ITEM 14 Q3 Performance Report
North Lanarkshire Council · 22 May 2024
Back to IJB Performance, Finance and Audit Committee — 22 May 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 14 SUBJECT: Performance Update – Quarter 3 (October - December 2023) TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 22 May 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
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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 ☒
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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 NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved Yes ☐ No ☐ N/A ☒
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4 ☐ 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 ☒
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5 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1- Areas for Improvement (Quarter 3, October – December 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
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6 Appendix 1 1. Cervical Screening Target 2022/23 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 72.3% 71.8% RED Narrative & Corrective Action Analysis was carried out using data extracted from MiLan on 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% and the overall performance is for a slow decline in performance. It is important to note that in addition to variation by locality, there can be significant variation by practice(s), with the leadership, direction and resourcing of the practice(s) likely playing a significant role in their rates for screening. Q3 covers the winter period and it is important to recognise that winter pressures will potentially had a detrimental impact on screening appointment availability, access and attendance rates.
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7 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%. 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
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8 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. Bi-annual reports are due at the end of February 2024. A report from Jo’s Cervical Cancer Trust on the engagement work with South Asian Women is available on request. The report provided beneficial insight into local barriers in accessing cervical screening. The recommendations from the report will inform future communication and planning. 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. It is of note that there was an increase in communication activity, with a targeted campaign of both workforce and community communications during the period 22-28th January 2024 to highlight Cervical Cancer Prevention Week. It is hoped that this will be reflected in positive performance in Q4. Quality Improvement Activity The North Health Improvement Team Leaders continue to report progress with actions to the Public Health Screening manager at the Health Inequalities and Screening Group. This more detailed reporting on both performance and progress with key actions is to be brought to the Locality “Four” Management Teams for further consideration and localised action, where necessary. 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. 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
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9 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: 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 the 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 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 89.9% 90.6% RED Narrative & Corrective Action It should be noted that the metric for 2-year old immunisations has improved and remains RAG Green for two consecutive quarters. In Q3 there has been slight increases in uptake for both the 2-year old and 5-year old metrics.
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10 Following analysis and focussed work in Bellshill to improve uptake, the approach and learning is now being expanded to all six localities. The service is working intensively based on the analysis of detailed reporting on incomplete immunisation records. Strategic actions have been identified through themes emerging from the analysis, such as addressing transport issues that may prevent immunisations. The team are also analysing the data available on the Discovery platform to try and better understand the issues and the interventions that might best improve uptake. At patient level, all incomplete and held immunisation records are being reviewed to ensure that any hold on the record relates to a refusal of consent and if there is any error in the recording that it is corrected and the issue followed-up appropriately, including contact with partners in Primary Care. The team have also met with colleagues in South Lanarkshire in order to discuss whether further collaboration and development of a pan-Lanarkshire approach is possible in the longer-term. Since the last update, the management team have started to develop joint-working initiatives with NLC Education colleagues for both School and Nursery age children. The purpose of such initiatives is to maximise the opportunities for engagement with parents regarding vaccinations, increase and enhance access and ultimately improve immunisation rates through shared communication and event planning. This work is overseen by the Chief Officer and his peers in NLC Education. It is of note that in the wider context for immunisations, there is lower than expected uptake for both the Covid and flu vaccine, we have experienced measles outbreaks and anecdotal evidence suggests that public attitudes and behaviours toward vaccination appear to be changing. Changing public attitudes and behaviours may have some bearing on uptake for childhood immunisations. 3. 6 – 8 Week Reviews Target 2022/23 2023/24 Q2 2023/24 Q3 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% 81.3% Quarterly/ 1 quarter behind RED... Narrative & Corrective Action In Q2 (note this performance data is one quarter in arrears) we can see continued improvement in the overall performance for this metric. Given the timescale from documenting the planned improvement recommendations in the now widely circulated SBAR and then implementing actions, it is of note that improvements are now manifest in the data. 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 some GP practices may be playing some part in the decline in performance. 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.
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11 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. The demand for Health Visiting services and the impact of the Health and Social Care Staffing Act on capacity increases the need to utilise digital solutions to enhance the efficiency and sustainability of the service. 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. As an interim solution for North Lanarkshire, a recent SBAR documents how the Elsie App could be deployed as a potential improvement in Health Visiting for appointment scheduling, patient education, feedback collection, and communication with staff. The introduction of such a solution would reduce the over-reliance on manual processes, address issues of communication and information sharing with patients, and assist in standardising service delivery and process across the service. It should be noted that procurement of any digital solution is complex and subject of the SFI/tendering process. The proposal detailed in the SBAR is in the early stages of development and aspects of the procurement, such as the delivery company are yet to be fully outlined in more detailed project planning. The SBAR outlines the benefits of the Elsie App, which is widely used in other healthcare settings. It requests support for the proposal, which requires some investment and advises that engagement and collaboration with South Lanarkshire HSCP would be desirable. Although investment is required, it is likely that the reduction in DNA, manual processes and an increase in productivity would represent an overall benefit to the service. The suggested implementation would involve piloting use of the app in Wishaw locality before further expansion across North Lanarkshire. Further updates will be provided as the service engages with stakeholders regarding the SBAR proposal. In addition to this, the service is engaging with neighbouring boards to understand how these challenges are being met elsewhere. The service is finding that the approach of their peers varies, with some boards having blended paper-based and digital solutions, including blended approaches involving the use of Morse. This research and learning will inform how Lanarkshire implements improvements. 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. The impact of the improvements can be seen in a locality breakdown; the overall trend is for improvement in all localities. Locality March 2023 (Q4 2022/23) June 2023 (Q1 2023/24) September 2023 (Q2 2023/24)
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12 Airdrie 76.0% 93.3% 88.5% Coatbridge 64.1% 80.8% 74.3% North 66.9% 73.0% 79.7% Bellshill 71.4% 79.1% 75.4% Motherwell 70.9% 68.0% 86.5% Wishaw 78.0% 89.1% 86.2% 4. Reablement and Rehabilitation Target 2022/23 2023/24 Q2 2023/24 Q3 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% 48.0% 58.8% RED Balance Of Care - % Of People (Age 65+) 45% 36.7% 34.0% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 49.9% 53.5% RED Narrative & Corrective Action During Q3, there were more service users starting the Reablement process than previous quarters in 2023/24; during Q3, the service supported in excess of 500 people, which is a level of service that had been targeted prior to the Covid 19 pandemic and the achievement of this represents the significant effort and progress in enhancing the Reablement service in North Lanarkshire.
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13 Consequently, there were more service users completing the Reablement process in Q3 than in previous quarters. This increase in demand is potentially driven by the Firebreak carried out during Q3 and additional focus on system flow that creates downstream demand within rehabilitation services. 11 24 29 31 16 14 37 28 22 29 36 30 34 29 31 43 29 2611 19 16 26 14 15 18 36 1912 36 32 33 34 28 52 35 50 26 18 19 36 17 15 33 35 28 25 33 22 27 24 20 39 28 26 0 50 100 150 200 250 APR-23 MAY-23 JUN-23 JUL-23 AUG-23 SEP-23 OCT-23 NOV-23 DEC-23 Service users starting reablement process by locality Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw
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14 There is a dynamic relationship between Reablement services and the capacity offered by the Home Assessment Teams (HAT). Since the creation of the HAT, there have been 1658 referrals accepted and the latest data available shows that in February 2024 the highest monthly volume of referrals were received to date. 25 17 28 25 19 11 15 24 18 30 31 33 36 28 37 32 39 25 12 6 10 20 8 7 10 24 9 29 42 17 42 24 34 40 35 68 28 15 26 18 19 23 30 33 3140 21 8 15 22 19 23 34 40 0 50 100 150 200 250 APR-23 MAY-23 JUN-23 JUL-23 AUG-23 SEP-23 OCT-23 NOV-23 DEC-23 Service users completing reablement process by locality Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw
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15 We can see in the data that as the teams have developed throughout financial years 2022/23 and 2023/24 that more people are being referred to HAT and are following that pathway. Those people who are referred to HAT are being discharged quicker from hospital to be fully assessed in their home environment.
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16 25% 67% 33% 55% 48% 58% 70% 78% 73% 78% 80% 64% 58% 69% 62% 63% 61% 59% 57% 55% 54% 54% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% May 2022 Jun 2022 Jul 2022 Aug 2022 Sep 2022 Oct 2022 Nov 2022 Dec 2022 Jan 2023 Feb 2023 Mar 2023 Apr 2023 May 2023 Jun 2023 Jul 2023 Aug 2023 Sep 2023 Oct 2023 Nov 2023 Dec 2023 Jan 2024 Feb 2024 People completing service with no further service noted as being required by month 0 days 82% 1 days 13% 2-4 days 4% 5-7 days 1% 8+ days 0% Number of days from HAT referral to hospital discharge 2023/24 0 days 65% 1 days 22% 2-4 days 9% 5-7 days 2% 8+ days 2% Number of days from HAT referral to hospital discharge 2022/23
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17 Following the establishment of HAT, there was a natural, gradual build and expansion of the team and this is reflected in the gradual build-up in the volume of referrals. As the teams have become more established, their ability to accept more complex cases and fully support the multi-disciplinary team working that is required has increased and now presents a true “Home First” approach to rehabilitation for the patient. We can see above that over time, as more complex cases were being accepted in financial year 2023/24, that the proportion of people recorded as completing the service with no further service required decreased, however we know from our monitoring of delayed discharges that the HAT approach is improving flow. The average number of input services from HAT appears to be settled at an average of around 2.2. The largest input service remains Home Support, followed by OT, which is now a consistent trend in the data. On completion of HAT, for those requiring a further service, the largest proportion is CAS, followed by Home Support Reablement/Mainstream, and IRT OT and Physio. The learning from Operation Flow and associated Firebreaks, along with the application of the Human Learning Systems approach across North Lanarkshire as an overarching approach to service design and change is manifest in the “Back to Basics” initiative that is being developed within the HSCP. This work will inform the system design and how rehabilitation services, including Reablement, IRT and Home Assessment Teams interact, complement and support each other. This approach is also informing the design and implementation of the new Social Work information system, Mosaic. 5. CAMHS Target 2022/23 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Service at Completion HS - Reablement 12% HS - Mainstream 12% IRT - Physio 10% IRT - OT 11% Rehabilitation - Other 1% CAS 17% Locality SW Referral 1% IDS 0% LSS 1% District Nurse 6% NL Leisure 1% Third Sector 3% Input SW 3% OT 57% Physio 18% AHP Support Staff 16% Home Support 80% CAS 22% Technology 3% Pharmacy 3% Com. Nursing Team 10% Med. Realignment 2%
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18 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 47.1% 72.6% RED Narrative & Corrective Action The continued application of CAPA and the Waiting List Initiative are manifest in a steady downward trajectory in children and young people who are waiting to be seen and a reduction in the longest waits. There has been a sustained recovery in performance since August 2023 and continued work is required to assure the continuance of positive progress in line with trajectory. 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. The expected consistent positive trajectory from prior modelling is manifest in the data and RTT at the targeted level should be achieved in the medium-term if the current trajectory is maintained. The team are now analysing management data, specifically levels of attendance and DNA, with a particular focus on rates around the holiday seasons, to see whether any patterns in the data could inform future improvement activity. 6. Adult Mental Health Target 2022/23 2023/24 Q2 2023/24 Q3 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%* 48.9% 40.4% RED 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 Governance and Accountability
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19 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. In order to deal with demand and capacity issues within General Adult Psychiatry, notably the significant increase in the number of referrals for assessment and treatment of ADHD, it is NHS Lanarkshire’s intention to create an adult neurodevelopmental pathway. It is planned that this is introduced with adult Autism Spectrum Disorder assessments being delivered as part of a holistic MDT service and that this will then extend to ADHD for those people who fulfil the referral criteria. The significant increase in the number of referrals for assessment and treatment of ADHD is work that is within the scope of General Adult Psychiatry and although effectively new demand, there is no associated funding stream and it is having to be absorbed within the extant funding envelope. As both recruiting and retaining General Adult Psychiatrists from a limited supply is highly challenging, there is a reliance on locum cover, including agency supply. As a result, waiting times are increasing as ‘Core’ work such as MHA and in-patient care is prioritised using the available resource. It is known that a significant proportion of those who await psychiatric assessment and care are likely to create additional unscheduled demand in the wider Mental Health system. An Options Appraisal has been commissioned to consider the future models of care in General Adult Psychiatry and SLWG mentioned above who have been dealing with the immediate and short-term response is to be restructured as a Programme Board to monitor and co-ordinate all of the relevant improvement work streams within the service. Developing an adult neurodevelopmental pathway and holistic MDT service, including a robust response to the prevalence of ADHD mirrors the actions being taken in other NHS Boards and by the Scottish Government, who are convening a short life working group to consider these issues. The overall approach to be taken in NHS Lanarkshire is characterised in an SBAR, which has been endorsed by the CMT and the recommendations accepted. A key recommendation is that guidance consistent with national guidance for acceptance to an ADHD waiting list should be produced for North Lanarkshire and that core messages around the management of the waiting list should be communicated widely, particularly to our key stakeholders in General Practice and Local Authorities. Briefing and communications for CMHT, GP and elected members is required and will be managed by the Programme Board. 7. Medical Paediatrics Target 2022/23 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 56.1% 88.8% RED
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20 Narrative & Corrective Action Medical Paediatrics waiting times have seen considerable improvement since the position at Q1 at the beginning of this financial year. The performance in earlier part of year had been adversely affected by long-term absences and the diversion of staff resource to cover acute care. Through the significant efforts and hard work of the team, with particular focus on making best use of available resource, the position has been recovered and the general waiting list has significantly improved. The team has been supported by locum consultant cover during the peak winter period; as well as filling gaps in Tier 3 rota, the cover allowed us to meet our commitments to continued community paediatric clinic delivery. The future service model is being designed to deliver a sustainable medical paediatric consultant workforce that is capable of delivering the core work of a district general attached community paediatric service. This is a focus of our ongoing paediatric modernisation work. Naturally occurring vacancies within the workforce and a greater understanding of our challenges have presented opportunity to consider how we most efficiently use our workforce to maximise capacity without compromising quality of care. 8. SLT Target 2022/23 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 18.3% 23.2% RED Narrative & Corrective Action Work on the Service Improvement Plan is in progress and ongoing. There are several independent work streams reporting to the well-established Speech and Language Therapy Service Improvement Steering Group. These include: - Waiting List improvement work HR and Workforce Administration and Digital Communication and Engagement Accommodation All of the work streams are at different stages of progress, although it should be noted that not all need to proceed in a linear way. However, it is recognised that service improvement activity is the highest priority and first and foremost of that is a focus on improving the waiting time position. Through our scoping of service capacity and activity we have been able to evidence: -
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21 The lack of a robust TrakCare model makes it difficult to provide reliable data across all areas of service delivery. This has been addressed by undertaking a service model review to ensure that future TrakCare builds on local learning and builds on organisational learning from other builds. Forward planning for inclusion in the AHP Hub model will proceed in parallel to these TrakCare developments. Variance in waiting list length by area, which is being addressed through revised workforce planning, incorporating the best-practice and learning from other areas who have specialist children’s health services units. Our future focus will be to transition from restrictive locality models for managing the waiting list. Continued challenges around the recruitment and retention of newer colleagues. As a result of this, we are working with university colleagues to identify new practitioners who have expressed their desire to work in Lanarkshire on registration. This allows us to maximise and enhance opportunities for placement, improvement projects and induction planning, ensuring that we present ourselves as an area that is not only welcoming but committed to the ongoing development of individuals and the service. In addition to this, we are actively determining whether there are any skillmix solutions available when remodelling our service delivery. The funding stream from Local Authority has been reduced, which will reduce staff WTE. However, this provides an opportunity to work with professional colleagues to ensure that all activity is aligned to direct and/or indirect pursuit of meeting the SLT waiting time target. Our links with further education can be further enhanced. The professional relationships between service and university have already been improved and we have academic representation that actively contributes to both our Workforce Planning and Service Improvement Steering Group. Good communication processes, and the sharing of information and practical learning online have been established and will be further developed as service improvement work progresses. Scoping of accommodation options is ongoing to ensure we have the appropriate capacity and environment to support the delivery of our future service model. 9. Dietetics Target 2022/23 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 69.1% 74.8% RED Narrative & Corrective Action Following the significant reduction in the level of performance in Q2, a similarly significant improvement has been realised for Q3. The overall long-term trend is for improving performance, however further analysis would be required to understand any cause/effect relationship with wider system factors, as the service continues to be restricted by the (approximately) 20% reduction in available workforce, which is due to both long term sickness and sustained vacancies. 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.
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22 10. Adult Social Work Target 2022/23 2023/24 Q2 2023/24 Q3 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% 41% 36% RED % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 14.8% 12.7% RED % Of Adult Protection Investigations Going To Initial Case Conference 20% 10.4% 19.2% RED Narrative & Corrective Action The number of ASP referrals received by localities continues to rise. Care Homes continue to be the primary source of referrals for ASP and this 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 that is based on a good understanding of risk, harm and the impact (or lack-of) this has on the adult being referred. This encourages awareness of whether ASP is the correct referral route to take in certain situations and circumstances. 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 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. Caution should be applied when interpreting ASP Investigation and Case Conference data. The performance database shows a relatively low conversion rate for both in comparison to information gathered via locality trackers. An ongoing audit is being completed with colleagues from performance to establish why this is the case and to rectify any issues identified. 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. The total of AP1 referrals submitted by Health colleagues in North HSCP increased in Q3 by 15%; 102 were submitted compared with 89 in the previous quarter. Staff in Cumbernauld submitted the most AP1 in Q3 (25%), followed by Coatbridge and Motherwell at (18%). The most common reported type of harm was “Physical Harm/Abuse/Assault”, comprising 25% of referrals. The quarterly NHSL Public Protection newsletter was published during this quarter and is a key tool in raising awareness with Health colleagues, as are briefings sessions for managers, which have been arranged in February 2024 to disseminate ASP Learning Review Guidance. In addition, multi-agency, bespoke ASP training is available and a bespoke training programme is offered to the three Acute hospital sites.
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24 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