the teams to ensure appropriate skill mix and experience to support safe patient care and staffing. Complexity level descriptors have been developed in line with the National Workload Tool. A PRAG Matrix tool has also been devised and will be rolled out to support assessment of safe staffing and decision making and give clear guidance and an escalation process in preparation for the implementation of the Scottish Government’s Health and Care (staffing) Act 2019. Care/case management- we will review the care/case management process and will develop a system to proactively identify patients with complex needs and frailty. The new system will enable District Nurses to work collaboratively with patients and their
Page 123
13 carers to enable them to live their best lives at home. This will include future care planning, admission avoidance and will support a speedy discharge from hospital. We will promote a change in terminology from discharge to transfer of care and work with our acute colleagues to improve relationships and communication to facilitate this. Developing care/case management will also be about expanding nurse led services in the community with District Nurses and Advanced Nurse Practitioners leading fully or in specific aspects of care which were traditionally overseen by General Practitioners. Person centred The Nursing 2030 Vision calls for personalised care planning by working in partnership with patients, finding out what matters to them, giving them all the information they need and choices as appropriate in order to make decisions that are right for them as an individual. Whilst the stakeholder event showed nurses are providing a level of person centred care we want to expand this and improve our clinical records to provide evidence of this approach. Holistic Care will not just be focused on the initial intervention required but on wider physical, social and psychological needs. Community Nurses will identify the key factors contributing to patient’s immediate acute problem/illness and work collaboratively to reduce risk and prevent issues reoccurring in the future. We will support self-care, where appropriate using an asset based approach. Community Nurses will support people to recognise and develop their own strengths and abilities to enable them to live as independent and fulfilling a life as possible. Realistic Future Care Planning, is the process of documenting the preferred actions, interventions and responses that need to happen if a patient becomes unwell. We will introduce ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) discussions with patients around Future Care Planning to ensure their wishes are visible to heath care professionals should an emergency situation occur where they are unable to make decisions as recommended by the Chief Nursing Officers letter issued September 2023. Evidence based An audit of leg ulcer management highlighted that best practice using evidence based guidelines were not always being followed. An assurance process is now in place however we know there are other areas where these are needing developed. We have prioritised this in order to ensure our service is safe, effective and person centred by continuously monitoring the quality of care, listening to feedback and learning from adverse events in line with Excellence in Care. Right time
Page 124
14 Referral Criteria Community Nurses take referrals both in and out of hours from a number of sources; GPs, Treatment Rooms, hospital, Social Work, self-referrals and other health care professionals with no agreed set process in place. Referrals can be over the phone or written but nurses have highlighted the quality is often poor and lacking the key information required. This can result in delays in care and patient safety issues. Indeed, between January and September 2023 there were 168 DATIX submitted related to discharge issues. There are also various referral forms being used which also vary in quality. We will work with all stakeholders to make improvements in the referral process to ensure patient’s care is safe, effective, person centred. Single point of access/ Triage The stakeholder engagement highlighted a need for a single point of access and Triage system to be developed. This would ensure that patients are reviewed to assess patients and navigate care to the most appropriate service/environment to meet their individual needs, in a timeously manner, prioritising care and reducing waste visits. Seamless care delivery Community nursing is a 24 hour 7 day a week service however there is a reduction in staffing at the weekend which means only patients who require daily visits i.e. patients requiring daily dressings, injections or those with end of life care needs are seen. This often puts pressure on other days of the week especially Monday and Fridays. It also means that care provided needs to fit round the reduced service which is not always in the best interest of the patient. We will therefore develop the service to better fit around the needs of the patient. Flexibility in patient visit scheduling Flexibility in the scheduling of visits to suit individual patients needs also needs to be more formalised, with the date and approximate time of visits being discussed and agreed in advance, as well as updates being given when a visit is delayed or deferred. This is essential to enable social connections/networks and reduce stress created by unpredictable appointments. Lack of planning, discussion and agreement has been shown to have negative impact on patients which can effect; when they eat, drink and even go to the toilet. We will improve our approach to scheduling patient visits to ensure a more person centred approach. Technology Technology is rapidly changing the way people live, work and interact. Telehealth systems for example, Near Me, were used very successfully during the COVID-19 pandemic with many services continuing to use it to support patient care. Whilst not a replacement for direct patient care it can be used to support self and shared care with other services. Agile working also has many benefits for patients and community nurses it improves clinical record keeping, makes better use of resources, improving efficiency and
Page 125
15 empowering staff to organise their workload. Whilst systems are in place to support agile working for Community Nurses it is not widely used. The use of near me, agile working and other forms of technology will be encouraged and supported to improve the efficiency of our nurses and support person centred care. Right People Values NHS Scotland’s core values are at the heart of Community Nursing in North Lanarkshire. We have developed professional and clinical assurance and governance structures to ensure all patients receive care with compassion, dignity and respect, promoting openness, honesty and responsibility through high quality and teamwork. We will continue to support quality improvements and monitor progress to ensure our values are being upheld in practice. Continuity Knowing your patients is a key factor to support patient care in the home. Having the same or a few nurses not only helps build confidence and trust but helps monitor progress, recognises deterioration quicker and enables more effective communication. Patients become frustrated when they have to repeat information to numerous healthcare professionals. The Overnight Nursing Service is currently hosted in the Adult Unit which is out with the Community Nursing Teams. As a result, the team cover a large geographical area which is not ideal as continuity of care is difficult to achieve. A formalised locality/sector based, rotational service will be scoped to enable better communication, allow for staff development and support and provide a less fragmented approach to care. Flexibility in work pattern During the stakeholder engagement some staff highlighted the need for more flexible working, with the lack of 12 hour shifts being cited as a barrier for some nurses choosing Community Nursing as a career option. However, any change in shift pattern needs also to align with patient care needs. Furthermore, it would require a change in working practice as the majority of patient visits are carried out in the morning and late afternoon. A more flexible approach however, may be possible and different start times as well as lengths of shifts will be explored to assist with recruiting and retaining staff. Role development As the balance of care shifts even further to community we are preparing for the future care needs of our population in the backdrop of ongoing challenges in recruiting and retaining registered nurses. Our response to this will involve reviewing roles and responsibilities. Work has begun in developing the Assistant Practitioner, Band 4 role. This will not only provide patient care but support career development
Page 126
16 for Healthcare Support Workers and create a pathway to becoming a registered nurse for those who aspire to this. We also created a Lanarkshire District Nurse Trainee framework that has enabled us to work towards quickly filling the large deficit in District Nurses due to chronic under investment. This has not been without challenges however with staff leaving prior to completing the framework and staff moving to work in GP practices or other areas once qualified. A focused piece of work has therefore been completed to understand why staff are leaving with exit interviews being conducted by the Senior Nurse. We will use the recommendations developed from these to make improvements in order to support completion and retention. Going forward we will monitor all grades and roles of staff, ensuring succession planning to prevent similar situations occurring in the future. For the past 5 years all Trainee District Nurses have been completing non-medical prescribing (V300) qualification, however on qualifying there is a wide variance in their prescribing practice. We will work to reduce this by supporting the development of V300 prescribers in areas that patients will benefit most and provide assurance through fully imbedding the Non-Medical Prescribing Governance Framework in practice. Induction and training We will develop a role specific; comprehensive induction, competency framework and bespoke training programmes for all levels of Community Nurses. This will reduce variation and ensure that not only District Nurses and Advanced Nurse Practitioners but all staff are supported and equipped with the knowledge and skills required to provide high quality care. This will also enable the review of roles and responsibilities to benchmark against Transforming Roles. Leadership Team Leaders having clarity of the Community Nursing Vision as well as in their roles and responsibilities is essential to ensure effective leadership. We will support team Leaders to develop their leadership skills by creating a bespoke competency framework, training and induction for them, as mentioned above. We need to invest in our team leaders and promote compassionate leadership. Effective leadership is a key factor in the quality of care and will be vital in initiating and sustaining the changes required by our new model of nursing. Voluntary services We will develop ways for nurses to build relationships and work closer with voluntary services. This will help ensure the available supports are accessed for patients and carers. Whilst this can help promote wellbeing and independence it also has a part to play in supporting staff by freeing up their time to prioritise clinical care as some patients may not require ongoing professional interventions. Wellbeing
Page 127
17 With an ageing workforce of nurses who will need to work longer before retirement it is important that we support staff to be healthier and fitter for longer. This will be done via a range of activities; embedding a robust supervision framework, having staff centred meaningful personal development plans, supporting sickness absence, ensuring equality and diversity, more flexible working and ensuring compassionate leadership are only a few examples. Ensuring a safety culture by introducing the use of safety culture cards to team meetings, encouraging staff to complete Psychological Safety and iMatter surveys and ensuring they are fully involved in the development of improvements plans identified by these tools are other areas we will promote. Right Place Integration Community Nurses play a pivotal role in shifting the balance of care from hospital to community, however we recognise that improvements could be made therefore we will create the right conditions to work collaboratively and integrate further with social care, voluntary workers and carers. To do this effectively for the benefit of our patients we need to have a better understanding of each other’s roles and break down barriers that are preventing effective, person centred care. Advanced Nurse Practitioners Advanced Nurse Practitioners are being introduced into Community Nursing Teams, this autonomous role will develop over time to support teams to care for patients with acute illness and those with long term conditions who are deteriorating, by developing care plans to enable them to be cared for safely at home. This will also include improved integrated working between Community Nurses and Hospital at Home in order to manage patients more effectively. Early recognition of deterioration and earlier referral to Hospital at Home will lead to earlier diagnosis and improved outcomes for patients. We will also develop our Community Nurses to administer Intravenous Antibiotics in the community to reduce hospital stay and the risks associated with being in hospital for those patients deemed suitable. Treatment Room A caseload cleansing exercise was carried out in one of the teams which highlighted Community Nurses were seeing some patients who were suitable for their care to transfer to the Treatment Room. There is therefore a need to educate staff on better use of the treatment rooms and on having early discussions with patients during the first visit to highlight that their care will be transferred to a Treatment Room once/if they are assessed as suitable. The cleansing exercise also showed there were other patients who were not housebound and where Treatment Rooms would offer more flexibility of appointments however the Treatment Room did not carry out the
Page 128
18 interventions required. An example of this was stable, routine urinary catheter insertion. Furthermore, there are patients who are seen at weekends by Community Nurses as there are no Treatment Room facilities available out of hours. This leads to a lack of continuity of care with patients who are not housebound having to wait in for a visit. This can also result in patients having to take time off from their work. Right Care- Right Time- Right People- Right Place Community Nursing in North Lanarkshire needs to evolve, our new Vision and Model will ensure the service meets the challenges of increasing demand and complexity of patients. It will equip our nursing staff with the appropriate knowledge and skills to provide safe, effective, person centred care.
Page 129
19 Appendix 2 Author Dawn Currie Contact Details Owner Sharon Simpson/Caroline Martin Version Control Insert additional details of the document below Date 9.11.23 Document No. 1.0 Document Status Strategic Alignment Communication Matrix & Stakeholder Engagement Community Nursing Review PM0 5
Page 130
20 Version Control History Version Date Version Number Summary of Changes Author 0.1 Draft for comment & Review Dawn Currie 1. Overview As we embark on a review of Community Nursing in North Lanarkshire, we aim to ensure effective communication and stakeholder engagement throughout the process, this paper highlights how we will achieve this. The Community Nursing Service was last reviewed in 2006. There have been significant changes in the population of North Lanarkshire and their health and social care needs over this period. A review has therefore been commissioned to modernise the service and ensure it meets the current and future needs of our increasingly complex patients. The Covid19 pandemic came at a time when there had already been a stalling in life expectancy and a widening of inequalities. The pandemic has compounded pre- existing health inequalities with evidence showing that Covid-19 has had greater direct and indirect effects on people living in more deprived localities and those who are most vulnerable. The impact of the Covid-19 pandemic has been a strong reminder that health and wellbeing outcomes are influenced by wider determinants in terms of the life circumstances and opportunities and fundamentally the control people have over their lives. Lanarkshire’s predicted changes are highlighted in the table below;
Page 131
21 Health inequalities are driven by wider socioeconomic determinants such as poverty, employment, education and place thus actions that can be taken to positively influence these wider determinants through maximising our role as an inclusive anchor organisation will support our overarching ambition to reduce health inequalities. 1.2 Aims: We will review the current service to ensure the following service evolves to meet the challenges of needs, demography and economy be appropriate and responsive to the changing needs of patients, be proactive (not reactive), anticipate need and prevent illness be at the centre of the delivery of coordinated joint services 1.3 Objectives To communicate a positive message about the project to all stakeholders. To raise awareness and impart information. To provide opportunities to address individual queries and concerns. To communicate a positive message to internal and external stakeholders about the project deliverables, and the importance to the ambitions of the council and the benefits it will assist in achieving. To keep all members of the project team up to date with the work taking place and address any queries, issues or concerns raised during any aspect of the project delivery. 1.4 Stakeholder Engagement Plan This programme consists of four Short Life Working Groups and an overarching Working Group, that have been established to work on the Community Nursing Review. During the initial stage the communications is concerned with the discovery phase of the work streams and communications will be co-ordinated at senior level. Once the discovery phase has been completed and scoping approved the work stream leads and the project manager will be responsible for developing communication activity with this being co-ordinated and approved by the Project Board. During the planning and delivery phase there are crucial changes to the involvement required from certain key parties and this is illustrated in the heat map at the end of this document. Our stakeholders are identified as those who have a vested interest in the project and business change/transformation activity that will occur during this project and have the influential power to affect the strategic future of Community Nursing. No stakeholders have been excluded and there will be opportunity to involve stakeholders throughout all activities and engagement performed by the work streams and project team.
Page 132
22 This activity also allows us to determine the right messages and the optimum time to engage with our stakeholder community and assists in our ability to carry out meaningful engagement without overloading the work stream teams or stakeholders. For the purpose of all phases of delivery we will focus on those identified in the key player quartile as these are the stakeholders that need to be involved and communicated with on a regular basis. At that point a more comprehensive refresh will take place and all stakeholders will have tailored engagement activity. This may of course change as the engagement activities commence in earnest and the activities will be under constant review. 1.5 Target Audiences Communication activity is considered from the perspective of several target audiences, both internal and external. These include, but are not limited to: Name (Individual / Group) Role (briefly describe role, function or responsibility of the individual or group) Impact of Project (briefly describe how the project / deliverables may impact the individual or group) Community Nursing Teams Staff and current roles impacted by the project. Require to be fully informed during all aspects of project delivery and clear communication regarding options available to them. Patient Representatives Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. Short Life Working Groups (SLWGs) Key staff leading related work streams. Awareness of other work streams and impact to overall delivery and timescales. Communications Teams Support the project going forward. Awareness of project progress and timelines. General Managers Staff and current roles impacted by the project. Require to be fully informed during all aspects of project delivery and clear communication regarding options available to them. General Practitioners Staff and current roles impacted by the project. Require to be fully informed during all aspects of project
Page 133
23 delivery and clear communication regarding options available to them. Service Managers Staff and current roles impacted by the project. Require to be fully informed during all aspects of project delivery and clear communication regarding options available to them. North Lanarkshire IJB Support the project, approve governance documentation and make decisions on issues escalated. Escalate issues to as required. Awareness of progress, risk and issues, decisions to be made. Allied Health Professionals Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. Acute Colleagues Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. Project Board Support the project, approve governance documentation and make decisions on issues escalated. Escalate issues to as required. Awareness of progress, risk and issues, decisions to be made. Senior Leadership Team Support the project going forward. Awareness of project progress and timelines. Social Work Colleagues (North) Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. South Partnership Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. Wider Organisation Full awareness of project deliverables and how they influence service delivery. Awareness of project progress, integration options and any other requirements for their services.
Page 134
24 Other Boards Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. Patients/Service Users Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required. General Stakeholders Awareness of project deliverables and understanding of outcomes. Ongoing communication and where required.
Page 135
25 1.6 Communications Matrix The following table identifies the communication requirements for this project. Audience Communication Type Objective of Communication Frequency Owner Community Nursing Teams Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Patient Representative Email/ Social media Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Short Life Working Groups Email- via flash reports Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Communications Team Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group General Managers Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group General Practitioners Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Service Managers Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group North Lanarkshire IJB Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group AHPs Email Update on progress and outcomes of Community Nursing Review As and when required CNR Working Group Acute colleagues Email Update on progress and outcomes of Community Nursing Review As and when required CNR Working Group
Page 136
26 Project Board Email or directly at Project Board meetings Update on progress and outcomes of Community Nursing Review 12 weekly CNR Working Group Senior Leadership Team Email or directly via SLT Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Social Work Colleagues (North) Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group South Partnership Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Wider Organisation Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Other Boards Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group Patients/Service Users Email/Social Media/Targeted Press coverage Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group General Stakeholders Email Update on progress and outcomes of Community Nursing Review as and when required CNR Working Group
Page 137
27 High Influence Low Influence Keep Satisfied (Inform) Patients/Service Users General Stakeholders Engage Closely (Inform/Engage) Community Nursing Patient Representatives Short-Life working Group Communications Teams General Managers General Practitioners Service Managers North Lanarkshire IJB Monitor (Inform) Other boards Wider Organisation Keep Informed (Inform) Allied Health Professionals Acute colleagues Project Board Senior Leadership Team Social Work colleagues South Partnership Low Interest High Interest
Page 138
1 REPORT Item No: 10 SUBJECT: Winter Resilience TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NLHSCP Author(s) of Report Ross McGuffie, Chief Officer NL HSCP DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐ The HSCP Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: (1) Note the progress made through Operation Flow and the impact so far over the winter period. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required Yes ☐ No ☒ N/A ☐
Page 139
2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Operation Flow commenced in early 2023, with a 9-day Firebreak taking place that reduced site occupancy by around 15% and supported NHS Lanarkshire to move from black to red status on 6th March 2023. 5.1.2 Since then, learning from this intervention has led to the Operation Flow 2 action plan and developments that commenced in summer 2023 with the aim of having the whole system better prepared for winter 23/24. 5.2 Operation Flow 2 – January Firebreak 5.2.1 One of the key areas of learning from Operation Flow has been the positive impact of targeted and intensive firebreaks. Early January is always a significant pressure point across the health and social care system following two four-day weekends, so a proactive Firebreak took place from Wednesday 3rd – Friday 12th January 2024. 5.2.2 The 3 acute sites and 2 HSCPs developed plans with a range of actions which included: • Increased Hospital @ Home capacity to reduce admission • Enhanced use of Hospital Assessment Team and Home First to support earlier discharges • Length of stay reviews of patients to support discharge planning • Increased use of discharge lounge • Additional on-call support • Enhanced medical cover and additional nursing staff • Senior staff supported Board Rounds • Maximised Senior Decision within the Flow Navigation Centre (FNC) to ensure patients access the most suitable treatment pathways and/or clinical advice 5.2.3 All non-essential meetings were stood down to free up members of the senior team to support flow enhancing activities across the whole system. 5.3 System Learning 5.3.1 Following the January firebreak, a learning review was undertaken, with a number of highlights noted: Structured, organised and robust processes Team working and MDT collaboration Timely discharge planning Real time solutions found for challenges Focus on patient safety and getting the right care in the right place at the right time Occupancy reduced Ward beat achievement improved Increased discharges Improved weekly performance
Page 140
3 Frailty team at front door – 25% avoided downstream moves 5.3.2 A number of challenges were also noted that require further exploration and development: Weekend Care Home discharges Reduced referrals and discharges during Christmas week Off-site bed purpose – need clear expectations with staff, patients and families Side room demand due to flu/covid impacting both 8hr and 12hr performance Referral rates, unplanned referrals and cancelled discharges remain high Admin capacity to keep Trak updated 5.4 Impact on site performance 5.4.1 While the January firebreak provided a comparative boost in performance from the previous year (4hr performance 62% for week ending 14th January), performance overall was still lower than before the Christmas period, with both 12hr waits and occupancy increased. 5.4.2 At week ending 14th January, site occupancy was 102%, up from 98% pre- Christmas. 5.43 While performance is not yet at the levels being aimed for, winter performance has been much more stable in 2023/24. When comparing daily performance from mid-December to mid-January 22/23 and the corresponding days in 23/24, performance was better in 23/24 in all but 6 instances (2 equal, 4 worse, 22 improved). 5.4.4 Comparative performance with neighbouring Boards highlights NHS Lanarkshire’s comparative improvements in ED performance from 2022/23 to 2023/24, though still significantly short of where we aspire to be.
Page 141
4 5.5 Delayed Discharge 5.5.1 Delayed Discharge performance has remained much more stable than in previous winter periods, with strong and consistent discharge rates of over 100 per week being maintained since October and throughout December and January. 5.5.2 While dips in both referrals for supported discharge and discharges from delay were noted in both the Christmas and New Year weeks, discharge performance recovered to normal levels on week beginning 8th January. 5.5.3 At 15th January, the national Delayed Discharge census shows the positive performance improvements: 5.5.4 Weekly management data highlights the much greater stability in delay numbers and the consistently high volume of discharges being supported. For context, during peak winter pressures in 2019/20, North Lanarkshire supported on average 77 supported discharges per week, but now consistently supports well beyond 100.
Page 142
5 5.6 Measures of Success 5.6.1 Revised governance arrangements have been established to support the operational delivery, underpinned by a robust performance management framework. 5.6.2 Flow Oversight Boards have been set up for each acute site, supported by representatives from the HSCPs and Scottish Ambulance Service. A joint HSCP Flow Oversight Board has also been established between the North and South HSCPs. 5.6.3 The key objective of each Flow Oversight Board will be to improve performance at a site/sector level, as set out in the Whole System Key Performance Indicators: Reducing Demand by redirection and streaming of patients via REACT Reduce Admission Conversion to <25% Reduce Occupancy <95% Reduce LOS in Wards Improve Daily Ward Beat > 90% Increase am Discharges > 40% Improve 4 Hour to >70% Reduce 12 Hour Waits > 10/day Reduce Delayed Discharges 5.7 Next Steps 5.7.1 A number of new posts commence in January 2024, completing the recruitment as planned for Operation Flow 2, supporting the full roll out of the new planned model.
Page 143
6 5.7.2 The new hospital site Flow Oversight Boards will support a whole system and integrated approach to full implementation of the plan and ongoing service improvement, particularly around the area of integrated discharge planning. 6. CONCLUSIONS 6.1 While winter has remained challenging and performance has still not recovered to where we aspire, there are some positive signs of improvement from last year. 6.2 Through Operation Flow, there is now a much deeper understanding of the how the system works as a whole, with collaborative structures in place to continue developments. The commencement of Site Flow Boards that bring the hospitals and HSCP sectors together is a particularly positive step towards supporting positive change. 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) 7.2.1 New whole system KPIs are currently under development, as outlined in 5.6.3. 7.3 FINANCIAL Any financial impact will be highlighted at the end of the review This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT
Page 144
7 Relevant Risk Register Details Current Risk Level Risk Owner IJB 17/22 Very High Chief Officer Risk IJB 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 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 Significant staff engagement through the Operation Flow process ☒ 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
Page 145
8 EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
Page 146
1 REPORT Item No:12 SUBJECT: Financial Monitoring Report 2023/2024 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 21st February 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the PFA Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period 1 April 2023 to 31 December 2023. 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) Acknowledge the projected outturn for 2023/24 is an underspend of £5.796m. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Head of Financial Solutions. The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in the following table, the IJB projected outturn position, prior to removal of ring-fenced funding, is an underspend of £5.796m, assuming the current trajectory of spend continues until the end of this financial year.
Page 147
2 Care Group Annual Budget 2023/24 £m In Year Drawdown From Reserves £m Revised Budget 2023/24 £m Projected Year End Spend 2023/24 £m Projected Year End Variance 2023/24 £m Health Care Services 528.310 24.895 553.205 550.522 2.683 Social Care Services 247.726 3.176 250.903 247.790 3.112 TOTAL 776.037 28.071 804.108 798.312 5.796 6.2 Appendices 1 to 3 show a detailed revenue budget position for each care group above. 6.3 In line with Scottish Government guidance, unspent ring-fenced funding must be transferred to relevant reserves at the end of each financial year for use in later years. Subject to IJB approval, in-year underspends will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2023/24 PERFORMANCE 7.1 The current financial forecast for 2023/24 projects a yearly underspend of £5.796m relating to various under and overspends across the whole integrated budget. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – underspend of £10.518m There are continuing challenges in terms of recruitment and retention across all service areas. Recruitment plans continue to be progressed to fill vacancies as quickly as possible however this is proving challenging in the current market. 7.1.2 Payments to Other Bodies (PTOB) – overspend of £1.229m There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. Independent care homes have a yearly budget to fund 1,361 care plans but at present the number of projected care plans is 1,501 resulting in a projected overspend of £0.708m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,817 estimated care plans for 23/24. In line with the IJB strategy to address the demand pressures within the plan, a drawdown of £2.337m from the social care demand reserve is being used to offset the current projection. An action plan is currently under development which focuses on overdue client reviews and ensuring outcomes and budgets are aligned. 7.1.3 Prescribing – overspend of £0.824m The current overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on actual prescribing data available to September 2023. The forecast will be updated as further data becomes available. Similar to the increase in SDS demand, the prescribing increase was in part forecast and reported in the financial plan and therefore a drawdown of £3.835m
Page 148
3 from the prescribing reserve is being used to offset the current overspend.
Page 149
4 7.1.4 Work continues to mitigate this overspend through the savings program (para 8) and from a non-recurring allocation being issued to fund the pharmacy tariff increase amounting to £1.598m for the IJB. 7.1.5 North Lanarkshire Hosted Services – overspend by £2.641m The 3 main areas of overspend within the NL hosted services relate to continence service, children services and prisoner healthcare, due to increases in product costs and additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. There is also an increase in costs linked to the delivery of the new pharmacy contract and drug price associated with prisoner healthcare. 7.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and the table below shows the current funding allocation received from Scottish Government: Scottish Government Allocations as at December 2023 £m Additional Staffing Band 2-4 1.093 Alcohol and Drug Partnership 2.562 Child Death Review 0.024 Dementia Post Diagnostic Support 0.430 Digital Therapy Posts 0.111 Distress Brief Intervention 2.944 District Nursing 0.607 Family Nurse Practitioner Funding 1.196 ICU Bed Capacity Uplift 0.045 Learning Disabilities Health Checks 0.172 Long Covid Support Fund 0.260 Meningitis C 0.106 Mental Health Action 15 3.930 Mental Health Community Perinatal 0.505 Mental Health Infant and Maternity 0.476 Mental Health Outcomes Framework 10.243 Mental Health Support Veterans 0.126 Multi-Disciplinary Teams 1.996 Neonatal Psychological Interventions 0.138 Outcomes Framework 2.770 PCR Prison Care Nursing Roles 0.013 School Nursing Posts 0.840 North Lanarkshire Council Sustainability Payment 0.220 TOTAL 30.807 7.3 In addition, CORE management team and various sustainability and value workshops have been meeting on a regular basis to discuss and monitor the management actions reported in the financial plans to identify potential savings and redesign of services to help support future years budget planning. This includes the following areas of work: Review of financial planning assumptions for 2024/25. Review of all current vacancies including length of time left vacant.
Page 150
5 Review of all earmarked reserves.
Page 151
6 Updates on saving planning in significant areas of budget pressures. Service reviews including home support and self-directed support. Collaboration with South HSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 7.4 As recommended by Audit Scotland in their audit annual report, a Long Term Financial Plan (LTFP) will be presented to the IJB in March 2024 which includes an update on planning assumptions for 2024/25. 8. SAVINGS 8.1 Within 2023/24 prescribing budget, the HSCP has an action plan that includes our contribution to the health board-wide efficiency measures, including drug switches and prescribing improvement projects with a savings target of £2.7m. 8.2 A wide range of work has commenced from March to ensure the balance of the savings target is achieved, ranging from reducing waste and inefficiencies to changing prescribing practices and culture. The impact of this work has recorded savings at the end of December totalling £1.212m and if this continues the forecast annual savings expected by March 2024 is £1.942m. 8.3 These measures will only contribute in a small way to easing the pressure on our budget and at this stage are being outstripped by global price increases. The only way to deliver a significant improvement on pressure in this budget area will be through a reduction in drug price inflation and items being dispensed, additional Scottish Government funding, or a policy decision at a national level to restrict the scope of drugs that can be provided by the NHS. 8.4 The following tables give additional information on the cost of prescribing and number of items dispensed for this financial year, in comparison to 2022/23. These tables will be refreshed once current data on prescribing is made available: 1.942 2023/24 Prescribing Savings (£m) Savings Achieved 1.212 Savings Expected Savings Target 2.700 0.000 0.500 1.000 1.500 £m 2.000 2.500 3.000
Page 152
7 8.5 It should be noted that due to the volatility within this area and the time lag in receiving up to date information from the recording systems, the current projection is likely to change month on month. Additional monitoring is in place with the data being analysed by a dedicated working group and regular updates on progress will be reported to the IJB throughout the year. 9. GENERAL RESERVES 9.1 The current IJB reserves position for 2023/24 after adjustment for the drawdown of reserves, is a revised balance of £67.538m and is summarised in the table below: LEAD SUMMARY Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 31 December 2023 £m £m £m £m NHSL Ring-Fenced Reserves 19.191 (0.224) (8.473) 10.494 NLC/NHSL Earmarked Reserves 33.324 0.326 (2.676) 30.974 NLC/NHSL Risk-Based Reserves 12.952 8.237 (6.172) 15.017 NHSL Contingency Reserves 8.060 2.993 0.000 11.053 NLC/NHSL Closed Reserves 24.419 (11.332) (13.087) 0.000 Table 1: Prescribing Cost (£m) 8.000 7.000 6.000 5.000 4.000 3.000 2.000 1.000 0.000 2022/23 2023/24 Table 2: Prescribing Items Dispensed 720,000 700,000 680,000 660,000 640,000 620,000 600,000 580,000 560,000 540,000 2022/23 2023/24 £m No. of Items Dispensed
Page 153
8 Total 97.946 0.000 (30.408) 67.538
Page 154
9 9.2 A detailed list of all reserve movement during 2023/24 and the relationship to our ambitions statement and performance within the Strategic Commissioning Plan has been included within the PFA reserves strategy paper. 9.3 Regular updates will be provided to the IJB throughout the year as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 10. CURRENT VACANCY POSITION 10.1 As highlighted throughout this report, employee costs are projecting a significant underspend within all services. 10.2 The table below shows the full time equivalent (FTE) vacancy numbers within each service against their budgeted establishment: Service Establishment Actual Vacancies FTE FTE FTE North West Locality 394.02 343.54 50.48 North East Locality 332.48 297.00 35.48 Adult Services 286.73 281.74 4.99 Children Services 593.20 557.30 35.90 Mental Health 1,194.55 1,148.84 45.71 Social Care Services 986.90 788.25 198.65 Home Support 1,000.17 981.58 18.59 Other 205.78 205.01 0.77 TOTAL 4,993.83 4,603.26 390.57 10.3 To help cover the vacant posts, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 6. SERVICE Costs As At 31 December 2023 Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.121 0.034 0.621 0.216 0.992 North East Locality 0.051 0.019 0.366 0.047 0.484 Adult Services 0.055 0.077 0.289 0.136 0.556 Children Services 0.178 0.059 0.485 0.085 0.807 Mental Health 0.397 0.058 2.545 3.491 6.490 Social Care Services 0.844 - - 0.315 1.159 Home Support 3.277 - - - 3.277 Other 0.024 0.016 0.070 - 0.110 TOTAL 4.948 0.262 4.376 4.290 13.877 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES
Page 155
10 People are able to look after and improve their own health and wellbeing and live in good health for longer ☐
Page 156
11 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 ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 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 National 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 Medium Ross McGuffie 12.5 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
Page 157
12 □ 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. 12.6 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 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1- North Lanarkshire Health and Social Care Partnership Budget Appendix 2- Hosted Services Led by North Lanarkshire Appendix 3- Hosted Services Led by South Lanarkshire Appendix 4- North Lanarkshire IJB Budget Reconciliation 2023/24 Appendix 5 - Analysis of Additional Employee Costs Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
Page 158
13 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
Page 159
14 Appendix 1 North Lanarkshire IJB Revenue Budget Position 1 April 2023 to 31 December 2023 Funded By: Annual Budget 2023/24 £m NHS Lanarkshire Funding (528.311) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.961) Transfer from Reserves (Approved) (24.895) Total Funding - NHSL (607.559) NLC Funding - Social Care Services (190.727) NLC Funding - Housing Services (2.095) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) (3.176) Total Funding - NLC (196.549) Total Funding - NHSL and NLC (804.108) Projected Year End Outturn Total 2023/24 £m 3.670 (0.019) 0.212 (0.824) 0.103 0.319 (0.777) 0.000 0.000 2.683 3.070 0.042 3.112 0.000 0.000 3.112 5.796 Year To Date Year To Date Variance Budget December 2023 £m Actual December 2023 £m Total December 2023 £m 46.205 43.453 2.752 2.984 2.998 (0.014) 3.259 3.100 0.159 57.358 57.976 (0.618) 3.238 3.161 0.077 5.401 5.162 0.239 140.258 140.840 (0.583) 90.777 90.777 0.000 52.877 52.877 0.000 402.356 400.344 2.013 193.772 191.410 2.362 (2.805) (2.838) 0.033 190.967 188.573 2.394 1.612 1.612 0.000 0.424 0.424 0.000 193.002 190.608 2.394 595.358 590.952 4.407 Care Group Annual Budget 2023/24 £m Health Care Services Locality and Other Services Addiction Services Medical and Nursing Directorate Prescribing Out of Area Services Area Wide Services Hosted Services Family Health Services Set-Aside Budget Total Expenditure - NHSL 65.292 6.941 4.398 76.406 4.318 7.803 193.324 124.223 70.502 553.206 Social Care Services 251.903 Social Care Services Gross Expenditure Social Care Services Gross Income (3.647) Social Care Services Net Expenditure 248.257 Housing Revenue Account 2.095 Transport Services Account 0.551 Social Care, Housing and Transport Services Net Expenditure 250.902 Total Expenditure - NHSL and NLC 804.108 Appendix 1
Page 160
15 Appendix 2 Hosted Services Appendix 3 Hosted Services Annual Budget 2023/24 £m Year to Date South Lanarkshire IJB - 48% Share December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m 3.910 2.916 2.322 0.595 1.652 0.889 1.123 (0.234) 4.790 3.486 3.347 0.139 3.632 2.717 2.658 0.060 5.631 4.242 4.237 0.005 0.424 0.322 0.269 0.053 4.296 3.241 3.066 0.175 2.211 1.706 1.703 0.003 10.527 7.924 7.634 0.290 37.074 27.444 26.359 1.085 Annual Budget 2023/24 £m Year to Date North Lanarkshire IJB - 52% Share December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m 4.236 3.159 3.159 0.000 1.789 0.963 0.963 0.000 5.190 3.777 3.777 0.000 3.935 2.944 2.944 0.000 6.100 4.595 4.595 0.000 0.459 0.349 0.349 0.000 4.654 3.511 3.511 0.000 2.395 1.848 1.848 0.000 11.404 8.584 8.584 0.000 40.163 29.731 29.731 0.000 Led by the South Partnership Annual Budget 2023/24 £m Year to Date December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m CommunityDentalServices 8.147 6.076 5.481 0.595 BrainInjuryUnit 3.441 1.852 2.085 (0.234) Outof Hours Services 9.980 7.263 7.124 0.139 Palliative Care Services 7.567 5.661 5.602 0.060 PhysiotherapyServices 11.731 8.837 8.833 0.005 PrimaryCare Services 0.883 0.671 0.618 0.053 OccupationalTherapyServices 8.950 6.752 6.577 0.175 Diabetic Services 4.606 3.555 3.551 0.003 PrimaryCare ImprovementFund 21.931 16.508 16.218 0.290 TOTAL 77.237 57.175 56.089 1.085 Annual Budget 2023/24 £m Year to Date South Lanarkshire IJB - 48% Share December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m 1.633 1.240 1.240 0.000 1.184 0.889 0.889 0.000 1.623 1.340 1.340 0.000 3.399 2.561 2.561 0.000 7.465 4.947 4.947 0.000 6.353 4.810 4.810 0.000 0.272 0.204 0.204 0.000 2.077 1.578 1.578 0.000 2.388 1.808 1.808 0.000 0.976 0.733 0.733 0.000 0.769 0.582 0.582 0.000 1.348 1.038 1.038 0.000 44.030 31.324 31.324 0.000 73.517 53.053 53.053 0.000 Annual Budget 2023/24 £m Year to Date North Lanarkshire IJB - 52% Share December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m 1.770 1.343 1.472 (0.129) 1.283 0.963 1.618 (0.656) 1.759 1.451 2.123 (0.672) 3.683 2.775 2.551 0.223 8.087 5.359 4.885 0.474 6.882 5.211 5.958 (0.747) 0.295 0.221 0.396 (0.174) 2.250 1.710 1.488 0.222 2.587 1.959 1.858 0.101 1.057 0.794 1.360 (0.566) 0.833 0.630 0.733 (0.103) 1.460 1.124 1.152 (0.028) 47.699 33.934 32.464 1.471 79.644 57.474 58.057 (0.583) Led by the North Partnership Annual Budget 2023/24 £m Year to Date December 2023 Budget £m December 2023 Actual £m December 2023 Variance £m Sexual HealthServices 3.403 2.583 2.712 (0.129) Continence Services 2.466 1.852 2.507 (0.656) Immunisation Services 3.382 2.791 3.463 (0.672) Speech and Language TherapyServices 7.082 5.336 5.113 0.223 Children and Adolescents Mental HealthServices 15.553 10.306 9.832 0.474 Childrens Services 13.235 10.021 10.768 (0.747) Integrated Equipment and Adaptations Store 0.567 0.426 0.600 (0.174) Dietetics Services 4.327 3.288 3.066 0.222 Podiatry Services 4.974 3.766 3.666 0.101 Prisoner Healthcare Services 2.032 1.527 2.093 (0.566) Blood Borne Viruses Services 1.602 1.212 1.314 (0.103) Hospital at Home 2.808 2.162 2.189 (0.028) Mental Healthand Learning DisabilityServices 91.730 65.258 63.787 1.471 TOTAL 153.161 110.527 111.110 (0.583) Appendix 2 Appendix 3
Page 161
16 Appendix 4 North Lanarkshire IJB Budget Reconciliation 2023/24 2023/24 NLC Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 190.727 NLC Funding - Housing Services 2.095 NLC Funding - Transport Services 0.551 Pay Award Drawdown from Reserves 3.176 NLC Financial Allocation at 21 July 2023 196.549 2023/24 NHSL Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 333.065 Set-Aside Budget 70.502 South Hosted @ 52% 37.901 Family Health Service South @ 52% 116.616 NHSL Financial Allocation at 30 June 2023 558.084 Budget Adjustments Posted in Month 4 1.845 Draw Down From Reserves Pay Award Uplift Including One-Off Payments 14.592 Scottish Government 2% Uplift to Resource Transfer and Contracts 1.135 Scottish Government Non Recurring Ring Fenced Monies 7.073 Increase in Hosted Services Led by South 1.843 Increase in Area Wide Services 0.571 Other Budget Adjustments 0.185 NHSL Financial Allocation at 31 July 2023 585.328 Budget Adjustments Posted in Month 5 4.985 Draw Down From Reserves NHS Lanarkshire Unscheduled Care Reserve -2.790 North Lanarkshire Council Provider Sustainability Payment 0.220 Scottish Government Non Recurring Ring Fenced Monies 0.125 Increase in Hosted Services Led by South 1.058 Other Budget Adjustments 0.200 NHSL Financial Allocation at 31 August 2023 589.126 Budget Adjustments Posted in Month 6 3.276 Draw Down From Reserves Increase in Family Health Services 3.944 Medical Pay Award 1.705 Funding from NES and Digitial Therapy Posts 0.366 Decrease in Hosted Services Led by South -0.142 Other Budget Adjustments 0.027 NHSL Financial Allocation at 30 September 2023 598.302 Budget Adjustments Posted in Month 7 1.653 Draw Down From Reserves Funding from NES & Glasgow 0.419 Increase in Hosted Services Led by South 0.059 Other Budget Adjustments 0.127 NHSL Financial Allocation at 31 October 2023 600.560 Budget Adjustments Posted in Month 8 0.999 Draw Down From Reserves Non-Recurring Pay Award -2.329 Service Level Agreements Uplifts 0.728 Funding for Dementia Post 0.430 Increase in Hosted Services Led by South 3.060 NHSL Financial Allocation at 30 November 2023 603.448 Budget Adjustments Posted in Month 9 1.788 Draw Down From Reserves Non-Recurring Taskforce Funding 0.258 Non-Recurring Hospital @ Home 0.188 Non-Recurring Pharmacy Tariff Increase 1.598 Funding from NES 0.162 Other Budget Adjustments 0.117 NHSL Financial Allocation at 31 December 2023 607.559 Appendix 4
Page 162
17 Appendix 5 Analysis of AdditionalEmployee Costs 2023/24 Period BANKAIDECOSTSYEARTODATE NorthWest Locality £ NorthEast Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 74,898 36,739 35,561 69,550 331,019 10,506 558,273 2 67,549 30,009 34,077 52,510 234,588 8,215 426,948 3 71,996 33,984 29,543 55,338 233,159 7,164 431,184 4 77,147 49,890 31,916 62,994 337,320 8,162 567,429 5 73,672 36,828 42,883 48,749 315,567 8,740 526,439 6 73,701 50,064 34,181 47,520 320,258 7,555 533,279 7 64,435 42,627 29,527 43,917 240,358 6,547 427,411 8 55,201 42,019 24,288 45,014 240,941 6,029 413,492 9 62,864 44,132 26,592 59,452 291,603 7,046 491,689 10 0 11 0 TOTAL 621,463 366,292 288,568 485,044 2,544,813 69,964 4,376,144 Period AGENCYCOSTSYEARTODATE NorthWest Locality £ NorthEast Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 42,416 - 2,717 1,571 406,062 -13,522 439,244 2 62,289 2,876 25,213 6,576 389,942 32,744 519,640 3 27,805 2,262 9,143 - 405,161 36,290 480,661 4 5,197 16,099 14,458 25,834 377,191 53,866 492,645 5 6,542 734 11,784 28,422 415,155 44,091 506,728 6 9,846 10,346 19,352 21,284 438,512 5,887 505,227 7 6,662 3,251 17,960 1,609 355,250 40,989 425,721 8 17,479 - 21,870 - 367,171 47,998 454,518 9 37,811 11,091 13,317 - 336,741 41,651 440,611 10 24,639 24,639 11 0 12 0 TOTAL 216,047 46,659 135,814 85,296 3,491,185 314,633 4,289,634 Period OVERTIMECOSTSYEARTODATE NorthWest Locality £ NorthEast Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 15,591 5,617 9,055 25,740 47,690 4,691 87,355 5,664 201,403 2 13,874 6,412 7,221 23,070 40,800 86,847 309,302 4,051 491,577 3 13,617 5,469 5,833 24,261 40,838 105,859 304,161 2,651 502,689 4 11,666 3,537 6,890 19,867 38,083 85,974 314,146 2,718 482,881 5 18,101 4,007 4,757 20,670 53,362 87,461 355,153 3,486 546,997 6 10,892 7,970 4,565 22,477 44,961 92,742 358,190 3,201 544,998 7 14,033 5,262 4,075 12,600 46,278 86,480 350,687 1,162 520,577 8 10,831 6,048 8,322 13,901 45,513 88,577 364,293 589 538,074 9 12,467 7,133 4,360 15,899 39,353 105,900 514,029 699 699,840 10 99,595 319,748 419,343 11 0 12 0 TOTAL 121,072 51,455 55,078 178,485 396,878 844,126 3,277,064 24,221 4,948,379 Period EXCESSPART TIMECOSTSYEAR TO DATE NorthWest Locality £ NorthEast Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,273 4,839 7,436 7,174 11,599 2,093 39,414 2 3,055 1,717 5,869 5,494 6,373 2,626 25,134 3 4,200 2,878 7,399 5,563 6,369 972 27,381 4 3,944 2,268 6,222 5,946 5,735 2,039 26,154 5 3,958 2,798 8,666 7,518 5,736 2,723 31,399 6 3,725 1,451 9,861 3,175 4,302 2,020 24,534 7 4,084 2,024 12,318 7,358 5,005 1,370 32,159 8 2,121 910 9,672 8,200 5,730 1,289 27,922 9 2,468 289 9,507 8,144 6,745 1,135 28,288 10 0 11 0 Appendix 5
Page 163
18 TOTAL 33,828 19,174 76,950 58,572 57,594 16,267 262,385
Page 164
1 REPORT Item No:13 SUBJECT: IJB Reserves Strategy 2023/24 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 21st February 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the PFA Committee for: For approval For endorsement For noting 1.2 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report; and (2) Approve the proposed realignment of reserves in appendix 1. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Consistent with a number of other Health and Social Care Partnerships, an underspend was reported to the IJB on 21 June 23 totalling £35.495m and was transferred to reserves. This 2022/23 underspend included funding made available by the Scottish Government to progress policy commitments and national priorities. 6. CONCLUSIONS 6.1 The IJB Reserves Strategy 2023/24 provides an opportunity to strengthen long-term financial sustainability by considering all current reserves to ensure those held are still required and sufficient to meet on-going pressures. The IJB Reserves Strategy 2023/24 will enable the IJB to balance current commitments whilst planning and addressing financial risks.
Page 165
2 6.2 It is essential for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that section 106 public bodies do not over- commit themselves financially. 7. IJB RESERVES STRATEGY 2023/24 7.1 As detailed in the summary table below, the reserve balances at 31 March 2023 were £97.946m. This figure comprised of £47.408m earmarked reserves to support the delivery of projects which span financial years and £27.577m ring-fenced monies to enable the IJB to deliver on specific Scottish Government funded programmes. The remaining balance of £22.961m, are risk-based and contingency reserves which are not held to meet any specific liability and offer the IJB some flexibility to deal with unforeseen events or emergencies. LEAD SUMMARY Revised Balance As At 31 March 2023 £m NHSL Ring-Fenced Reserves 27.577 NHSL & NLC Earmarked Reserves 47.408 NHSL & NLC Risk-Based Reserves 14.901 NHSL Contingency Reserves 8.060 Total 97.946 7.2 A further in-year analysis and review was carried out with both partners in respect of all reserves to ensure the reserves held in 2023/24 were still required and sufficient to meet on-going pressures. 7.3 As a result of this review, it was evident that some of the reserves were no longer required for their original purpose. This has been driven by two key factors; (i) due to changes and redesign to services, has resulted in making the held reserve no longer fit for purpose; and (ii) the need to consider the utilisation of reserves in the context of the IJB Strategic Commissioning Plan 2023-26 and the range of pressures that remain as a result of the Medium-Term Financial Plan 2023-26. 7.4 Following on from the above, a proposed realignment of reserves has been determined, as summarised in Appendix 1. The revised structure of the reserves will continue to enable the IJB to meet its agreed strategic objectives, and Scottish Government policy requirements. 7.5 The table below shows the revised summary position of the proposed realignment which would increase the risk-based and contingency reserves from £22.961m at the start of the financial year to £26.07m:
Page 166
3 LEAD SUMMARY Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 £m £m £m £m NHSL Ring-Fenced Reserves 19.191 (0.224) (8.473) 10.494 NHSL & NLC Earmarked Reserves 33.324 0.326 (2.676) 30.974 NHSL & NLC Risk-Based Reserves 12.952 8.237 (6.172) 15.017 NHSL Contingency Reserves 8.060 2.993 0.000 11.053 NHSL & NLC Closed Reserves 24.419 (11.332) (13.087) 0.000 Total 97.946 0.000 (30.408) 67.538 7.6 A detailed analysis of the realignment and audit trail of the movement of reserves throughout this financial year is at Appendix 1 and 2. 8. RISK 8.1 As part of the development of the financial plan and in line with the North Lanarkshire IJB Financial Plans, if possible, it is recommended that the risk-based and contingency reserves are established as a percentage of the mainstream financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 8.2 The IJB contingency reserves currently equate to 4.6% of the financial envelope, however, following completion of the 2023/24 financial year end, it is anticipated this percentage may increase. 9. IMPLICATIONS 9.1 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 ☒ 9.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision.
Page 167
4 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
Page 168
5 9.4 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 National 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 Medium Ross McGuffie 9.5 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.
Page 169
6 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10. BACKGROUND PAPERS None. 11. APPENDICES Appendix 1HSCP Reserves Realignment Appendix 2Movement of Reserves Year to Date Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
Page 170
7
Page 171
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
Page 172
9 Appendix 1 Proposed Realignment HSCP Reserves Realignment Opening Balance As At 1 April 2023 Transfers / Drawdown From Reserves New Reserves Awaiting IJB Approval Close Reserve Increase Reserve Total Risk- Based and Contingency Reserves £m £m £m £m £m £m Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 - - (0.123) - - Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 - - (0.034) - - Care Homes Allocation 0.318 - - (0.318) - - Champions Board, Promise & Public Potection Joint Resourcing Funding (HSCP Contribution) 0.172 - - (0.172) - - Discharge Support Workers Band 4 x 2 WTE 0.107 - - (0.107) - - Distinction Awards 0.036 - - (0.036) - - Forensic Band 3 x 5 WTE 0.147 (0.035) - (0.112) - - GP-IT Reprovisioning Gap 0.181 - - (0.181) - - Integrated Authority Support (Future Service Recovery) 4.926 (0.090) - (4.836) - - Psychology Posts 2 x Band 6 0.098 - - (0.098) - - Supervisor Training 0.065 - - (0.065) - - Social Care Regrading of Staff (SSW, SP, SW, OT, TL and TM) 3.169 (0.346) - (2.823) - - Long Covid Contingency 1.949 (1.199) - (0.750) - - Mental Health Psychology Posts 0.670 (0.142) - (0.528) - - Prescribing Fund 4.361 (3.835) - - 3.835 4.361 Contingency Balance Held By NHSL 8.060 0.218 - - 2.775 11.053 Social Care Demand 8.591 (1.508) - - 3.573 10.656 TOTAL 33.007 (6.937) 0.000 (10.183) 10.183 26.070
Page 173
10 Appendix 2 North Lanarkshire IJB APPENDIX 2 Movement on Reserves Audit Trail NHSL & NCL LEAD RING-FENCED RESERVES Opening Balance AsAt 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance AsAt 31 December 2023 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 0.255 0.000 ✓ ✓ 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.250 (0.144) 0.106 -0.144 ✓ 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.171 (0.034) 0.137 -0.034 ✓ ✓ 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services 4.101 (1.252) 2.849 -1.252 ✓ 1, 2, 4, 5 NHSL Community Living Change Fund 1.298 1.298 0.000 ✓ ✓ 1, 4, 5 NHSL Hospital at Home Services - Support Development 0.621 (0.084) 0.537 -0.084 ✓ ✓ 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.246 0.246 0.000 ✓ ✓ 2, 3 NHSL Long Covid Pathways 0.764 (0.224) (0.462) 0.078 -0.686 ✓ 2, 3, 4, 5 NHSL Mental Health and Learning Disability Services - Action 15 3.930 (2.640) 1.290 -2.640 ✓ ✓ 1, 2, 4, 5 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.751 (0.128) 0.623 -0.128 ✓ ✓ 1, 2, 3, 4, 5 NHSL Mental Health Eating Disorders 0.070 (0.034) 0.036 -0.034 ✓ 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.100 (0.015) 0.085 -0.015 ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 1.840 0.000 ✓ 1, 2, 4, 5 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 0.000 ✓ 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts 0.933 (0.890) 0.043 -0.890 ✓ 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 ✓ 3 NHSL Third Sector Initiatives To Improve Health 0.306 0.306 0.000 ✓ ✓ ✓ 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 3.120 (2.790) 0.330 -2.790 ✓ ✓ NHSL Upper GIDietetics Band 4 0.033 0.033 0.000 ✓ 3 TOTAL RING-FENCED RESERVES 19.191 (0.224) (8.473) 10.494 (8.697) LEAD EARMARKED RESERVES Opening Balance AsAt 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance AsAt 31 December 2023 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.941 (0.941) 1.000 -0.941 ✓ ✓ 1, 2, 3, 4, 5 NLC Adaptations Fund 0.289 0.099 0.388 0.099 ✓ 2, 4 NLC Adult Protection (share with C&F and NHSL) 0.050 0.050 0.000 ✓ ✓ 1, 2, 4, 5 NLC Advocacy Services 0.118 0.118 0.000 ✓ ✓ 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.828 (0.067) 0.761 -0.067 ✓ ✓ 1, 2, 5 NLC Business Case - Non-Recurring NLC Costs 3.811 0.001 3.812 0.001 ✓ ✓ 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.643 0.058 2.701 0.058 ✓ ✓ ✓ 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 (0.078) 0.268 -0.078 ✓ 4 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.414 (0.210) 0.204 -0.210 ✓ ✓ 3 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 ✓ 1, 5 NHSL Dietetics Services - Double Running Costs 0.110 (0.040) 0.070 -0.040 ✓ ✓ NLC Digital and IT Strategy TechnologyImprovements - Community Alarms 0.588 0.588 0.000 ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.776 3.776 0.000 ✓ ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.566 0.000 NLC Digital and IT Strategy TechnologyImprovements - SWIS 0.700 0.700 0.000 ✓ ✓ 2, 3 NLC Financial Strategy - Changes to LAServices Muirpark 1.099 (0.419) 0.680 -0.419 ✓ NHSL Health Inequalities - Screening 0.071 (0.020) 0.051 -0.020 ✓ ✓ 2 NHSL Health Visiting Students/Trainees 0.484 0.090 (0.192) 0.382 -0.102 ✓ ✓ 3 NLC Home Support Resilience (2 year funding) 3.498 0.148 3.646 0.148 ✓ ✓ 3, 4 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.187 (0.101) 0.087 -0.101 ✓ ✓ 3 NLC IJB Helpline (2 years funding) 0.575 0.575 0.000 ✓ ✓ 1, 4, 5 NHSL Kylepark Works 1.578 1.578 0.000 ✓ 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.069 0.120 0.189 0.120 ✓ ✓ 3, 4 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 ✓ 2, 4 NHSL Minor Capital Works 1.162 (0.093) 1.069 -0.093 ✓ ✓ 3 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 (0.052) 0.498 -0.052 ✓ ✓ ✓ 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.881 (0.292) 0.589 -0.292 ✓ ✓ 1, 2, 3 NLC Planned Date of Discharge - Discharge To Assess 0.304 0.304 0.000 ✓ ✓ 1, 5 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.077 0.077 0.000 ✓ ✓ 3 NHSL Podiatry Services - Foot Screening 0.426 (0.065) 0.361 -0.065 ✓ ✓ 1, 2 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 (0.038) 0.032 -0.038 ✓ ✓ 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 ✓ ✓ 3 NHSL Scottish Clinical Leadership Fellowship 0.100 (0.019) 0.081 -0.019 ✓ ✓ 3 NHSL Sexual Health Services - Forensic Medical 0.175 0.035 (0.035) 0.175 0.000 ✓ ✓ 1, 2 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.491 (0.087) 0.404 -0.087 ✓ ✓ 1, 2 NLC Social Care Contracting Staff within Quality Assurance Services 0.003 0.157 0.160 0.157 ✓ ✓ 3 NLC/NHSL Staff Training Academy 2.400 0.037 (0.155) 2.282 -0.118 ✓ ✓ ✓ 3 NHSL Stigma Free Lanarkshire (3 year funding) 0.450 0.450 0.000 ✓ ✓ ✓ 2, 4 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.030 0.000 ✓ 1, 2, 4, 5 NHSL Vulnerable and Complex Cases - Test of Change 1.092 (0.192) 0.900 -0.192 ✓ ✓ 5 TOTAL EARMARKED RESERVES 33.324 0.326 (2.676) 30.974 (2.350)
Page 174
11 -30.408 LEAD RISK-BASED RESERVES Opening Balance AsAt 1 April2023 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance AsAt 31 December 2023 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Prescribing Fund 4.361 3.835 (3.835) 4.361 0.000 ✓ ✓ 2, 4 NLC Social Care Demand 8.591 4.402 (2.337) 10.656 2.065 ✓ ✓ ✓ 2, 4 TOTAL RISK-BASED RESERVES 12.952 8.237 (6.172) 15.017 2.065 LEAD CONTINGENCY FUND RESERVES Opening Balance AsAt 1 April2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance AsAt 31 December 2023 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL ContingencyBalance Held ByNHSL 8.060 2.993 11.053 2.993 ✓ ✓ TOTAL CONTINGENCY FUND RESERVES 8.060 2.993 0.000 11.053 2.993 LEAD CLOSED RESERVES Opening Balance AsAt 1 April2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance AsAt 31 December 2023 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 2.926 (2.926) 0.000 -2.926 ✓ 1, 2, 4, 5 NHSL Alcohol and Drug Partnership - LocalImplementation Plan 0.167 (0.167) 0.000 -0.167 ✓ 1, 2, 4, 5 NHSL AreaWide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 (0.123) 0.000 -0.123 NHSL AreaWide Services - NES Training 0.132 0.006 (0.138) 0.000 -0.132 ✓ 3 NHSL AreaWide Services - PrimaryCare Corporate (iHUB Project - NES funding) 0.034 (0.034) 0.000 -0.034 NHSL Assistive TechnologyContract x12 months (ATC) 0.008 (0.008) 0.000 -0.008 ✓ 3, 4 NHSL Business Case - Health Care SupportWorkers, Multi-DisciplinaryTeams 1.797 (1.797) 0.000 -1.797 ✓ 1, 2, 3, 4, 5 NHSL Care Homes Allocation 0.318 (0.318) 0.000 -0.318 2, 5 NHSL Champions Board Funding 0.172 (0.172) 0.000 -0.172 NHSL Covid-19 Funding 0.007 (0.007) 0.000 -0.007 ✓ 2, 3, 4, 5 NHSL Discharge SupportWorkers Band 4 x2 WTE 0.107 (0.107) 0.000 -0.107 3 NHSL Distinction Awards 0.036 (0.036) 0.000 -0.036 3 NHSL District Nursing - Scottish Government Funded 0.376 (0.376) 0.000 -0.376 ✓ 1, 2, 4, 5 NHSL Forensic Band 3 x5WTE 0.147 (0.147) 0.000 -0.147 3 NHSL GPITReprovisioning Gap 0.181 (0.181) 0.000 -0.181 NHSL Integrated AuthoritySupport 4.926 (4.926) 0.000 -4.926 NHSL Learning Disabilities Band 3 x4 FTE 0.118 (0.118) 0.000 -0.118 ✓ 3 NLC Local Government PayAward 23/24 2.653 0.177 (2.830) 0.000 -2.653 ✓ 3 NLC Long Covid Contingency 1.949 (1.949) 0.000 -1.949 2, 3, 4, 5 NHSL Medical Director - Child Death Review Funding 0.012 (0.012) 0.000 -0.012 ✓ 2 NHSL Mental Health and Learning DisabilityServices - Distress Brief Intervention 3.155 (3.155) 0.000 -3.155 ✓ 1, 2, 4, 5 NHSL Mental Health Covid Clinicians (Cossette) 0.200 (0.200) 0.000 -0.200 ✓ 1, 2, 4, 5 NHSL Mental Health Pharmacy RecoveryPlan 0.175 (0.175) 0.000 -0.175 ✓ 1, 2, 4, 5 NHSL Mental Health Perinatal, Infant, Maternityand Neonatal 0.005 (0.005) 0.000 -0.005 ✓ 1, 2, 4, 5 NHSL Mental Health PsychologyPosts 0.670 (0.528) (0.142) 0.000 -0.670 ✓ 1, 2, 3, 4, 5 NHSL NES SLAPharmacy Training 0.173 (0.173) 0.000 -0.173 ✓ 3 NHSL PsychologyPosts 2 xBand 6 0.098 (0.098) 0.000 -0.098 3, 4 NLC Social Care Regrading of Staff (SSW, SP, SW, OT, TL and TM) 3.169 (2.823) (0.346) 0.000 -3.169 ✓ ✓ ✓ 3 NHSL Supervisor Training 0.065 (0.065) 0.000 -0.065 3 NHSL Test and Protect Funding 0.520 (0.520) 0.000 -0.520 ✓ 1, 2 TOTAL CLOSED RESERVES 24.419 (11.332) (13.087) 0.000 (24.419) TOTAL RESERVES 97.946 0.000 (30.408) 67.538 (30.408) KEY AmbitionStatement & Performance 1 Do theright thingfirst time. 2 Increased focus on prevention, earlyintervention andtackling inequalities byworking with communities and people. 3 Developand support a workforce for the future. 4 Improvemental health and wellbeing. 5 Supporting peoplethrough a whole familyapproach.
Page 175
1 REPORT Item No: 14 SUBJECT: Performance Update – Quarter 2 (July – September 2023) TO: 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: 21 February 2024 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
Page 176
2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Note the contents of the report and the appendix. 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 ☒ Yes ☐ No ☐ N/A ☒
Page 177
3 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) 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 Yes ☐ No ☐ N/A ☒
Page 178
4 ☐ 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 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: Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
Page 179
5 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix One- Areas for Improvement (Quarter 2, July – September 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
Page 180
6 Appendix One 1. Cervical Screening Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 72.3% 72.3% Narrative & Corrective Action MiLan was used to analyse uptake for cervical screening across Lanarkshire. The graph below highlights that the cervical uptake rate for North Lanarkshire appears to be stable in the 6 localities, although none of the localities achieved the recommended target of 80%. Although there has been no significant change in uptake across localities, there has been a shift in uptake for 3 GP practices within Coatbridge. One practice has increased from 69.5% to 73.4%, with 2 practices declining from 76.0% to 67.2% and 73.8% to 67.9%. 69.1% 70.7% 71.5% 72.6% 75.8% 71.8% 69.4% 71.1% 71.4% 72.8% 75.9% 71.7% 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 North 2023 Quarterly Uptake by locality 2023 Quarter 1 June 2023 Quarter 2 September 2023 Target
Page 181
7 Of the 50 GP practices in North Lanarkshire, only 3 achieved the 80% target in quarter 2, this was consistent with 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 Other Activity – Community Engagement. Two community engagement projects in Airdrie and Bellshill continue to work with local communities to raise awareness and identify barriers to engagement in cervical screening. More data will be available in Quarter 3. The “Culture Junction” project commenced delivery with workshops during October 2023. Following the in-person consultation with groups at the Lanarkshire Mosque, an online survey was developed by Jo's Trust to engage younger women, as this was identified as a gap in the previous consultations. This online survey was shared with relevant community contacts as well as on NHS HI social media at the beginning of August. Jo’s Trust are collating the results of both the online and in-person consultations and once analysed, the results will inform future communication and engagement plans. Work to address health inequalities, including the HPV vaccine and work with Jo’s trust to encourage screening for young people continues and is expected to impact positively in the longer-term. Quality Improvement Activity As described in the previous report, a small amount of capacity was released to provide support for GP practices to identify any areas for improvement in their uptake for cervical screening that could assist in achieving the national target of 80% uptake.
Page 182
8 Creating Conditions Establish relationships and link with health improvement colleagues and GP practices Link with individual GP practices and provide support and assistance with accessing and analysing data Access MiLan for breakdown of uptake by locality and GP practice Offer of support to GP practices in understanding systems Understanding Systems SCCRS is the national programme for recording and inviting individuals to participate in cervical screening. Results are recorded quarterly in the local system (MiLan). Reviewed SCCRS in order to identify areas for improvement and monitoring of uptake Analyse MiLan to identify uptake across Lanarkshire geographical areas. This provides a breakdown of uptake and number of patients eligible for cervical screening each quarter by locality and GP practice. Results for this quarter are shown in the above table and narrative. Developing Aims A questionnaire was developed to establish processes in place for cervical screening across Lanarkshire GP practices. This has been shared with some GP’s across the North locality who are keen to improve their screening uptake and help support ease of access to services. Evidence of uptake for GP practices was collated and presented at the GP cluster meeting. Other work ongoing is as follows:
Page 183
9 Meetings have taken place with Health Improvement Team (MH) & GP Cluster Lead (WH) for Bellshill in order to provide information specific to their practices. This has resulted in more in-depth engagement with cluster leads and increased intelligence on uptake and defaulters. A report on defaulters for Bellshill Practices used anonymised data and information and was shared with GP cluster lead. Meetings have taken place with GP cluster (JA cluster lead) for Bothwell, Uddingston and Viewpark. Intelligence on uptake and defaulters was shared, along with the questionnaire to identify processes within the GP practices for cervical screening. This identified that one practice had no practice nurse in place, however plans were identified to fill the post. However, as training was required for preferred candidate and it is not available locally, the service was able to provide access to that training in NHSGGC through their professional network. The service is now offering support in making best use of SCCRS to analyse data and also to assist with tailoring correspondence that reflects practice availability for patients due for screening (if required). 2. Childhood Immunisations Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 91.4% 89.9% Narrative & Corrective Action It is of note that indicator for the percentage of 2 year olds, which was consistently below target is now RAG GREEN, however the measure 5 year olds remains in decline. A further deep-dive study of immunisation data and a pan-Lanarkshire SLWG to address performance in this area commenced in December 2023. The “Immunisation Inclusivity” programme has also now commenced, with a pan-Lanarkshire approach to addressing inequalities. As a result of recent analysis, the service is investigating a possible trend relating to recent migration and attitudes toward immunisation that may be impacting on performance in this area. With issues relating to cultural attitudes toward immunisation, it is believed that long-term engagement will be required to improve performance. There is significant work within locality teams to improve uptake of vaccinations, currently focusing on issues around consent, partial consent and withdrawn consent; this is resulting in focussed work and engagement with particular families. An SBAR has been produced explaining a recent analysis of the available data and found that 1149 pre-school children had incomplete immunisations. However, there was complexity within cases around the withdrawal of consent, multiple immunisations, etc., and on a more in-depth analysis, 322 cases were identified were the status was not clear due to incomplete data. This identified a very small number of exceptional cases that were not allocated to a HV but most issues seemed to involve recording errors, or omissions in the SIRS3 process, particularly for those moving into the authority area from elsewhere. The service has identified that the SIRS form and process is not effective in dealing with cases of partial, or complete withdrawal of consent; there is an overall increase in the numbers of those withdrawing consent, however the recording process and current practice is not best at managing such cases and there is a lack of understanding across the many stakeholders of how to record and manage this.
Page 184
10 The service has identified that there is inequity and inconsistency in delivery; depending on the alignment of HV to a GP or Locality and the custom and practice within that setting, the service delivery can be greatly affected including the provision of clinics and appointments, availability of home visits and travel expenses paid to HV. Immunisation Inclusivity” programme will work to address these inequalities. The service recommends that a SOP and standardised practice is required, however in the long-term, it will be essential to implement a digital solution. Communications, use of social media and staff training will be key to embedding improvements. The work in North localities, aligned to the direction of the pan-Lanarkshire SLWG are characterised in the Action Plan for North Lanarkshire Health Visiting Teams, which will be jointly managed by the Service Manager and Senior Nurse. The actions are organised around 5 key areas recommended for improvement: 3. 6 – 8 Week Reviews Target 2022/23 2023/24 Q1 2023/24 Q2 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% 79.9% Quarterly/ 1 quarter behind Narrative & Corrective Action The management team have carried out “deep dives” of the historic data in order to better understand the decline in performance for this measure. This indicator reflects on the wider Home Visit/ Universal Home Visit Pathway and the deep-dive analysis identified that inconsistency in practice across GP practices and less effective communication between Health Visitors and GP practices may be playing some part in the decline in performance. Guiding Principles/Professional Practice • Home Immunisation position for all teams with guiding principles/SOP • Review Locality boundaries to realign with workforce utilising information from boundary paper and workload tool. • Agree guiding principles for immunisation scheduling and number of staff immunising. • Agree Interim latter for localities to use for non-attendance if Did Not Bring Policy not agreed. • Agree grade of staff to complete transfer in visit and completion of SIRS 3 form, • Consider any training needs in completion of the SIRS 3 form with guiding principles. IT • Review SIRS 3 form alignment with Morse • Agree platform for recording immunisations with consideration to Turas and new SIRS/CHI system implementation. • Review any potential options for text messaging system to remind patients of appointments Accomodation • SM to review and agree any locality requests for accommodation for additional clinics/pop up clinics • SM to review and agree any accommodation requests for evening and weekend clinics • SM to review and agree any financial costs associated with alternative clinics Locality processes for monitoring Q print • GP Practice and Health Visiting local processes to be considered to monitor Q print monthly and transfers in and out of locality. Public Health and Communications • Agree any media coverage to promote childhood vaccination programme.
Page 185
11 The analysis identified issues with those reviews completed closer to the 8-week deadline where multiple and part records were being generated, resulting in recording errors. More generally, issues were identified where missing demographic information resulted in recording forms being rejected and then returned, leading to failures and errors in recording. The potential for multiple, parallel and incomplete records increases the risk of poor performance in this area. Many findings from the analysis related to administrative error that can be characterised by the lack of an applied standardised process for recording, returning and storing of records. Many of the problems are manifest at the point of recording and with the GP practice, where there are continual failures to complete or return forms. It was also noted that any delay in registration of children by their parents, for any reason, can result in failure to meet the target. The management team are using the analysis to provide more detailed presentation of the data showing the impact of various issues on overall performance, including the impact of “opting-out”. More work is required to understand how the uptake of reviews may be impacted by the nature of the opt-in, or opt-out approach to managing the UHVP reviews. The findings of the analysis and recommendations resulting from this work were documented in an SBAR that was presented to the CMT, who endorsed the recommendations. There is a national programme to move to an electronic recording solution, however this is not expected to be delivered until 2025. There is significant local work to investigate how Morse might facilitate an interim electronic solution. Following the submission of the SBAR to CMT, the Executive Team and their Digital colleagues are now reviewing the overall prioritisation of Morse implementation within the partnership to reflect areas the areas of greatest need and risk. The service continues to engage with the national work for a digital recording solution alongside the local work. It should be noted that although some improvement might be found through the adoption of Morse, this would not address the issue in entirety as GPs are not able to access the system. Changes in GP practice, changes in approach and the autonomy of GP practices mean that even embedded improvements can be subject to changes that are out with the control of the HSCP. The service believes that the lack of consistent process, or SOP is the critical factor in both performance, quality and safety. At a locality level the service continues to implement practical actions to address the immediate concerns around missed reviews, and incomplete or missing records. There is regular engagement with GP practices on the importance of communicating any non-attendance and specific engagement with GP and their Practice Managers to discuss the processes in place to ensuring CHSP forms are collected and delivered. There is a Test of Change in progress within Motherwell locality to trial an improved process; this is in the early stages but has already improved communication between the HV staff and GP practices and the early indication is that the change is positive. 4. Reablement and Rehabilitation Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 21.3% 22.6% Balance Of Care - % Of People (Age 65+) 45% 40.2% 36.7% IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 47.5% 49.9% Narrative & Corrective Action A working group has been formed to update the Standard Operating Procedures for Reablement. The group has MDT representation from the six localities, including locality Integrated Rehabilitation Teams and Home Support.
Page 186
12 Rehabilitation and Reablement have increased their levels of collaboration with the Technology Team to introduce more technology options, supporting improved outcomes for service users. A number of staff awareness sessions have taken place and where possible, co-location of Technology Team staff within the locality has enhanced the knowledge and understanding of tech options, built relationships and improved joint working. Wishaw locality has been involved in a test of change to take all functional and environmental assessments away from Access Social work and this has proved to be very successful in reducing waiting times for service users and provided quicker access to rehabilitation. This approach will be further tested in another locality to assess the effectiveness of this way of working. There are continued challenges faced by IEAS, however performance against the seven-day standard appears to have stabilised. There has been focused work on reducing the number of outstanding uplifts and higher priority deliveries. The ordering and delivery of equipment should be prioritised according the risk matrix, however most items ordered remain a Priority 1 and almost all equipment requested from hospitals is deemed essential for discharge, which increases strain on the service. IEAS staffing levels have significantly improved; the current position overall is a deficit of 5.89 WTE, however a refreshed induction and training programme for new staff members requires that the full capacity of these new staff is not wholly available to the service as yet. The procurement of the ELMS2 digital management system will improve processes, management information and communication. The system is currently in build and the training is being planned; the rollout is planned over six months with full integration expected in Autumn 2024. The Home Support Team continues support the wider Rehabilitation and Reablement services, with 1,253 referrals to HAT to 30th October 2023. Generally, a third of all referrals are Wishaw locality; Bellshill and Coatbridge have yet to fully start the HAT service. The number of referrals with no input services noted from HAT appears to be decreasing, suggesting that that people may be refusing services upon discharge. The largest input service is Home Support, followed by OT.
Page 187
13 The number of people being re-admitted to hospital at the end of the HAT process is decreasing, the number of those requiring no further service is increasing, as is the percentage of people completing the HAT process. The approach is well embedded in Wishaw and Cumbernauld, with increasing activity in Airdrie and Motherwell localities. The next steps for the project are to complete recruitment and the locality roll-out, ultimately leading to adopting the HAT approach for all people being discharged from hospital, allowing for a seamless flow to Reablement and greater capacity within Home Support. Further service improvements are expected through the review of Home Support, which has necessary interdependencies with HAT, Reablement and IRT teams. The Home Support Programme Board governs and provides strategic direction for this work. Input SW 4% OT 51% Physio 17% AHP Support Staff 11% Home Support 70% CAS 22% Technology 4% Pharmacy 3% Com. Nursing Team 10% Med. Realignment 2%
Page 188
14 5. CAMHS Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 28.1% 47.1% Narrative & Corrective Action The Waiting List Initiative continues to evidence a steady downward trajectory in children and young people who are waiting to be seen. Combined with the impact of CAPA, there is evident reductions in the waiting list and the longest waits. Although embedded as standard practice, the service continues to monitor the impact of CAPA and the WLI to ensure that it is addressing ongoing challenges around the RTT target and that appointment capacity is maximised across the whole system. Modelling suggests that increased activity through waiting list initiative will not fully deliver RTT improvement in RTT in the short-term, however the expected consistent positive trajectory appears to be manifest in the data. 6. Adult Mental Health Target 2022/23 2023/24 Q1 2023/24 Q2 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%* 57.4% 48.9% Narrative & Corrective Action The Scottish Government published their Core Mental Health Quality Standards in September 2023. The standards are available at Core Mental Health Quality Standards (www.gov.scot). These set out the vision for Scotland to achieve the best mental health and wellbeing possible, built around a clear national framework with themes informed by people with lived experience of using mental health and psychological services and the workforce. The themes are: Access Assessment, Care Planning, Treatment and Support Moving between and out of Services Workforce
Page 189
15 Governance and Accountability The long-standing shortage of psychiatrists and the wider staffing emergency in mental health services across Scotland presents a significant challenge for Lanarkshire to adhere to these standards. Currently, staff are working in an environment with reduced staff availability but with increased levels demand. It is believed that in Lanarkshire, ADHD cases are the most significant area of increased demand. The following actions are ongoing to address operational planning and business continuity for the services: Escalation to senior medical management and the NHSL executive; the issue is being managed on the risk register and the position noted as deteriorating. SLWG to implement actions to mitigate the low staffing levels whilst still allowing for the cover of core work. Bespoke recruitment process and documenting of a recruitment and retention strategy. 7. Medical Paediatrics Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 49.5% 56.1% Narrative & Corrective Action In-reach capacity is limited and capacity is being balanced across the system to ensure cover. Vacancy gaps in the Tier 3 rota have been partially filled with two locum positions and have stabilised staffing arrangements. The service is investigating potential OD and CPD opportunities for staff that may contribute to recruitment and retention of core staff. It should be noted that whilst the RTT target was not being met, significant improvement had been made in the length of wait, from 11.5 to 4.5-months had been realised. The complicated system pressures between Neuro and Paediatrics are currently being analysed as patients can be subject of multiple referrals and waits. This is in parallel with modernisation work within the service and work to identify the data, information and metrics similar to that in CAMHS is being considered as part of the approach. 8. SLT Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 25.1% 18.3% Narrative & Corrective Action A service improvement plan is in progress and the management team have been provided with additional support to implement the improvements. There are six discreet areas of improvement work: -
Page 190
16 1. Communication and Engagement – Communications are being disseminated via the dedicated website and YouTube. This is led by the NHS Communications Team and supported by the SCHSU Engagement Officer. 2. Waiting List – Improvement work is ongoing to address the waiting list and waiting times, with a focus on consistency of approach and use of Trakcare. 3. Accommodation - A review is yet to be undertaken of currently allocated space and capacity of clinical rooms to meet clinical demand. 4. HR and Workforce - Scoping of workforce demography and the development of a new workforce and service delivery model is yet to be undertaken. 5. Administration - A scoping of tasks against current capacity and demand is planned. 6. eHealth - Testing of the current Trakcare build and expanding this to all parts of service is to be led by colleagues from eHealth. 9. Dietetics Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 75.4% 69.1% Narrative & Corrective Action The improvement in performance seen in Q1 has not been sustained, although the overall trend in the longer-term is still for improving performance. Recovery continues to be restricted by the (approximately) 20% reduction in available workforce, which is due to both long term sickness and sustained vacancies in the workforce. Although recruitment activity continues, as with many services Dietetics has difficulty in attracting suitably skilled and experienced staff due to lack of available workforce nationwide. 10. Adult Social Work Target 2022/23 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of Notifications Received by LAC Team Within 3 days of LAC Date 95% 13% 41% % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 12.4% 14.8% % Of Adult Protection Investigations Going To Initial Case Conference 20% 20.3% 10.4% Narrative & Corrective Action The number of APS referrals received by localities continues to rise. Care Homes continue to be the primary source of referrals for ASP, which has been a consistent trend over the last 12 months. It is important to recognise that number of referrals does not automatically equate to the number of adults at risk of harm. Work continues to be undertaken with Care Homes and relevant stakeholders to promote high-quality ASP referrals and defensible decision-making based on a good understanding of risk, harm and the impact (or lack-of) this has on the adult being referred, and ultimately whether ASP is the correct referral route to take. In addition, community based referrals are more likely to progress to ASP investigation when compared to referrals from Care Homes. Referrals generated by Social Work and partners often relate to
Page 191
17 multiple types of harm but our analysis has identified that self-neglect and hoarding continue to rise; these cases are often complex and require a long-term, inter-agency response. Police “Adult Concern” reports continue to rise; combined with ASP referrals, these generate a significant body of protection work that is undertaken by localities to keep adults in the community safe.
Page 192
18 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
Page 193
REPORT Item No: 15 SUBJECT: Risk Management Report TO: Performance Finance and Audit Committee Lead Officer for Report: Ross McGuffie , Chief Officer NL HSCP Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 21st February 2024 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. 1
Page 194
3. RECOMMENDATIONS 3.1 The IJB PFA is asked to note the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 A full review of the risk management reporting within the IJB has taken place as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. This review included how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session was held at the IJB Liaison Session in November. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. 6. CONCLUSIONS 6.1 The IJB currently has 17 risks identified on its IJB risk register with 11 risks rated as high or very high. 2
Page 195
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 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 ☒ 3
Page 196
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 4
Page 197
□ 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. 5
Page 198
9. APPENDICES Please include a glossary of terms if not already included. Appendix 1– IJB Risk Register Appendix 2‐ Risk in Focus Dashboard Presentation 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 6
Page 199
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 7
Page 200
Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead AssuranceSource NextReview Date ClosedDate IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges TherearearangeoffinancialchallengeswhichwillimpactontheIJB'sabilitytodelivertheStrategic CommissioningPlanintentionswithinthefinancialenvelopeavailable. Theseinclude: 1. TheabsenceofauniqueIJBfinancialsettlementfromtheScottishGovernment. 2. TheIJBisdependentonfunding frombothpartners. 3. LateScottishGovernmentfinancialsettlement. 4. BudgetreductionsduetoinsufficientScottishGovernmentfinancialsettlementsand/orpartnercontributions. 5. NewScottishGovernmentpolicycommitmentse.g.Carers(Scotland)Act2016. 6. Demographic growth. 7. Competingservicepriorities. 8. ConflictingpartnerefficiencysavingsprogramswhichadverselyimpactontheHSCP'sabilitytodeliver services. 9. In‐yearcostpressuresemergingduetotheunderachievementofplannedsavings,pandemicsandother emergingriskswhichmayleadtoanoverspend. 10. EachpartnermaybeunabletomaintaintheirfinancialcontributionstotheIJBinfutureyearswhichwould impactonfrontlinehealthandsocialcareservices. 11. Theagreedtransformationalplansandserviceredesignsarenotimplementedinfullandinlinewiththe originalimplementationplanand/ordonotsecuretheintendedimprovementoutcomesinbothperformance standardsandfinancialefficiencytargets. 12. Futuresavingstargetswillcontinuetobechallengingandarelikelytoimpactonessentialcoreservices. 13. TheIJBFinancialPlancannotbeadheredtoandbudgetrecoveryplansfailtoachievefinancialbalancefor bothpartners. 14.The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15.The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. Theabovefactorswouldleadtoafailuretoachievethedesiredstrategic aimsandwouldalsoimpactonservice delivery. HIGH CONTROLS 1. IJBPFACommittee. 2. IJBChiefOfficerisamemberofeachpartner'skeydecision‐makingforums. 3. EffectivejointworkingbetweenNorth and SouthChiefFinancialOfficerandbothCouncilandNHSFinanceDepartments. 4. RegularbudgetmeetingswithChiefExecutivesandDirectorsofFinance. 5. RegularHSCPbudgetmonitoringmeetingsacrossSeniorLeadershipTeam. 6. TheIJBFinancialPlanshavebeenagreedandarereviewedregularly. 7. IJBmediumtermfinancialplan2023‐26andreservesstrategy2023‐24approvedatMarch23IJB 8. Capacityplansinplacetomaximiseefficiency. 9. IJBIntegrationSchemesettingoutthebudgetrecoveryprocesses. 10. IJBFinancialRegulationsandfinancialprocedures. 11. Consultationandinvolvementwithkeystakeholdersincludingserviceusersandcarers. 12. PrescribingQualityandEfficiencyProgramme,SWEG,ARGandHomeSupportmonitoringgroupsareinplace. 13. JointStrategicNeedsAssessmentandongoingmovetowardspreventativeandanticipatoryapproaches. 13. StrategicPlanningGroup,LocalityengagementsessionsandPartnershipBoards. 14. Effectiveandongoingserviceuserengagement,staffconsultationandTradeUnionliaisonatstrategicandlocallevels. ACTIONS 1. Annualbudgetsettingprocesseswithineachofthepartners. 2. HSCPparticipatinginNHSLSustainabilityandValueprocess 3. Partnershipwillalsobeconnectedtonewnationalwholesystemgroupsaroundbudget HIGH MEDIUM AmandaKilburn AmandaKilburn SLT,IJBPFA,IJB 28.02.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewedand UpdatedMay 2023.Reviewed andUpdatedSept 2023. Reviewed and updated Jan 2024. IJB02. 21 Financial Reputational 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption ThereisariskthattheIJBisunabletopreventanddetectfraudandcorruptionwithinservicesbecauseof inadequategovernancearrangementsandinadequateinternalcontrolsystemswhichcouldleadtofinancialand reputational damage. LOW CONTROLS 1. Fraudawareness e‐learning. 2. National Fraudinitiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relationto authorising and processing directpayments. 5Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversightvia NLC Audit andScrutiny Panel and NHSLAudit Committee. 8. Effective governance arrangements are in place andsubject to internal and external auditreview. 9. IJB and IJBPFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintainits own policies relating to the prevention and detection of fraudand error but instead depends on those in place at its partner bodies. TheIJB has aCode 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 toraise fraud awareness through teambriefings. 2. Annual plannedProcurementandStanding FinancialInstructions 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 atthe IJB PFA. LOW LOW RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 31.03.24 PreviouslyIJB6. Reviewedand updatedon March2023. Reviewedand UpdatedOct 2023, (previouslytitle ineffective governance arrangements). Report Prepared by Stacey Anderson on behalf of the Chief Officer
Page 201
North Lanarkshire Integrated Joint Board Risk Register IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead AssuranceSource NextReview Date ClosedDate 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 peopleathomee.g.transitionalcaremodels. VERYHIGH CONTROLS 1.ThereiscompletetransparencyandongoingdialoguebetweentheIJBandtheHealthBoardonthechallengesassociatedwiththe implementationofthenotionalset‐asideconcept. 2. Bedmodellingandcapacityplanningarrangementsareinplace. 3. EffectiveworkingrelationshipsbetweenbothpartnersandtheIJBhavebeenestablished. 4. SincetheinceptionoftheIJB,anagreementisinplacewherebytheNHSLHealthBoardwillmanagetheoverspendorunderspendacrossthe notionalset‐asidebudget. Thisarrangementcontinuestobeinplace. ACTIONS 1.TheChiefOfficerandtheChiefFinancialOfficercontinuetoraisethisconcernatanationallevel. 2. DiscussionsongoingwithNHSLDirectorofFinancearoundunscheduledcarespendfor current and future years. HIGH MEDIUM RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 28.02.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed and updated Jan 2024 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services ThereisariskofdisputebetweentheNorthLanarkshireIJBandtheSouthLanarkshireIJBinrespectofthe financialallocationsunderpinningtheHostedServicesparticularlyasaresultofthebudgetchangeslinkedtothe implementationofdevolvedlocalitymodels. Thiscouldimpact ontheabilityofeachIJBtoachieveits commissioningintentionsandmayalsohaveanadverseimpactonserviceusersacrossLanarkshire. VERYHIGH CONTROLS 1. NorthandSouthIJBsaimtoco‐operatetoensureapan‐Lanarkshireapproachisachievedacrossallhostedservices. 2. Financialandbudgetarycontrols. 3. Performancereportsonservicedelivery. 4. In line with the Scottish Governments Integrated Resources Advisory Gorup and North Lanarkshire IJB Financial Regulations, it is agreed that the host partnership is required to manage any in-year overspends or underspends within the hosted service it relates to. MEDIUM MEDIUM RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 28.02.2024 ReviewedJan2024 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs Thecostofprescribingisgrowingduetoissuesinsupplychainsdrivingincreasedwholesalercostofmedicines, advancetreatmentdevelopmentsresultingintheneedformoreexpensivemedications,agingpopulationand increaseinpatientsrequiringregularmedication.MedicationavailabilityhasbeenimpactedfollowingtheEU withdrawaltheUK'smembershipofthecommonregulatorybodiesandEUagencies,suchastheEuropean MedicinesAgency,(EMA),EuropeanCentreforDiseasePreventionandControlandtheEuropeanAtomicEnergy Community.Theriskisthatthiscouldimpactontheavailabilityofmedicines,healthcaretechniquesand technologyandinrespectofthesupplyofmedicinesandmedicaldevices,additionalchecksarenowrequiredat portsintheUKandtheEEAbeforegoods,includingmedicalproducts,cancrosstheborder. Newcustomschecks arerequiredwhenmoving medicinesbetweentheEEAandtheUK. Medium CONTROLS 1..PrescribingQualityandEfficiencyProgramme. 2. PrescribingManagementBoardfunctionsandmembership. 3. DeputyLeadPharmacistsupportingHSCPSeniorLeadershipTeam. 4. LocalityPharmacistinput. 5. Earmarkedreserveestablishedtoaddressprescribingcosts. 6. RegularHSCPmonitoring. Inrespectoftheregulationofmedicinesandmedicaldevices,theMedicinesandHealthcareproductsRegulatoryAgency(MHRA)becamethe UK’ssovereignregulator. 7. ThenewtradedealcontainsspecificclausesthatmeanboththeUKandEEAstatesformallyrecogniseeachother’sgoodpracticeinmedicine manufacturing. 8. Toreducetheriskofdivergence fromtheEUrules,therearethreeinterrelatedfactors;thetechnicalannexesofthenewtradedeal,the NorthernIrelandprotocolandtheUKInternalMarketAct. 9. TheeffectivenessoftheBorderOperatingModeltoimportandexportgoodstoandfromtheEEA,whichwasbeingimplementedinstages from2020tominimiseanyriskofdisruption,isstillbeingassessed. Theriskofborderdelaysisstillevident. Othermeasureswerealso implementedspecificallytomitigatetheriskofsuppliesofmedicinesandmedicaldevicesbeingdisrupted. InAugust2020theUKgovernment instructedmedicinesupplierstomaintainastockpileequivalenttosixweeks’supplythoughthefirstthreemonthsof2021. Inaddition,the DepartmentofTransporthassecuredadditionalfreightcapacitytobringmedicinesintothecountryviaotherroutes. ACTIONS 1. ReviewofLocalityPrescribingActionGroups. 2. PrescribingpartofNHSLSustainabilityandValuestructures 3. ContinuationofScriptswitch. 4. Prescribingupdatesbeing providedtoIJBasperfinancialreports VERYHIGH LOW RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 28.02.24 PreviouslyIJB11. Reviewedand updatedJune 2023. Reviewedand Updated October2023. ReviewedJan 2024 IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector ThereisariskthatThirdSectororganisationsinNorthLanarkshirearevulnerablebecauseofthelackofcertainty inrespectoflong‐termfundingsecurity. Thisuncertaintyhasthepotentialtoleadtoserviceinstability, recruitmentandretentionchallengesandanincreasingrelianceonstatutoryservices. HIGH CONTROLS 1. ThirdSectorInterfacerepresentedonkeystrategicgroups. 2. CommunitycapacitybuildingandcarersupportinfrastructureembeddedacrossNorthLanarkshire. 3. Communitycapacitybuildingisregularlyreviewed. 4. Maximisingfundingopportunitiesforthethirdandvoluntarysectorwillcontinuetobeprogressed. ACTIONS 1.TheannualHSCP fundingwhichisdirectedtothethirdsectorisrecurringfunding. Fundingwillbeconfirmedeachyearinlinewiththe agreementoftheIJBFinancialPlanandsubjecttotheScottishGovernmentfinancialsettlementsforfutureyears. 2. UpdatedSLAwithVANLnearingcompletion LOW LOW RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 30.03.24 PreviouslyIJB16. Report Prepared by Stacey Anderson on behalf of the Chief Officer
Page 202
North Lanarkshire Integrated Joint Board Risk Register IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead AssuranceSource NextReview Date ClosedDate IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements 1. ThereisariskthattheintensityoftherequiredresponsetoCovid‐19may haveresultedinafailureof governanceimpactingontheeffectivenessoftheIJBdecision‐making,IJBdirectionstopartnersandIJB oversightofoperationalservicedelivery. Routinegovernanceprocessescouldbeoverwhelmed. 2. NeworamendedlegislationandScottishandUKGovernmentguidancemaynotbeadopted effectivelyandtimeously. 3. IneffectiveinformationgovernancecontrolscouldleadtodatabreachesandanimpactontheGeneralData Protection Regulations. 4. Communicationswithemployees,patientsandserviceusersmaybeineffective. 5. Therewillrequiretobechangestotheworkingenvironmentincludingremoteworkingandworkingfrom home. 6. Thereisareducedabilitytoprotectthewellbeingofemployees,patientsandserviceusers. 7. Theremaybeadversemediacoveragelocally,alossofpublicconfidenceandreputationaldamage. MEDIUM CONTROLS 1. NationalNetworksareestablishedwhichareprovidingtheframeworktosupportanationalapproachwhereappropriate. 2. PublicHealthadviceandsupportisinplace. 3. Increasednumbersofagileworkersandincreasednumberoflaptops/tablets. 4. ContinuedworkingfromhomearrangementssupportedbytherolloutofMSTeams/Zooms. Regularupdatesontheguidancefortheuseof MSTeams/ZoomMeetingsiscirculated. Ablendedapproachtohome/work‐basedworkingisbeingdevelopedgoingforward. 5. RiskregistersareinplacefortheIJBandeachpartner. 6. TheIJBandbothpartnersaimtocomplywiththeEuropeanWorkingTimeDirective(WTD)andminimisetheriskofallstaffworkingbeyond48 hoursperweek,inparticularfront‐lineservicedelivery. AsaresultofthewithdrawalfromtheEuropeanUnion,theWTDceasedtoapplytothe UnitedKingdomattheendofthetransitionperiod(31December2020). However,theUK'sWorkingTimeRegulationswhichimplementtheEU WorkingTimeDirectivewillcontinuetoapplyunlessanduntil amendedbyUKlaw. 7. BacktoBasicsexercisehashelpedtofocusontheunderpinninggovernancerequirementsacrossthewholeHSCP ACTIONS 1. Staffhealthandwellbeingisakeypriority forbothpartnersandallkeystakeholders. Thecommitmenttostaffhealthandwellbeingisbeing activelypromotedthroughallavailableforums. 2. WorkisbeingcarriedouttoembedgovernanceprocesseswithintheH&SCPincludingriskreview,complaints,patientfeedback,adverse events MEDIUM LOW RossMcGuffie AmandaKilburn SLT,IJBPFA,IJB 30.03.24 Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity Thereisariskthatthe IJBisnot providedwithadequateorsufficient performanceinformationtoenableitto dischargeitsscrutinyandoversightrole;makeinformeddecisionsandrecommendremedialactionstoaddress anyperformanceconcerns. LOW CONTROLS 1. Regular(quarterly)reportsontheIJBperformanceframework,providingupdatesonareasforimprovement,remedialactions(andtimescales) andupdatesonperformanceissuespreviouslyreported. 2. ChiefExecutivePerformanceReviewarrangements. 3. HostedServicesPerformanceReviewarrangements. 4. Sector/LocalityPerformanceReviewarrangements. ACTIONS 1. Requestdetailedtopicbasedperformancereportsonspecificareasofconcerne.g.CAMHS&PsychologicalTherapies. 2. FacetofaceQ3performancereviewstakingplacethroughoutMay23withsectors/units LOW LOW RossMcGuffie M oragDendy SLT,IJBPFA,IJB 31.12.23 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing ThereisarisktothedeliveryoftheStrategicCommissioningPlanasaresultofsustainedpressuresonstaff availabilityduetoadditionalpressuresassociatedwith Covid19,currentsicknessabsencelevelsandpotential forfurtherstaffredeploymentduetowinterplanningcontingencyarrangements. medium Controls 1. StrategicStaffHealth&WellbeingCommitteeestablishedreportingtoNLC&NHSLcorporatemanagementteams. 2. Rangeofsupportservicesavailablebothnationallyandlocallye.gOccupationalHealth,Spiritualcare,PsychologicalServices,national wellbeinghub(www.PRoMIS.scot.uk). 3. Rest&Recuperationareasidentified. 4. PeerSupportNetworksestablished 5. WellestablishedOccupationalHealthsupportsavailabletosupportstaffsickness. Actions 1. ShortLifeWorkingGroupforwellbeingwithtargetedapproachforimmediateactionsincludingStaffHealth&WellbeingChampions,accessto onlinesupports,accesstoOccupationalHealthServices,helplineestablishedanddedicatedresourceidentifiedforwellbeingofficerstobe recruited. 2. FundingreceivedbyScottishGovernmentspecificallytargetingstaffwellbeingprogrammesandsupports.Localplansforuseoffundingbeing developed. 3. Managerssupporting&encouragingstafftotakeplannedleave/usefullleaveallocation 4. Auditsofadherencetosicknessabsencepolicybeingundertaken HIGH low RossMcGuffie RossMcGuffie SLT,IJBPFA,IJB,SC&CG,AH&SC 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. IJB.13. 2021 Performance 30.08.21 Care Homes Inabilityofcarehomestosustainserviceduetostaffing andcost pressuresresulting inclosuretonewplacement andclosureofcarehomes.Thismayincreasedelayeddischargenumbersputtingadditionalpressureonacutesite capacityandimpactingonrecovery. High Controls 1. EstablishmentofCareHomeAssuranceTeam. 2. EscalationProcessinplace. 3. NationalprotocoltosupportdischargeofCovid19patientsinplace. Actions 1. PublicHealthteamsprovidingguidanceoninfectioncontrol. 2. CareHomeassuranceteamundertakingsupportvisitstoallcarehomes&actionplansinplaceforeachcarehome. 3. AllcarehomesadvisedtousePPEinlinewithnationaladdendum. 4. Developmentdayon12thMay23toagreestructuresandapproachforyearahead medium medium RossMcGuffie TrudiM arshall IJB,PF&A,SLT,SC&SC,AH&SC 28.02.2024 Reviewedand updatedOct2023. Report Prepared by Stacey Anderson on behalf of the Chief Officer
Page 203
North Lanarkshire Integrated Joint Board Risk Register IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead AssuranceSource NextReview Date ClosedDate IJB.14. 2022 Strategic& Performance 30.04.22 CAMHS‐ ThereisariskthattheCAMHS servicecannot meettheincreasingclinicaldemandsduetoasignificantlyhighnumberofcumulativestaff vacanciesforbothclinicalandnon‐clinicalpostsandchallengesrecruitingtonewpostsidentifiedthroughthe nationalrecoveryandrenewalfund. Thisisimpactingoncommunity,in‐patientandout‐patientcarewiththe potentialtoadverselyaffectresponsetimetoreferrals;longerwaitingtimes;pooreroutcomes;delaysinredesign andreputationoftheIJB. VeryHigh Controls ‐ 1.Prioritisationofreferrals;allreferrals1vetteddailywithurgentreferralsprioritised 2. CommencedprogrammeofworkandimplementationofamorestructuredpartnershipapproachthroughChoices&PartnershipApproach (CAPA)servicemodel,withtier1&2referredthrough3rdsectorandinterfacingwithNorth&SouthEducationDepartments 3. Securedsignificantnationalinvestmenttofullyimplementnewservicemodel 4. Activereviewofskillmixtoutilisemedicalstaffonlywhenrequiredforhighlycomplexpatients 5. Vacancygapanalysiswithactiverecruitmentcommenced. Expectedtohaverecruited75%ofgapbyendofMay2023 6. Continuousreviewandvalidationofthewaitinglist Action 1. Incrementalimplementationofthenewservicemodel 2. CAPAappointmentsbeginon1stMay2023‐firstcycle(16wks)nearingcompletion 3. RefurbishmentofNorthLanarkshirefacilitiescommencesearlysummer2023 High medium RossMcGuffie M oragDendy IJB,PF&A,SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. IJB.15. 2022 Strategic& Performance 05.09.22 Cost of Living ThereisariskthattheIJB'sStrategicCommissioningPlanwillbeunabletobe deliveredornot havethedesired impactduetothecostoflivingrisesbeingfacedbyresidentsacrossNorthLanarkshire,leadingtoafurther wideningoftheinequalitygap,reducedqualityoflifeandincreasedhealthandsocialcaredemanddueto individualsandfamilieshavinginsufficientfundstosupportbasicrequirementssuchasfoodandheating. High CONTROLS 1. NLCSilvercommandgroupstoodupfocusedoncostofliving 2. NHSLcommencedreviewthroughCMT 3. PopulationHealthCommitteetoreviewactivityaroundcostofliving 4. NLCapprovedcostoflivingcontractincreasesinMay2023 ACTIONS 1. SurveyofNLChybridworkerstoseeifhomeworkingremainsfinanciallyviable 2. Businesscasebeingdevelopedtoexpand'supportforpeople'arrangementsusedinpandemictosupportresidentaccesstowelfarerightsand othersupports 3. 3%increaseinindividualbudgetstosupportserviceuserstomaintaincurrentlevelsofsupportsathighercost 4. Recommendationfromadultsocialwork,careandwellbeingcommitteetoreviewallchargestoserviceusersandwidercostoflivingsupports thatcouldbeoffered High Medium RossMcGuffie RossMcGuffie SLT,IJB 30.03.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. IJB.16. 2022 Strategic 05.09.22 National Care Service ThereisariskthattheongoingworkaroundaNationalCareServicecoulddestabilisecurrentservicedeliverydue tosignificantchangeactivity,timedemandsaroundtheco‐designprocess,staffuncertaintyandpartner organisationshavingtofocusinwardlyduetotheimpactofchangeleadingtoanimpactontheabilitytodeliver thesignificantongoingchangeprogrammesalreadyapprovedbytheIJBandtheStrategicCommissioningPlanfor 2023‐26. High CONTROLS 1. NLCestablishingNCSworkinggroups 2. KeyHSCPleadsinvolvedinnationaldevelopments 3. OngoingprogressupdatestoIJBandIJBPFA ACTIONS 1. IJBresponsesubmittedonproposedBill 2. StrongpartnershiplinksintoworkinggroupsatChiefOfficers,ChiefFinanceOfficersandSocialWorkScotlandgroups 3. SG/COSLAworkinggroupsbeingestablished‐localrepsnominatedforeach High Low DianeFraser RossMcGuffie SLT,IJBPFA,IJB,ASW C&W B 31.12.23 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. IJB.17. 2022 Strategic& Performance 05.09.22 Unscheduled Care Thereisariskthatwecannotsustainwholesystempatient flowthroughpeakwinterpressuresduetoincreased frontdoordemand;hospitalworkforcecapacity;delaysinonwardmovementofpatientsduetocarehome capacity/outbreaksandcareathomecapacity;andcommunityhealthandsocialcareworkforcecapacityleading toreducedabilitytomeet'routine' andincreasingbeddemandformoreunwellpatients,deterioratingdelayed dischargeperformanceandaninabilitytorecoverservices. VeryHigh CONTROLS 1. CareHomeAssuranceGroupandassociatedsupportsforcarehomesthroughliaisonservice,IPCadviceandsupport,riskassessmentfor onwardmovementofpatientsetc. 2. CareatHomeAssurancegroupandassociatedactivitytotrytosupportandsustainindependentsectorprovision 3. NHSCMTandCovidresponsegroupoversightofperformance 4. DailyPDDmeetingstorevieweveryplannedsupporteddischargeanddelayeddischarge 5. OperationFlownowunderwaytoensurewholesystemapproachtounscheduledcare/delayeddischargechallenges ACTIONS 1. ExpansionofHomeSupportservice 2. RolloutofHomeAssessmentTeamsacrossall6LocalitiesbyFeb 3. NewCSWrolesinDistrictNursingteamstoproactivelysupportCareManagedpatients 4. AdditionalNursingcapacityinDistrictNursingTeams 5. ExpansionofEquipmentandAdaptationServicetosupportrapidaccessincommunity 6. ExpansionofH@Hservice(hoursofprovisionaswellasmoving tosupportdischargesaswellasadmissionprevention) 7. ExpansionofIntegratedRehabilitationTeamsinallsixLocalitiestosupportrehabinthecommunityandreducelong‐termservicedemand 8. 5TaskandFinishgroupsnowestablishedtorolloutthekeyactionsagreedthroughtheOperationFlow programme(Phase2tobecompleted bySept 23) 9. FirebreakimplementedJan2024. VeryHigh Medium RossMcGuffie RossMcGuffie SLT,IJBPFA,IJB 28.02.2024 Reviewedand UpdatedinJune 2023. ReviewedOct 2023 ReviewedJan 2024. Report Prepared by Stacey Anderson on behalf of the Chief Officer
Page 204
IJB ID Category OpenedDate Description of Risk Risklevel(initial) Mitigating Controls Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead AssuranceSource NextReview Date ClosedDate IJB.18. 2022 Strategicand Performance 05.09.22 Community Alarms Thereisariskthatthecommunityalarmsystemwillbedestabilisedduetothenationalchangefromanalogueto digitaltelephonyby2025,leadingtocommunityalarmusersnotgettingaresponsewhenrequired. High CONTROLS 1. Workinggroupestablishedtocoordinateallactivity 2. OversightthroughHomeSupportProgrammeBoard 3. ReportingtoAdultSocialWork,CareandWellbeingCommittee 4. ReportingtoIJB ACTIONS 1. NLCCommitteeapprovaltopurchase1000digitalalarmssotheservicecansupport anyimminentchangesovertodigitalinindividualareas 2. NLCpartofSGonceforScotlandprocurementprocessforanewdigitalalarmreceivingcenter 3. Communicationouttoallcommunityalarmserviceusers 4. Instructionsissuedtoallcommunityalarmserviceusersonhowtodotestcallstoensurealarmsareoperational 5. EngagementwithtelecommunicationsupplierstoensuresightofrolloutplansacrossNL Medium Low DianeFraser RossMcGuffie SLT,IJBPFA,IJB,ASW C&W B 28.02.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. IJB.19. 2023 Performance 27/02/2023 Service Sustainability Duetocompeting service prioritiesandworkforce/operationalandfinancialchallengesthereisariskthattheIJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of theIJBposesariskonoperationalservicedeliveryandtheachievementoffinancialbalanceandpatientsafety High Controls 1. IJBPFA Committee. 2. IJB Chief Officer is amember of each partner's key decision‐making forums. 3. Effective joint working between Chief FinancialOfficer and both Council and NHSFinance Departments. 4. Regular budget meetings with Chief Executives andDirectors 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 placeto maximize efficiency. 8. Consultation and involvement with keystakeholders including service users and carers. 9. Joint StrategicNeeds Assessment andongoing move towards preventative and anticipatory approaches. 10. Strategic Planning Group, Locality engagementsessions andPartnership Boards. 11. Effective and ongoing service user engagement, staff consultation and TradeUnion liaison at strategic and locallevels. Actions 1. Sustainabilityplans tobe reviewed regularly 2. Re‐introductionofscrutiny 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 IJBto ensure continuous review ofservices/ service developments. 5. Development of the programme of work toensure regular reporting structure in place forservice review. 6. OperationFlowTask andFinishGroups analyzingservice challengesandimplementingphasedchanges tosupportwinter pressuresandbeyond. High Low RossMcGuffie RossMcGuffie SLT,IJBPFA,IJB 28.02.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. IJB.20. 2023 Workforce Sustainability ItisbecomingincreasinglydifficulttorecruittoparticularrolesacrossHealthandSocialCare. Gapsinthe workforcecanresultinreductionofserviceprovision,increaseinstaffworkloadandinabilitytodeliverthe strategicplan.FollowingEUwithdrawalthereis nolongerthefreemovementoflabourbetweentheUKandEEA countries. AllworkersarrivingfromtheEEAandnon‐EEAcountriesaresubjecttothesameimmigrationrules. Thenewpoints‐basedimmigrationsystemmakesexceptionsforthemajorityofhealthcareprofessionalswithan NHSjobofferandforqualifiedsocialworkersviaanewfast‐trackvisaroute,knownastheHealthandCareWorker Visa.Therearehowevernoexceptionsmadeforothersocialcareroles,suchascareworkers. TheMutualRecognitionofProfessionalQualificationsDirectiveisanEU‐widedirectivethatallowsprofessional regulatorsinallmemberstatestoautomaticallyrecogniseprofessionalqualifications. TheUKgovernmenthas decidedtocontinuerecognisingqualificationsgainedintheEEAforatleasttwoyearsafterthetransitionperiod ends. Thishoweverisnot areciprocalandthereisnoguaranteethatqualificationsgainedintheUKwillbe acceptedbyprofessionalregulatorsinEEAnations. High CONTROLS 1. AllsuccessfulHealthandCareWorkerVisaapplicantsareexemptfromtheImmigrationHealthSurcharge,aone‐offchargeleviedagainst arrivingmigrantworkersaspartofthevisaapplicationprocess. Thesystemhasbeendesignedtomakeinternationalrecruitmentintohealthand socialcarerolesmorestraightforwardforemployersandemployeesalike. Thesechangestoimmigrationrulesareinlawaspartofthe ImmigrationandSocialSecurityCo‐ordination(EUWithdrawal)Act2020. Assuch,from1January2021,theyapplytoallworkersarrivingtoworkin theNHSoradultsocialcare. AllworkersfromEEAnationswhoarealreadyresidentintheUKhaduntil30June2021toapplyfortheEU SettlementSchemewhichwillguaranteetheirrighttoworkintheUKindefinitely. 2. Inrespectofthemutualrecognitionofprofessionalqualifications,professionalregulatorybodiesareworkingwiththeUKgovernmentto reviewfutureregistrationrequirementsforthosewithqualificationsgainedintheEEAanddecidewhattheywillbefromJanuary2023. 3. DevelopmentoftheCareAcademy 4. DedicatedHRsupportidentifiedinNHSLandNLCtosupportkeypriorityareasofrecruitmentsuchasMentalHealthandHomeSupport ACTIONS 1. Annualworkforceplanbeingprepared 2. NHSLprogrammeunderwaytosupportinternationalrecruitment 3. OnthedayrecruitmenteventsbeingtrialedinHomeSupport 4. UseofuniversitystatusbeingexploredfollowingpositivegainsinPodiatryandPsychologicalTherapiesrecruitment 5. Recruitmentof15ModernApprenticeshipswithintheH&SCPworkingwithinBusinessAdmin,CommsandHealthCareSupport. High Medium RossMcGuffie RossMcGuffie SLT,IJBPFA,IJB 28.02.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24
Page 205
Appendix 2 NL H&SCP Risk Overview Report Meeting Name – IJB PFA Reporting Period: IJB PFA Risk Register – Feb 2024
Page 206
NL HSCP IJB Risk – Dashboard February 2024 Executive Summary Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 10 IJB Highest Scoring Risks NL H&SCP Risks Reported to Assurance Committees Service risks‐ Service level Level 3‐ North Health Professional/ Operational Group and Support Care and Clinical Governance Risk Overview Process NL H&SCP IJB Risk Register – IJB and IJB PFA Level 2‐ Core Risk Register Number of Risks IJB 17 NL Council NHS Lanarkshire 21 Risk Score Trend IJB 06/21 Prescribing Activity and Costs VH IJB 17/22 Unscheduled Care VH
Page 207
Level 3‐ Very High and High Risks ‐ Summary IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date 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 continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing 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 HIGH MEDIUM Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.02.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and updated by AK Jan 2024.
Page 208
IJB ID Category Opened Date Description of Risk Risk level (initial) 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 HIGH MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Dec 2023 Reviewed and Updated Jan 2024. Further additions may be required 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 VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.02.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed Jan 2024
Page 209
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 HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Report on Staff Health and Wellbeing due to IJB in March 2024
Page 210
IJB ID Category Opened Date Description of Risk Risk level (initial) 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 High medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 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 High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.03.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 31.12.23 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. 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 Very High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024.
Page 211
IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date 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 Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 28.02.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. IJB.19. 2023 Performance 27/02/2023 Service Sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the 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 High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. 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 High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24
Page 212
Current – High Target – Medium Risk in Focus – De‐escalated Risk Trend Risk Level Reduced A range of controls, actions and mitigations have been put in place since the risk was initially created in April 2022. On creation the risk was originally provided with a risk level of very high. The risk level was reduced to high in May 2023 following implantation of a range of actions by the service. Following further implementation of regular report, reviews by the scrutiny panel and further actions being implemented it is for consideration by the IJB for further risk rating reduction. Risk Description Risk Owner Risk Lead Delivery of CAMHS Service RMc MD Current Controls Controls 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals seen 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 recurring investment to fully implement new service model 4. Completed 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 50% of gap by end of May 2022 ( 53% achieved) 6. Continuous review and validation of the waiting list 7. Waiting list validation exercised completed in April 2022 wtih reduction in list by 16% 8. New SL CAMHS facility at Udston Hospital became operational in June (this is a vital development to create physical capacity for implementation of the new CAMHS model) 9. Established programme board to oversee both incremental implementation of the service model and performance 10. All workstreams in train 11. Dedicated Recruitment Team Actions Action 1. Incremental implementation of the new service model 2. Performance monitoring through the programme board 3. CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals 4. Waiting list initiative commenced 5. Udston opened for patients September 2022 6. upgrade to North physical infrastructure agreed. Update 28th December 1. CAMHS WLI now embedded. 2. Monthly monitoring at board ongoing. 3. CAPA be introduced AND will be on trakcare to go live March 2023. There will be a concurrent WLI as above. 4Close working with health improvement and GP reps
Page 213
Current medium Target - low Risk in Focus – De‐escalated Risk Trend Risk Level Reduced and details updated The risk was originally created in April 2021 and detailed concerns around the ineffective governance arrangements following the Covid Pandemic. The risk was updated in Dec 2023 to review the mention of Covid. Following implementation of a range of actions and a review of the governance processes across the H&SCP it is for the IJB to consider if the risk can now be reduced to a low level risk. Risk Description Risk Owner Risk Lead Ineffective Governance Arrangements RMc AK Current Controls 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. 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 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 carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse events. 3. IJB Governance reporting reviewed and associated documents updated.
Page 214
Current – VH Target‐ Medium Risk in Focus – De‐escalated Risk Trend Risk Level Lowered The risk was created in Sept 2022, due to a concern regarding sustaining flow during peak winter due to increasing patient demand. The risk was originally provided with a Very High Risk Rating. Since the creation of the risk a range of mitigations and actions have taken place including Operation Flow, increase resource and service development of key areas including frailty, H@H, discharge support. It is for the IJB to consider if the implementation of these actions now reduced the risk rating for this risk. Risk Description Risk Owner Risk Lead Unscheduled Care RMc RMc Current Controls 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 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) 9. Firebreak implemented Jan 2024.
Page 215
Current – Medium Target‐ Low Risk in Focus – De‐escalated Risk Trend Risk Level Lowered The risk was created in Sept 2022 and was given a high risk level rating. Risk Description Risk Owner Risk Lead Community Alarms DF RMc Current Controls 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 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
Page 216
Current – High Target‐ Low Risk in Focus – Review Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Risk Description Risk Owner Risk Lead Service Sustainability RMc RMc Current Controls 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 Actions 1. Sustainability plans to be reviewed regularly 2. Re‐introduction of scrutiny panels 3. Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. 4. Review of reporting process into IJB to ensure continuous review of services/ service developments. 5. Development of the programme of work to ensure regular reporting structure in place for service review. 6. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond.
Page 217
Current – High Target‐ Low Risk in Focus – Review Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Risk Description Risk Owner Risk Lead Workforce Sustainability RMc RMc Current Controls 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 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.