ITEM 9 Community Nursing Review
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.
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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: ☐
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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 ☐
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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.
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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
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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
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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 ☒
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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
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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
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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
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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;
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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.
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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
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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.
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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.
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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
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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
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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