Combined Agenda Pack
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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A meeting of the IJB PFA will be held on Wednesday 22nd May 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 ( 21st February 2024) For Approval Attachment Chair 4. Matters Arsing & Rolling Action Log For Noting Attachment Chair Strategic Planning & Development 5. Prisoner Healthcare For Noting Attachment Maggs Thomson 6. Prescribing: Sustainability and Value Programme 2023/ 2024 Progress Update For Approval Attachment Dr Lucy Munro 7. Supporting Unpaid Carers and North Lanarkshire Carers Strategy 2024 - 2027 For Approval Attachment Morag Dendy 8. Delivering for Communities – Engagement & Participation For Approval Attachment Morag Dendy 9. Community Solutions Programme Update For Approval Attachment Thomas Moan Performance & Finance
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10. Audit Scotland Annual Audit Plan (AAR) 2023/24 For Approval Attachment Fiona Owens 11. Internal Audit Plan 2024/2025 For Approval Attachment Jocelyn Lyall 12. Financial Monitoring Attachment Amanda Kilburn 13. Lanarkshire Winter Plan Debrief For Noting Attachment Ross McGuffie Governance & Policy 14. Q3 Performance Report For Noting Attachment Morag Dendy 15. Category One Responder Update For Noting Attachment Stacey Anderson 16. Hatton lea Closure Update For Noting Verbal Ross McGuffie 17. Risk For Approval Attachment Stacey Anderson 18. Forward Planner For Noting Attachment Ross McGuffie For Noting 19. 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 20. Date of Next Meeting 21st August 2024 9.30am-12pm For Noting
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st February 2024 2pm-4.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Michael McBride 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: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Cathy McGinty NHSL Partnership/Staff Side Rep Harry Robertson Carer Representative Elizabeth Seaton Carers Together John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager John Boyd Audit Scotland Stacey Connor (Minutes) Governance Support Manager Nauman Dar (Shadowing) NHS Lanarkshire Nominated Non Exec Director Mark Dell Communications Manager Trudi Marshall Nurse Director North HSCP Fiona Owens Audit Scotland Dr Josephine Pravinkumar Director of Public Health Apologies: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Paul Carey Audit Scotland Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddy Halliday Chief Exec, VANL Third Sector Rep Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Dr Lucy Munro Medical Director North HSCP
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2 Maggs Thomson Head of Health NHSCP 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 (18th October 2023) The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Ross McGuffie updated the committee on the action log as follows: Item 11 Financial Plan Provision of Smoke Alarms –Have procured additional alarms this week which will work with the current system and the new system for smoke alarms. An update will come to a future meeting. Item 18 IJB Self-Assessment Report- No update. Item 23 Risk Register- This will be discussed at a future liaison session, Item 24 Performance Report- A report to update on SWISS progress will be tabled at the May PFA. 5. Chryston Hub Update The report was shared with the IJB PFA committee to provide an update on the development and delivery of Chryston Community Health Clinic. The build Programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. 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. 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 within the known funded establishment and skill mix of the NHS Lanarkshire service model.
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3 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. 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. It was noted the committee will hold a future meeting at the new Chryston hub to allow members to have a walk round of the Health facility and also the school within the hub. Details will be shared in due course. Ross McGuffie noted that an updated capital plan for Primary Care linking with council services as well will be developed. Phillip Couser asked what work are we doing to look at new ways of working in the community hub and also have staff from GGC been transferred over as part of the Health Board boundary change. Ross McGuffie advised work is being done to look at the future operating models working with councils particularly creating synergy with the teams based in the same locations. Working with education colleagues to look at CAMHS and immunisation programs developing. Currently discussion is ongoing with HR colleagues to look at some Mental Health teams staff moving across. Cllr McBride advised Police Scotland may also become involved in future hubs across the community. Ross McGuffie advised there is a partnership agreement penned that will allow staff across the different agencies to use facilities and enhance partnership working. The IJB PFA: 1) Note the active and ongoing progress with the delivery of this capital programme. 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 work to date to progress towards final conclusion. 6. Hospital At Home The report tabled outlined the current Hospital at Home service provision, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. 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
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4 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 used 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. As part of Health Improvement Scotland (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. Phillip Couser queried if the geriatric recruitment something we are still progressing. Ross McGuffie advised still progressing this but there is ongoing work to consider how the service can run. Trudi Marshall advised H@H in Lanarkshire was the first in Scotland so went with consultant led model to manage anxieties of it being a new service, but now we are in a different space where we can consider going with Advanced Nurse Practitioners (ANP) staff. Phillip Couser also asked do we have occupancy activity data. Ross McGuffie advised we have data but it is not a fixed number as it is not against a set number of beds and even with consultant led model it is still a far cheaper model in comparison to traditional hospital beds. Cllr Burgess noted he has some community intelligence of young men passing away with heart attacks recently he asked has this been raised anywhere else. Dr Pravinkumar advised covid and flu cases have decreased recently so doesn’t appear to link to this but there is no further intelligence. Brian Moore queried around the funding source for the service. Ross McGuffie advised this has been funding though non-recurring source to date and currently awaiting confirmation in the new financial year of funding continuing. The IJB PFA agreed 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.
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5 (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. 7. Health Care Resettlement for Asylum Seekers & Refugees Across Lanarkshire Ross McGuffie spoke to the report which provided an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. The report also provided an update on the work of the healthcare resettlement team that was developed as a response on an interim basis to support those arrivals. 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. Ross McGuffie advised there is a Health Improvement manager and admin staff in post to undertake health needs assessment for this population. Currently down to 1 hotel (Bruce hotel) with roughly 70 men still awaiting housing, have also linked with tower programme via North Lanarkshire council to help progress. Ross McGuffie noted his thanks to the teams that have been involved. Cllr Burgess questioned has there been a rise in Tuberculosis cases linked to the programme. Dr Pravinkumar advise nationally there has been a discussion around routine screening been undertaken as there has been a slight increase. There has been a TB network established which is coordinated through Public Health Scotland. Dr Pravinkumar will share additional information with the committee to offer assurance. The IJB PFA noted the report and requested further updated when available. JP 8. Care Home Support 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:
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6 • 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 within the care home sector. 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. The 2022 National framework has been development through a session involving staff, care inspectorate and commissioned services. Cllr Barclay asked has this collaborative work been fast tracked due to the pandemic. Trudi Marshall advised prior to covid there was a very small number of staff to support care homes but with national funding being available this has helped to expand the service as a whole. By working in collaboration with the care home provider’s outcomes have improved. Funding is due to stop at the end of the financial year and risk implications will need to be considered as well as options for future funding. Brian Moore asked are all care homes engaging with our staff. Trudi Marshall advised majority are engaging but for those who are not we approach the care inspectorate to assist in engagement. The well-being work within care homes has been really welcomed by the service. Ross McGuffie noted unhappiness is around the national care home contract and that some areas have done more than others. The IJB PFA agreed to consider the professional oversight and clinical leadership that is provided to the care home sector. 9. Community Nursing Review 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.
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7 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. 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. The report also outlined the vision and purpose of the service. We are currently testing out Single Point of Access which will tie into future models of care. Section 5.3.4. of the report outlined the new training programme for District Nurses, have also created own internal training programme which is now all work based learning rather than staff taking time out. Phillip Course queried if there has been enough investment to the service. Trudi Marshall advised Morse roll out has concluded and all staff have ipads now which has been an investment to the service. Have been looking at care assurance for quality of care within district nursing caseloads too. Still need to consider other digital investments that could be used within the service for preventative and proactive work. James Muir asked what other methods can we use to measure that the training programme has gone well. Trudi Marshall replied it has been successful in stabilising the workforce and that we review recruitment and retention in tandem, particularly through the practice development team undertaking surveys with trainees. It was noted that although we train staff but they then move to other services or Boards. Cllr Burgess asked is there a period of time that staff need to remain in the role before they move on. Trudi Marshall advised the previous programme of training would cost £48k per staff member whereas now costs roughly £1200. NHS Lanarkshire policy is that staff who complete higher education should remain in post for 2 years; would consider using the policy depending on the situation. Brian Moore asked what is the extend of the work staff which other Health and Social Care staff could undertake and is there national work reviewing the DNs workforce and role. Trudi Marshall advised in Lanarkshire there is differences even locally, have established a community nursing group for Scotland to benchmark across the service to bring this into line. Brian Moore asked when will an update come back to the committee; Trudi Marshall noted should be in next 6 months. The IJB PFA considered progress of Community Nursing review as recommended.
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8 10. Winter Resilience 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. 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. 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. 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 • Frailty team at front door – 25% avoided downstream moves 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 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.
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9 Ross McGuffie advised that partners are undertaking review of the winter plan which will be coordinated nationally and will start to embed any learning into the plan for Easter and consider proactive firebreaks. Brian Moore asked from a North perspective is there capacity to reduce delayed discharges further. Ross McGuffie noted the original target was in the 70s which is below the national target, so far largely been able to get there consistently. Next step is to get into 60s with a key focus on home assessment and working with multi-disciplinary teams. The IJB PFA noted the progress made through Operation Flow and the impact so far over the winter period. 11. 2024/25 Budget Briefing John Boyd from Audit Scotland advised will have a draft audit plan shared by the end of March, there are no significant issues to bring to attention of the committee. Awaiting work from NHS and council to influence the plan. Ross McGuffie delivered a presentation to the committee to outline the current financial position. There has been no budget uplift and the pay award for next year has not been included in the below figures. There is a system-wide deficit forecast of £112.5m in 2024/25 • £78.2m for the rest of Health • £17.7m for North • £16.7m for South There has already been some work undertaken in NHS North HSCP on prescribing savings and financial management which has reduced the expected savings. Next steps are: • Continued review of financial planning assumptions for 2024/25 • Review of all current vacancies including length of time left vacant • Financial management of all areas of budgets currently in an overspend position • Continued service reviews including home support and self-directed support packages • Engagement working with key stakeholders, in the transformation of reform process • Collaboration with South Management Team primarily to review hosted services and joint working arrangements across Lanarkshire • Budget proposals submitted for approval • Tracking and reporting on agreed savings plans • Focus on reviewing areas of over spends James Muir requested details of timeline that will enable delivery of firm actions and what is the challenge to meet the savings targets. Ross McGuffie advised need to set a balanced budget by end of the financial year. As part
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10 of the process both partner organisations need to link together, the Council have more experience of managing financial challenges of this scale. Sessions are taking place with senior management teams and a finance board has been established- scrutiny will come from HSCP, NHS board and local authority. Brian Moore noted need to make it clear to new members that we need to set a balanced budget and the implications if we don’t. Stacey Anderson added currently reviewing induction document for new members which includes the scheme of delegation. Cllr McBride requested that the presentation be shared with the group. It was noted there will be a liaison session on 13th March to focus on the budget. The committee acknowledged the financial update. 12. Financial Monitoring The report shared provided 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. As detailed in within the report, 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. A summary of the main variances including financial challenges and key pressures are highlighted below: 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. 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.
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11 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 from the prescribing reserve is being used to offset the current overspend. Work continues to mitigate this overspend through the savings program and from a non-recurring allocation being issued to fund the pharmacy tariff increase amounting to £1.598m for the IJB. 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. Phillip Couser asked where can we realistically close the vacancies gap and manage the impact on temporary staff. He also queried noted if there are seasonal variations in prescribing which show particular patterns. Trudi Marshall noted have a level of vacancies across the system not filled but we don’t want to remove these as there is still a level of unmet need, looking at new roles coming into the system such as assistant practitioners and apprentices. Medical colleagues are also looking at vacancies and manage use of locum staff. Stacey Anderson advised in summer can see peak in patients stocking up on medication for holidays and then around October public health messages increase which encourages prescription uptake. Cllr McBride noted that social care services have a high vacancy level, how is it developing currently. Amanda Kilburn advised awaiting Mental health outcomes funding unfortunately the wrong amount has been allocated and it was only issued last week. In social care its social care mainstream vacancies where the rate is coming down, Amanda Kilburn will provide a breakdown of the figures with the group. The IJB PFA committee: (1) Acknowledged the contents of the report; and (2) Acknowledged the projected outturn for 2023/24 is an underspend of £5.796m. AK
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12 13. IJB Reserves Strategy 2023/24 A paper was shared with the committee to provide an update for IJB reserves. Consistent with a number of other Health and Social Care Partnerships, an underspend was reported to the IJB on 21 June 23 totaling £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. 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. When reviewing reserves have identified £10.183m of reserves which are no longer needed for the originally purpose. Would look to move this money into contingency reserves if agreed by the committee. Ross McGuffie added some areas we have not been able to progress and for others funding has come from other sources. Brian Moore asked will Scottish Government look to claw back any spend which has not been spent as planned. Ross McGuffie advised they do not mechanism to claw back on ring fenced contingency reserves. Amanda Kilburn added only clawed back covid funding last year which they allocated and for long covid the reserve sits within the council budget, it was created around 3 years ago and it has never been needed. Cllr McBride noted there has been some discussion around ring fencing certain areas of the council budgets do we need to do the same. Amanda Kilburn advised ring fenced reserves are from Scottish Government, they can only be used for the purpose the outline. Earmarked reserves are created by the HSCP locally to meet areas of demands, if something came up that required funding would create a new ear marked reserve and bring back to the committee for approval. The IJB PFA Committee: (1) Acknowledged the contents of the report; and (2) Approved the proposed realignment of reserves in appendix 1 of the report.
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13 14. Q2 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. Area identified in this report as rated as red are as follows: Cervical screening Childhood Immunisations 6-8 week reviews Reablement and Rehabilitation CAMHS Medical Paediatrics Speech & Language Therapy Dietetics Adult Social Work Ross McGuffie advised performance scrutiny panel has been running for the last few months, it bring in reps from each service which is RAG rated as red or amber for assurance. Brian Moore noted Speech & Language Therapy (SLT) did previously provide a more detailed report. Also for CAMHS we are still not achieving the target set. He asked is there anything the committee should be aware of now. Ross McGuffie advised for SLT there is a programme board to support the service and now getting more accurate data. Ross McGuffie advised for Q3 the CAMHS figure is over 70% and seeing rapid improvement every month in the next cycle of CAPA there has just been a delay linked to reporting cycles. The IJB PFA committee noted the report. 15. Risk Register The report provides a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register.
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14 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. The IJB currently has 17 risks identified on its IJB risk register with 11 risks rated as high or very high. The report outlined a risks in focus for the committee to consider if the current risk score and mitigations are suitable. Brian Moore acknowledged that we need to consider reviewing financial risks as more information becomes available. He proposed to add a recommendations tab in future for the committee to consider updates required for particular risks. Stacey Anderson will add this for future reports. The IJB PFA noted 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. SA 16. Risk It was noted to consider continued funding for hospital at home and financial risks going forward. 17. Date of Next Meeting 22nd May 2024 2pm-4.30pm
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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 Bring to next Liaison session 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report
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2 Bring to May PFA meeting 25. Future Meeting R McGuffie Host a future meeting face to face in Chryston hub ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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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
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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
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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
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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.
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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
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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
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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
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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
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1 REPORT Item No: 5 Prisoner Healthcare, HMP Shotts SUBJECT: Prisoner Healthcare TO: IJB Performance Finance Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer, NL HSCP Author(s) of Report Hazel Mitchell, Service Manager, AHSU Tracey Hughes, Senior Nurse, AHSU DATE: 22 May 2023 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for noting. This paper is to inform the Board of the health service improvements undertaken in the prison, in compliance with the local Service Model Review, and in parallel with the HIS recommendations. Also to note on-going work and next steps. For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been prepared by Hazel Mitchell, Service Manager, and Tracey Hughes, Senior Nurse, to update the Board on the current prisoner healthcare service, and to update on on-going service improvement plans and workstreams. The paper has been reviewed by Jamie Quin, General Manager, AHSU, & Maggs Thomson, Head of Health, NHSCP. Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS: (1) It is recommended that the IJB PFA recognise the service changes and improvements made in the Prison Health centre at HMP Shotts in accordance with the recommendations made by HIS. (2) It is recommended that the IJB PFA recognise the service changes and improvements made in the Prison Health centre at HMP Shotts in accordance with the local recommendations and actions identified in the Local Service Model review, including the efforts made by the AHSU to address the recruitment & retention issue within Prisoner Healthcare. (3) It is recommended that the IJB PFA endorse the future work streams of the Prisoner healthcare team. 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 Background The Prison Health centre based within HMP Shotts serves a population of 540 male patients. The service is to provide these patients, many with advanced Mental Health and Addictions issues, with a primary care level service, equivalent to that of patients in the community. In terms of health equalities, it is estimated that the prison population has an average health age of 10 years higher than their actual age. Prior to the introduction of the Adult Health Services Unit (AHSU) into the NHSCP, Prisoner Healthcare was a hosted service within the Motherwell locality. The Service Manager within the Motherwell locality worked remotely and was responsible for the daily operations of the service, with a Senior Nurse based on-site, whose sole remit was to oversee the professional aspects of healthcare provision within HMP Shotts. In 2021 operational responsibility for Prisoner Healthcare transferred to the AHSU. For consistency in management and governance purposes, it was agreed that both the operational and professional management of prisoner healthcare would replicate that of the other services, whereby both the Service Manager and Senior Nurse would work remotely and have Prisoner Healthcare as part of their portfolio. Within a few months of the service reporting via the AHSU, it was identified that there were issues with staffing, including cultural issues as well as training, recruitment and retention. This impacted on the level of care being able to be Yes ☐ No ☒ N/A ☐
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3 delivered to patients within the prison. It was agreed locally to undertake a local Service Model Review to address these issues. 5.1) Service Model Review Commissioned in January 2022, this was a comprehensive service review of Prisoner Healthcare and encompassed the following 8 standards: Standard 1: Effective Management of Resources & Staff Governance Standard 2 Primary Care & chronic disease Management Standard 3: Mental Health & Addictions Standard 4: Medicines Management Standard 5: Infection Prevention and Control Standard 6: Person Centred Health and Care Standard 7: End of Life Care Standard 8 : Deteriorating Patient From this Action Plan 31 recommendations were made, all of which are now complete and signed off. **Please see Appendix 1 – Service Model Review Baseline Update – April 2024 5.2) HIS Inspection The scheduled HIS inspection took place in May 2022. This followed the approved national process with all relevant self-evaluation tools having been complete and submitted in advance. The Lead Inspectors from HMi spent 11 days on-site at HMP Shotts, 5 of those within the Health Centre. While the preparatory work and the information transparently given to the inspection team by the management team, in particular the Service Model Review, demonstrated the AHSU management team’s awareness of the improvements needed, the HIS report was returned to HMP Shotts with 64 recommendations for improvement. Twenty-two of these recommendations were categorised under: Standard 9: Health and Wellbeing - The prison takes all reasonable steps to ensure the health and wellbeing of all prisoners The HIS Inspection team met with the AHSU management team and discussed all 22 of these recommendations. The HIS team were understanding of the extreme staffing issues in prisoner healthcare at this time and acknowledged that this was a
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4 factor contributing to many of the recommendations whereby Health were classified as being below the required standard and required significant improvement. Of the 22 recommendations for improvement, 11 of these were classified as “Priority” areas. The AHSU management team worked well in collaboration with the prisoner healthcare team, and SPS to ensure these actions were addressed in a timeously manner. The Service Manager and Senior Nurse temporarily based themselves within the prison for a period of 5 months to provide leadership and initiate actions as efficiently as possible. The team met with HIS a further twice between the initial inspection and August 2023 to review the progress made. As of September 2023 HIS officially signed off the plan as complete with no further review required until the scheduled inspection in 2027. Commendations were made at the efforts made to address the recruitment, retention, and overall staffing issue in the prison. As of April 2024, 20 of the 22 recommendations are 100% complete, with the remaining 2 on-going and as part of a Pharmacy review. 5.3) Workforce There is a historical recruitment/retention issue within prisoner healthcare, both nationally and locally in Lanarkshire. Post covid pressures impacted greatly on the service as the lack of available workforce and availability of high vacancy rates, a huge focus was placed on re-establishing and stabilising the clinical workforce within the prison. The current FE in the prison is 28.88 wte Through 2020 to 2022 seen consistently low staffing numbers, at one point recorded a low of 67% substantive staffing, with only 19.49 wte in-post. In some month’s sickness rose as high as 27%, with supplementary staffing reaching 36% in an attempt to backfill these gaps. This left the team and the patients vulnerable with staff unable to fulfil the requirements of a Gold standard health centre, with some tasks having to be withdrawn on a daily basis to focus on delivering the essential services to keep patients as safe as possible. It created a gap in stability and consistency of care which was a concern to NHSL, SPS, and HIS. The management set up a recruitment drive by holding Open Days. These were advertised nationally in NHSL communication channels and social media. They run in collaboration with SPS to allow staff with any interest or curiosity to visit the establishment in an attempt to eliminate any preconceptions about the lack of safety. A tour of the facility was conducted with presentations from Senior personnel from both NHSL & SPS. A similar event was also derived for students, aimed at graduates and NQNs. This was a staffing group previously avoided by prisoner healthcare. A recruitment drive in collaboration with Staffbank was devised and allowed staff to book “shadow shifts” whereby they would come and work some shifts alongside a
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5 designated “buddy” to allow them to trial working the service while not compromising safety of neither staff nor patients. This was SPS approved. A new training and induction programme was devised, as was the role review and development of the Band 5 nursing role. This allowed us to use previous feedback that the role was heavily focused on medicines administration and therefore not challenging to nurses who want to clinically advance themselves. New “named nurse” profiles were developed allowing each nurse to be responsible to named patients, ACPs, and chronic disease management. Collaboration with Practice Development and Organisational Development has allowed the staff to undertake many more training opportunities and in turn, aswell as making the role more interesting, it has provided much more advanced and progressive patient centred care to the patients. So far in 2023 we have recruited 2 substantive and experienced Team Leaders, providing leadership and stability for the teams. 4 NQNs, 2 experienced RGNs and a Band 6 Addictions Charge Nurse. In addition to this, following an Options Appraisal exercise, the first full-time dedicated ANP has recruited for HMP Shotts. We have also see the addition of a Band 5 Health Improvement Practitioner and a part time Band 7 OT vis Act 15 monies. Staffing culture and psychological safety was a key part of the management response to recruitment and retention. Staff meetings, questionnaires, feedback sessions were organised as a priority and continued throughout 2023. During the staffing crisis of 2022/23 whereby the organisation saw a sharp increase in Agency use/costs, the prison used the equivalent of 1 wte per week. For safety and consistency purposes this was the same staff member who had years of prison experience. This was used within framework and ceased completely in August of 2023. As at March 2024 the in-post figure was 25.52 wte, equating to 88% substantive staff, with 2 additional vacancies being deliberately backfilled by long term bank. These bank staff are retirees who bring much needed leadership and clinical skills to support our NQNs in their first year of nursing. Supplementary staffing was recorded as 7.35% and sickness was below the organisational target at 3.95%. 5.4) Finance The financial position as at Month 11 of the 2023/2024 financial year is as follows: Annual Budget YTD Budget YTD Actuals YTD Position PAYS £1,602,525 £1,470,380 £1,416,628 £53,752 NON PAYS £436,188 £399,839 £1,194,155 (£794,316) TOTAL £2,038,713 £1,870,219 £2,610,783 (£740,564)
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6 The Pays budget is reviewed/scrutinised/managed accordingly in-line with allocated funds. The £800k overspend within non-pays is within the Medicines Management/Pharmacy remit of the prison health centre, to be discussed below in Section 5.5 All other areas of the prisoner healthcare budget are reviewed and managed accordingly within the SFIs and allocated budget. 5.5) Pharmacy Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. The non-pay spend relating to Pharmacy/Drugs is as below: Annual Budget YTD Budget YTD Actuals YTD Position Drugs £298,974 £274,060 £832,950 (£558,891) Misc. £69,519 £63,726 £310,260 (£246,534) TOTAL £368,493 £337,786 £1,143,210 (£805,425) The £559k overspend is for the actual drugs bought, with the £246k miscellaneous overspend being the management fees for the contract. Prior to 2023 the National contract for pharmaceutical supplies was held by Lloyds group. Upon expiry of this contract Lloyds did not want to renew this, Boots uninterested in tendering also. Upon first tender request no supplier submitted any interest. With time against the national team, and a high risk raised on the SPS register regarding potential prisoner riots, a second attempt at sourcing a contracted supplier was met with a bid from M&D Green. This new bid came in 2 parts, the processing and management of drugs by M&D Green, and the delivery from Pheonix Healthcare. This new contract came with an almost 22% increase in costs, aswell as a £35k per month management fee. This contract came into effect from June 2023 and none of these factors were uplifted in the Annual budget, creating a potential £600k annual cost pressure. Drug spend for the same period last year was £267k. With the previous contract, 6 hours of Clinical Pharmacist time was allocated to the prison health centre to help review prescribing habits, this was removed from the new contract, leaving a vulnerability within the service, and no additional monies have been received to recruit to this internally. Having no direct pharmacy input is not consistent with primary care health centres in the community, leaving an inequity to the prison population, as they have no access to pharmaceutical advice without having to request an appointment at the health centre. The introduction of Buvidal to the prison has seen many positive outcomes, commended by both SPS staff and prisoners. At present we have 95 patients using
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7 this type of Opiate replacement, given once a month by injection, this is seen as the Gold standard treatment and negates the need to take oral methadone on a daily basis. However, with no additional budget this has placed an estimated cost annual cost pressure of over £2.5k per patient in the service. It is anticipated the number of Buvidal recipients will increase over time once the true benefits are formally assessed and published. The prison processes and dispenses over 500 prescribed items per week. This is resource intensive and very expensive. Traditionally the issuing of these medications took place on a Friday. It required the whole staffing complement to complete it. The volume led to high risk of error, and any missing items meant that patients were left without medicines over the weekend. Discussions and planning with SPS saw a new agreement whereby this would take place twice weekly, mid week. This took meticulous planning with the pharmacy provider, but has reduced error, allowed for a quicker response to get missing medications delivered, and eased the staffing pressures to undertake the task. In a response to this the Prescribing Action Group has been re-established to try and manage the number of items prescribed, and to review the actual items prescribed. Pain and medicine management pathways are being developed, whereby prescribing rules deter expensive Gold standard drugs being used as a first line treatment where clinically avoidable. This will also review prescribing habits, and any new guidelines to be discussed and actioned. A substantive ANP has been recruited to help provide consistent clinical cover to patients, working closely with the GP clinical lead in an attempt to reduce prescribing volumes and costs. It is hoped to undertake a Pharmacy/Medicines management review in the imminent future to tackle as many of the aforementioned issues as possible. This will need to be done collaboratively with the NHSL Pharmacy department. 5.6) Other Notable Service Improvements; 5.6.i) Chronic Disease Management/National Screening The Senior Nurse and Team Leaders have implemented a CDM and national screening programmes into the prison. This means that patients are now receiving all annual reviews & scheduled and unplanned appointments with named nurse, to ensure that all health management is in a preventative, rather than responsive manner. This also tackles the health inequalities issues that exist in a prison, and provides the patients with health education on how to manage their conditions, aswell as understand the need to identify symptoms and escalate accordingly. The relevant documentation has now been electronically uploaded into the Vision system with individual patient care records being held and managed accordingly. The following specialist services are now implemented and endorsed in the Health Centre: Diabetes (clinics & awareness)
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8 Sexual Health (clinics & awareness) Keep Well clinics Asthma – initial stages of implementation Hypertension – initial stages of implementation National Bowel Screening Prostate Screening Routine eye tests Treatment Room services 5.6.ii) Clinical Assessment Tools To ensure compliance and consistency of patient care, the service revisited the requirement for clinical assessment tools and their purpose. The Senior Nurse worked with e-health to upload all relevant documentation into Vision and devised a robust training plan for all staff to ensure competence in the use of these documents. Use of these documents including ACPS, NEWS charts, Wound charts & MUST tools have been promoted and endorsed and are now part of everyday practice. This has improved patient outcomes and compliance with national standards. 5.6.iii) Staff Training As part of the programme to fully utilise new increased staffing has been devised in collaboration with the Practice Development & Organisational Development teams. This includes Mandatory and other relevant desired training, including both practical on-line sessions.
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9 Clinical Supervision has been a large focus this year, specifically for the NQNs, but also for the development and advancement of the more experienced nurses. In-house training has also taken place with different disciplines leading sessions for each other, this includes examples such the Psychology team session held for staff to discuss the management of patient’s with complex Personality Disorders. 5.6.iv) Clinical Escalation and Call Before Convey Model The clinical escalation route for OOH period was reviewed and redesigned to allow staff to call the FNC and use the Consultant Connect option before
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10 conveying a patient to hospital. Collaborations have also been enacted and DNs and OOH GP have attended the hospital as per request in the past year to enable OOH care to be delivered to deteriorating or sick patients to avoid a prisoner transfer to hospital. A “Call Before Convey” pilot was launched in 2023, whereby the patient and potential hospital transfer is discussed prior to an ambulance being called (unless it’s a 999 emergency). This was launched in July 2023 and by December ED attendances had reduced from 31 per month to 7. 5.6.v) Complaints Patient complaints have by nature always been exceptionally high in prison health environments. Between 2020 & 2022, an average of over 50 complaints per month was received. A full analysis of these complaints were carried out. The health team have worked very hard at patient engagement throughout the 2-year service review and improvement plan. By listening to patient views, increasing staffing levels, improving staff training, and providing a higher standard of patient centred care, the number of complaints have dropped accordingly. By December of 2023, 15 complaints per month were being logged. The main reason for these complaints is medication related. 0 5 10 15 20 25 30 35 HMP Shotts ED attendances July 23 - Dec 23
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11 5.7) Associated Risk As the improvements undertaken above were all necessary for patient care, staff governance, and as per HIS recommendations, any reduction to staffing levels within the prison would create a clinical risk to the successful delivery of the service. This will be discussed as per the finance cluster review meetings. 5.8) On-going Working Groups Programme Board – Chaired by Head of Health, purpose of co-ordinating and ensuring delivery of all on-going workstreams, including the aforementioned reviews, aswell as upcoming local & national projects. Attended by senior management representing operational & professional leads, primary care, mental health, psychology, addictions, pharmacy, and health improvement representation. Attendance by SPS senior management also requested. Held quarterly. SPS Strategy Meeting – Chaired by AHSU GM, purpose of collaborative development of operational and strategic purpose between Health & SPS, respecting governance and objectives of both individual organisations. Attended by operational senior management of SPS, including Governor and Deputy, GM, ADN, Service Manager & Senior Nurse in AHSU. Clinical Lead and Head of Psychology also attend. Held bi-monthly. HOLM Meeting – Chaired by Clinical Lead GP, purpose of addressing all “on the floor” issues relating to delivering healthcare in a non-health controlled environment. Attended by Service Manager, Senior Nurse, Team Leaders, Pharmacy, First line SPS management. Held Bi-monthly. Prescribing Action Group (PAG) – Chaired by Clinical Lead GP, purpose of reviewing the prescribing legislation and habits within the health centre. Attended by Service manager, senior nurse, Team Leaders, pharmacy, GPs, medical and non-medical prescribers. Held bi-monthly. Team Meetings – Chaired by Team Leaders, held for each service and attended by relevant staff cohorts within PCT, MH, Addictions, Psychology. Held monthly.
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12 IPM Meeting – Chaired by Independent Prison Monitors on behalf of NSS, with purposes of representing prison population, attended by Service Manager and Prison Governor – Held quarterly. All National Groups as instructed by NSS are attended as necessary. 5.9) Next Steps Continue to provide service delivery as per new model above Continue with staff training & development programmes Continue to roll-out CDM services to various specialties Continue to work collaboratively with SPS Complete national TOM benchmarking and evidence gathering, making any service changes/improvements as requested Complete MATS standards benchmarking and evidence gathering, making any service changes/improvements as requested Represent the Prison Healthcare service at finance cluster review meetings 6. CONCLUSIONS The AHSU, in collaboration with SPS, and on-site staff, have successfully undertaken a Service Model Review to implement an improved Prisoner Healthcare service to the population of HMP Shotts. This includes stabilised staffing models, improved staff training plans, and improved patient centred care for all patients, in particular those with identified existing health needs. 7. IMPLICATIONS As previous mentioned in section 5.7, any reduction in budget to the Prisoner Healthcare service, could result in a significant adversity in the ability to fulfil the service provision as per national guidelines. The fragility of the staffing budget would not allow for any reduction in FE otherwise the implication of reverting to an unsatisfactory outcome for patients. 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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13 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) HIS Recommendations NSS published guidance for prisoner health MHWC Recommendations Safe Staffing Legislation 7.3 FINANCIAL Any reduction in staffing budget would adversely affect service provision and performance. £600k annual cost pressure in drug/medicines management provision 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 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
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14 ☐ 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 Staff, patients & SPS involved in service review process ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services IPMs, SPS and patients involved ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Monthly meetings with SPS and review meetings with HIS ☐ 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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15 8. BACKGROUND PAPERS HIS Review – HMP Shotts, published May 2022 Inspection report available on request 9. APPENDICES None. . CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Hazel Mitchell, Service Manager, AHSU, NHSCP Hazel.Mitchell@lanarkshire.scot.nhs.uk Tracey Hughes, Senior Nurse, AHSU, NHSCP Tracey.Hughes@lanarkshire.scot.nhs.uk
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1 REPORT Item No: 6 SUBJECT: Prescribing: Sustainability and Value Programme 2023/ 2024 Progress Update TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Lucy Munro, Medical Director NL HSCP Author(s) of Report Karen Grant, Project Manager, Julie Russell, Lead Pharmacist for Prescribing Management Primary Care North 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: Karen Grant, Project Manager, Julie Russell, Lead Pharmacist for Prescribing Management Primary Care North ☒ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS The IJB PFA is asked to note the following: - [rec 1. The savings for the financial year 2023/2024 2. The project workstream activities planned for 2024/2025 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Analysis published by Public Health Scotland in September 2023 shows that prescribing volumes have increased over the last 10 years in Scotland, with an overall increase of 11.6% from 98.8 million items in 2013/14 to 110.3 million items in 2022/23. The cost of items reimbursed (the Net Ingredient Cost) increased by 5.8% between 2021/22 and 2022/23 and increased by 33% over the last 10 years (Figure 1). Figure 1 - Total (Net) cost (£) in NHS Scotland: 2013/14 - 2022/23 (Public Health Scotland) 5.1.1 Prescribing costs vary between different health board areas and are influenced by a variety of factors including population demographics, prescribing culture and the prevalence of chronic disease. Yes ☐ No ☒ N/A ☐
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3 Figure 1 - Average total (net) cost (£)per head of population by NHS Board: 2022/23 (Public Health Scotland) 5.1.2 Lanarkshire has consistently significantly higher costs per patient in most main therapeutic areas of prescribing compared to the Scottish average and generally lies above most other Health Board areas in Scotland. The prescribing data generally follows the national trend but at a higher level. Previous work carried out by the Locality Quality Medicines Actions Groups and the Prescribing Quality and Efficiency Strategy achieved their targets the trend is unchanged. 5.1.3 In 2022/23 both South and North Lanarkshire IJBs ended the year with a prescribing overspend: North Lanarkshire £1.750m; and South Lanarkshire £3.750m. 5.1.4 The total primary care prescribing budget for NHS Lanarkshire in 2023/34 was £148.5M. The North Lanarkshire HSCP share of this was £76.4M. The budget had received the 2% allocation uplift in 2023/24 but the numbers of items dispensed has increased by 3.43% and the price per item had increased in the first 6 months from an average of £9.65 per item to £10.32. 5.1.5 In North Lanarkshire, the prescribing overspend forecast for 2023/24 at March 2023 was £3.835M. 5.1.6 Audit Scotland’s Integration Joint Boards Financial Analysis 2021/2022 report stated that IJBs have reached the point where ‘significant transformation will be needed to ensure the (1) long-term capacity, (2) financial sustainability and (3) quality of services individuals receive’. Audit Scotland have highlighted that there
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4 remains a significant overall and recurrent budget gap across all IJBs; and that failure to make the necessary changes to how public services are delivered will likely mean further budget pressures in the future. 5.1.7 The Sustainability and Value Programme 2023/4 included a Prescribing Services Efficiencies Project with a view to bringing Lanarkshire’s prescribing levels closer to the level of a comparable health board i.e. NHS Lothian. This included reducing prescribing spending by £2.7m through 2023/24 (as part of a £5.4m primary care prescribing target pan-Lanarkshire), noting that this would reduce the level of overspend but not eliminate it. The purpose of this project was to further assess the causes for Lanarkshire’s high prescribing costs and to develop and implement change ideas with associated action plans. 5.1.8 The main areas of change which were required in order to achieve cost savings of this magnitude are themed below, with examples of some to the change ideas discussed below. 5.2 Objectives Aim for a Pan Lanarkshire reduction in spending of £5.4M (with at least £2.7M of this in the North HSCP) in the financial year 2023/24. Evaluate potential cost saving of individual proposed change measures identified in Prescribing Efficiencies Workshop and prioritise those with greatest recurring financial impact. Effect cultural change by adopting a visible Pan Lanarkshire approach to efficiencies highlighting the responsibility of all stakeholders (including patients) to use resources responsibly. Support and enable collaboration at the interface between primary and secondary care to achieve our shared aim of reducing waste and improving levels of formulary adherence. Guidance and visible support for prescribers to implement and embed these changes i.e. clear and open communication with patients and their representatives that this is Lanarkshire wide guidance. 5.3 The following primary drivers were agreed: 5.3.1 Reduce waste inefficiencies and variation Identify high spend medications where we are able to safely switch to an alternative on a pan Lanarkshire basis Increase Formulary compliance by making the Preferred Formulary option the default setting on Vision
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5 Examine Script Switch use and improve the acceptance rate Resume project in Care Homes to test stock order of formulary wound dressings. Test use of Script Switch in Pharmacotherapy hubs Develop agreed process of medication ordering within Care Homes and standardize this pan-Lanarkshire Liaise with LIST to map areas over ordering and help guide targeted change measures Collaborate with Care @ Home Service and DNs to develop and test and alert system to identify patients with high volumes of unused medications or who are not compliant with medications for review by practice pharmacist 5.3.2 Quality prescribing Nursing are leading a review of ANP/DN/GPN prescribing Address high volume continence and stoma prescribing; Targeted delivery of PQES by Locality Prescribing Management Teams prioritizing practices with highest prescribing spend. Develop and test MDT (Multidisciplinary team) models to increase polypharmacy reviews and de-prescribing 5.3.3 Prescribing culture Develop and test Health Board guidance for prescribers to avoid prescribing specific drugs of low therapeutic value Refresh and promote GP (General Practitioner) locum- specific prescribing guidance Deliver a pharmacy-led training workshop at GPST training days, commencing August 2023 Develop and test a process for working across the Primary /Secondary Care interface to increase alignment to the NHS Lanarkshire Formulary Improve signposting to alternative management options (Social Prescribing) Facilitate improved communication with Community Pharmacy Appendix 1outlines the project plan workstreams and their current status of activity. 5.4 2024/5 Plan 5.4.1 Addressing polypharmacy
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6 Looking ahead, cost reduction work in 2024/25 will focus on polypharmacy reviews – i.e. consultations with people who are on multiple medications to determine whether they still need to be on all of them. A data-driven approach will be taken, to ensure that the resource is targeted in areas where the greatest yield will result. Past evidence shows that an average of £120 per reviewed patient per annum can be saved from annual prescribing costs. Polypharmacy reviews address the culture of prescribing and result in sustained change rather than relying on medication equivalent switches. Simulation training is an important tool in upskilling pharmacists to have complex risk/benefit-orientated conversations with patients 20 pharmacists trained in simulation facilitation and additional training for a smaller group in creating relevant scenarios. 5.4.2 Targeted work In addition, targeted local work will take place, with bespoke reports created for each GP practice, highlighting where their prescribing varies from comparators and enabling conversations to take place between practice teams and locality prescribing advisors on how prescribing practice might change to reduce future prescribing costs. 5.4.3 Medications of low therapeutic value A list of medications of low therapeutic value has been launched. This is a range of medicines from which evidence suggests patients are unlikely to benefit and NHS Lanarkshire has been the first Health Board in Scotland to implement such a list. Reviews will take place of patients already on these medications and they will be stopped where possible. The implementation approach taken to this work is summarised in Appendix 6. 5.4.4 Non medicines The year 2024/25 will also be characterised with a stronger focus on non-medicines spend, with NHS Lanarkshire working collaboratively with a national group to identify potential savings from non-medicines prescribing e.g. dressings, catheters and stomas. It is becoming more difficult to estimate future savings as work moves towards changing the overall trajectory of prescribing, rather than easily countable switches. This is compounded by a delay in obtaining data due to a national issue with the Prescribing Information System for Scotland. For planning purposes, however, a savings target of £2.2M for North Lanarkshire has been set composed of: Polypharmacy Reviews £1.08m Review of medicines of low therapeutic value £0.81m Script Switch savings £0.3m
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7 6. CONCLUSIONS All project workstreams aligned to reducing waste inefficiencies and variation, quality prescribing, and prescribing culture to aid cost savings were identified by the Prescribing Management Team in collaboration with the Primary Care Prescribing Efficiencies Operational Group. This has resulted in a total saving of £3.9M (Pan Lanarkshire) and £2.1M in the North to 31st March 2024. The ongoing projects will be reviewed for 2024/25, along with new identified projects as noted below in Appendix 1. As has been highlighted in finance monitoring reports to the IJB and the Performance and Audit Sub-Committee, prescribing volatility and uncertainty continues to represent a high-risk area within the IJB’s budget. 7. IMPLICATIONS Further work will be carried out for 2024/25, including - Move forward with polypharmacy reviews across localities Complete Benefits mapping profiles and dashboard reporting system Continue with ongoing project workstreams Seek new workstreams 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
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8 Annual savings of 5.4million pan Lanarkshire. The target for South was £2.7M. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT There is an operational risk register with mitigations which will be updated now that the 2023/24 workstreams are moving to polypharmacy reviews and drugs of low therapeutic value. The relevant IJB risk is; IJB06.21 – Prescribing Activity and Costs, Current Risk Level High. 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 Patient and Staff group involvement in all workstream activities ☒ Provide stakeholders with information on how to get involved Engagement opportunities available for any of the workstream activities, in particular the work on Guidance on Items that should no longer be prescribed ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs This is part of the Project Communications and Engagement Plan ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services This is part of the Communications and Engagement Plan ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Feedback from patient support groups fed into the Primary Care Prescribing Efficiencies Operational Group ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Opportunities available at governance group meetings as well as other meetings supporting the workstreams Yes ☒ No ☐ N/A ☐
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9 ☐ 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 and attached to report: EQIA added to website: 8. BACKGROUND PAPERS N/A 9. APPENDICES Appendix 1– North Lanarkshire Health and Social Care Partnership Primary Care Prescribing Efficiencies Project Summary of the Project Workstream Activities to date. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Yes ☒ No ☐ N/A ☐ Yes / Date added ☒ No ☐ N/A ☐
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10 Dr Lucy Munro, Medical Director for Health and Social Care North Partnership, Lanarkshire Headquarters, Kirklands Hospital, Bothwell, 01698 752618 Lucy.Munro@lanarkshire.scot.nhs.uk
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11 Appendix 1 North Lanarkshire Health and Social Care Partnership Primary Care Prescribing Efficiencies Project Summary of the Project Workstream Activities to date: Overall projected savings for North Lanarkshire to 31st March 2024 = £2.13Million Completed project workstreams: Medication Switches: Oxycodone MR to Oxypro MR switch, Ethosuximide to Epesri switch Training on quality prescribing for trainee prescribers (including GP, nursing and AHP trainees) Increase ScriptSwitch compliance -savings made as of January 2024 £770,242 and at 154% of the target Quantity limits for scripts (noted a 4 month saving of over £10k) Scriptswitch use across all pharmacy hubs Publication of guidance on products of low therapeutic value which should not routinely be prescribed in Lanarkshire (estimated savings from this to be £1.5M) Care Home Pathway standardisation project rolled out Increase the use of social prescribing by developing an easily accessible and up to date directory of services (Vaslan Locator Tool and VanL tool “ALISS”) Ongoing project workstreams: Increase number of polypharmacy reviews in practices (estimated savings £120 per review) Review and reduce over-ordering from community pharmacies Care Homes Medicines Waste Policy development (1 care home returned over £2700 worth of products) Care Homes Stock order test of change Collaborate with Care@Home Service to develop and test an alert system to identify patients with high volumes of unused medications Develop Stoma Prescribing Guidelines- part of national workstream (also consideration for non-medicines prescribing guidelines) OOH stock supply project, reducing waste in inefficiencies Review Formulary adherence and processes around prescribing on Vision/eMIS
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12 Main focus and plans for 2024/25: Move forward intently with all polypharmacy reviews across localities Complete Benefits mapping profiles and dashboard reporting system Continue with ongoing project workstreams Begin new identified workstreams based on workshop held on 22nd February e.g Identifying work with prisons services, over ordering of inhalers PRIMARY CARE PRESCRIBING EFFICIENCIES PROJECT
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1 REPORT Item No: 7 SUBJECT: Supporting Unpaid Carers and North Lanarkshire Carers Strategy 2024 -2027 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager, Quality Assurance DATE: 22 May 2024 1. PURPOSE OF REPORT This report provides a progress update on actions taken to support unpaid carers, over the past year, following extensive carer engagement and participation activity themed around “what might help?” Previous reporting to the IJB outlined our planned approach to strengthen supports to unpaid carers. A number of carer led and carer informed initiatives have been introduced over the past year. These initiatives have been part of Quality Assurance’s wider approach to engagement with, and the participation of, carers and carer organisations; developing market facilitation, to help broaden choice, control, and support options for both carers and supported people. The report seeks committee approval for North Lanarkshire Carers Strategy 2024 – 2027, and endorsement on the approach to supporting Carers. This paper is coming to the IJB PFA for: For approval ☒ For endorsement ☒ To note ☐
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2 2. ROUTE TO THE BOARD This paper has been: Prepared By: Morris Howat, Service Manager, Quality Assurance ☒ Reviewed By: Maria Williamson, Senior Manager, Quality Assurance ☒ Endorsed By: Morag Dendy, Head of Planning, Performance and Quality Assurance ☒ 3. RECOMMENDATIONS It is recommended that the Integration Joint Board: (1) Approve the North Lanarkshire Carers Strategy 2024 2027 (2) Endorse the approach to supporting Carers in North Lanarkshire (3) Note the range of supports to unpaid carers available locally. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 Scotland’s national and local public bodies are committed to improving the ways individual people, and communities are engaged in decision-making that affects them. This is particularly relevant to the development of the health and social care services upon which we all rely. (Source: Planning with People; Community engagement and participation guidance. (Published by COSLA and The Scottish Government 2021) 5.2 North Lanarkshire has a strong history of engagement and participation and long-standing relationships with supported people, carers, and community organisations. This approach has ensured that the citizens of our area can influence, inform, and shape local policy, strategy, and services. We are Yes ☐ No ☐ N/A ☒
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3 committed to ensuring ongoing meaningful engagement with the communities we serve. 5.3 The approach to engagement and participation has helped carers, supported people and carer focused organisations influence and shape the range of carer services described within this report as well as our local Carers Strategy 2024 -2027 (appendix 9.1). 5.4 Whilst we are far from immune to many of the themes and negative carer experiences outlined in the State of Caring Report (Carers Scotland, published 2023), local carer experience has been significantly more positive than that reported nationally. The Care Inspectorate inquiry into people's experience of support within North Lanarkshire, including carer experience, as well as carer feedback through engagement and participation activity related to the Carers Strategy 2024 - 2027, have both demonstrated that we are performing consistently higher than the national average regarding most, if not all, aspects of carer support. Lanarkshire Carers Centre report that several of the initiatives outlined in this report have generated significant interest from other areas, due to both their innovative nature and the efficacy of the approaches being taken. Similarly, NLCT highlight that Carer Breather has attracted similar levels of interest. All these approaches have resulted in a demonstrably more positive local picture. Report 5.5 Relationships with a wide range of carer focused organisations in supporting and facilitating engagement and participation has been a significant factor in our collective approach to date. Input from carer focused organisations has proven invaluable generally, but particularly so regarding parent carers, carers from minority ethnic backgrounds and LGBTQI+ carers. 5.6 To date, initiatives to support carers have included: 5.6.1 An innovative Hospital Discharge Payment Scheme for Carers offering a one- off payment of £1,000 to families to support their loved one for the first 6 weeks out of hospital. This was introduced to ensure people did not remain in hospital for any longer than needed to reduce the risk of delayed discharge arising from prolonged wait times for people who required support upon hospital discharge, but where social care provision could not be guaranteed due to difficulties arising from the pressures around social care recruitment, retention, and staffing. Initially introduced as a pilot \ demonstration scheme, ninety carers and ninety cared for people have benefited from this scheme to date, at a cost of £90,000. This expenditure compares very favourably when set against both the financial and human costs of delayed discharge. Although the scheme ended on 31st March 2024, further evaluation will help inform future options. 5.6.2 Expansion of Carer Breather. Designed in partnership with carers in North Lanarkshire, Carer Breather is a pioneering initiative that not only supports carers to have time out, but also ensures carers have better access to their communities and works to reduce loneliness, isolation and foster friendships
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4 and relationships. The second round of funding for Carer Breather services was allocated to 11 organisations across North Lanarkshire. Funding is being used to provide breaks to carers from their caring roles in their local communities. These breaks allow carers to access time-out a few hours per week to focus on themselves in ways that support overall wellbeing. Some services provide support for carers at the same time as providing support for the person they care for. This reflects requests from carers that they can access support that allows them to enjoy some joint time-out to relax in a community setting. Carers can self-refer to the Carer Breather services by contacting organisations directly. The range of Carer Breather services sits within a much wider range of carer break options, with the Lanarkshire Carers Short Breaks Bureau, Time to Live Funding and individual Carer Budgets ensuring that carers can exercise choice and control in accessing the type of break most in keeping with their individual needs. 5.6.3 Increased funding to PAMIS (Profound and Multiple Impairment Service) to build capacity in the PAMIS Family Support Service, offering support to families caring for a family member with complex multiple disabilities. Around 160 families in North Lanarkshire are currently supported through this service. The nature of carer support goes beyond that offered by the three commissioned carer services (Lanarkshire Carers Centre, North Lanarkshire Carers Together and Action for Children, Young Carers) as experience has shown that support around issues like postural drainage, daily stretching, physiotherapy, and specialist toileting techniques all require carers to have specialist knowledge. 5.6.4 Introduced support for carers supporting a family member with Dementia, through an Alzheimer’s Scotland. The service provides holistic support to carers of people who have been diagnosed with dementia with a focus on meeting the needs and improve the quality of life, physical and mental wellbeing of carers of people with dementia to reduce stress and distress, maintain a healthy live/work balance and a reduction in the people with dementia being admitted to long term care. 5.6.5 An extended 3-year contract for HOPE for Autism, removing the uncertainties arising from the year-to-year annual funding that was in place previously. HOPE provides an all-age information and advice service for people with Autism, family members, carers, and professionals. Our approach was further augmented by an investment in practitioners from Autism Network to ensure that families have access to specialist knowledge locally around neurodivergence and the challenges that can arise around neurological conditions. 5.6.6 Further investment in Lanarkshire Carers to enhance existing programmes of carer support. An update from Lanarkshire Carers is included as appendix 9.4. 5.6.7 Continued support for Action for Children Young Carers Project who directly work with young carers to complete Young Carer Statements, assessments, reviews, and referrals for the young carer service. An update from Action for Children Young Carers is included as appendix 9.6.
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5 5.6.8 Improved development opportunities for Social Work staff around commissioned organisations, Adult Carer Support Plans, carer budget processes and Young Carer Statements. 5.6.9 Organising carer awareness events in tandem with the Assistive Technology team, to promote the uptake of assistive technology as a means of supporting both carers and those being cared for as a means of maximising independence, minimising risk, and encouraging a pro-active preventative approach. 5.6.10Hosting the first Commitment to Carers Event, celebrating the positive developments around carer support, as well as hearing the challenges being faced by carers. The second Commitment to Carers Event took place on 21st May 2024. 5.6.11 Supporting a range of engagement and participation activity aimed at all carers, but with a focus on underrepresented individuals, groups, or communities, including carers from minority ethnic communities and LGBTQI+ communities. 5.6.12 The continued promotion of Carer Budgets (where applicable) and support around innovative use of these. Most carers who are known to services are supported through the wider carer support infrastructure described in this report. In every situation where a cared for person is in receipt of an individual budget, the unpaid caring situation is also considered, and individual budgets are adjusted accordingly to take account of that. In addition, there are around eighty carers who are in receipt of an individual carer budget. 5.6.13 Preparatory work is being undertaken in anticipation of revised legislation around the right to carer breaks, including an updated Short Breaks Statement. The approach continues to be in line with a wider ethos of supporting and enabling self-help, enablement, and empowerment, so that wherever possible, carers use their own family and friends’ networks to facilitate breaks from caring, rather than rely on statutory services. As such, our approach to carer breaks will continue to be based on self-help first, and only when those possibilities either do not exist, or have been fully explored, should funded support around carer breaks be required. 5.6.14 Developments in carer support around Dementia and Autism described above at 5.6.4 and 5.6.5 were informed by findings from the most recent national Carer Census, where these two conditions, along with age related frailty, were identified as being the three largest areas of caring responsibility. In relation to frailty, North Lanarkshire has been a pathfinder area in the national Getting it Right for Everybody (GIRFE) approach where it is anticipated that learning from engagement with people with lived experience will lead to further innovation in our approach and within any services provided. 5.6.15 Additional investment with North Lanarkshire Carers Together (NLCT) to fund an Equalities post, ensuring that underrepresented communities have access to carer related information, signposting, campaigning, and carer advocacy. An update from NLCT is provided as appendix 9.5.
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6 5.6.16 In addition to the detail noted above, a wide range of community and voluntary sector organisations, including those with an age related, or condition specific focus, have been in receipt of North Lanarkshire Council funding and have had a role in direct, or indirect, support to carers as well as supported people. Work around monitoring and quality evaluation regarding carer support across these organisations took place throughout the year to ensure that our approaches are not solely carer and supported people informed, but carer and supported people led. 5.6.17 Facilitating participation, particularly with harder to reach groups and those who experience exclusion, is achieved through reaching out, finding out, making connections, and presenting opportunities. Investment was made to develop networks, connect people with shared experiences, help with sharing information, identifying issues that are important to carers, supported people and communities in North Lanarkshire and delivering approaches to improve carer wellbeing. There has been direct representation in governance structures and strategic forums, involvement in improvement areas, consultation, and co- production, with identified actions that further engagement and participation in our day-to-day practice. Locally we want to ensure that we have the best possible approach to engagement with, and participation of, supported people and unpaid carers. 5.6.18 These fit with key drivers that supports a preventative and anticipatory approach and helps ensure that people can live independently and are supported within their own networks and communities. We also seek to ensure “lived experience” can influence and shape strategic direction, policy, and support services. The Carers Scotland: State of Caring Report (appendix 9.2) presents a bleak picture nationally regarding carer experiences, using the term “health and social care crisis”. The report states that “Despite their huge contribution to the Scottish economy, to our communities and to the lives of the people they care for, carers are facing deteriorating physical and mental health, loneliness and isolation with too many driven to despair and denied access to the very supports they need to maintain a healthy life.” Whilst we cannot be complacent, the local picture is much more positive, largely due to the range of support options described above, alongside the range of carer support services offered by the three commissioned carer organisations and the wider community and voluntary sector. Carers face a wide range of challenges, so a wide range of responses is needed. Based on engagement with carers, we are confident that the supports and services that are in place are the right ones, but equally, that yet more can be done, both in terms of ensuring that carers experience a consistent approach and in developing further innovative solutions to meet caring related outcome and need. 5.6.19 The Analysis of Carers (Scotland) Act 2016 funding 2022-2023: responses to Freedom of Information request (released March 2024) (appendix 9.3) notes that the unallocated spend in North Lanarkshire related to Implementation of the Carers (Scotland) Act 2016 stood at £1,032,017. This figure is based caring related spend reported to Committee in 2022. Since then, there has been further investment in the carer support options described above, with most of the remaining balance aligned to approaches and developments outlined in our
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7 Carers Strategy 2024-2027. A small amount was also retained to mitigate any impact that may have arisen from waiving of charges. The range of support described above, and the overall approach, demonstrates that we are already meeting the main recommendations of the report: Providing significantly more funding directly to third sector organisations (including Carer Centres) to expand and develop services to support unpaid carers, including a wider range of short breaks opportunities. Ring-fencing Carers Act funding and developing consistent budget headings for use by all local areas. Developing financial reporting processes to ensure robust tracking, monitoring, and forecasting of spend under each budget heading. Ensuring that our Annual Performance Reports provide details of support for carers / Carers Act implementation and Annual Accounts provide figures for Carers Act funding, to improve transparent reporting of impact and spend. 5.6.20 The current commissioned Carer contracts are due to end in February 2025. In line with statutory procurement rules, we will be required to begin the process of retendering for carer services later this year. This will be an opportunity to further enhance and align carer support, as set out in the Carers Strategy 2024- 2027, and any remaining balance of funding, as described in 5.6.19 can be utilised to further augment carer led innovative approaches and solutions to meet caring related needs and outcomes. 5.6.21 Earmarked reserves from the allocated funding to support The Carers Act Implementation are noted below: EARMARKED RESERVES Opening Balance as at 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance as at 28 February 2024 £m £m £m £m Carers Act Support 2.643 0.058 0.105 2.596 This and directed funding allocated for Carers support will be used to procure and deliver services that continue to support Carers across our communities. North Lanarkshire Carers Strategy 2024-2027 5.7 The Carers (Scotland) Act 2016 stipulates that each local authority and relevant health board must jointly publish a local carer strategy and that this should be reviewed three years after the integration start date; or the date a replacement strategic plan takes effect after a strategic plan has been reviewed; or the date the integration authority has decided not to prepare a replacement strategic plan following such a review.
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8 5.8 The Carers (Scotland) Act 2016 further stipulates that before preparing a local carer strategy, the local authority and the relevant health board must carry out extensive consultation. As is evidenced throughout this report, the range of engagement and participation activity informing our new Carers Strategy 2024- 2027 has been extensive, and we will continue with that approach over the lifespan of the new strategy. 5.9 The previous Carers Strategy was issued as a partnership update in 2019, due to the impacts of COVID and due to the circumstances at that time, did not involve as extensive a consultation or engagement process as we would otherwise have undertaken. As such, the 2019 Strategy was a refreshed updated version of the 2015 Carers Strategy. During the intervening period between 2015 and now, the Carers (Scotland) Act 2016, enacted 2018, was introduced, and the COVID 19 pandemic occurred. . Measures of Success 5.10 Carers are engaged, included, and represented to the extent they wish to be. 5.11 Creation of better opportunities for under-represented and seldom heard carers to participate and have their voices heard. 5.12 Improved opportunities for carers to influence, shape, co-produce and \ or co- design policy, strategy, and services. This goes beyond caring related policy or strategy, as through good design and engagement, the needs of carers and cared for people can be incorporated into wider policy and strategy. 5.13 Provision of approaches which can be influenced and shaped by the engagement and participation activity set out above. 5.14 Clear focus on the nine priority areas for action that carers have identified as a priority for them, as set out in the Carer Strategy 2024-2027. Improving preventative approaches, anticipatory and future planning (and preventing crisis). Improving communication with carers and their access to information and advice. Ensuring carers know their rights. Supporting carers health and wellbeing Ensuring carers get a break from caring. Ensuring carers, and people being cared for, have their income maximised. Improving carer experience around hospital discharge. Improving awareness of and access to Assistive Technology. Influencing and shaping policy and strategy. 5.15 Reduction in the number of carers and \ or supported people first presenting whilst already in crisis.
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9 6. CONCLUSIONS 6.1 The approach to both carer support and the Carers Strategy 2024-2027 continue to be based on the principles of the Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013. Self-Directed Support (SDS) continues to be Scotland’s national Social Care policy, promoting a whole system approach that enables people to have more choice and control in their lives. SDS is based on enhancing the principles of participation, dignity, involvement, informed choice, and collaboration. 6.2 The aspiration is to offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them. Through these initiatives, carers can lead full and meaningful lives, and ensures that people can engage in, participate in, and contribute to the local economy and wider society, should that be their choice. The wider approach also encompasses the principles of Getting it Right for Everyone (GIRFE) and Community Wealth Building. Carers, carer focused organisations and University Health and Social Care North Lanarkshire (UHSCNL) have, over time, developed a very robust carer support infrastructure, and our Carers Strategy 2024-2027 seeks to utilise this to best effect. 6.3 The requirement to draft the 2024 - 2027 Carers Strategy gave us the opportunity to undertake extensive engagement and participation activity with carers and supported people. This has resulted in a carer led and carer informed strategy, co-produced with carers and carer organisations locally. The sense of “joint ownership” that has emerged is something that carers, carer organisations and UHSCNL can be proud of. 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 ☒
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10 Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Earmarked reserves and directed funding allocated for Carers support will be used to procure and deliver services that continue to support Carers across our communities. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner n/a Choose an item. 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 Through commissioned carer support organisations locally. ☒ Provide stakeholders with information on how to get involved Through commissioned carer support organisations locally. ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Through commissioned carer support organisations locally. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Through commissioned carer support organisations locally. Through participatory self-appraisal. Yes ☒ No ☐ N/A ☐
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11 Through monitoring and assurance. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Through engagement and participation processes with commissioned carer support organisations locally, framework support provider organisations, governance groups. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Through commissioned carer support organisations locally. Through Advocacy Through individual support. Through carer development programmes, such as Recognition to Rights. ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Through the Engagement and Participation Strategy, NLDF, and through co-production with stakeholders. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Through the Engagement and Participation Strategy, NLDF, and through co-production with stakeholders. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS N/A Yes ☒ No ☐ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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12 9. APPENDICES 9.1 North Lanarkshire Carers Strategy 2024-2027 9.2 State of Caring Report (Carers Scotland) published 2023) 9.3 Analysis of Carers (Scotland) Act 2016 funding 2022-2023: responses to Freedom of Information request March 2024 9.4 Lanarkshire Carers Centre update for Committee. 9.5 North Lanarkshire Carers Together update for Committee. 9.6 Action for children Young Carers update for Committee. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Maria Williamson, Senior Manager, Quality Assurance, WilliamsonM@northlan.gov.uk
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14 NORTH LANARKSHIRE CARER STRATEGY 2024-2027 Welcome to our Carer Strategy for North Lanarkshire, 2024 to 2027, developed with carer-focused organisations and carers locally. The role of carers in supporting loved ones is immense and without it, the wider impact on Health and Social Care Services would be immeasurable. Key to our progress is the strong working relationship between carers, carer organisations, and University Health and Social Care North Lanarkshire. It is crucial that we continue to build on this firm foundation. Our strategy sets out: 1. Our shared aims - shared across carers, carer organisations, Community and Voluntary Sector and University Health and Social Care North Lanarkshire. 2. Our shared approach - aimed at ensuring that adult carers and young carers across North Lanarkshire can continue to care, so long as they are willing and able, and with the best possible health and wellbeing. 3. Our shared ambition – that policy and strategy not only takes account of caring related need, but that carers shape, influence and inform these, as well as the supports and services that assist, enable, and empower carers. What is University Health and Social Care North Lanarkshire (UHSCNL)? We are a caring and empowering partnership, dedicated to working with our communities to enable people across North Lanarkshire to lead independent, fulfilling, and healthier lives. We have established partnership agreements with a range of organisations. By enhancing and extending our work through these agreements we aim to develop sustainable, innovative, and practical solutions to health and social care challenges that directly benefit our communities and our workforce.
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15 CONTENTS 1. What is the Carer Strategy? 2. Vision and strategic priorities 3. The context for our strategy 4. Who is a carer? 5. What carers told us is important 6. Carers rights 7. Support for carers in North Lanarkshire 8. Our approach 9. Strategic intention overview 10. Specific actions 2024-2027 11. Investment, disinvestment, and reinvestment 12. Reviewing the strategy Appendix 1: Carer organisations in North Lanarkshire Appendix 2: Achievements and Progress 2019-2024
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16 1. WHAT IS THE CARER STRATEGY? The University Health and Social Care North Lanarkshire (UHSCNL) Carer Strategy 2024 -2027 explains our strategic intentions and the actions we intend to take over the next three years to: Improve the lives of carers and young carers. Deliver positive outcomes for carers and cared for people. Ensure carers are involved in individual plans. Ensure carers are involved in influencing and shaping policy and strategy. Why do we need a new Carer Strategy? To continue to respond to the changing needs of carers and young carers. To ensure that strong partnership continues to underpin how we support carers across North Lanarkshire. To fulfil our statutory requirement to update or develop a new Carer strategy every three years. (Our previous Carer Strategy ended in March 2024.) Who is the Carer Strategy For? Carers living in North Lanarkshire. Carers living in North Lanarkshire caring for people elsewhere. Carers who live elsewhere but who care for a person or people living in North Lanarkshire. How did we create the Carer Strategy? Through engagement sessions with carers – facilitated by North Lanarkshire Carers Together, Lanarkshire Carers Centre & Action for Children Young Carers Project – we sought information on areas for improvement. Using information from everyday engagement activity that is embedded within our support of carers across North Lanarkshire.
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17 2. VISION & STRATEGIC PRIORITIES Our shared vision is that: Across North Lanarkshire, Carers and Young Carers, as well as the people being cared for, feel valued, respected, listened to, and well supported. Carers and Young Carers feel as well as possible and have scope to access their interests and a life beyond any caring responsibilities. Our strategic priorities 2024-2027 in support of this vision are: 1. Improve preventative approaches, anticipatory and future planning. 2. Improve communication with carers. 3. Ensure carers know their rights. 4. Promote Income maximisation and social inclusion. 5. Ensure carers can get a break from caring. 6. Continue to ensure carers are at the heart of policy, strategy, and service design. 7. Improve carer experience around hospital discharge. These priorities aim to ensure that all carers are valued, recognised, and supported effectively. Cutting across our priorities are guiding principles of: ‘Getting it right first time’ from the outset, in a timely and efficient manner, to ensure that carers can continue caring for their loved ones without undue burden. Engagement and Participation – Creating meaningful opportunities for carers to shape and influence local plans, policies, strategies, support, and services. Our approach is intended to promote carer inclusion, offer support to get involved in planning and working together, assessing what methods work, effective communication, and evaluating impact. This is to inform and influence decisions on services and support. 3. THE CONTEXT FOR OUR STRATEGY National Carers Strategy The National Carer Strategy, (Scottish Government, December 2022) looks to progress long-term changes to improve the lives of unpaid carers across Scotland. It was created after extensive engagement with carer organisations, carer centres, local government, and unpaid carers themselves. It sets out the action the Government will take across a range of policy areas to ensure its resources for carers are directed to
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18 where they will be most effective. Across Scotland, the intention is that all local authorities and carer-focused organisations will ensure their local strategies fit with this wider strategy. As well as meeting the aspirations of carers locally, our Carer Strategy also needs to align with the aims of the National Carers Strategy and its five pillars, which are: Living with COVID-19 Valuing, Recognising and Supporting Carers Health and Social Care Support Social and Financial Inclusion Young Carers North Lanarkshire priorities Our Carer Strategy must also align with the ambitions of The Plan for North Lanarkshire and Our Health Together, which outlines the long-term vision for our area. Several Ambition Statements within The Plan have a direct connection with our Carer Strategy. These are: Statement 13. Improve preventative approaches including self-management and giving people information and choice over supports and services. Statement 15. Encourage the health and wellbeing of people through a range of social, cultural, and leisure activities. Statement 18. Ensure our digital transformation is responsive to all people’s needs and enables access to the services they need. Statement 19. Improve engagement with communities and develop their capacity to help themselves. Statement 20. Improve the involvement of communities in the decisions, and development of services and supports that affect them. Statement 24. Review and design services around people, communities, and shared resources. Statement 25. Ensure intelligent use of data and information to support fully evidence-based decision making and future planning. Connecting our work to wider initiatives Local Carer strategies must also meet a range of statutory requirements as set out in the Carers (Scotland) Act 2016, and link with other national or local strategies and policies, such as: Condition specific or age-related policies or strategies; Childrens Plan; Self-Directed Support (SDS); Getting It Right for Everyone (GIRFE); and Trauma Informed Practice (TIP).
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19 Our priorities to make our vision a reality Focus of strategic action during plan period National Strategy pillars links Link to Plan for NL 1. Improve preventative approaches, anticipatory planning, and future planning. 2. Improve communication with carers. 3. Ensure carers know their rights. 4. Income maximisation. 5. Ensure carers can get a break from caring. 6. Continue to ensure carers are at the heart of policy, strategy, and service design. 7. Improve carer experience around hospital discharge. These priorities aim to ensure that all carers are valued, recognised, and supported effectively. 1. Improving preventative approaches, anticipatory and future planning (and preventing crisis). 2. Improving communication with carers and their access to information and advice. 3. Ensuring carers know their rights (and that Adult Carer Support Plans and Young Carer Statements are offered and progressed consistently). 4. Supporting carers health and wellbeing (including Living with COVID-19). 5. Ensuring carers get a break from caring. 6. Ensuring carers, and people being cared for, have their income maximised. 7. Improving carer experience around hospital discharge. 8. Improving awareness of and access to Assistive Technology. Additional actions for specific groups of carers 9. Young Carers 10. Parent Carers 11. BAME Carers 12. LGBTQI+ Carers Pillar 2 Pillar 2 / 3 /4 Pillar 2 Pillar 1 / 3 Pillar 3 Pillar 2 / 4 Pillar 1 / 2 Pillar 2 / 3 / 4 Statement 13 / 25 Statement 13 / 19 Statement 13 / 19 Statement 15 / 24 Statement 13 / 15 Statement 15 / 19 Statement 13 / 19 / 20 / 24 Statement 13 / 18 / 24 Cutting across our priorities are guiding principles of: ‘Getting it right first time.’ Engagement and participation Pillar 2 / 3 / 4 Statement 19 / 20 / 24
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20 4. WHO IS A CARER? The Carers (Scotland) Act 2016 defines a carer as an individual who provides or intends to provide care for another individual (the cared-for person). A young carer is a carer who is under 18 years old or is 18 years and still a pupil at a school. An adult carer is a carer who is at least 18 years old but is not a young carer. A carer can be a spouse, partner, parent, sibling, or other family member, or in the case of young carers, be a son, daughter, friend, or any other relation. To be recognised as an adult carer or young carer: You can be any age, gender, culture, race, or religion, can become a carer at any time and might care for more than one person. You might be providing care to a parent, child, sibling, other relative, partner, friend, or neighbour. The person you care for might have a long-term physical condition, learning disability, mental illness, frailty, sensory impairment, or issues with substance misuse. You do not need to live at the same address as the person you care for. You do not need to be claiming Carers Allowance. There is no threshold amount of time if you provide care & you are a carer. You can be in employment or studying and still be a carer. The person you care for does not need to be receiving social care support. We know that many carers, particularly in the early part of their caring journey, may not self-identify as carers. Often, this is because they see themselves primarily as a spouse or family member, for example. Who is not a Carer? The Carers (Scotland) Act 2016 also explains that: Parents of dependent children are not usually considered carers. However, parents of dependent children with additional care and support needs can still be considered carers. Paid care workers and foster carers do not fall within the definition of ‘Carers’ under the Act. Why it is important to identify carers? The early identification of unpaid carers is a key part of our approach. This allows us to: 1. Introduce preventative approaches at the right time. 2. Develop anticipatory approaches and early planning. 3. Support future planning. 4. Minimise the chances of crisis occurring. 5. Target responses and resources appropriately. Local carer strategies must set out plans for identifying carers, such as outreach and awareness raising activity, communication and information dissemination, and events for and about carers.
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21 Carers in North Lanarkshire Not every carer identifies as a carer or is captured within the national Carer Census. This makes it difficult to state with any certainty how many carers we have within our area or the demography around who is caring for who. North Lanarkshire’s population is currently around 341,000 people, and around 13,000 carers in our area are known to carer organisations and/or to University Health and Social Care North Lanarkshire. However, we believe that there may be as many as 50,000 to 60,000 people delivering some form of unpaid care locally at present. This figure would be in keeping with wider research on unpaid caring, which suggests that two out of three people will be a carer at some point in their lives.
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22 5. WHAT CARERS TOLD US IS IMPORTANT THE IMPACT OF CARING Being a carer can often be rewarding and have positive impacts, but it can also result in a range of challenges. During engagement with carers to inform this strategy, the following issues and concerns were highlighted: Impact on health and wellbeing. Carers reported: Poor physical and/or mental health. How the challenges facing NHS services (such as the unavailability of GPs and delays getting to see consultants and specialists) severely impacts their health and cared-for people’s health. Feeling exhausted and experiencing feelings of guilt. Struggling with the expectations of the person they care for who does not want to accept other support; reliance on carers and feeling intense pressure to keep going. Impact on finance. Carers reported: Loss of income. Additional costs associated with caring. Struggling financially affects their health. The need for more financial support to look after their health and wellbeing and greater recognition of the financial impacts of caring. Access to information and advice, particularly around income maximisation, is crucial. Impact on relationships. Carers reported: Social isolation. No scope to “switch off” from caring responsibilities. Valuing opportunities to meet with other carers and accessing peer support. Impact on life balance. Carers reported: Balancing work, relationships, and other caring responsibilities with main caring responsibilities, is challenging. Little scope to have a life outside of caring. Not having any “down time” away from caring. RECOGNITION AND SERVICE RESPONSIVENESS Through engagement, carers shared how they would wish to be recognised and how services and support could be more responsive. Recognition
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23 To be recognised as carers To be supported timeously. To have regular breaks from caring. To be treated with dignity and respect. To be listened to, first time, every time. To be recognised as a parent carer. To be properly involved in hospital discharge planning. Employment and Training The importance of training and support, notably around caring for someone with Dementia, Autism, or other neurological conditions. Future planning Wanting to be involved in shaping policy, strategy and services and recognition that to be able to participate in this may require replacement care. Needing to be properly involved in hospital discharge planning. Worrying about the future. Information, advice, and support. Needing better understanding of what is available to carers from community support options. To have responsive, flexible support when needed. Getting support when it is needed. Consistency when engaging with Social Work; better continuity, and to not feel they must fight for the support they require. Parent carers reported: Feeling that Parent Carers are not listened to in the decisions being made for their children. Concerns surrounding their child not being listened to. Needing to bring in third parties before they are taken seriously. Needing their role as carers recognised within Education. Engagement Sessions with carers from Minority Ethnic communities and LGBTQI+ Carers highlighted commonality with all of the areas noted above but included some specific concerns. For Minority Ethnic carers: Services and support are not always culturally sensitive and can lack understanding of the needs of Minority Ethnic communities. “Minority Ethic” is not one homogenous group and approaches need to be tailored to individual circumstances. Lack of culturally appropriate support for older adults in the community adds
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24 to caring responsibilities. Many Ethnic Minority carers, particularly women, do not feel recognised, understood, and valued within communities and families; the caring role is taken for granted and considered a family duty. Anxiety around COVID continues, with many older adults struggling to participate in activities and gatherings because of this. For LGBTQI+ carers: Recognition that carer needs and those of the person they care for may require a specific approach, or specific support. LGBTQI+ is not a single homogenous group. Greater understanding that approaches are appropriate and unique to individual circumstances. Working Carers Hopes that the new Carers Leave Act, with regulations published and implementation scheduled in April 2024, will have a positive impact on some of the challenges they face.
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25 6. CARERS RIGHTS The Carers (Scotland) Act 2016 outlines the rights of carers in Scotland. It explains the specific duties and powers that each local authority must follow in order to help improve the health and wellbeing of carers, so that they can continue to care, if they so wish, are able and willing to provide care and have a life alongside caring. The key aspects of the Act for Local Authorities, NHS and Health and Social Care Partnerships are: To prepare an Adult Carer Support Plan (ACSP) or Young Carer Statement (YCS) for any carer/young carer who requests one, and to offer one to anyone who appears to be a carer. To provide support to carers based on need which meets our eligibility criteria. To help carers put arrangements in place for the provision of care to the cared-for person in emergencies. To establish and maintain an information and advice service for carers. To consider whether any support should include or take the form of a break from caring. To produce a Short Break Services Statement. To involve carers in the planning of discharge from hospital of the cared-for person To adhere to timescales for the preparation of ACSPs/YCSs for carers of people who are terminally ill. To prepare a local carers strategy. Our strategy sets out how we are responding to these requirements and how we will continue to support carers through a range of services and supports. Adult Carers Support Plan (ACSP) We will offer an Adult Carer Support Plan (ACSP) to any adult we identify as a carer or any adult who requests one, in line with the statutory duty to do so. The ACSP provides a framework for identification of adult carers’ individual needs and any supports required to help achieve personal outcomes. In North Lanarkshire, the responsibility to offer an ACSP sits with Lanarkshire Carers Centre and Social Work. Health staff also have a responsibility to offer an ACSP to all carers they encounter. Young Carers Statement (YCS) Young carers identified by support agencies or who self-identify as Young Carers are offered a Young Carer Statement through North Lanarkshire Young Carers which is the delegated support provider responsible for completion and review of YCSs. Each YCS identifies the caring role carried out and whether this role is manageable, safe, appropriate, and what additional support is required. Eligibility Criteria We have prepared our eligibility criteria for carers using guidance issued by the Scottish Government. This is based on the impact that caring has on the following aspects of the carer’s life: Health and wellbeing Relationships Living environment Employment and training
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26 Finances Life balance In North Lanarkshire eligibility is based on Adult Carer Support Plans and Young Carer Statements and the identified level of need. We are increasingly moving towards a “what would help” approach as opposed to “eligibility.” Waiving of charges Support and/or services to meet caring related needs identified within an Adult Carer Support Plan cannot be charged for. Any charges must be waived. Hospital Discharge NHS Lanarkshire has made a commitment to involve carers in the discharge planning of the person they care for, in line with this requirement as stipulated in the Carers (Scotland) ACT 2016. Work is ongoing in partnership with local carer organisations to provide an information service and direct support for carers throughout the hospital discharge process. Breaks from caring The Scottish Government has intimated an intention to pass legislation ensuring that carers will have a legal right to a break from caring. The UK Government has progressed a Bill enabling carers in paid employment to have five days unpaid annual leave from caring. Our approach to breaks from caring is set out within our Short Breaks Services Statement, which complements this strategy. Situation Suggested Response Cared for person can cope independently enough that the Carer can take a break without the need for support from services or that a family break without the need for any additional support is possible Self-help (no service responses are required around Carer breaks) Also consider whether preventative or anticipatory planning is required? Is a Future Plan in place? Cared for person requires support so that the Carer can have a break. Wider family and friends can assist with this or a family break without the need for any further support is possible Self -help (no service responses are required around Carer breaks) Also consider whether preventative or anticipatory planning is required? Is a Future Plan in place? For the scenarios above, it is suggested that the Carer identifies that they can self -manage breaks without support or service input, in line with the principles of independence, self-reliance and self-help. This approach should also mean that resources can be targeted towards those Carers with greater levels of need as suggested in the scenarios below. At present, this is an outline approach only. Each situation will be unique. There may be different options or ways of approaching this area. The Carer Strategy cannot be prescriptive and simply reflects that bespoke solutions, according to the individual circumstance of the Carer and cared for person should be the default
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27 position. Engagement and Participation with Carers and local Carer Organisations will continue to help inform this. Cared for person may need to summon assistance if the Carer is not present and there is no family or friends support available. Person’s own technology (mobile phone, Portal, Facetime and so on) or services responses such as Community Alarm Service or other Assistive technology options (for example remote support) Cared for person requires in person support and Carer requires breaks, and there is no wider support from family or friends available Carer Breather (North Lanarkshire Carers Together) A test of change Carer Sitter demonstration project is also being planned for later in 2024 – 2025 and this may offer further options, should the demonstration project prove successful. Cared for person requires in person support and Carer requires breaks and there is no support from family or friends available Flexible short break fund (Lanarkshire Carers) Carer Breaks (Lanarkshire Carers) Young Carer Breaks (Young Carers Support Project) Cared for person requires in person support and Carer requires breaks. Support Services in place – Integrated Day Service, Locality Support Service, agreed respite and so on Cared for person requires in person support and Carer requires breaks. Carer Budget following an Adult Carer Support Plan being progressed and identifying unmet need. Carer Budgets can be across Low, Moderate, Significant or Critical Carer need, dependent on individual circumstance. Cared for person may be in receipt of an Individual Budget
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28 7: SUPPORT FOR CARERS IN NORTH LANARKSHIRE University Health and Social Care North Lanarkshire As highlighted on Page 1, we are a caring and empowering partnership, dedicated to working with our communities to enable people across North Lanarkshire to lead independent, fulfilling, and healthier lives. The Scottish Government has set out nine national health and wellbeing outcomes that we, along with every other health and social care partnership in Scotland, is working towards. Commissioned Carer Organisations University Health and Social Care North Lanarkshire currently commissions three carer organisations to ensure that carers and young carers are supported, that there is the provision of an information, advice and signposting service and that carer interests are represented. These organisations are: Lanarkshire Carers Centre North Lanarkshire Carers Together Action For Children Young Carers Project All three of these organisations have carer representation on their management board or committee and feed into the Carer Support Network and North Lanarkshire’s Integrated Joint Board. This helps ensure that carer voices are heard, and can influence and shape policy, strategy, and service development. Lanarkshire Carers Centre www.lanarkshirecarers.org.uk Lanarkshire Carers provides information, advice and a range of direct support and services which can help carers maintain or improve their quality of life and continue to care. Its services are open to all carers aged 18 years and older living in Lanarkshire. Its Short Breaks Bureau helps carers to take breaks from caring, while its Carer Training Programme can help carers to manage the caring role, understand specific conditions, and look after their own health and wellbeing. North Lanarkshire Carers Together www.carerstogether.org North Lanarkshire Carers Together provides a range of information, advice, and signposting services. Its Carer Breather helps carers to access regular short breaks from caring. A dedicated Equalities post focuses on ensuring that under-represented groups or communities have a voice. Its carer advocacy work helps carers to access advocacy support (distinct from any advocacy provision for supported people). Action For Children North Lanarkshire Young Carers www.actionforchildren.org Action For Children North Lanarkshire Young Carers raises awareness, identifies, and provides direct support to children and young people who look after or help to look after someone in their family who is unwell or disabled, including children caring for parents who have mental health or substance misuse problems.
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29 OTHER GROUPS OR ORGANISATIONS PROVIDING SUPPORT TO CARERS There is a range of Community and Voluntary Sector organisations which provide a range of support, including condition-specific and age-related support to carers, whether directly or indirectly. These organisations form part of the Carer Support Network. The list of organisations includes, but is not limited to: PAMIS Family Support PAMIS | Promoting a more inclusive society Provides support to families caring for someone with profound and multiple disabilities. HOPE for Autism Hope for Autism – Providing support across Lanarkshire Provides support to people with Autism as well as to family members and carers. Deafblind Scotland www.dbscotland.org.uk Provides sign guide interpreters for people with dual sensory impairment, as well as support to family members and carers. Alzheimer’s Scotland We are Scotland's dementia charity (alzscot.org) Provides a post diagnostic support service and support to family members and carers. North Lanarkshire Disability Forum (NLDF) www.nldforum.org.uk The lead agency locally facilitating the Engagement and Participation of supported people (including carers). Voluntary Action North Lanarkshire (VANL) www.voluntaryactionnorthlanarkshire.org The lead agency for the Community Solutions programme, whereby people, including carers and cared for people can be supported by a diverse range of community or voluntary sector organisations. Getting Better Together (GBT) www.shottshealthyliving.com Offers a post hospital discharge support service, and wider carer support options to support family members and carers. Playpeace www.playpeace.org.uk Offers parental peer support and activities for children with additional support needs.
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30 OTHER SUPPORTS FOR CARERS Making Life Easier (MLE) This is an online service for people experiencing difficulties with everyday activities, including carers. It offers information, advice and direct access to services and support, and can assist people with equipment solutions, many of which can be ordered online direct from its equipment service. Assistive Technology A range of specialist equipment technology can support carers by helping the person they care for live at home independently or alert the carer if help is needed. The range of technology available from Health and Social Care includes falls sensors, bed monitors, fire safety sensors and GPS locators. Care Opinion Offers supported people and carers an online platform with which to provide anonymised feedback on their experiences of care and support.
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31 8. OUR APPROACH Our approach is based on the principles of promoting independence, self-help, enablement, and empowerment for carers in the community. We aim to support carers to maintain their autonomy and decision-making capabilities, enabling them to care for their loved ones while also prioritising their own well-being. By providing resources, information, and guidance, we seek to empower carers to access the support they need and navigate the caring journey with confidence. We recognise the strength and resilience of carers and encourage self-care practices that enhance physical, emotional, and mental well-being. Through this and peer support networks, carers can learn from each other, share experiences, and build a sense of camaraderie. We are committed to enabling carers to fulfil their caring responsibilities effectively and efficiently. By offering training, skill development opportunities, and practical assistance, to augment carers’ existing experience and expertise, carers are equipped with the tools and knowledge they need to navigate complex care situations and engage with health and social care services with confidence. At the core of our approach is the empowerment of carers to advocate for themselves and their loved ones, and to actively participate in decision-making processes that affect their lives. We strive to create a supportive environment where carers are respected, valued, and empowered to voice their needs, concerns, and aspirations, leading to positive outcomes for both them and the individuals they care for. Engagement and Participation of carers Engagement and participation underpin our approach and all of our strategic priorities and actions. We aspire to improve the ways we consult with, and involve, carers on matters which affect them. We have identified five levels where outcomes need to be considered across the engagement and participation activity that takes place. These are: 1. Individual Level - Where carers and people being cared for can use lived experience, self-appraisal, and engagement through options such as feedback, surveys, and focus groups, to self-identify where support for them as an individual carer and/or to the cared for person is needed, how it is provided and in what way provision is making a positive difference. 2. Carer Support Service and/or Project Level - Where carer organisations can use engagement processes such as carer feedback, case studies, performance
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32 management and performance reporting information to discern and measure the impact and efficacy of carer support approaches. 3. Organisational Level - The organisational aim of University Health and Social Care North Lanarkshire is that people remain as independent as possible, for as long as possible, are more socially included/connected and appropriately supported where necessary. The One Plan for North Lanarkshire through several of its Ambition Statements, Local Outcome Improvement Plans, and Carer strategies, as well as the Self-Directed Support (Scotland) Act and Carers (Scotland) Act, all set out desired organisational outcomes that we work to. 4. Partnership Level - This is a shared outcome working towards people being able to maintain independent living for longer. Carers play a key role in this, in terms of supporting people at home, in their local community and in ensuring that those they care for remain as independent as possible. Carers can also lead on or inform preventative approaches and anticipatory planning. 5. National Level - Each Integration Authority, including University Health and Social Care North Lanarkshire is required to publish an annual performance report which sets out how the national health and wellbeing outcomes are being improved.
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33 9: STRATEGIC INTENTION OVERVIEW The focus of our strategic actions across the three years of the Carers Strategy 2024 -2027 are as follows and detail of how we will progress these are provided in the next section ‘Specific Actions’. These priority area actions will help to ensure that all carers are valued, recognised, and supported effectively. 1. Improving preventative approaches, anticipatory and future planning (and preventing crisis). 2. Improving communication with carers and their access to information and advice. 3. Ensuring carers know their rights. 4. Supporting carers health and wellbeing 5. Ensuring carers get a break from caring. 6. Ensuring carers, and people being cared for, have their income maximised. 7. Improving carer experience around hospital discharge. 8. Improving awareness of and access to Assistive Technology. 9. Influencing and shaping policy and strategy. Additional actions for specific groups of carers: 10. Young carers 11. Parent carers 12. BAME carers 13. LGBTQI+ carers All these actions will be tackled through a shared approach across University Health and Social Care North Lanarkshire and carer organisations.
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34 10: SPECIFIC ACTIONS 1. IMPROVING PREVENTATIVE, ANTICIPATORY AND EMERGENCY PLANNING Why this is a priority: Preventative, Anticipatory and Emergency Planning is about taking a person-centred, thinking ahead approach. It gives carers opportunities to consider their options and ‘plan for the future.’ Improving this area is about ensuring that the right conversations take place with health and social care professionals and that carer preferences are explored and responded to. It is also about trying to prevent carers from having to repeat conversations with different organisations about their circumstances. To be effective in this area we also need to identify carers before they present at a point of crisis. We estimate that only around one in four carers is currently known to services in North Lanarkshire. Specific actions: 1. Support the development of a comprehensive system to proactively identify and assess carers, including regular screenings, assessments, and follow-ups to ensure all carers’ needs are captured effectively. 2. Build in a bespoke offer for training sessions, workshops, and resources to empower carers in developing and implementing their Preventative, Anticipatory, and Emergency Plans. This can include practical information and tools tailored to the specific needs of carers and ensuring that carers are aware of the local arrangements regarding Adult Carer Support Plans and Young Carer Statements. 3. Continue with our collaborative approach to provide guidance and support in creating these plans, ensuring they align with the care needs of the cared-for individual and are regularly reviewed and updated, as necessary. 4. Utilise technology and digital platforms, and explore innovative ways to utilise technology, such as mobile apps or online platforms, to facilitate the development and sharing of Preventative, Anticipatory, and Emergency Plans among carers and care professionals. This can improve accessibility and communication, making the planning process more efficient and effective. What success will look like. More carers will have Preventative, Anticipatory and Emergency Plans in place through reviews, adequate information on supports and services, identification, and assessment, which can help in better preparation for any unexpected situations and improve overall well-being and quality of care provided.
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35 There will be a reduction in the numbers of carers coming into crisis. An increasing number of carers, and cared for people, will be aware of, and using, assistive technology (digital solutions) as an integral part of caring and support arrangements. 2. IMPROVING COMMUNICATION WITH CARERS AND THEIR ACCESS TO INFORMATION AND SUPPORT Why this is a priority: Effective communication is essential in ensuring carers receive high-quality support that is tailored to their unique needs. Access to the right information, at the right time and in the right place, is crucial. Specific actions: 1. University Health and Social Care North Lanarkshire will continue to commission carer organisations to provide information and support: 2. In addition to commissioned services, University Health and Social Care North Lanarkshire has invested in PAMIS, HOPE for Autism, Alzheimer’s Scotland, and North Lanarkshire Disability Forum to provide condition specific information and support to carers. What success will look like. Carers will be able to access the right information and advice for their particular situation at the right time and place. 3. ENSURING CARERS KNOW THEIR RIGHTS Why this is a priority: Carer rights and entitlements matter to carers, not just because this helps them to feel valued and recognised for what they do, but because it is a key factor in ensuring carers receive the support they need. Understanding rights also raises awareness of choices around caring. Specific actions: 1. Continuing to inform carers of their right to an Adult Carer Support Plan or Young Carer Statement.
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36 2. Expand the range of resources, such as informational leaflets, online resources for staff and people, share workshops and training, that specifically outline carers' rights, entitlements, and available support services. 3. Continue to support dedicated carer advocacy to assist carers in navigating their rights and entitlements, advocating on their behalf when needed, and supporting carers in accessing relevant support services. This can include providing individualised guidance on how to assert rights effectively. 4. Continue to support celebratory platforms for carers to connect with each other, share experiences, and support one another in understanding and exercising their rights. 5. Build on existing partnerships with community organisations, and advocacy groups to enhance carers' knowledge and awareness of their rights. What success will look like. Carers understand what they are entitled to. Carers are enabled to manage their caring role and are able and willing to continue with their caring role. Carers feel valued and respected by services, and are listened to, understood, and involved in individual planning, support, and services with the person that they care for as well as for themselves. 4. SUPPORTING CARERS HEALTH AND WELLBEING (including Living with COVID) Why this is a priority: Supporting carers’ health and wellbeing is a key focus for statutory services, commissioned services, and others, as it is essential to the ability to continue to provide care. It is important to both carers and to the people they care for. The strain of caring can impact each carer differently; recognising that every carer has unique and specific needs with regard to maintaining their health and wellbeing is important. Many carers continue to live with the impact of COVID and require support to rebuild confidence and to feel safe to re-engage with wider communities and services. Specific actions: 1. Increase awareness and encourage engagement of carers who are not currently affiliated with carer organisations in North Lanarkshire. 2. Greater visibility of resources, accurate signposting, information, and advice, regardless of the carer’s entry point to carer support.
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37 3. Continuing to support the provision of carer health checks and counselling/wellbeing services, on demand wellbeing library and health focused carer training. 4. Continuing to meet carers, and carer organisations, regularly to hear current concerns regarding COVID and provide up-to-date information. 5. Supporting carers to rebuild confidence and feel safe to re-engage with wider communities and services. 6. Ensuring that any carers who require PPE, continue to have access to it. What success will look like. Carers feel healthy and well enough to manage their caring role, have support as needed and can access opportunities alongside or out with caring. Carers are able and willing to continue with their caring role. Carers feel confident and supported to protect themselves from COVID, to re- engage with their communities, and to are supported to recover from the negative impacts of COVID. 5. ENSURING CARERS GET A BREAK FROM CARING Why this is a priority: Many carers may struggle to maintain their health and wellbeing without access to regular and substantial breaks from their caring responsibilities. Breaks from caring are important for sustaining caring relationships and ensuring that carers have time for themselves and their interests. Specific actions: Our approach to breaks from caring is set out within our Short Breaks Services Statement, which complements this strategy. 1. Continue to support and develop individual choice and control regarding breaks, for both carer and cared for person. 2. Build responsiveness to ‘here and now’ situations which can arise at extremely short notice. 3. Carers will have someone to talk to through being connected to services and support. What success will look like.
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38 Carers will be able to have breaks from caring, whether through natural supports, short break options or through individual budgets, where appropriate. Individual carers conversations lead to personalised break from caring. Widening the understanding of what a carer break can look like: ‘regular time for me,’ ‘small pockets of respite.’ 6. ENSURING CARERS, AND PEOPLE BEING CARED FOR, HAVE THEIR INCOME MAXIMISED Why this is a priority: For most carers there is a monetary impact to caring. Income maximisation enables and empowers carers to self-fund costs, such as travel and activities, and to meet additional or ‘hidden’ costs associated with caring, such as increased utility bills or food costs. Specific actions: 1. Embedding income maximisation as part of every new Community Care Assessment and making it a consistent approach. 2. Every Adult Carer Support Plan, or Young Carer Statement to consider what financial help and support may be available. 3. Delivering awareness raising and training to UHSCNL staff and wider staff teams to ensure that carers and people being cared for have their income maximised. 4. Carer organisations continue to offer a wide range of other financial and non-financial supports to help alleviate hardship, as well as information, money advice and signposting. What success will look like. Carers will be aware of the range of the financial support or assistance available to them. All carers locally will be aware that support put in place to meet caring related needs as identified in an Adult Carer Support Pan, cannot be charged for. Carers will experience better financial inclusion and less hardship. Through income maximisation, carers can enjoy greater social inclusion.
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39 7. IMPROVING CARER EXPERIENCE AROUND HOSPITAL DISCHARGE Why this is a priority: Often a hospital admission can mark the beginning of a changing, increased, or new caring role. The right information, advice, and support can help to reduce the pressure and anxiety often faced by carers when this occurs, and lead to more successful and positive discharges from hospital. Specific actions: 1. Better and earlier discharge planning that includes carers. 2. Increased partnership working from all organisations involved in discharge. 3. Increased capacity for organisations that actively support carers at discharge and in the community. 4. A reduction in instances of carers being informed of discharge at short notice. 5. Evaluation of carer hospital discharge payment scheme 6. Implementation of discharge passport. 7. Increased feedback and engagement from carers to inform discharge improvements. 8. Continued support of hospital linked carer support workstream and its carer support staff linked to the three acute hospital sites in Lanarkshire. What success will look like. Carers and cared for receive the right support at the right time. Reduction in complaints.
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40 8. IMPROVING AWARENESS OF AND ACCESS TO ASSISTIVE TECHNOLOGY Why this is a priority: Technology solutions enable and empower people to be as independent as possible, for as long as possible, as well as reducing risk. For example, assistive technology could support a carer to safely leave the cared for person for periods of time, secure in the knowledge that support could be summonsed, if required. Creating greater independence can help to reduce levels of stress and strain on carers and assistive technology can play a key role in improving carers’ health and wellbeing. Specific actions: 1. Continue to help carers and cared for people to use their own technology in ways that can support their independence and individual needs. 2. Continue to promote the support and services provided by University Health and Social Care North Lanarkshire’s Assistive Technology Team, for example through attendance at carer events and providing promotional material or merchandise. 3. Continue to promote the ‘think technology first’ message with partner agencies and stakeholders. 4. Reduce barriers to accessing assistive technology support. What success will look like. Carers and cared for people will be aware of the range of technology options aimed at supporting independence and/or minimising risk. A significant increase in the number of people using technology as part of their support arrangements. Carers will be able to access Assistive Technology, following an ACSP or assessment when required. Carer services, carers and cared for people will be able to request this directly. Wait times for equipment will be reduced, so reducing the number of delayed discharges.
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41 9. YOUNG CARERS Why additional specific actions are required for this group: For young carers, the experience of providing care can be stressful and isolating. For many it can negatively impact their experience in education. It is particularly important to support young carers so they can still enjoy being young, have a better chance of succeeding in all parts of their lives, and be able to pursue their dreams outside of caring. Specific actions: 1. Continue to work within schools to improve the identification of young carers and ensure that they are aware of their entitlement to a Young Carer Statement. 2. Continue to review the support for young carers regarding the different routes to further and higher education and employment. 3. Continue to develop transitional support, building on the existing links with New College Lanarkshire, Skills Development Scotland, and Community Jobs Scotland. 4. Improve support of young carers with hospital discharge. (Young carers tend to be unseen regarding the discharge of cared for individuals.) 5. Through increased partnership working, innovative thinking and development, implement ways to better reach young carers from ethnic minorities. 6. Continue to deliver awareness training to UHSCNL staff, to improve recognition and support of young carers. 7. Continue to provide a range of supports, including group work programmes, one to one supports, short breaks, and in-school support, and respond in a flexible way to the issues that young carers identify. 8. Continue to ensure that the views of young carers are built into the planning and shaping of support and services and ensure links with the North Lanarkshire Engagement and Participation Strategy. What success will look like. As far as possible, young carers will enjoy a childhood like other young people and children. Young carers will be well supported, able to understand and cope with their caring responsibilities and have access to the right support, at the right time and place, should circumstances change. Positive destinations become more achievable through educational support.
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42 10. PARENT CARERS Why additional specific actions are required for this group: Parent carers have to balance the role of a parent with meeting their child’s needs as a carer. They are less likely to see themselves as a carer because looking after their child is something they would naturally do, regardless of the circumstances. Making the distinction between being a parent or a parent carer is important, so that there is recognition of any need for additional support. Specific actions: 1. Implement a dedicated support framework that recognises and addresses the unique challenges and needs of parent carers. This framework should provide targeted information, resources, and services that cater to the dual role of being a parent and a carer. 2. Coordinate with carer organisations awareness campaigns and training sessions to educate UHSCNL staff, as well as parent carers themselves, about the distinction between being a parent and a parent carer. The emphasis should be on the importance of identifying parent carers and ensuring that parent carers are aware of additional support options. 3. Support the parent carer working group comprised of parent carers to provide insights, feedback, and recommendations on how best to support this specific group. Collaborate with parent carers in decision-making processes and support involvement in the development and evaluation of support initiatives. 4. Regularly review and assess the impact of support initiatives for parent carers, including the outcomes of the established working group. Ensure that any changes in circumstance, learning and recommendations can feed into the Carer Strategy to keep it “current,” as well as to continuously improve and tailor support for parent carers. What success will look like. Parent carers feel valued and respected by services. Parent carers are identified as carers, should that be their choice, have a voice, are listened to, understood, and involved in individual planning, support, and services with the person that they care for as well as for themselves.
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43 11. MINORITY ETHNIC CARERS Why additional specific actions are required for this group: Carers from ethnic minorities can experience additional barriers and challenges. Many carers from minority ethnic backgrounds do not recognise themselves as carers due to cultural expectations; the term “carer” does not exist in some cultures. People in these circumstances are also more likely to report negative experiences of trying to access help and support. Minority ethnic does not describe a single homogenous group, and person or situation specific support should be tailored to individual needs. Specific actions: 1. Working with partners to identify, engage, and support carers from Minority Ethnic communities. 2. Awareness raising and training for UHSCNL staff, wider staff teams and consideration of awareness raising through corporate communications. 3. Seek input from carers from Minority Ethnic communities regarding the barriers faced and the support required to overcome these. 4. Greater recognition of cultural differences and their implications. 5. Support tailored to individual needs. What success will look like. Carers from Minority Ethnic communities will be able to access the range of carer support options available to other carers, with reasonable adjustment to reflect any specific needs. This could include, and is not limited to, translation services, interpreters, recognition of English as a second language, culturally sensitive support, and other considerations identified as barriers by carers from Minority Ethnic communities.
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44 12. LGBTQI+ CARERS Why additional specific actions are required for this group: LGBTQI+ carers face unique challenges, both practical and emotional, in their caring role. They may experience additional stress and strain because of worries about others’ reactions, or even discrimination, when seeking support and accessing services. LGBTQI+ carers can experience increased isolation, as well as losing aspects of their LGBTQI+ identity as a result of the demands of their caring role. Specific actions: 1. Training programmes for healthcare professionals, social workers, and service providers to increase awareness of equality issues in relation to caring and enhance their cultural competence in addressing the needs of LGBTQI+ carers. 2. Increasing visibility of LGBTQI+ carers in awareness campaigns and information materials regarding caring. 3. Expanding support services to reach diverse LGBTQI+ communities, considering factors such as age, ethnicity, and gender identity. 4. Implementing strategies to address and reduce stigma and discrimination faced by LGBTQI+ carers. 5. Promoting collaboration between LGBTQI+ organisations, carer support groups, and health and social care to create a comprehensive and integrated support network. What success will look like. Increased awareness and understanding of the unique challenges faced by LGBTQI+ carers among healthcare professionals, service providers, and the broader community. Better availability of accessible and inclusive support services tailored to the specific needs of LGBTQI+ carers. Improved mental health outcomes for LGBTQI+ carers, including reduced stress and increased well-being. An empowered and engaged LGBTQI+ carer community that actively participates in decision-making processes. Positive changes in policies and legal frameworks that protect the rights and well- being of LGBTQI+ carers.
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45 10. INVESTMENT, DISINVESTMENT AND REINVESTMENT Given the widespread cost of living crisis and the financial pressures across Health and Social Care, the approaches described above may also require elements of disinvestment, to free up resources for reinvestment. In the lead up to the Carer Strategy 2024 -2027 there has been further investment in: PAMIS: Family Support Service (expanded service commencing April 2024) North Lanarkshire Carers Together: Equalities post North Lanarkshire Carers Together: Carer Breather Lanarkshire Carers Centre: Carer Outcomes Grant and Flexible Support Fund Lanarkshire Carers Centre: CarerSpace Hospital Discharge Carer Support Scheme Alzheimer’s Scotland: Post Diagnostic Support Service (Dementia) Autism related support through the Autism Network HOPE for Autism: extended contract. Investment in carer support around both Dementia and Autism is a direct consequence of these being identified in both the 2021 and 2023 Carer Census as being amongst the highest caring related conditions. A third priority caring area is around Frailty. North Lanarkshire is a pathfinder area in a national programme; Getting it Right for Everybody (GIRFE), with findings from this work, directly influenced by people with lived experience, expected to help influence and shape our future approaches.
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46 11. REVIEWING THE CARER STRATEGY Our Carers Strategy has an outcome focused approach. We need to ensure that in setting out a 3-year approach to supporting carers and cared for people, that our strategy can still be flexible enough to respond to changing circumstances without going off-course due to such changes. We need flexibility that is informed by two interconnected strands: 1. Professional expertise and knowledge, analysis, data, and research. 2. Carer experience, community knowledge, and the involvement of both carers and people being cared for. Both strands must be used to achieve impact, then assess that impact - the difference that we make; and also help us understand where that impact came from. Both approaches must also reflect the diversity of voices, backgrounds, and perspectives. Progress will be reviewed through: The governance structure and processes of the Integrated Joint Board. The Carers Oversight Group, which has a key role in monitoring impact. Introducing a carer led group to support the work of the Carers Oversight Group The Strategy should also be formally reviewed at the midway point. All stakeholders, including individual carers, and cared for people, carer organisations, and wider organisations with a direct, or indirect role in supporting carers, can have a say in determining how things are working for them.
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47 | P a g e APPENDIX 1: Supporting carers in North Lanarkshire Commissioned Carer Organisations University Health and Social Care North Lanarkshire currently commissions three carer organisations Lanarkshire Carers Centre North Lanarkshire Carers Together Action For Children Young Carers Project to ensure that carers and young carers are supported, that there is the provision of an information, advice and signposting service and that carer interests are represented. Lanarkshire Carers Centre www.lanarkshirecarers.org.uk Lanarkshire Carers Centre provide information, advice and a range of direct support options and services which can help carers maintain or improve their quality of life and to continue to care. Services are open to all carers aged 18 years and older living in Lanarkshire. Delivers practical and emotional support to individuals and groups, building trusted relationships with carers that help them to identify and address their support needs and make sure they know their rights. Offers outreach and locality support and works in partnership with a range of organisations and services that also help carers. Carer Support Workers are co-located in social work localities and health settings and the staff team works from Lanarkshire Carers Centre in Airdrie and also Hamilton. Support is also provided to carers from Minority Ethnic communities, Young Adult Carers aged 18–25 years old and other groups of carers who are under-represented. Its Short Breaks Bureau provides a range of information and support for carers to take a short break from caring, including identifying short break opportunities that meet their needs and circumstances, direct carer grant funding which may assist carers to take a short break from caring or access other things that can help reduce isolation and exclusion, information and guidance with arranging a short break and other useful resources for carers. Accesses funding and other initiatives to support carers in financial hardship due to having a reduced or limited income, particularly with rising cost-of-living pressures. [Lanarkshire Carers Centre is the local delivery partner through Shared Care Scotland for funding provided by the Scottish Government.]
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48 | P a g e Works with an independent partner to provide carers access to counselling sessions and wellbeing support. An extensive Carer Training Programme provides in-person, online and some hybrid options to suit carers circumstances, which enables carers to meet, share experiences, develop connections/friendships and access self-managed peer support, often out with the particular carer training activity. North Lanarkshire Carers Together www.carerstogether.org North Lanarkshire Carers Together provide a range of carer information, advice, signposting services as well as a campaigning remit. Carer Breather is an innovative approach to ensure that carers can access regular short breaks from caring. A dedicated Equalities post aims at ensuring that under-represented groups or communities have “a voice.” A Carer Advocacy worker ensures that carers can access advocacy support that is distinct from any advocacy provision for supported people. A Recognition to Rights Development Programme for carers equips participants with knowledge, skills, and tools to help shape and influence policy and strategy related to caring. Action For Children North Lanarkshire Young Carers Project www.actionforchildren.org Action For Children North Lanarkshire Young Carers Project offer a support service, including short breaks for young carers across North Lanarkshire. Carers Oversight Group University Health and Social Care North Lanarkshire facilitates a group meeting with the three commissioned carer organisations to discuss and agree approaches to supporting carers, whether through direct carer support carer information, advice and signposting services, and carer advocacy. Carer Support Network
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49 | P a g e Comprises a broader range of carer organisations and other organisations involved in the provision of direct carer support or indirect carer support, ensuring that the carer ‘voice’ is represented and that any planning/actions taken are in line with identified carer outcomes. Integrated Joint Board (IJB) Carer representation is a key facet of the Integrated Joint Board. Carer Support Groups All three commissioned carer organisations host a range of carer groups and act as a conduit to ensure that caring related issues can be fed into the Carer Oversight Group, Carer Support Network or to University Health and Social Care North Lanarkshire. A wide range of other groups or organisations also support or work on behalf of carers providing a range of condition specific or age-related support to Carers, whether directly, or indirectly. These organisations form part of the Carer Support Network. The list of organisations includes, but is not limited to: PAMIS Family Support www.pamis.org.uk Provides support to families caring for someone with profound and multiple disabilities. HOPE for Autism www.hopeforautism.org.uk Provides support to people with Autism as well as to family members and carers. Parkinson’s self-help Group provides support to people with Parkinson’s Disease and associated Neurological conditions, as well as an information/outreach service to family members and carers. This is augmented by The Autism Network, which provides bespoke additional Autism- specific input. Deafblind Scotland www.dbscotland.org.uk Serves the Deafblind community, sustaining deafblind people’s personal and professional support networks and influencing statutory services and policy. Raises awareness of deaf blindness, and highlights the everyday challenges faced by deafblind people. Also provides sign guide interpreters for people with dual sensory impairment, as well as support to family members and carers. Alzheimer’s Scotland www.alzscot.org Alzheimer’s Scotland provide a post diagnostic support service and also support family members and Carers.
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50 | P a g e North Lanarkshire Disability Forum (NLDF) www.nldforum.org.uk North Lanarkshire Disability Forum is the lead agency for the Engagement and Participation of supported people (including carers). It holds a fund that curated organisations (those organisations with particular skill, knowledge, experience, or expertise) can access to facilitate engagement and participation from specific sectors of the community. Voluntary Action North Lanarkshire (VANL) www.voluntaryactionnnorthlanarkshire.org Interfaces with third sector organisations locally and acts as the lead agency for the Community Solutions programme, whereby people, including carers and cared for people can be supported by a diverse range of community or voluntary sector organisations. VANL also support the Carer Breather programme, facilitated by North Lanarkshire Carers Together, where carers can access regular breaks from caring. Getting Better Together (GBT) www.shottshealthyliving.com GBT offer a post hospital discharge support service, and wider carer support options to support family members and Carers. Playpeace www.playpeace.org.uk Offers parental peer support and activities for children with additional support needs. All of these organisations have carer representation on their management board or committee and act as a conduit to feed into the Carer Support Network and Integrated Joint Board. This helps ensure that carers voices are not only heard, but influence and shape policy, strategy, and service development.
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51 | P a g e APPENDIX 2: Achievements and Progress 2019 - 2024 Introducing a new strategy is an opportunity to look forward, but we were also keen to capture the range of successes and progress over the past five years and reflect on this too. Since 2019, our partnership of UHSCNL, Lanarkshire Carers, NLCT and Action for Children - Young Carers, as well as a wide range of Community and Voluntary Sector organisations, and most importantly, carers, has made considerable progress. The 2024 -2027 strategy builds on this progress. Collectively, we have made significant progress regarding carer information, advice, and communication. Carers have reported that they feel recognised, supported individually, and are more involved in wider policy and strategy development. We intend to build on this progress over the next 3 years. A considerable number of ACSPs and YCPs have been progressed resulting in a range of good outcomes for carers. We do, however, recognise that this has not been a consistent experience for every carer. This is why this is remains a key focus within our new strategy. Support for young carers has been embedded in all secondary schools across NL for the past 20 years - ensuring that young carers are aware of how to access support. This will continue to be a focus in the new strategy. Our partnership has ensured that carers are aware of all four Self-Directed Support options. We are also aware that this has not been everyone’s consistent experience. We want to tackle this inconsistency, hence our enhanced focus in the new strategy and links to the SDS Transformation agenda. We have had success in promoting and supporting carer identification. However, as can be seen from the strategy, more work is needed to improve in this area. Identification of carers at the earliest possible stage helps us all. Support can be introduced at an early stage, assistive technology can be considered, and it is always easier to plan interventions when things are settled than it would be in time of crisis. The uptake of assistive technology has increased significantly. We are keen to build on this to help minimise risk and maximise independence for carers. We have an expanded Assistive Technology team to support this, and the team has already provided very helpful and informative input at locality events, carer organisation AGM’s as but two examples. Disability Information Officers have been in post for some time. They provide support, advice and signposting to local support groups, charitable organisations and University Health and Social Care services. They also assist with MLE assessments and recommendations including equipment.
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52 | P a g e Lanarkshire Carers, North Lanarkshire Carers Together, and Action for Children Young Carers Project have provided an invaluable range of information, advice, signposting, and support to carers. Carers have reported that the range of support on offer has proven invaluable to them in their caring role. These supports are too numerous to mention but further details are available on each of the organisation’s websites found in this strategy. University Health and Social Care North Lanarkshire would like to express our thanks to all three organisations, individual carers and staff across both the statutory and voluntary sectors who have all made such a positive contribution to carer support in North Lanarkshire over the last 4 years. We trust that our combined efforts over the next 3 years will further develop and enhance carer support and positive outcomes across North Lanarkshire. Alternative language options This document can be made available in a range of languages. If you require a copy in an alternative language please contact us at: To make a request, please contact Corporate Communications on 01698 302527 or email: corporatecommunications@northlan.gov.uk
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53 | P a g e Appendix 2 State of Caring 2023 A health and social care crisis for unpaid carers in Scotland
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54 | P a g e ‘I just do not have time to look after myself’ About this research This report, produced by Carers Scotland, explores the key findings from the State of Caring Scotland survey 2023 on the health of carers and the support they receive from local authorities, health and social care partnerships and the NHS. Carers Scotland’s annual State of Caring survey has been undertaken for over a decade and is Scotland’s most comprehensive research into the lives and experiences of unpaid carers. This year’s survey was carried out between June and August 2023 and completed by 1,771 unpaid carers in Scotland. We have interspersed this report with the voices of carers. These are highlighted in red, and we thank those quoted for sharing their experiences. November 2023
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55 | P a g e Note: Not all respondents completed every question in the survey, and some questions offered the ability to select more than one option. About unpaid carers An unpaid carer is a family member, partner, friend or neighbour who helps a person with daily activities that they would not be able to manage if they did not have help. This could be a partner, family member or friend who has a long term or terminal illness, someone who is disabled, has a mental health condition, is affected by addiction or who needs extra help as they grow older. There are approximately 800,000 people in Scotland providing such unpaid care1. It would cost an estimated £13.1 billion2 every year to replace the care they provide. Carers in State of Caring 2023 The demographic breakdown of carers responding to State of Caring 2023 is as follows: • 81% of respondents are female, 18% male with the remaining 1% preferring to selfidentify as either non-binary or transgender. • 3% are aged 18-34, 13% are aged 35-44, 25% are aged 45-54, 36% are aged 55-64, and 23% are aged 65+. • 29% have a disability3 • 98% of respondents are white Scottish, Irish or other white; 2% of respondents are black, Asian or minority ethnic. • 92% of respondents are heterosexual, 4% are gay, lesbian or bisexual, the remainder preferred not to say or skipped this question. • 45% are in some form of employment and 24% are retired. • 20% also have parental responsibility for a non-disabled child under 18. • 3% have been caring for less than 1 year, 25% for 1-4 years, 25% for 5-9 years, 27% for 10-20 years and 20% for more than 20 years. • 19% provide 1-19 hours of care per week, 10% provide 20-34 hours of care pre week, 15% for 35-49 hours and 14% for 50-89 hours, 42% provide 90 or more hours of care per week. 1 Scotland’s Carers update release, Scottish Government 2022 2 National Care Service Financial Memorandum, Scottish Parliament 2022 3 As described under the Equality Act 2019: this defines a disabled person as someone who has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities
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56 | P a g e • 71% care for one person, 21% care for two people, 6% care for three people and 2% care for four or more people. The people carers care for Carers responding to State of Caring 2023 provided information about who they care for and the conditions the person(s) live with: • 35% are caring for a parent/parent-in-law, 34% were caring for a spouse or partner, 38% for a son/daughter/in-law), 11% for another relative and 3% for someone else eg. a friend or neighbour. • 18% care for someone aged under 18, 22% for someone aged 18-34 years, 30% for someone aged 35-64 and 58% for someone 65 or over • Respondents were caring for people with a range of health conditions and/or disabilities: o 90% said that the person(s) they care for has a long-term health condition or illness such as arthritis, diabetes, kidney disease o 34% a mental health condition o 29% autism, ADHD or another neurodiversity o 26% a physical disability o 25% needs that arise from being older o 24% a neurological condition such as multiple sclerosis o 24% dementia o 22% a learning disability o 18% a sensory impairment o 4% alcohol or substance misuse. Thanks Carers Scotland would like to thank each and every carer who contributed to this survey, from those who helped us develop and test the survey to every single person who took the trouble and time to tell us about their experiences. Your experiences will be used to help build a society that recognises and supports carers more.
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57 | P a g e Contents Introduction 05 Key facts 06 Carers health 07 Mental health 09 Breaks from caring 13 Social connections and loneliness 15 Support and social care 18 Planning for emergencies 20 Information and technology 22 Carers as healthcare providers 23 Carers and suppport from the NHS 27 Hospital Discharge 29
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58 | P a g e Conclusions and recommendations 31 Introduction Last year, in State of Caring 2022, Carers Scotland provided a snapshot of the lives of unpaid carers in Scotland, setting out the toll that providing care was having upon their lives, finances, employment, health and wellbeing. Battered by the cost-of-living crisis and living with the ongoing effects of the pandemic, carers were breaking. Last month Carers Scotland published “State of Caring 2023: the financial impact of caring in Scotland”4 which brought no better news for carers, particularly those who were already struggling to make ends meet. Poverty and financial insecurity had grown yet again, as the cost-of-living crisis extended and continued its damage to carer households. In this report, “State of Caring 2023: A health and social care crisis for unpaid carers in Scotland” we show the ongoing struggle that carers face to access the services and support they need to provide care and to care for themselves including to take regular breaks from caring. We do not shy away from using the term “health and social care crisis” in this report. Despite their huge contribution to the Scottish economy, to our communities and to the lives of the people they care for, carers are facing deteriorating physical and mental health, loneliness and isolation with too many driven to despair and denied access to the very supports they need to maintain a healthy life. This cannot continue. In this report we set out a range of recommendations, not just for Government but for local councils, health and social care partnerships and NHS Boards across Scotland. Action is needed, urgently. Carers simply cannot wait. 4 Find this report at: www.carersuk.org/reports/state-of-caring-in-scotland-the-financial-impact-of-caring-in-2023/
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59 | P a g e Key Findings
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60 | P a g e Carers health Providing care for someone has is a highly challenging responsibility, frequently affecting the physical and mental health of those who are providing care. Throughout Scotland, unpaid carers provide high levels of care, seldom having the chance to take a break from caring. They grapple with constant anxiety, stress, and the consistent prioritisation of the person they are caring for, often resulting in numerous sleepless nights and feelings of isolation. These factors collectively contribute to physical fatigue and emotional exhaustion. It is clear from the results of State of Caring 2023 that a significant number of those who provide care are not receiving the necessary support to attend to their own health and wellbeing alongside their caring responsibilities.
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61 | P a g e We asked carers if caring had an impact on their health and wellbeing. In this context, it is no surprise that more than half (54%) said that their physical health had suffered because of their caring role, with one in 5 (20%) suffering a physical injury from caring and two thirds (69%) saying that they struggled to get a good night’s sleep. Nearly four fifths (79%) of carers said that the main challenge they would face over the coming year would be the impact of caring on their physical and/or mental health. “I constantly have lack of sleep; I assist with care during the night but unable to catch up during the day due to other chores. I am constantly tired and depression kicks in which I try to hide from my family display all's fine approach” Of particular concern in the findings of State of Caring 2023 is the number of carers who have put off healthcare treatment because of their caring role. Four in 10 (41%) carers have put off healthcare treatment, with more than two fifths of carers (46%) who care for 35 hours or more a week said that they had put off such care. This increases to 50% of carers with a disability. These findings are reinforced by comments from carers themselves, further illustrating the impact caring is having on their ability to care for their own health. “I have cancelled a hospital appointment twice as I had no one to assist me after an anaesthetic” “I have been told I may have a tumour and need operation, got no offer of any assistance from social work - have no idea what will happen if I am not able to manage.”
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62 | P a g e As well as having to put off treatment because of the demands of caring, nearly a third of carers (30%) have been waiting over a year for NHS specialist treatment and 18% have waited for more than six months. This can be compounded by the person they are caring for also having to wait for specialist treatment - 28% of carers reported that the person they were caring for had been waiting over a year for specialist treatment and 16% for more than 6 months. This can add to the physical and mental demands of caring and thus the impact on carers own health. Mental Health A large proportion of carers also reported that their caring responsibilities impacted negatively on their mental health. More than a quarter of carers (28%) said their mental health was bad or very bad. This impact on mental health was particularly prevalent amongst carers in receipt of Carers Allowance. Over one third (37%) of carers on Carer’s Allowance described their mental health as either bad or very bad. This may be because those in receipt of Carers Allowance were particularly at risk of struggling to making ends meet financially and were more likely to be cutting back on essential items such as food and heating, which could explain the significant impact their the mental health. “My mental health has rapidly deteriorated in the last year. I am in a very poor place.” “I am permanently stressed depressed And just feel completely hopeless and feel like I'm serving a prison sentence for committing no crime.”
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63 | P a g e Carers went on to share in detail the impact of caring on their mental health. The majority (88%) had difficulty sleeping or increased tiredness, continuous low mood (85%) and feelings of hopelessness (82%). Three quarters (79%) experienced an inability to switch off from worrying about caring and similar proportions experienced irritability and mood swings (77%), low self-esteem (76%) and regularly feeling tearful (71%). “Tearful & very emotional, trying hard to accept how my life has changed since my caring role began in July 2021” Of significant concern is that over a third (36%) said that they had thoughts related to self-harm or suicide. We share below just a few quotes from carers – there are many more, equally distressing that set out the devastation that caring can cause to mental health. “Would like to walk into sea, to float away, but know I can’t because there’d be no-one to step in to support dad.” “It will only end when I die, but knowing my luck there will be reincarnation and it will be worse next time” “My anti-depressants were increased recently and though my mood has been less suicidal my weight has gone up- a known side effect of the tablets- Venlafaxine-this in turn makes me feel physically and mentally worse. I have no confidence in myself and look and feel a right mess.
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64 | P a g e I exist I don't really live and the only thing that keeps me alive is my cat. She will be 14 next month and if anything happens to her, I cannot see any reason to go on.” Although a third (31%) of carers responding to this survey are receiving some form of NHS support for their mental health, and 17% are getting emotional support from their local carers centre, over a third (35%) indicated that they are not receiving any mental health support at all. A quarter of carers (25%) said that accessing counselling, therapy or a listening support service which would improve their health and wellbeing. However, too many carers are struggling on unsupported. We asked carers why they might not be seeking help with their mental health and the results revealed some stark findings. Half (50%) of carers said that they were simply too busy with the demands and responsibilities of their caring role. “No time to go” “I just feel stuck and not able to make decisions about my happiness as it always comes back to my caring responsibilities.” However, delays in NHS appointments have a critical role, with a quarter (25%) of carers saying that this was the reason they had not accessed mental health support. “I am on four different waiting lists and have been for a year”
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65 | P a g e Worryingly, the stigma around mental health seems to still play a role in carers who are not accessing mental health support as more than one quarter (26%) said they do not feel comfortable talking about their mental health. In addition to this, one in five (20%) said they were too embarrassed to speak about their mental health. Overall, it is clear, too many carers are missing out on the support they need to look after their own health and wellbeing while providing care. This is directly influencing many carers capacity to care. More than a quarter of carers (24%) said they had to stop or reduce the amount of care they provided because of their poor mental health, with family or social care having to take over in 12% of these cases. Shockingly, almost three quarters (72%) said they had to continue providing care even though they felt they were at breaking point. In addition to having an influence on their capacity to care, it is also having an impact on carers’ ability to earn; vital in these times of financial strain. Around one fifth (18%) said that they had to leave a job or reduce working hours because of poor mental health caused by their caring role.
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66 | P a g e The important role of breaks from caring More than half (58%) of carers said taking a break from caring was critical to maintaining both their physical and mental health and there is a clear link between access to breaks from caring and better health outcomes amongst unpaid carers. However, just over a third of carers (35%) in State of Caring 2023 told us that they had not had any break from caring in the past year, often saying that it is just too difficult to get the breaks they desperately need. For those who have had a break only one in 10 (11%) were able to receive this break with support from social care services, with the greatest majority relying on friends and family to have any sort of break from their caring responsibilities.
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67 | P a g e Some groups of carers are struggling most to take a break. Duration of care and hours spent caring have a clear impact and our evidence also suggests that the cost-of-living crisis and financial insecurity plays a significant part in the ability (or not) to take a break from caring. More than half (51%) of carers who told us that they are struggling to make ends meet and 42% of carers on any carer benefit have not had a break. And 40% of those caring 35 hours a week or for 10 years or more have not had a break in the last year. Worryingly, almost half (49%) of carers with a disability also told us they have not had a break. “I don't feel I am able to take the time to prioritise anything for myself. I would love to be able to take a paid break without feeling guilty and for this to be on a regular basis as any other person doing a job would expect.” “Cannot get respite from my role despite being entitled to it.” “If you were guaranteed paid respite breaks throughout the year to look forward to and plan things around it would relieve so much pressure” “I'd like to go away with my husband occasionally but we're unable to leave our son alone overnight” “It feels rare that I get to commit time to doing things just for me, without worrying about fulfilling my caring role or being interrupted.” My husband has Vascular Dementia so I would dearly love to have regular breaks from caring.
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68 | P a g e His personality has changed completely towards me, but only me, so its very draining to live with 24/7. Social connections and loneliness Carers continue to tell us that their caring responsibilities bring loneliness and isolation. Over a quarter (29%) said that they always or often feel lonely, with a further 59% saying that they sometimes feel this way. However, the level of loneliness is far higher for some groups, with a further 59% saying that they sometimes feel this way. However, the level of loneliness is far higher for some groups. Carers who told us that they are struggling to make ends meet financially were almost twice as likely to be always or often lonely (50%) and 39% of carers who are on Carer’s Allowance say they are always or often lonely. This suggests that there is a link between a carer’s financial
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69 | P a g e wellbeing and loneliness and isolation, for example, many carers have reported that they have cut back on social activities because of increased costs. And, 40% of carers with a disability also reported always or often feeling lonely, suggesting that carers with aal disability face greater barriers in supporting their mental health and wellbeing. Loneliness directly affects carers’ health and wellbeing with 49% of all carers, 54% of carers with a disability, and 57% of carers on Carer’s Allowance or struggling to make ends meet saying loneliness was affecting their health. Nearly a third of carers (21%) said that they needed support to prevent or reduce their social isolation and loneliness with one in 4 (23%) saying they need more help with maintaining and building relationships with others; relationships that have been limited or lost because of their caring responsibilities. Having a life outside caring and being able to have opportunities to build and sustain connections with others is critical for carers’ health and wellbeing. Carers stated clearly in response to the survey that having time, and money, to spend time with friends and family helps sustain and improve their health and wellbeing. More than two thirds (68%) of carers that responded emphasised this was important. This was particularly prevalent in responses from older carers (65 and over) where three quarters (75%) said that spending time with friends improved their health and wellbeing. However, as the “State of Caring 2023: the financial impact of caring in Scotland” report sets out carer poverty and the cost-of-living crisis reduces this option significantly for too many with nearly half (46%) of all carers having cut back on seeing friends and family simply to make ends meet. This leaves carers isolated without valuable support. “I haven't been able to spend time with friends for 3 years now, since I became a carer. At the moment I don't have enough money to live on so can't afford breaks, to pursue hobbies or follow interests. I also can't leave my partner overnight when he is vulnerable which is a lot of the time.” “I would like to meet up with friends I have known for 70 years but can’t leave my husband for any
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70 | P a g e length of time. Someone to step in & allow me to go away for a day would be wonderful.” Many carers also told us about the importance of hobbies and interests. 57% said that engaging in hobbies and interests would improve their health and wellbeing. “I don't have time to paint, which is a lifelong hobby.” Others talked about how the chance to have education or training opportunities would help their health and wellbeing (17%) as well as the ability to be in paid employment (32%) giving opportunities for the future and much needed financial security. Healthy activities were also important to carers. 58% said that being more physically active would help their health and wellbeing and being able to eat a balanced diet (42%) both limited by time and money. “I would like to be able to go out walking or swimming more but can’t leave my husband for very long.” “Would like more exercise, to join a class” Finally, and perhaps most importantly, carers said that having good quality care services for the person they care for (45%), getting a break from caring (58%) and being valued as a carer (54%) were critical to improving their health and wellbeing. “I don't prioritise my health and wellbeing as there is nothing in place to allow me to have a break. I would like to have a hobby again and to have friends.”
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71 | P a g e Support and Social Care Unpaid carers save Scotland £12.8 billion5 per year in social care costs yet, just a third (38%) of carers are receiving support in their caring role from formal social care services. Indeed, most (44%) support received by unpaid carers responding to this survey is informal from friends, family or neighbours. Around a third of carers (37%) reported receiving some help from a local carers’ organisation, a local charity or community organisation (10%) or from a faith organisation or place or worship (3%). Of those who were receiving social care services, 57% were satisfied with the quality of care provided. Nearly half (48%) said that they felt that they would be listened to if they raised concerns about the quality of care provided. “Alanmart Day Centre are truly outstanding. My mum attends for two afternoons per week. They treat her with dignity, kindness and love. They offer her mental stimulation and a place to socialise. They help foster her sense of place in the world as a person with dementia. She 5 Scottish Government, National Care Service Financial Memorandum Para 7.2
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72 | P a g e also receives four daily visits from Nightingale Care, funded by the council. The carers are all very competent and a few have formed a close bond with my mum.” However, only just over a third (36%) said that they felt they could rely on social care services and a similar proportion (37%) said that care support did not meet their needs or those of the person they care for. Around a third (30%) said that social care was not consistent (ie. provided by the same staff at regular times). “Care workers as individuals try very hard but are overstretched. Changes in personnel are unsatisfactory for an individual with dementia who relies on familiarity and routine. Also requires me to be more active in care giving as staff are unfamiliar with home and routine.” “Service, especially day centre, is not as good as pre Covid. There are fewer services available now as well and everything comes down to cost, not the needs/what’s best for the cared for person.” “Lack of services. No care staff. Lack of community amenities. Poor accessibility. Left to fend for yourself. Have self-directed support budget and had no support with implementing it.” “Can’t find a PA for my caree as no applicants on rural area.” “I've become disabled and struggling to cope with both of our separate needs. No staff in the Highlands to help and no support.” We asked carers what assistance from local councils and health and social care partnerships could better support them in managing their caring responsibilities. Nearly half (47%) said that councils needed to better recognise their needs as a carer and deliver increased choice (41%), better quality (37%) and more affordable (25%) services for the person they care for.
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73 | P a g e Caring responsibilities can have a significant impact on carers’ ability to maintain employment. Carers are less likely to work full-time work6 (34% v 47%) and more likely to be in part-time work (16% v 12%) than non-carers6. And, given the stresses and strains that can result from balancing work and caring, it is unsurprising that 1 in 6 carers give up work or reduce their hours to care7. Therefore, it is of significant concern that one in five (19%) carers in State of Caring 2023 said that they needed better support from social care to return to or maintain paid employment. In State of Caring 2022, carers set out at range of services that had been reduced and had not returned to pre-pandemic levels (27% were facing reduced care at home services, 44% reduced day services and 24% reduced after school services for disabled children). In 2023, there has been little improvement, with four in ten (42%) carers say that support services were still not operating at full capacity or had not reopened and that this is one of the biggest challenges they face. Planning for Emergencies The Carers (Scotland) Act 2016 sets out that carers should be supported to develop an emergency plan as part of their Adult Carer Support Plans (ACSP) and Young Carers Statements (YCS). An emergency plan is a written record of the arrangements that are in place for the cared for person if the carer has an emergency eg. if they go into hospital or are unwell and unable to care. However, it is clear that despite the Act, there is insufficient awareness of emergency plans amongst carers. A quarter (22%) of carers had never considered planning for an emergency and a similar proportion (29%) were not sure how to plan for an emergency – and would like more support with this. Even amongst those carers who have planned for an emergency, only one in five (21%) have a formal emergency plan in place, although a larger proportion (41%) have more informal plans in place; identifying people who might be able to provide care in their absence. 6 Family Resources Survey 2021/22 7 Employers for Carers, Carers UK
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74 | P a g e For those who have planned, only one in twelve (8%) have let social work services and just 3% their GP (or the GP of the person they care for) know what should happen if they are unable to provide care and support in an emergency. There is a worrying gap between the intention of the Carers (Scotland) Act and its implementation. Carers should be enabled to plan for emergencies and processes to ensure that relevant professionals involved in care are both aware of a carer’s emergency plan and be ready to step in should a carer require support. “We were in a crisis emergency. A car accident put me in hospital. Despite this we were give zero assistance to help care for my child. He missed school due to me being unable to drive as I was physically housebound. Social Work, school and Connecting Carers charity all let us down. My son was left unable to care for himself. It was a dreadful time which has left me traumatised over the lack of care. “ “I have power of attorneys in place for my parents and myself, more needs done to support all over the age of 18 getting POAs in place as a routine.” “I did try to plan for my total knee op. Social work agreed to increase the budget for time to recover. Support provider knew I needed support. They knew it was coming. But in the end, I got NOTHING from them. I was told that they didn't have anyone to help, because most workers had been transferred to supported living during the pandemic. I was asked on the Friday if I could go in the following Wednesday. OK, I get that was a bit short notice, but since the team leader did the rota, she knew I was going in, she could have juggled things. As it was, my husband had to take time off work, my daughter, who was on maternity leave had to help out and my youngest son was coming in from his work (support worker), to help out.
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75 | P a g e My daughter texted the team leader that I was out of surgery and how it went. A year later, were still waiting for her to reply.” “I have tried to plan but I don't have relatives or friends who can help. Social services can't help until an actual crisis arises.” Information and technology to support carers Every day, nearly 1000 people start caring8. This is often a time of uncertainty, managing sudden or progressive disability, illness or frailty of a partner, family member or friend and getting the right information at the right time is critical. This criticality of information was recognised in the Carers (Scotland) Act 2016, with local authorities required to provide information and advice services for carers. We asked carers where they would go for information about caring and support. The largest proportion would rely on the voluntary sector – a local carer organisation (50%), a national carers charity like Carers Scotland (14%) or a charity specialising in a particular illness, condition or age group such as Age Scotland, MS Society Scotland (15%). Friends, family and other carers (19%) and the internet (42%) are also vital sources of information. The public sector remains critical with one in five (21%) saying they would ask their GP or other health professional, 16% social work services, 5% their local pharmacy and 6% their local council. However, one in 10 (11%) carers said they did not know where to go for information, so it is clear that more remains to be done to ensure that the ever-changing population of carers can access the information they need in a way that suits their needs. Carers continually tell us of their frustrations at having to tell their story again and again to health and social care services in order to access even minimum levels of support. As part of the consultation on the National Care Service, the majority of carers (86%) surveyed at Carers Parliament in 2021 8 Analysis from University of Sheffield, Centre for Care from the UK Household Longitudinal Survey (UKHLS), also known as Understanding Society, using data from 2010-2020. The sample includes all people who participated in the survey in any of those years. Carer churn from 2011 onwards, requiring the use of the data from 2010.
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76 | P a g e were in favour of a new electronic health and social care record which has been proposed, believing it could help to share information and be identified as an unpaid carer. This support was reinforced by carers in this year’s State of Caring with two thirds (63%) saying that they would like systems in which information about they or the person they care for is shared across services, so they do not have to repeat themselves. Systems are in place to record caring on GP records; however, this is not necessarily consistent. Therefore, carers also identified the need for any system to be able to identify them as carers on the record of the person they care for (71%) and on their own patient record (69%). More than half (52%) of carers said they would like digital access to their own health and social care records and a similar proportion (54%) suggested that there should be an extra feature on such a record where they could identify themselves as an unpaid carer. Six in 10 (60%) carers said that they would like digital access to the patient and care records of the person they care for. Whilst this approach would need safeguards and consent, there are opportunities for this approach to support simplicity and flow of information from carers to professionals in improving the care and support of the person being cared for. Technology also offers other opportunities to make carers lives easier and to support improved health and wellbeing of both carers and those they care for. A third (35%) of carers said that they would like access to technology to support care such as remote monitoring (such as motion sensors, fall detectors), a quarter (25%) to technology to support vital signs monitoring (such as blood pressure, blood glucose, heart rate) and 23% to apps that help pain or mood management. A third (33%) said they would like to be able to access online support groups and activities for carers. Carers as healthcare providers More than three quarters (77%) of carers told us of the significant and varied health care tasks they provide to support the health of the person they care for. Recent calculations from the Scottish
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77 | P a g e Government9 estimate that providing these types of tasks save the health services £320 million each year. These responsibilities can range from monitoring the mental health and wellbeing of the person they care for (68%), monitoring blood pressure or blood sugar (18%), dressing wounds (16%) and hoisting (9%) through to complex health support such as supporting home dialysis or devices that provides oxygen or continuous positive airway pressure (CPAP)10 (6%), tube feeding (2%), giving injections (12%) and making decisions about whether or not to give emergency or specialist medication (24%). “Luckily, I am a trained nurse. Although the older I get, the harder it is, but my husband would refuse help anyway.” “I assist my wife in setting up her Parkinson’s medication pump and her colostomy bag.” “Have had to adjust diabetic support/care due to symptoms of dementia.” Many carers talked about how they had little choice but to provide such support due to lack of local primary and community health options for the person they care for, with four in 10 (41%) saying they needed more support from the NHS or healthcare professionals. “Due to the lack of NHS support (eg. GPs being a primary problem), I just get on with dressing wounds for the person I care for. This includes buying wound dressings (Quite expensive at times) and cleaning/applying dressings. At times I have contacted the person I care for GP practice to seek advice/help, I get a response of "go to hospital". I don't mind doing these tasks for the person I care for. The point is, even when help/support is needed from the NHS it’s not there. A message of "go to hospital" is not needed and not wanted - it doesn't warrant going to hospital, also, most crucially the person I care for would absolutely not be able to manage sitting in a hospital waiting for hours on end. So, I 9 National Care Service Financial Memorandum 10 A CPAP (continuous positive airway pressure) machine is used in the treatment of sleep apnoea. This device delivers continuous pressurized air through tubing into a mask that you wear while you sleep.
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78 | P a g e get by doing what I need to do to ensure the person I care for has a clean wound.” “I didn't have a choice taking on monitoring my Mum’s mental health and wellbeing - she lives alone and has attempted to take her own life previously. I am mental health first aid trained through my career path however, it is very different when it is your own family there is a lot more emotion attached to decision making.” “No choice as two insulin dependent sons one with progressive neurological disorder and one registers as partially sighted.” Although some carers spoke of the support and training they had received to carry out such tasks, others felt that this type of training was too limited and, for some, non-existent. “We had extensive support and training from health re: the current medication, delivered subcutaneously via a pump, and still have support from specialist nurses.” “I received some training for taking blood pressure though not that confident. It's a huge responsibility to monitor emergency medication. As a carer, you just have to do what you can.” “I have had training to use both the ceiling tack hoist and sling that we have and the mobile hoist. I am having to pack and dress a pressure sore for my cared for and I have had no official guidance or training on doing so. We visit the nurse twice weekly and show a photo of how the wound is looking and get supplies. My cared for is not able to get on the bed at the nurse so in the whole time that the pressure sore has been there (approx. 6 months) no health professional has seen the wound in person only in photos.”
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79 | P a g e “I feel out of my depth with supporting mental health and how to help, with no training.” “Given rescue medication (syringe) to use for epilepsy. Given a brief talk but no real training or any understanding of stress this causes me to make decision on when to use this for partner.” Medication As well as a range of health support, many carers also support the medication of the person they care for carrying out a range of tasks from collecting (69%) and/or ordering (68%) medication (68%), sorting into correct doses (39%) and checking and prompting someone to take medication (67%). However, nearly half (48%) administer medication and nearly a third (30%) check for contraindications or allergies with other medications. Whilst over a third (34%) of respondents had asked for and received help with ordering and collecting repeat prescriptions from their pharmacy, less have been able to access advice on how to take a medicine safely (20%), administering medications (19%) or dealing with devices such as inhalers (11%). Just under a third (31%) said that they had received help with treating minor health concerns but almost one in 10 (9%) would like more help with this. Keeping safe from COVID19 In 2022, 16% of respondents told us that they had concerns about returning to support services as they were worried that the person, they care for would catch COVID19, with over a third (34%) saying that keeping the person they care for safe (when there are less public health measures to reduce COVID19) would be a significant challenge over the next year. This year, these concerns remain for too many, with a quarter (26%) of carers telling us that keeping the person they care for safe from COVID19 would be a significant challenge in the coming year. “I have a reduced immune system, which not only affects my choice of wise social events, it also restricts the things to which I can take my husband”
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80 | P a g e Carers and support from the NHS Carers are an important support in helping the people they care for to have the best experience from the health services they receive. State of Caring 2023 asked carers about their experience of the NHS as a carer and what might improve this. This covers a wide range of areas from hospital admission and discharge, attending appointments and future developments such as virtual wards. Hospital Appointments The support that carers provide in helping the person they care for in their appointments with health professionals cannot be underestimated. Significant proportions of carers in State of Caring support the people they care for to attend hospital appointments. This can range from booking appointments, arranging transport and attending with the person. Nearly all the carers responding to the survey (92%) reported that they have supported someone to attend at least one appointment in the last 12 months, with 25% helping someone attend five or more appointments. Indeed, over a quarter (29%) have supported
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81 | P a g e someone to attend 10 or more appointments in the last 12 months. Hospital Admission We asked carers whether the person they care for had attended accident and emergency (A&E) in the last 12 months and their experience of this admission. A third of carers (34%) reported that they had attended A&E. Of these, a third (34%) had waited 30 minutes or less for an ambulance, 25% for between one to two hours and 29% for between two to six hours. One in eight (12%) waited eight hours or more for an ambulance to arrive. Half of carers (50%) who had attended A&E said that handover between ambulance and A&E staff had taken 30 minutes or less, but a quarter (26%) had waited between one to two hours, 19% between two to six hours and 5% eight hours or more. Waits for initial examination by a doctor or nurse took less than 30 minutes for almost a quarter (23%) of carers, between one to two hours for a third (33%) and similar percentage for between two to six hours. For 9% waits for this initial assessment took eight hours or more. Hospital Discharge State of Caring 2022 showed a significant lack of involvement in hospital discharge. Disappointingly, this year’s report shows no improvement.
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82 | P a g e Of those who had someone discharged from hospital, 60% were not informed and involved in decisions about this discharge . Worryingly, only 20% were asked about their willingness or ability to provide care and just 18% said that they received sufficient support to protect the health and wellbeing of the person they cared for as well as their own health. Only 20% received an Adult Carer Support Plan. The Carers (Scotland) Act 2016 places a duty on NHS boards to involve and inform carers in discharge of the person they care for. As such, it gives carers a right to be involved and promotes the importance of ensuring that carers have access to support. Thus this lack of progress by health services in effectively involving and supporting carers as part of discharge processes is deeply concerning, and in need of urgent action. “Admitted with same complaint – delirium and infection. Very little information. Drs not available. Information given on discharge summary on occasion incorrect – missed medications resulting in missed doses of cardiac medicine at home as informed on letter discontinued. Phone calls to GP practice who are very supportive resulting in phone calls to hospital. Human error medication missed on admission although list of medication and blister pack given to nurse. GP recommenced medication immediately and chemist delivered.” “He was discharged in the same state he went in with. No formal assessment was carried out nor the family asked how things were at home.” “Mum was discharged and I voiced my concerns on her getting home after having a serious infection. I had to keep emphasising that it was an infection on her tooth and was still in a lot of pain even
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83 | P a g e although on antibiotics which the hospital were guessing the infection was until a junior dr listened to me and got a community dentist out as mum’s tooth was badly infected and needed urgent removal that day and they still discharged her back home to missing her carer so she had missed her medication so I had to come up to attend to my mum. It was an absolute shambles.” There is also a worrying variance for some groups of carers. For carers with a disability, just a third (33%) reported being involved in decisions about discharge and only 14% were asked about their ability and willingness to provide care. Only 12% said that they received sufficient support to protect the health and wellbeing of the person they care for as well as their own health. Given these carers already have disabilities or health conditions that affect their day to day lives, it is striking that healthcare professionals, instead of providing additional consideration for their need to manage care alongside these, instead appear to offer even less support. “Being able to continue as I have a disability and my condition will get worse” Older carers are more likely to be asked about their ability and willingness to provide care (30%) and to be provided with sufficient support to protect their health and wellbeing and those of the person they care for (31%). However, given that the prevalence and incidence of most health conditions rises with increasing age11, it is concerning that large numbers of older carers in State of Caring 2023 are being neither asked about their ability to care nor provided with sufficient support to protect their health and wellbeing. Carers in the early stages of their caring journey also face additional barriers to support. Just one in 10 (9%) said that they were asked about their willingness or ability to provide care and a similar proportion – just 9% were offered an Adult Carer Support Plan. The lack of involvement of carers in hospital discharge planning and failure to listen to carers and provide them with sufficient support can have significant consequences for both carers 11 Scottish Public Health Observatory
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84 | P a g e and those they care for, with carers telling us about hospital readmissions and further deterioration of the person they care for. “We have had more than 20 admissions since January” “She was discharged but a stomach bug came 8 hours later and she fall going to the toilet in the middle of the night, and fractured her neck” “Went to hospital on Monday, discharged that day and readmitted by the Saturday.” Virtual Wards/Hospital at Home A virtual ward is services a “time-limited service enabling people who have an acute condition or exacerbation of a chronic condition requiring hospital-level care to receive this care in the place they call home, either as an alternative to hospital admission or by facilitating an earlier discharge from hospital.”. This enables multidisciplinary healthcare teams and remote monitoring to support someone to stay at home rather than being admitted to hospital. The Scottish Government has been keen to expand these virtual wards which are better known as Hospital at Home. However, such home based hospital level care is not yet widely available in all NHS areas in Scotland. Indeed, only 4% of respondents to State of Caring 2023 said that the person they care for had received care through a virtual ward/Hospital at Home. However, we asked all respondents - with or without experience of receiving care from a virtual ward - what they saw as potential benefits and drawbacks of such an approach. Nearly half (46%) of respondents said that it could prevent the person they care for being admitted to hospital unnecessarily, a third (33%) that it could allow them as a carer to provide more personalised care and 55% that the environment would be more comfortable. However, it is important to note that carers have concerns that this will increase the demands of their caring role. More than half (54%) felt that virtual wards/hospital at home would involve them providing more care.
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85 | P a g e Conclusion The findings in this report paint a stark picture of carers buckling under the strain of propping up a health and social care system that is under severe pressure. This pressure in the delivery of public sector services has meant that carers have been left to carry a growing burden of significant care – where social care cannot provide a service, it is unpaid carers who are expected to step in, where the NHS needs a “bed” it is carers who are left to support discharge. At the same time, carers physical and mental health continues to deteriorate, often significantly whilst they have little time, money or energy to be able to maintain their own health and wellbeing. Rightly, the Government has recognised the need to bring down NHS waiting lists and improve access to health services, including crucial mental health services. However, dedicated funding and planning is urgently needed to ensure that carers can access the health services they need and support for caring from social care services to prevent the shocking levels of poor health they are experiencing. Quite simply, action is needed, and it is needed now. Recommendations To ensure all carers get the support they need to look after their own health: 1. The Scottish Government should develop and introduce a Carers Health Plan, recognising that unpaid care is a social determinant of health, and setting out how they will in the short, medium and long term not only maintain and improve the health of unpaid carers and young carers but prevent long term health inequalities. 2. Support for mental health is of significant concern and the Scottish Government should fund dedicated, tailored mental health support for unpaid carers, including providing funding to local carers centres, disability and condition specific organisations and palliative care organisations to enable them to commission mental health support for those they support. This should include support for anticipatory grief, bereavement counselling and specific mental health support for young carers. 3. The Scottish Government should fast track unpaid carers to support to maintain their health whilst caring. This could include: introducing direct payments or vouchers for carers to spot purchase non-NHS assessments, physiotherapy, counselling and other
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86 | P a g e such services. Carers should have access to occupational support in the same way as health and care employees. 4. To ensure that carers are able to look after their own health, the Scottish Government should progress at pace actions within the National Carers Strategy to deliver flexible health appointments for carers, including providing replacement care for appointments. 5. Local health and social care partnerships and NHS Boards should develop their own local plans to deliver regular health checks for unpaid carers to identify health concerns or pre-conditions, such as high blood pressure and diabetes. 6. Local councils should seek to develop concessionary or free access to leisure services within their areas not just to carers in receipt of Carer’s Allowance but expanding to include all carers and young carers. This could include working with local carers centres and GP practices to develop social prescribing of leisure access. 7. The Scottish Government should work with NHS Boards to ensure their plans for reducing waiting lists set out how they will consider the unique and individual needs of unpaid carers, including prioritising carers for healthcare support that will support their ability to care. 8. Prior to the introduction of a right to a break from caring in the National Care Service, the Scottish Government should commit to: • increase funding year-on-year for short breaks delivered by the voluntary sector, including through the: o Time to Live fund administered by Shared Care Scotland and local carers services. o Take a Break Scotland fund for families with disabled children and young people administered by Family Fund. • increase funding year-on-year to health and social care partnerships and local councils for a range of breaks from caring and ensure that this funding is protected within their budgets. • work to expand availability of short breaks services across Scotland to ensure that when the right to a break is introduced, there are sufficient and varied services for carers to choose from 9. The Scottish Government should work with local councils, health and social care partnerships and NHS Boards to improve knowledge of carers rights amongst staff who come into contact with them and ensuring that carers can access support when it is needed by:
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87 | P a g e • improving access to Adult Carer Support Plans, in particular ensuring that they are offered as standard to all carers during the hospital discharge process. • improving referral routes between services for Adult Carer Support Plans and Young Carer Statements to ensure that carers and young carers are able to have access an assessment and services promptly. • encouraging greater and more consistent use of flexibility within self-directed support to empower and better support unpaid carers and those they care for. This should include simplifying administration, promoting the ability to employ close relatives and considering enabling unspent budgets, (which cannot be spent due to lack of services) on other costs that support wellbeing. • improving uptake of emergency planning (and anticipatory planning) within both Adult Carer Support Plans/Young Carer Statements and in care planning. 10. To improve both the visibility and value of care, the Scottish Government should introduce add a new dedicated national outcome on care to fully values and invests in those experiencing care and those providing it. 11. The Scottish Government should work with partners to develop a more coordinated approach across health, social care and local council services to refer carers to third sector and community support including, in particular food support and fuel vouchers, vital to protecting health and wellbeing.
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88 | P a g e Carers Scotland is Scotland’s membership charity for unpaid carers. We work to represent and support the approximately 800,000 people in Scotland who provide unpaid care for ill, older or disabled family members or friends – fighting for increased recognition and support for all carers and to ensure they have a voice in the issues that affect them. www.carerscotland.org info@carerscotland.org @CarersScotland /CarersScotland © Carers Scotland, November 2023 Carers Scotland is the Scottish nation office of Carers UK. Carers UK is a charity registered in England and Wales (246329) and in Scotland (SC039307) and a company limited by guarantee registered in England and Wales (864097). Registered office 20 Great Dover Street, London SE1 4LX
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89 | P a g e Appendix 3 Analysis of Carers (Scotland) Act 2016 funding 2022-2023: responses to Freedom of Information request March 2024 1. Background In November 2023, the Coalition of Carers in Scotland (COCIS) submitted a Freedom of Information (FOI) request to all local authority areas in Scotland asking for details of what the funding to support implementation of the Carers (Scotland) Act 2016 had been spent on during 2022/23. This report presents the findings from analysis of the data provided in FOI responses and concludes with a series of recommendations to improve transparency of reporting and monitoring for Carers Act funding. 1.1 Unpaid carers: rights and support needs There are estimated to be at least 700,000 to 800,000 unpaid carers in Scotland, including 28,000 young carers12. The Carers (Scotland) Act 201613, aimed to enable unpaid carers to be better supported so that they could continue to care, if they wished to do so, whilst also having a life alongside caring. Breaks from caring are vital to carers’ health and well-being, yet survey data in Scotland has consistently shown that only 3-4% of carers report having breaks. For full-time carers, providing 35 or more hours of care a week, only 9-10% have access to breaks from caring.14 Since the pandemic, increasing numbers of short break services and day services have closed, or reduced their level of service, due to financial insecurity and 12 https://www.gov.scot/publications/scotlands-carers-update-release-december-2022/ 13 https://www.legislation.gov.uk/asp/2016/9/contents 14 Annual Scottish Health Survey
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90 | P a g e unsustainability. This has a profound impact on carers’ health and wellbeing, with recent research from Carers UK reporting that 61% of carers have said they needed more support to be able to look after their health and wellbeing.15 Moreover, Carers Centres across Scotland report a significant increase in referrals and number of carers registered with their service over the last two years16. This is combined with an increase in the complexity of carers’ support needs. Many Carers Centres report that demand outstrips their resources and capacity to deliver much needed support. 1.2 Funding to support carers and implementation of Carers (Scotland) Act 2016 When the Carers Act came into e\ect on 1st April 2018, local authorities were provided with additional funding to support implementation. The funding is awarded to local authorities in the first instance, who then allocate this to Health & Social Care Partnerships (HSCPs). Funding awarded to support Carers Act implementation has increased year on year as follows: Carers Act funding awarded to local authorities since 2018 2018/19 2019/20 2020/21 2021/22 2022/23 £19.4m £27.9m £39.5m £68m £88.4m* *This £88.4m is now the baseline level of funding which is awarded annually. In a letter to councils and local integration authorities on 9 February 202217, Humza Yousaf, then Cabinet Secretary for Health and Sport, stated: “Effective support for carers is not a new issue but the consistent feedback from carer representatives is of sustained pressures on carers; huge demand for carer support; and local carer support organisations running beyond capacity. This makes it even more important that the substantial Carers Act funding uplift for 2022-23 goes to delivering the intended expansion in local carer support services. I therefore ask for your support 15 https://www.carersuk.org/media/xgwlj0gn/soc23-health-report_web.pdf 16 https://www.carersnet.org/wp-content/uploads/2023/09/Carers-Centre-Funding-Report-Aug23FINAL.pdf 17 https://www.gov.scot/publications/carers-act-funding-letter-to-councils-and-integration-authorities/
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91 | P a g e in ensuring these additional resources are allocated in full to expanding support for unpaid carers.” This report provides details of the data received from 31* local authorities relating to Carers Act Funding awarded and allocated in 2022/23** to Health & Social Care Partnerships (HSCPs); spend of Carers Act funding allocated to HSCPs; and the reliability of figures provided in FOI responses. *One local area did not provide an FOI response. **COCIS also submitted a FOI request for Carer Act funding allocated to HSCPs and associated spend in 2023/24. Some areas were unable to respond as it was too early to report on spend this year. However, brief analysis of figures which some areas did provide, showed that the proportion of awards which were allocated to HSCP was broadly equivalent to 2022/23. Similar spending trends to those contained in this report are therefore predicted in 2023/24. 2. Headline findings and recommendations Carers Scotland Act funding awarded and allocated FOI responses were received from 31 local authorities. Data provided indicates: • Of the £88.4m awarded to local authorities only £74.9m was allocated to HSCPs. • Twelve local authority areas allocated less than 80% of the award received to the HSCP. In ten of these areas the award/allocation ratio was even more pronounced (<70%). This suggests between £12.4m to £13.5m of Carers Act funding awarded was not passed onto HSCPs (allowing for two areas that did not report their allocations). While a proportion of this funding may have been used by local authorities to deliver young carer services, where this function is not delegated to HSCPs, there is still likely to be a significant shortfall. Spend on support for carers / implementation of Carers Act Of the £74.9m reported as allocated to HSCPs, analysis of the reported spend suggests: • 92% of funding (approx. £69m) was spent on direct or indirect support for carers / implementation. • 8% of spend (approx. £6m) did not relate to support for carers / implementation or was categorised as not yet allocated / other.
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92 | P a g e This indicates that the ‘real’ spend on support for carers / implementation of Carers Act by Health and Social Care Partnerships in 2022/23 was up to £19m less than the £88.4m of funding awarded. Reliability of data There were concerns related to the reliability of data provided in FOI returns, including: • Di\erences between figures provided for the funds allocated to the HSCP and actual reported spend suggests there were under/overspends in ten areas. • Discrepancies were noted by some Carers Centres in relation to the some of the data reported. • A response to a separate FOI request on Carers Act funding in 22/23 (submitted by an unpaid carer) presented a di\erent set of figures than those which were provided in the FOI response (for the same area) for this report. • Comparing data provided in FOI responses to forecasting within the Financial Memorandum produced for the National Care Service (Scotland) Bill suggests the estimated figures for existing spend on Short Breaks may be unreliable, overestimating the amount spent. As Carers Act funding is not ringfenced, many HSCPs do not appear to routinely record, track and monitor spend, which a\ects the reliability and transparency of data. Recommendations To improve transparency in the reporting and monitoring of Carers Act funding the following recommendations are made for Scottish Government and local authorities: 1. Provide significantly more funding directly to third sector organisations (including Carer Centres) to expand and develop services to support unpaid carers, including a wider range of short breaks opportunities 2. Ring-fence Carers Act funding and develop consistent budget headings for use by all local areas. 3. Develop financial reporting processes to ensure robust tracking, monitoring and forecasting of spend under each budget heading. 4. Ensure HSCP Annual Performance Reports provide details of support for carers / Carers Act implementation and Annual Accounts provide figures for Carers Act funding, to improve transparent reporting of impact and spend.
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93 | P a g e 3. Carers (Scotland) Act funding awarded and allocated 2022/23 FOI response data indicates that, of the £88.4m Carers Act funding awarded to local authorities in 2022/23, £74.9m was then allocated to HSCPs. This suggests that between £12.4m to £13.5 m of Carers Act funding awarded to local authorities was not passed on to HSCPs (see 5.1 below for more detail). Figure 1: Carers Act funding awarded / allocated in Scotland Figure 2 below shows the breakdown of Carers Act funding awarded compared to funds allocated to the HSCP in each local authority area.
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94 | P a g e Figure 2: Carers Act funding awarded and allocated by area (in £m’s) FOI responses show that 16 areas reported award and allocation totals that were broadly similar (where between 110% and 80% of awards were allocated to HSCP). Two areas reported moderately higher allocations (>110%) to the HSCP than funding awarded (Fife 117%; Glasgow 115%). However, in the remaining 12 areas the funding allocated to HSCP was less than 80% of the grant awarded. Of these, more significant disparity between awards and allocations (<70% allocated to HSCP) was reported by ten areas (Argyll & Bute 23%; East Ayrshire 23%; East Dunbartonshire 23%; East Renfrewshire 30%; Highland 43%; North Lanarkshire 67%; Orkney 54%; Perth & Kinross 20%; Scottish Borders 57%; Western Isles 50%). Shetland did not provide a figure for their allocation to HSCP and explained that this was because funding was "not separately listed as ring-fenced therefore diGicult to identify". Clackmannanshire did not submit a FOI response. 4. Spend of Carers Act funding To support the collection and analysis of data in the FOI request COCIS collaborated with HSCP Carers Leads to identify key spend categories which were aligned with the Carers Act (see Appendix 1). These categories were then grouped under four main headings:
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95 | P a g e • Direct support for carers / implementation of Carers Act • Indirect support for carers / implementation of Carers Act* • Not related to carer support / implementation of Carers Act • Not yet allocated / other *For the purposes of this report, spend reported as ‘Strategic Posts within the HSCP’ and ‘Health Board’ was categorised as indirect support for carers / implementation as no further information was available to fully analyse/breakdown these figures. 4.1 Spend of Carers Act funding awarded to local authorities Of the total funding awarded to local authority areas (£88.4m) across Scotland the percentage spend under each of these headings can be seen in Figure 3 below: Figure 3: Scottish average % spend of Carers Act funding awarded to local authorities *The ‘missing’ 15% in this figure relates to the funding which was not allocated to HSCPs. 4.2 Spend of Carers Act funding allocated to HSCPs When reported spend was analysed against the £74.9m of funding that was reported as actually allocated to HSCPs, there was a 12% variance in the ‘direct support for carers/implementation’ heading. FOI responses suggest that of the £74.9m allocated to HSCPs: • £59m was spent on direct support for carers / implementation • £9m was spent on indirect support for carers / implementation • £2m of spend was not related to support for carers / implementation • £4m was either not yet allocated or related to ‘other’ spend
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96 | P a g e Figure 4: Scottish average % spend of Carers Act funding allocated to HSCPs 4.3 Spend by local authority area Figure 5 below shows reported spend by local authority area. Figure 5: local authority spend of funding allocated to HSCPs (in £m’s) Two areas (Clackmannanshire and Shetland) did not report on any spend. As noted above, Clackmannanshire did not submit a FOI response and Shetland explained they
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97 | P a g e could not provide information on funds allocated to the HSCP / spend due to Carers Act funding not being ringfenced therefore di\icult to identify. 4.4 Not related to support for carers / implementation Figures provided suggest that a total of £1.9m of reported spend was not related to support for carers / implementation. This comprised of ten areas which reported funds being used to o\set ‘Loss of income / Waiving Charges’ (Argyll & Bute £103k; Dundee £250k; Fife £332k; Glasgow £331k; Inverclyde £317k; Midlothian £60k; North Ayrshire £157k; South Ayrshire £170k; South Lanarkshire £150k; West Lothian £29k). 4.5 Not yet allocated / other Within FOI responses ten areas reported spending that was categorised as either ‘not yet allocated’ or ‘other’. This amounted to £4.1m. As the 2022/23 financial year ended in March 2023, it is assumed that spend identified as ‘not yet allocated’ was not spent within 2022/23. Area Not yet allocated / other Aberdeen £132,604 Dundee £98,461 East Dunbartonshire £88,538 East Lothian £186,413 Falkirk £23,000 Inverclyde £284,120 North Ayrshire £1,743,307 North Lanarkshire £1,032,017 Perth & Kinross £26,000 South Ayrshire £40,000 West Dunbartonshire £505,505 4.6 ‘Real’ spend of Carers Act funding on support for carers / implementation Removing both the ‘not related to support / implementation’ (£1.9m) and ‘unallocated / other’ (£4.1m) figures from the total reported as allocated to HSCPs (£74.9m) suggests the ‘real’ spend which can be accounted for was approximately £69m. This means that potentially, up to £19m of Carers Act funding awarded to local authorities in 2022/23 was not spent for on supporting carers (allowing for the two areas which did not report on spend). 5. Reliability of figures provided in FOI responses A number of discrepancies were noted through analysis of the data provided in FOI responses. These are summarised below, alongside any additional comments provided.
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98 | P a g e 5.1 Carers Act funding awarded and allocated As noted above, of the £88.4m Carers Act funding awarded in 2022/23, only £74.9m was reported as allocated to HSCPs. This indicates that up to £13.5m was not passed on. Allowing for variances in reporting (i.e. grants awarded to Clackmannanshire and Shetland which were not reported on and ‘di\erences in reported allocations and spend’ (see point 5.2 below)) this figure could be slightly lower at £12.4m. While a proportion of this funding may have been used by local authorities to deliver young carer services, where this function is not delegated to HSCPs, there is still likely to be a significant shortfall. 5.2 DiRerences in funds allocated and reported spend In eleven areas there were di\erences between the funds reported as allocated to the HSCP, compared to the actual spend figures provided (resulting in a total reported overspend of £470k). In seven of these areas the discrepancies were minimal (< £25k over/underspend), however in the remaining four areas these were more notable: • Overspends: two areas provided figures which indicated spending was higher than the funds allocated to the HSCP (Highland £977k; Scottish Borders £28k). Highland provided an explanation that "NHS Highland have a budget for Carers Services that is comprised of both Carers Act Implementation funds and additional funding NHS provides from its general grant funding". • Underspends: two areas provided figures which indicated that Carers Act funding allocated HSCP was not fully spent during 2022/23 (Midlothian £477k; West Lothian £43k). Midlothian provided an additional comment that the ‘Shortfall in financial year 2022/23 has been committed to other years. Note that expenditure in 2023/24 exceeds budget. It would not give an accurate year on year comparison if the shortfall was marked as ‘used for a diGerent purpose/not allocated’ without a corresponding adjustment in financial year 23/24.’ Whilst noting this, it has been included here as an underspend as this report was only able to assess figures provided for 2022/23 financial year. 5.3 Voluntary sector funding and Carer Centre feedback Voluntary sector organisations (including Carer Centres) provide a range of services and support to meet the needs of carers and are key stakeholders in supporting the implementation of the Carers Act. As such, HSCPs provide a level of funding to Carer Centres and other voluntary sector organisations to undertake these services. FOI responses suggest funding in 2022/23 for Carer Centres, Young Carer Services and other voluntary sector organisations across Scotland amounted to £17.2m. Interestingly, within FOI responses 12 areas reported no spend at all against ‘Carer Centres’. One of these areas (West Lothian) provided additional information that their funding to Carers Centres comes from ‘core funding and not from the funding allocated to support the implementation of the duties in the Carers (Scotland) Act 2016’. It is unclear from FOI responses whether this may be the case in other 11 areas and/or if funding was allocated / categorised within one of the other budget headings.
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99 | P a g e FOI responses were also shared with Carers Centres, some of whom noted a number of additional discrepancies: • Inconsistences in categorisation of spend: the way spend was categorised made it unclear how funds had actually been allocated and spent. For example, one area reported spend against ‘Carer Support Plans’ (generally undertaken by Carers Centres) but this funding was not allocated to the Carers Centre; and as highlighted above, 11 areas reported no funding at all being allocated to Carers Centres. • Variances in funding allocated and received: some FOI responses reported a higher level of funding allocated to Carers Centres than that which was actually received. • Un/reliability of FOI figures provided: in one local area an unpaid carer submitted a separate FOI request on spend of Carers Act funding in 2022/23. The figures provided in response to this separate request7 were di\erent to those received in the FOI response for this report (for the same area). It is therefore unclear which set of figures is correct. 7 7 https://www.whatdotheyknow.com/request/request_for_detailed_information_6?nocache=incoming2532145#inco ming-2532145 5.4 Reviewing and forecasting Short Break funding As well as highlighting challenges with the accurate recording and reporting of Carers Act funding, the information provided in the FOI returns also raised questions around the reliability of financial forecasting. The National Care Service (Scotland) Bill includes costings for the implementation of a right to breaks from caring within the Financial Memorandum (FM). In the FM the total cost to implement a right to breaks from caring have been calculated, and the current estimated spend by local authorities on short breaks has then been deducted from this total. Within these calculations £57.7m of Carers Act funding has been included as part of the estimated current spend on short breaks (adults and young carers) 18. However, FOI responses submitted for this report suggest the actual spend on short breaks totalled £26.8m in 2022/23. This would leave a shortfall of £30.9m in the calculations for the Financial Memorandum. 6. Conclusions and recommendations The FOI responses have raised a number of concerns around both the allocation of Carers Act funding and the actual spend on supporting carers / implementation. This included funding awards which were not fully allocated to the HSCP, as well as reported spend on areas which were not related to support for carers / implementation or funds which were reported as ‘not yet allocated/other’. 18 Social Work Scotland (2024): Costing Carers’ Rights to a Break Comments on the Revised Financial Memorandum of December 2023 to the National Care Service (Scotland) Bill 2022, pages 21-22: [1] 9 https://www.carersnet.org/carers-collaborative/
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100 | P a g e In addition, as Carers Act funding is not ring-fenced, the availability, reliability and transparency of data showing how money was (and is being) spent is challenging. Indeed, Equal, Expert and Valued reports produced by COCIS in 2022 and 20239 show that details of Carers Act funding and spend very rarely appear within HSCP Annual Performance Reports or Annual Accounts. These key areas of concern combine to make it extremely challenging to fully track, understand and assess the impact of funding on the lives of unpaid carers, and the implementation of the Carers Act. This report therefore makes the following recommendations for Scottish Government, councils and local integration authorities to improve transparency in the reporting and monitoring of Carers Act funding: 1. Provide significantly more funding directly to third sector organisations (including Carer Centres) to expand and develop services to support unpaid carers, including a wider range of short breaks opportunities 2. Ring-fence Carers Act funding and develop consistent budget headings for use by all local areas. 3. Develop financial reporting processes to ensure robust tracking, monitoring and forecasting of spend under each budget heading. 4. Ensure HSCP Annual Performance Reports provide details of support for carers / Carers Act implementation and Annual Accounts provide figures for Carers Act funding, to improve transparent reporting of impact and spend.
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101 Appendix 1 Categorisation of reported figures within the headings used in this report to analyse spend of Carers Act funding: Direct support for carers / implementation • Carer Centres • Young Carers Services • Other voluntary sector • Short breaks (adult carers) • Short breaks (young carers) • Other (adult carers) • Other (young carers) • Awareness raising • Engagement / consultation • Carer support posts in HSCPs Indirect support for carers / implementation • Strategic posts in HSCPs • Health board Not related to support for carers / implementation • Loss of income (Waiving Charges) • Implement Living Wage Other / not yet allocated • Other / not yet allocated
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102 Appendix 4 Update from Lanarkshire Carers for North Lanarkshire Committee 2023 Background and General Information At the Annual General Meeting that took place on 27 September 2023, Lanarkshire Carers presented their Annual Report for the reporting year 1 April 2022 to 31 March 2023: Carers at the Centre. This committee update paper should be read in conjunction with the full annual report that can be accessed using the link below, along with the accompanying documents that provide further information. Lanarkshire Carers Annual Report 2022- 2023: Carers at the Centre 132 reasons to come and have a conversation with Lanarkshire Carers Lanarkshire Carers Service we offer booklet Caring roles are unique because individual circumstances are different for each person. The contribution carers make across every locality in Lanarkshire is enormous, with people of all ages and in various situations providing care for some else. Lanarkshire Carers works with and for carers to make a positive difference to their lives. We are commissioned by Health and Social Care North Lanarkshire (HSCNL) to provide information, advice and direct support services to unpaid carers and by South Lanarkshire Health and Social Care Partnership (SLHSCP) to provide engagement, empowerment, representation, information, advice and direct support services to unpaid carers. Services are open to all carers aged 18 years and older living in Lanarkshire. Both contracts are currently in place until 2025. Both also include delegated responsibility to lead on the provision of Adult Carer Support Plans in specific circumstances. Every carer has a right to be offered an Adult Carer Support Plan and we have a partnership statement in place that sets out local arrangements and responsibilities to meet this duty. Accessing early support is key to making sure carers can manage their caring role. We provide personalised help throughout the caring journey, working with individuals
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103 and groups, building relationships with carers, helping them to identify and address their support needs and making sure carers know their rights. We offer support and services across Lanarkshire through community outreach work, as well as in our own premises in both Hamilton and Airdrie. Lanarkshire Carers staff are co-located in social work localities, the three hospital sites and community health venues. To further enhance our generic services, there is also tailored support for carers from Black, Asian and Minority Ethnic (BAME) communities, Young Adult Carers aged 18–25 years old and other groups of carers who are under-represented. We work in partnership with a range of organisations and services that also help carers. Carers most frequently self-refer to the organisation. Facilities are also in place for professionals from any organisation to make direct referrals. The organisation continues to experience, and report increased levels of new referrals, along with increased complexity of the caring roles involved. Lanarkshire Carers delivers personalised, and case managed, emotional and practical help through meaningful, outcome focussed conversations with trusted, skilled and experienced professionals. A personal outcomes approach to carers support is integral to our work, providing the right support at the right time. It starts with a conversation, helping carers to understand the impact their caring role is having on their lives, what’s important to them and who can best offer the support they need. We take a strength-based approach encouraging carers to consider what they can do for themselves; what support is available through wider community resources and through the services we provide. We use the national wellbeing indicators as a guide to help carers to think about what matters to them, developing personal outcomes that form an Adult Carer Support Plan. This is underpinned by anticipatory and preventative measures and has a focus on providing tailored support to empower the carer. Thinking ahead and planning for the future are key aspects of the conversations we have with carers. Plans are agreed in partnership with carers and rather than focus on paperwork being completed, the emphasis is on the professional relationship and the conversation. This is recorded in a purpose build client relationship management system and the process is further supported through CarerSpace; an online portal for carers to start or continue their conversation with us. Carers do not have to repeat their story as they are already using the outcomes of their conversations to co-produce an Adult Carer Support Plan. The information is all in one place, and all the toolkits and conversations are linked together.
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104 Lanarkshire Carers Key Figures for North Lanarkshire (from April 2022 to March 2023) • 1,127 New carers in contact with Lanarkshire Carers. • 5,976 Carers are known to Lanarkshire Carers. • 3,363 Carers accessed Lanarkshire Carers services in reporting period. • 26,062 Services access by carers from Lanarkshire Carers. • 182 Young Adult Carers known to Lanarkshire Carers. • 363 Carers from Black, Asian minority ethnic (BAME) communities known to Lanarkshire Carers. • 817 Carers attended one or more training sessions. • 99 Carers took part in one or more carers week events. • 73 Carers referred to counselling and wellbeing service. • 27 Carers benefitted from the supermarket voucher initiative. • 928 Carers benefited from grant funding. • 1,173 Carer card holders. • 1,395 Carers were signposted, referred, or informed about the role of partner organisations (2022- 2023). • 912 Adult Carer Support Plans progressed by Lanarkshire Carers. We have been able to sustain increased service delivery levels through our system change and practice development. This is particularly relevant in relation to ACSP figures reported when an artificial peak was created last year through an additional resource allocation. This involved re prioritising activities for a short period of time in response to the national winter funding package for unpaid carers. Our recorded conversations with carers have been consistently higher each quarter this year compared to the previous 3 years, with one exception – the peak due to the winter funding package. Our conversation first approach continues to support all grant funding allocation. Achieving Quality Standards - Excellence for Carers Award Lanarkshire Carers has recently successfully achieved the Carers Trust Excellence for Carers Award. The award follows a rigorous assessment of Lanarkshire Carers services to unpaid carers across both local authority areas, as well as the quality of our leadership, staff, internal processes and engagement with key local partners and
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105 stakeholders. By achieving the Excellence for Carers Award by Carers Trust, Lanarkshire Carers demonstrates: • A clear and complete approach to involving carers in the work, activity and life of the organisation at every level in meaningful ways that value carers and makes a real difference to them. • A positive approach to the use of technology and digital to support carers and ensure services to carers are inclusive, accessible, and seamless. • Everyone at the organisation is focused on making a difference for and with carers. They are clear about what their purpose is, and they take a solution focused approach that helps carers articulate the challenges that they are facing and the outcomes they are seeking to achieve. • The leadership of the organisation is an example of best practice, nurturing sustainability, lateral leadership, and succession planning, which allows for a clear focus on strategic development that has unpaid carers at its heart. • There is an abundance of team passion, commitment, and enthusiasm, at all levels, to provide excellent services for carers. • Good practice in identifying unpaid carers and supporting and being inclusive to carers from a range of backgrounds and identities, particularly carers from BAME and LGBTQ+ communities. • Lanarkshire Carers approach to supporting staff wellbeing was impressive – its carers for carers and carers for its staff and volunteers. In making the award, Carers Trust has stated in the report that: “Lanarkshire Carers demonstrates excellence across all the Excellence for Carers standard areas. The service is well run, delivers a broad range of person-centred services for carers, and has built positive partnerships with external organisations for the benefit of carers in the local area." "The team are focused on delivering excellent services but are clear on where their expertise is and recognises the value of partnership working with others to support carers in their communities." "The organisation demonstrated a clarity of purpose and Carers Trust are impressed with the whole organisation- the Trustees on the Board of Directors, Management and Staff team should be immensely proud of the work that they do to make a difference to the lives of unpaid carers.” It was also noted that Lanarkshire Carers have a strong commitment to carry on making developments and improvements: “There was clear evidence of nurturing sustainability, lateral leadership and succession planning, which allows for a clear focus on strategic development, is embedded in their collective thinking and approach… a clear, cohesive and holistic narrative on their strategic focus on sustainability, outcomes and taking a carer-led approach to their delivery, culture and systems and processes… a genuine sense of
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106 inclusion with all staff, they are meaningfully involved in service development and there is a sense of shared ownership when it comes to the successes that they achieve." As an organisation run by, with and for carers we are absolutely thrilled to receive this external verification of our positive approach and clarity of purpose. It was great to be able to share this news with our Full Members who attended our AGM, especially when the theme of this event was Carers at the Centre. The team work incredibly hard to ensure quality standards are embedded in all areas of our work and to make a positive difference to the lives of carers across Lanarkshire. Governance, Involvement, Participation and Feedback As a carer-led organisation, carers can choose between Full or Affiliate Membership and can easily change between the two. The Board of Directors is elected from and by the full membership and meets regularly throughout the year. Directors volunteer their time to carry out this governance role and have overall responsibility for the organisation, our mission, vision and strategy. Some Directors currently care for someone whilst others have cared for someone in the past or have particular skills and knowledge the board needs. They all share a genuine and strong commitment to influencing and shaping services that identify, engage, inform, involve, empower and support carers. Board members make a significant contribution to the organisation both individually and collectively. The Board adopted The Scottish Good Governance Code for the Third Sector which ensures good practice. Connecting with members of the organisation is a priority and activities with Full Members have taken place throughout the year. This includes information sessions for carers who want to find out more about the organisation and how they can get involved. This work has been supported through participation and involvement training for Full Members. We recognise the contribution carers make, the rewards and challenges of caring and the impact a caring role can have on many aspects of life. Carers make time during their busy and demanding days to contact us about our services and the feedback highlights why the information, advice and support we provide matters. Comments are always read and shared, and it is very reassuring to hear about the positive difference made. We have published a collection of our #feedbackfriday posts in the booklet linked above. Through quarterly contract monitoring reporting arrangements, we provide numerous case studies and evidence of carers feedback and evaluation. We also prepare other reports and responses as required. An example of this recently was the Creative Break Time to Live snapshot report. We contacted every carer who had received micro grant funding between January and June 2023. Over 100 carers took the time to respond, telling us how we are getting this right for them. We always ask about the
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107 person they care for and when issues are identified we offer advice and can also negotiate, represent and advocate on behalf of carers in relation to this. 100% of carers responding felt listened to and supported by the member of staff who completed the grant plan with them. 100% of carers responding said a grant payment is their preferred way of accessing a short break from caring. Carer engagement and involvement is an important part of our work. We support carers to have their voices heard through local and national focus groups, surveys, consultation and other activities. The organisation also represents carers locally and nationally. Lanarkshire Carers Short Breaks Bureau (SBB) The SBB has local and national prominence and is an integral part of our commissioned service. In September 2023 we represented Lanarkshire at the International Short Break Association (ISBA) Conference in Poland. We are Shared Care Scotland’s local delivery partner for Creative Breaks Time to Live funding. We have levered in and managed extensive additional resources and funds that help support carers to access short breaks and deal with the financial impact that caring often has. The amount of individual carer grant funding Lanarkshire Carers has awarded to carers has increased significantly with a focus on supporting those in need of a personalised short break from caring as well as those needing financial assistance to cover essential and emergency costs. The ScotSpirit Holiday Voucher Scheme ensured additional breaks and holidays for carers across Lanarkshire through our local delivery of this national scheme. Developing short break initiatives such as Respitality has further expanded options for carers and we continue to distribute the Lanarkshire Carer Card initiative with access to many perks and discounts. The move to a digital card has maximized efficiency in managing this scheme, which we know is valued by many carers in Lanarkshire who apply/renew each year. We have responded to the cost-of-living crisis through partnership and development to meet the needs of carers quickly and efficiently. Lanarkshire Carers Flexible Support Fund supports this crucial part of our work, ensuring funding is available as part of a support plan for carers when this need is identified. These grants can help meet the costs of a range of things to help improve carers situations and are linked
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108 to a recorded outcome in an Adult Carer Support Plan. Many carers are facing immediate financial hardship and our response included establishing a Carer Supermarket Food Voucher Initiative. This proved to be extremely well received, offering immediate help to carers who are struggling financially. Due to the outcomes achieved, we are continuing this initiative, funded through Carers Flexible Support Fund and have developed the processes required for its successful delivery. Lanarkshire Carers distributed/approved a total of £659,181 grant payments during this reporting year equating to £12,676 of direct carer grants per week. This is a remarkable achievement for a small team who are making a very big impact. Recognition of the carers representatives involved is highlighted as they volunteer their time to bring lived experience to the grant funding panel process. Lanarkshire Carers Black, Asian and Minority Ethnic (BAME) Carer Support and Equalities Service Development activity has taken place through the delivery of our Making Carers Count project with a focus on LGBTQ+ carers. Innovation and best practice are central to our work and this year our staff learning and development programme has included the delivery of bespoke and specialised, diversity, equality and inclusion opportunities. This work also helped us achieve the Scottish Rainbow Partnership award and we were delighted to be Proud Scotland Small Employers Award winners in June 2023. Carers Census Data Lanarkshire Carers contributes to the requirement of Carer Census Data returns for North Lanarkshire, shared annually with Scottish Government to measure the impact of the implementation of the Carers (Scotland) Act 2016. We have developed systems to capture and report data on carers who access support through our service. For 2022-2023 reporting period, Lanarkshire Carers included 6,633 carer records in our return to Scottish Government (3,353 North Lanarkshire, 3,280 South Lanarkshire), detailing the types of support carers required and the how carers are supported to meet their needs. We carry out regular data cleansing activity to ensure the data we record and report on is as accurate as possible. The total number of carers supported figure reported at any time reflects only those that are currently
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109 known to the organisation and not the many carers who have moved on from the organisation due to a change in circumstance and/or support needs. Care Inspectorate ‘Understanding carer’s experiences of social work and social care service delivery’ Inquiry Following our contribution to the enhanced inquiry in North Lanarkshire, we received a detailed report from the Care Inspectorate outlining the key messages and areas of learning and improvement. Lanarkshire Carers noted a number of highlights in the local report and our practice leading to more positive experiences for carers in Lanarkshire including that: • 69% of carers in North Lanarkshire said their Adult Carer Support Plan helped them do things that are important to them compared with 42% in Scotland. • 74% of carers in North Lanarkshire said their Adult Carer Support Plan helps make sure that they get the right support to keep caring compared with 54% in Scotland. One carer from Lanarkshire, quoted in the report, refers to support available for carers and draws attention to the impact of our approach: “All the above support is provided to me by Lanarkshire Carers. They have always been transparent, honest, and timely, I would have been lost without the help and support Lanarkshire Carers have provided to me.[..] Funding to buy a cooker and folding bed from [Lanarkshire Carers Short Break Bureau] supported me through a hard time and helped [..] to cook for my family”. It was also good to see areas of our practice identified as possible positive practice examples with the care inspectorate highlighting our CarerSpace Portal, Hospital Linked Support Programme and BAME and Equalities service in their final presentation. Exemplary Status for Carer Positive This award is presented to employers in Scotland recognised for exemplary support for working carers and we were delighted to achieve this in March 2023. The health, wellbeing and development of all our staff remains a key priority supporting a diverse and highly skilled workforce able to meet the needs of carers. We have an Employee Assistance Programme and an extensive Staff Learning and Development
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110 programme. Our staff team go above and beyond to achieve the outcomes reported by the organisation with outstanding achievements over the last year. Lanarkshire Carers is a local employer of 38 people who mainly all live and work within Lanarkshire, many of whom are carers themselves. Partnership Lanarkshire Carers is an active participant in each of North Lanarkshire Local Consortiums, Strategic Commissioning Group, Carers Oversight group and other local networks and partnerships. Links are also being re-established with the Locality Planning Groups. We are supporting the consultation process in relation to the new Carers Strategy and other key documents in North Lanarkshire, providing a voice and input from and on behalf of unpaid carers. We deliver a range of information activities and presentations about the role of our organisation. www.lanarkshirecarers.org.uk 01698 428090 / 01236 755550 Author: Barbara McAuley, CEO, Lanarkshire Carers 3 October 2023
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111 Appendix 4 North Lanarkshire Carers Together (NLCT) provide a Campaigning and Representation service and are the dedicated Information and Advice service for carers and professionals who come into contact with carers. Information Over the past reporting period we have worked with 475 carers, 298 of those were new to the service and had not been in contact before, with the remaining 177 coming back to us as trusted providers of Information, Advice, and an active referral service. It is pleasing that so many carers trust our staff, and we have seen the number of contacts we make with carers increase significantly to an average of 4.6 times. This is more time spent emotionally supporting carers, providing information on their rights, and actively linking them into available supports in the community. The average length of each of these contacts is just under 1 hour, so this is reflective of the ongoing and increased challenges being faced by carers during the current climate of cost-of-living pressures and social care crises. The services our staff provide however, mean that more than 86% of carers who contact us can have their support needs met by us and our partners, rather than statutory services. This is testament to the vibrant third sector and the relationship we enjoy with so many of our brilliant partners. During the carer contacts, 1024 signposts and referrals were made on behalf to carers. These included carers directed to Bereavement/Counselling, Care Opinion, Carer Support across a range of organisations, Community Groups, Funds & Trusts, Tackling Poverty Team, and Health & Social Care services. In May 2023 we sent out over four thousand newsletters providing a range of information on ours and partners services. We have also increased our presence online via our website and social media channels. We use Facebook and Twitter and have seen our Twitter presence increase by over 27% in the last 2 years, and Facebook increase by 49% in the last 2 years. On Facebook alone, we reached 43,825 people in the last year. Our Mail Chimp platform is our way of keeping carers and our partners up to date with newsflashes and alerts direct to their email inboxes. Our experienced staff team have noted that our response and reaction rate to these emails are better than average comparative to other third sector organisations we have worked within. These platforms are a modern, convenient way to take part in snap polls, surveys and to keep up to date with information relevant to carers and the people they care for. While we still engage with carers face to face and in-person, the use of these platforms mean we can optimally meet our contractual obligations regarding engagement and participation.
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112 A novel way of ensuring information is available; our listening audience continues to grow as we share the stories of carers and partners through our Carer Podcast. Following the launch last year with the actor Jane McCarry, we have other interviews available to listen, including a local GP discussing the importance of carers being supported and listened to; a carer discussing the challenges and sharing her story in accessing respite for her husband; and a Senior Officer from Health & Social Care discussing the upcoming refresh of the North Lanarkshire Strategy for Carers. We were delighted to have recently been entrusted with additional investment to recruit a Carer Information & Engagement Worker (Equalities) with a focus on providing a service to marginalised communities, such as the BAME, LGBTQI+, and rural communities of carers. Carer Engagement & Representation Aligning closely with the North Lanarkshire Engagement and Participation Strategy and the Coalition of Carers in Scotland 3 Best Practice Standards for Carer Engagement, we recognise carer engagement and representation is essential to the development of local services and policies and to feed into national and local consultations. This must be meaningful, supported, funded and crucially the loop needs to close in that there has to be feedback to carers who give their time to contribute. NLCT frame all consultation with our guiding principle ‘We Asked, You Said, We Did’ and is our promise to those carers who form part of our Carer Forum. The Forum meets in-person, digitally and also has a closed private social media group. It has eighty-eight members. The Care Inspectorate is a scrutiny body which supports improvement in the quality of care in Scotland to ensure it meets high standards. Where they find that improvement is needed, they will support services to make positive changes, including recommendations to underpin that support. On hearing the Inspectorate’s intention to undertake a National Inquiry into carers’ experiences of adult social work and social care, which included a more detailed scrutiny into 5 Health & Social Care Partnership areas, North Lanarkshire Carers Together campaigned in late February last year to have North Lanarkshire as one of those areas, and following this intimation, North Lanarkshire Health & Social Care volunteered to take part and we were delighted to lead on this locally from April through to June, in partnership with Lanarkshire Carers. It was a detailed and intensive piece of work including scrutiny of Health & Social Care as well as surveys and facilitated discussions with both Carer Centre’s staff and managers, a specific survey by a nominated staff member in both Carer Centre’s and detailed group and one-to-one discussions with carers themselves into their experiences. It was not a good picture for carers across Scotland, but carer’s experiences were heard to be better in North Lanarkshire compared to other areas in Scotland. We also led on other consultations to shape services including Scottish Government changes to Carers Allowance, and the digitisation of the Community Alarm system in North Lanarkshire.
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113 Campaigning In partnership with the Carer Positive Team at Carers Scotland, our service host two events each year identifying and encouraging local partners to become carer positive employers and recently campaigned in support of the private members bill to Westminster for statutory time off for those working alongside a caring role. As costs of living continued to increase, carers told us how difficult things were becoming for them. Their feedback combined with timely reports from national organisations led to our Cost-of-Living campaign focussing on the impacts on carers in North Lanarkshire. We published our findings, making recommendations to Health and Social Care North Lanarkshire early last year. These recommendations were met in full besides one for a cash-first payment to support families due to potential triggers of a benefits check that was advised by Social Security Scotland. Our most recent campaign was on carer breaks in North Lanarkshire. The topic was high on the local agenda, but one carers story brought to the attention of Health & Social Care prompted a wide-reaching consultation to ascertain carers experiences of sourcing information on and accessing a short break. The report concluded with recommendations on improving the landscape, with one key recommendation being that carers are involved in every future step looking to improve short breaks. A key piece of work we provide is our Carer Aware Programme - where we deliver information sessions to carers and partners, informing them of the Carers (Scotland) Act 2016, of carer rights, and where and how to access support and services for carers locally. Over the past year we have delivered twelve sessions to 175 participants, which includes six sessions to ninety front-line Health & Social Care staff. Partners and carers who take part continue to tell us the rich value the information brings and helps to improve outcomes for carers. Carer Breather One of the more significant carer-led developments over the last 2 years was the Carer Breather programme. Designed by carers from the offset through robust consultation on what types of short break would help most to allow them a local and regular breather from caring; the first round of services ending in March last year was a huge success. Evaluations proved successful with a published report now available. In our role as Carer Network Lead, we were delighted to have been entrusted for a further 2 years covering the period April 2023 – March 2025 to lead on new Carer Breather services. A fresh investment of £600,000 by Health & Social Care to our partnership with Community Solutions (VANL) meant that through a multi-agency panel which included carers, we were able to allocate this investment into organisations and community groups geographically spread across North Lanarkshire to provide local carer breaks. A key addition this time around includes better provision for parent carers of children with additional support needs. Services offering these supports include One Parent Families Scotland, Play Peace and Pamis. The organisations funded in this round are:
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114 Bazooka Arts Getting Better Together Shotts Glenboig Development Trust North Lanarkshire Disability Forum One Parent Families Scotland Pamis Parkinson’s Self-Help Group Airdrie Play Peace The Haven The Health and Wellness Hub Watch Us Grow Carer Breather is pioneering and has attracted national attention as a model of good practice in supporting carers and has been nominated for a national award. Advocacy North Lanarkshire Carers Together have one staff member providing an Independent Advocacy service for adult carers living in North Lanarkshire. Over the course of the last year, we have provided 1-to-1 advocacy to forty carers for a range of support needs. The carers ranged from aged eighteen up to carers in their seventy’s, carers who lived across the six localities in North Lanarkshire and who cared for people with mental health challenges, autism, learning and physical disabilities, and addiction. The type of help and support we have provided includes support with Self Directed Support packages, hospital discharge, housing, accessing respite or short break provision, and Power of Attorney. This service ensures that carers have full access to their rights as outlined within the Carers (Scotland) Act 2016. We know that health and social care systems can often be difficult to navigate, coupled with the fact that many people struggle to understand their rights as unpaid carers, and our service seeks to address those issues. Family Support Service Commissioned by North Lanarkshire Council Education & Families, our Family Support Service has grown this year with two full time staff now providing a whole- family support service since January. Support to families is community based, responsive, timely, and flexible whilst providing the opportunity for families to be listened to. The support can be emotional or practical, help to understand the child/young person’s diagnosis and needs, signposting to further services, and support that may benefit the family within the local community.
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115 The support is tailored to meet the needs of each individual family, and this is aligned with the Ten Principles of Intensive Family Support within The Promise as well as the child/young person’s Wellbeing Plan and is underpinned by Children’s Rights. Families able to access the service are those where there is a child/young person with: A neurodevelopmental profile Social communication difficulty Challenges with emotions Behavioural issues Other similar challenges There is no need for a diagnosis to access the service. It is a niche service with referrals only accepted via the young person’s school or for those children on the waiting list for a neurodevelopmental assessment, via the Neurodevelopmental Team. Over the course of this year, we have worked intensively with 227 families, ensuring parents/guardians are better informed and more able to cope with challenges they may have been facing and young people meet their own outcomes.
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116 Appendix 5 – Action for Children Young Carers Update NLYC has continued to complete Young Carer Statements, assessments, reviews, and referrals for the young carer service. This includes online referrals via www.northlanarkshireyoungcarers.org We have been very busy providing varied and extensive short breaks for our service users in line with the requirements of the Carers Act Scotland. In the last quarter we completed over 50 (1:1s) and 36 young carer Groups. (Within the service and the community) We continued to apply for short breaks funding from the Lanarkshire Carers Centre (Short Break bureau). In March alone the team at NLYC successfully applied for £3990. Through Action for Children, we continued to provide added value which allowed us to enhance the service environment and quality of outings. We have been involved in aspects of development of the Childrens Plan in NL as well as the Carers Strategy group in NL. We participated in young carers day 2024 and had a large article in the Daily Record online platform. We continued to develop new awareness materials for the public as well as updating our website and Facebook resources. We continue to work with several partners including: ASH, NLCT, Reel time studios, Landed, CAMHS, New College Lanarkshire, Lanarkshire Carers Centre, FAMS, H&W HUB. Partnership remains critical to the success of the service. We supported NLC on design of the new Carers Strategy document via several meetings and provision of statistics. Staff continued to provide Mental Health supports to young carers including access to professional counselling for the most effected young carers. The service continues to work in most High schools in NL. In quarter four we presented to over 1500 first year pupils, 50 staff and 105 children attended school drop ins. AfC (NLYC) Report for Committee
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117 We had some issues with our vehicle pool, with one vehicle being out of use for three months. We continued to have issues changing the electricity supplier for our new location in enterprise House. We had two staff leaving service, but this was covered by management. We have continued to work with Lanarkshire Carers Centre and the short breaks bureau to provide short breaks finance to service users and their families. In addition, we secured over £1k in respitality support from the Bureau for our families. We continue to work with Lanarkshire Carers Together, VANL, Education via high schools in North Lanarkshire and advocacy services. Our awareness presentations and drop-in sessions continue within the high schools in North Lanarkshire. (This is a major part of our work). This quarter we worked with ASH, NLCT, Reel time studios, Landed, CAMHS, New College Lanarkshire, FAMS. We worked with Outward bound) on a residential in April), Carers Trust, Coalition of Carers, we also worked with Cumbernauld ‘Lantern house’ Theatre, Flip-out, Innoflate (Cumbernauld), The Health and Wellness Hub (Motherwell), Motherwell and Airdrie Consortium, CYPF Network, CSN Network, NHS Lanarkshire, Carers Rights and Support Steering Group and VANL. Adults form North Lanarkshire Carers Together have used our podcast suite twice this quarter. We continue to work closely with Motherwell FC and the Charity Foundation and Ravenscraig sport venue. Many short breaks for carers have been provided. We have settled into our new premises which we continue to develop, and this has been viewed very positively by carers and families and other partners. Financially, we successfully applied for £25k of additional funding for 2024-25 to support mental health and Cumbernauld \ Kilsyth area. We now have 10 season tickets to Motherwell FC which are used by YC and families. Some recent stats: 16 cases closed this 4th quarter. 142 actual young carers with direct support Over 130 families \ siblings involved in some form with NLYC. Over 1500 school children received awareness training Together, VANL, Education via high schools in North Lanarkshire and advocacy services. Our awareness presentations and drop-in sessions continue within the high schools in North Lanarkshire. (This is a major part of our work). Recently we worked with ASH, NLCT, Reel time studios, Landed, CAMHS, New College Lanarkshire, FAMS. We worked with Outward bound) on a residential in April), Carers Trust, Coalition of Carers, we also worked with Cumbernauld ‘Lantern house’ Theatre, Flip-out, Innoflate (Cumbernauld), The Health and Wellness Hub (Motherwell), Motherwell and Airdrie Consortium, CYPF Network, CSN Network, NHS Lanarkshire, Carers Rights and Support Steering Group and VANL. Adults form North Lanarkshire Carers Together have used our podcast suite twice this quarter. We continue to work closely with Motherwell FC and the Charity Foundation and Ravenscraig sport venue. Many short breaks for carers have been provided. We have settled into our new premises which we continue to develop, and this has been viewed very positively by carers and families and other partners. Financially, we successfully applied for £25k of additional funding for 2024-25 to support mental health
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118 and Cumbernauld \ Kilsyth area. We now have 10 season tickets to Motherwell FC which are used by YC and families. This has been a very busy period for NLYC. We have continued to provide short breaks, complete Young Carer Statements, and provide advice and support to families. Added value remains a very important part of the service with budgets so tight. Partnership also remains critical, and we worked with a variety of carer partners, local businesses, national carer organisations and local sports facilities. We continued to work with the Motherwell FC community Trust providing sports sessions for our young carers. In March we had a large article in the Daily Record around carers day and one of our service users. This highlighted what the service means to him and his family. Young carers enjoyed trips to Wicked, The woman in Black, Flip-out, Innoflate, Café Ceramo, Golf, Bowling, Cinema, and local restaurants. We had 203 young carers attend a cinema event in Cumbernauld theatre recently. We have continued to develop our service to make it more short break friendly. Recently we fitted a pool, table, air hockey table and two retro gaming machines. We also have a darts board and invested in more PS5 games for young carers. We work directly with our service users and their families. We consult via meetings, on-line support, school support and through our secure Facebook page and website. We regularly phone our service users as well as using texting services. We use questionnaires and group \ individual feedback sessions as well as provide comments and suggestions platform within the service and on-line. In quarter four our YC were consulted on the new Carers Strategy document for BL, as well as by ASH Scotland (Vaping) and landed. We have had very positive feedback from service user families. As part of our review, we ask for feedback from families and parents as to the service provision. We also invite comments via Facebook. We have recently been involved in several electronic surveys around service user feedback via Action for Children and the carers Trust. This quarter we had a questionnaire on the new Carers Strategy document for NLC. In quarter four we introduced new Friday feedback sessions held in localities in NL and attended by young carers. (we used menti-meter)
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119 We are aware of the North Lanarkshire Health and Social Care partnership page on care opinion. We see it as a platform for the public to comment on service provision. We encourage parents to utilise the site, however as we are a children’s service our service users tend to communicate directly with us, and not via the site, we have had no young carer related comments placed on the site for North Lanarkshire. We will look to promote better use of the site for our families wishing to feedback on services moving forward. Action for Children is committed to ensuring our employees and workers are enabled to work in a safe way and protected from harm and safeguarding is integral to everything we do. Funds have been used in line with service level agreement. Action for Children have also supported the service with substantial Added value via: Herbalife, Covid Fund, William Grant Foundation. The service has also successfully applied for £20k of mental health funding recently and 3% to support young carers in the Cumbernauld locality. In quarter 4 we met with over 1500 school pupils in NL to give awareness training. We have been using facilities in Cumbernauld, Motherwell, and Wishaw. In quarter four we secured £5k of funding to support carers in Kilsyth and Cumbernauld locality, working with local companies to improve quality of life within the carer’s community.
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120
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121 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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REPORT Item No: 8 SUBJECT: Delivering for Communities – Engagement & Participation TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager, Quality Assurance DATE: 22 May 2024 1. PURPOSE OF REPORT This report seeks approval from Committee for the North Lanarkshire Engagement & Participation Strategy 2024-2027. This strategy further embeds and supports engagement and participation across our structures and communities. 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: Craig Tobin, Senior Officer, Quality Assurance ☒ Reviewed By: Maria Williamson, Senior Manager, Quality Assurance ☒ Endorsed By: Morag Dendy, Head of Planning, Performance and Quality Assurance ☒
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3. RECOMMENDATIONS It is recommended that the IJB PFA committee: (1) Approve the North Lanarkshire Engagement & Participation Strategy 2024 - 2027 (2) Endorse the approach and the contents of the report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Since our last report to Committee in May 2023, there has been continued focus on further developing our overall approach to invest and resource engagement and participation that ensures the voices of supported people; carers and our communities are strengthened. 5.2 Co-production work has been ongoing to refresh the Engagement and Participation Strategy 2024-27. There have also been several stakeholder events held to help shape content and ensure the National Standards for Community Engagement, promoted by Scottish Community Development Centre, have been applied throughout. 5.3 As part of the work to refresh the Strategy led by the Strategic Engagement and Participation Working Group (SEPWG), a visual diagram has been designed to show the three main areas of investment that supports Engagement and Participation across our communities (Community, Carers and Supported People). The diagram, on the second page of the strategy attached at Appendix 1, highlights our ambition to ensure strong voices to: Improve communication and increase connections. Increase awareness of what matters. Increase capacity for early intervention and prevention. 5.4 Following on from the successful procurement exercise resulting in a contract award to North Lanarkshire Disability Forum (NLDF) as the lead partner, alongside Lanarkshire Links and Voice of Experience Forum, as reported to Committee in September 2024, work has begun again on the recommendations from an independent review of our engagement and participation structures concluded in June 2022. Yes ☐ No ☐ N/A ☒
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5.5 There is a long history of engagement and participation in North Lanarkshire and the strength of connection across our network continues to promote involvement and representation to amplify voice. There have been some key achievements over the past year as set out below. Engagement and Participation Strategy 2024-2027 5.6 Over recent months a focused effort has been directed towards refreshing the Engagement & Participation Strategy that will serve as the foundation across all areas of our work. In the development of the Strategy, we have actively engaged with stakeholders; representatives of community-based organisations, supported people, carers, and staff teams. 5.7 Learning from these sessions has highlighted what is considered good engagement and participation and provided confirmation that the refreshed strategy should: Be short and user friendly. Be an overarching strategy that can guide communication and action planning across all areas of services and supports. Build from the current strategy, including what we have learned and what people have told us. 5.8 It is anticipated that the Strategy will support all stakeholders across our networks as it is written in plain English to ensure it is accessible to people who do not work in the sector but have an interest or are receiving services and supports. The Strategy is included as appendix 1. Strategic Engagement and Participation Working Group 5.9 The primary function of the Strategic Participation and Engagement Working Group (SEPWG) is to drive forward the principles aligned to our Engagement and Participation Strategy. This group was re-established in the last year and has led on the coordination and development of the Strategy 2024-27. 5.10 The group brings together representation from across the authority and includes people who have a role to support and develop engagement and participation. The primary objective is to coordinate various activities aimed at fostering robust and effective engagement and participation across North Lanarkshire. 5.11 Its purpose is to streamline and synchronise initiatives that prioritise community involvement, ensuring that the voices, needs, and perspectives of people in North Lanarkshire are not just heard but actively integrated into the design and delivery of our services. Embedding Participation
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5.8 There has been good progress to increase the resource and capacity across community-based organisations to strengthen the voice of supported people, including those harder to reach e.g. BAME, LGBTQI+ and those in more rural communities. 5.9 We recognise the importance in ensuring that engagement and participation is meaningful and not tokenistic, so the principles of engagement and participation are now included in the Staff Induction programme, both as written information and as a direct input to programme for new social work and social care practitioners. 5.10 A wide range of stakeholders have been actively engaged in the development of the Strategy through consultation and direct involvement. Promotion to implement the Strategy will be a shared responsibility and will include awareness raising and the development of practical tools to support: An evidence base on how people experience services and how their experience shapes and improves future development of services and supports. The voice of supported people in our communities Increased capacity for early intervention and prevention. Two-way communication and a strengthened feedback loop back to decision makers Increased feedback and the role of lived experience in improvement of services and supports. Increased connections with supported people and communities that are harder to engage with. Increased awareness about what is important to supported people and their communities. 5.11 The refresh of our Locality Planning Group arrangements and alignment with the Locality Planning Teams and Community Boards is underway. Once finalised, this will provide sector, locality, and thematic forums, which can be influenced and shaped through engagement and participation with our Communities, Carers and Supported People. Care Opinion 5.12 We recognise the importance of feedback, so have actively promoted the use of Care Opinion, which is an independent, non-profit, web-based feedback platform where people submit stories to share their experiences of health and social care services. These can be both positive and negative. They are moderated and quickly forwarded to the relevant area of service who can respond directly to the story. Since 2020: 310 stories have been submitted through Care Opinion by people of North Lanarkshire. 239 of these stories have been shared in the year April 2023-March 2024.
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Most stories received a response from the service within 24 hours. 6. CONCLUSIONS 6.1 Previous reporting outlined our intention to create an Active Participation and Coordination remit, hosted by one lead organisation, which is now in place. This approach supports our ambition to: Involve people in the decisions that affect their wellbeing. Utilise feedback on the experiences of people to improve our services. Design services and supports based on what matters to people. Ensure a person-centred approach that follows the principles of Getting it Right for Everyone 6.2 This increased focus and additional investment, following our last report to Committee has helped develop our overall approach to promoting engagement and participation and in ensuring the voices of supported people, carers and our communities are strengthened, which is highlighted in our strategy 2024- 27. 6.3 Communities, Carers and Supported People are engaged, included and represented to the extent they wish to be. 6.4 Better opportunities exist for under-represented and seldom heard people to participate and have their voices heard. 6.5 The principles of engagement and participation are fully embedded across all our structures.
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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 This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner n/a Choose an item. Yes ☐ No ☐ N/A ☒
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7.5 ENGAGEMENT & PARTICIPATION 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 Consultations with people and stakeholders to develop the Engagement and Participation strategy to localise the approach to the national outcomes. Critical friends’ meetings were facilitated with community representatives, carers, staff, and communities. Staff were consulted at various meetings including the roadshow and Strategic Programme Board meeting. ☒ Provide stakeholders with information on how to get involved. Communication and style of communication has been considered at every milestone opportunity to reflect developments and key stakeholders and audiences linked with to ensure maximum involvement. We have utilised the representation at the Strategic Engagement and Participation Working Group to disseminate information on getting involved. Engagement and Participation activity will be ongoing, and we will ensure that communication remains two way and information loop which will always be completed. We will ensure that stakeholders have opportunities through participatory self-appraisal, learning events, service reviews.
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☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Staff have started to create opportunities but will consider the method in which this is applied to ensure equal access. This strategy aims to ensure that a diverse range of engagement and participation opportunities that suit different needs can be created. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services The strategy will ensure that we measure success and what success looks like. The Strategic Engagement and Participation Working Group will ensure that this a priority. Success will take different forms but the feedback loop, to ensure we have knowledge of what matters to people, will be enhanced. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Part of the development of this strategy is to enhance continued communication throughout the partnership. Communication channels will be utilised and lead by the Corporate Communications representative at the SEPWG meetings. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings. To ensure that stakeholder representatives can participate meaningfully and confidently at meetings adequate support was offered prior to. Clear communication was provided stakeholders with relevant information in advance of meetings, including agendas, background materials, and any necessary context. This helped them prepare and contribute effectively. We created a welcoming and inclusive environment that values the contributions of all. We provided resources such as meeting facilities.
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☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Clear goals were set with achievable timescales decided as a collective at the SEPWG meeting. A checklist for E&P to support people and staff with Engagement and Participation is being co- produced as a resource to ensure consistency in the approach for E&P across the partnership. The strategy will be the high-level reference to support people facilitate meaningful engagement across services and supports. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership There is a flow of communication around agreed actions in response to engagement participation. Linkage to work with the community boards and LOIPS has been considered. Action planning will see this further explored and improved in collaboration with teams. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA completed but not attached to report. EQIA added to website: EQIA will be made available following the launch of the strategy. Yes ☒ No ☐ N/A ☐
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8. BACKGROUND PAPERS N/A 9. APPENDICES Appendix 1Engagement & Participation Strategy 2024 – 2027 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Maria Williamson, Senior Manager, Quality Assurance, williamsonm@northlan.gov.uk Yes / Date added ☐ No ☒ N/A ☐
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Appendix 1 (Review date Oct 2025) Foreword
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It is my pleasure to introduce our new Engagement and Participation strategy for University Health and Social Care Partnership North Lanarkshire. This strategy aims to empower our community members, practice, staff, and partners to actively participate in decision-making processes to shape the future of our services and supports. In amplifying the voices of people in North Lanarkshire, I am confident that we can create a collaborative and inclusive North Lanarkshire. Professor Ross McGuffie Chief Officer, University Health and Social Care North Lanarkshire What people said about the development of this strategy “We should not be making decisions without supported people being involved.” (UH&SC staff member) “People are more likely to be involved if they see their involvement leading to change” (Representative from partner organisation) “100 page documents? Need for breakdown and summary we like bite sized chunks!” (Representative from supported people and carers) What is University Health and Social Care North Lanarkshire (UHSCNL)? We are a caring and empowering partnership, dedicated to working with our communities to enable people across North Lanarkshire to lead independent, fulfilling, and healthier lives. We have established partnership agreements with a range of organisations. By enhancing and extending our work through these agreements we aim to develop sustainable, innovative, and practical solutions to health and social care challenges that directly benefit our communities and our workforce.
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Our Vision A culture of engagement and participation, with the people of North Lanarkshire, is embedded in all aspects of health and social care. By • Improving communication and increasing connections • Increasing awareness of what matters • Building the capacity for early intervention and prevention There will be strong voices influencing and shaping decisions that affect people- from individual care planning to strategic decision making.
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Everyone with an interest or part to play in improving wellbeing in North Lanarkshire. This includes supported people, people with lived experience, staff, volunteers, carers and the wider communities Engagement and participation is part of everything we do as part of community planning in North Lanarkshire. It ties in to all strategies, cuts across all areas of work and a people first approach. It is one of the programmes of work within the UHSCNL Commissioning Plan 2023-26. It will facilitate engagement, meaningful participation and support strong voices. Our Strategy will cover a three year period, 2024-27, with regular reviews and updates to ensure it continues to be relevant. Our Strategy will be implemented across North Lanarkshire, encompassing all health and social care services, partnerships, communities and people.
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Our Strategy will be implemented through a range of activities • learning and education for staff • the Communications Action Plan • involvement in service planning • commissioning and delivery • development of accessible information Action Plans for relevant areas of services and supports will incorporate the principles of this Strategy. Meaningful engagement and participation will help bring about improved wellbeing for people and more valued and effective ways of working, services and supports across University Health and Social Care NL.
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(Develop into a graphic) This Group (1) building from (2) affected by (3) engaged with (4) asking (5) to come up with (6) People • Direct the care and support people receive • A pply and develop skills, knowledge and experience • Are motivated to make a difference Builds trust , improves outcomes and leads to higher satisfaction. Practice Is b etter informed and there are improvements in • Person - centred practice and decision making • Assessment and planning • Outcomes • R e lationships Services and supports are • B etter targeted, more relevant, and appropriate • I nfluenced by f resh perspectives, new ideas and relevant experiences • M ore accountable The evidence base is informed by actual need UHSC NL A s hared vision supports • C lear planning • S tructured, co - ordinated and consistent approach • E fficient allocation of resources • C ultural change and active citizenship . The requirements of legislation, policy and strategic drivers are met .
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6. University Health and Social Care NL Engagement and Participation Strategy 5. We asked… How do we ensure meaningful engagement and participation? 5 . We asked… What are the barriers and enablers to engagement & participation in UHSC NL ? . 5 We asked… What more can we do to enable people to engage & participate meaningfully? 5 . We asked… What does positive change look like for UHSCNL in relation to engagement and participation? 1. Strategic Engagement and Participation Working Group N orth L anarkshire C ouncil NHS L anarkshire U niversity H ealth & S ocial C are N orth L anarkshire N orth L anarkshire C arers T ogether Scottish Care N orth L anarkshire D isability F orum V oluntary A ction NL Community Solutions 4. Partners Supported People Carers Communities People of NL Staff and Volunteers 3. Key Drivers National Outcomes The Plan for NL UHSC NL Strategic Commissi on ing Plan National Standards for Community Engagement Planning with People Equality Framework 2. Building from Engagement and P articipation S trategy 2021 - 24 Self evaluation Improvement planning Feedback and reflection
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18 National Standards for Community Engagement These standards were developed and promoted nationally and are important to us in NL because we want to: o create an approach where well-being and dignity are prioritised o ensure that the services and supports are person-centred, strength based and adapt to the unique circumstances of individuals and groups o facilitate a shared responsibility, encouraging everyone to work together towards common goals The framework for our strategy is based on the National Standards for Community Engagement. The views and opinions about engagement and participation were grouped around each of the National Standards. This has informed the key statements about how we will apply each standard
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19 Inclusion Making it easier for individuals, groups, and communities to express what matters and what is important. • Understand and address the barriers to active participation • Reach out and connect to diverse and underrepresented groups • Apply a range of methods and approaches that support inclusion • Offer support and alternatives, considering digital inclusion • People are recognised and respected as experts in their own lives Support Enabling individuals to live as independently as possible and empowering them to direct their own care planning and collective decision-making. • Seek, recognise, and develop opportunities to support engagement and participation • Support learning opportunities to further knowledge, understanding and application • Recognise and invest in resources to realise goals and ambitions o Time to connect, build relationships, share ideas, prepare methods, deliver, digest, and follow up o Staff to support connections, have conversations and overcome barriers for individuals o Space for people to come together in accessible places on their own terms o Funds to enable activities and programmes of work o Connections with skills, knowledge, organisations, and networks Planning Planning for engagement and participation is vital. It should ensure there is a clear purpose and shared ambitions. • Engagement and participation activities are planned the right way, as opposed to the quick way • People’s involvement, their ongoing journey and personal goals are supported • There is a shared understanding of what is being asked, why we are asking and what the endpoint is • Plan for closing the feedback loop
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20 • Communicate plans operationally and strategically to ensure oversight and coordination • Engagement and participation activity is shared within planning and reporting Working Together Collaborating with colleagues, professionals, supported people and carers to develop innovative solutions and a more integrated approach to wellbeing. • Make it clear what is expected and what can be achieved • People’s definition of needs, problems and solutions differ from those of professionals • Everyone’s contributions, experience and knowledge are valued and respected • Through involvement, people are empowered to learn, develop, and influence change • Barriers are identified and challenged; solutions are identified together • Integrate knowledge and expertise of appropriate individuals, groups, and organisations Methods Utilising a variety of approaches and engagement methods to ensure that everyone has an opportunity to participate in a way that suits them. • Seek, recognise, and develop opportunities to support engagement and participation at every point of contact • Target and link to those who are, or will be, affected by planned change • Utilise a range of approaches, tools, and methods to o work in ways that are accessible o find out what matters to people o achieve shared goals Communication Having clear and open communication reflecting the Standards and ensuring a shared understanding. • Ensure communication is timely, uses plain language, is culturally sensitive and available in accessible formats • Review communications to maximise opportunities to better engage and support participation
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21 • Strengthen our communication pathways to o Widen the reach o Communicate clear expectations o Share progress and feedback with those involved o What people have to say is heard by those who make decisions • Recognise and share achievements Impact Continuing to learn from actions taken and evidence of what works • What happened? • What was learned? • What changed as a result? • What was the impact on those involved? • What was the impact on our practice, services and supports? • What do we do now? To assess the impact • The variety and frequency of actions to embed engagement and participation into practice are assessed • Evaluation and reflective practice enable learning to be identified • Through evaluation we are aware of the impact for people involved • Through self-evaluation we are aware of how voices have influenced change • Quality Assurance processes include assessment of engagement and participation activity • Engagement and participation activity is apparent in reporting across UHSCNL structures • Increase in application of a co-production approach • Analysis of 6 monthly reporting on Comments, Compliments and Complaints • Quarterly reporting on Care Opinion • The Quality Framework (reference this) that includes self-evaluation of engagement and participation is applied
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22 What we mean when we say... Inclusion of definitions of terms used in the strategy (To be completed) Inclusion of electronic weblinks to stakeholder groups, strategies and plans (To be completed) Engagement and participation activities that target children and young people should be informed by our strategies, plans and guidance specifically for children and young people. North Lanarkshire Children’s Services Plan and the GIRFEC Website.
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23 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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1 REPORT Item No: 9 SUBJECT: Community Solutions Programme Update TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Maddy Halliday, CEO, Voluntary Action North Lanarkshire Author(s) of Report Maddy Halliday, CEO, Voluntary Action North Lanarkshire DATE: 22 May 2023 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: ☐ Maddy Halliday, CEO, Voluntary Action North Lanarkshire (VANL). 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA Committee: (1) Acknowledge the positive progress of the Community Solutions Programme during 2023-24. (2) Note that the Community Solutions Programme reach and impact data for 2023-24 is currently being analysed and the Programme’s 2023-24 Annual Impact and Learning Report will be available for the September meeting of the IJB, (3) Consider the issues set out below concerning increasing risks to the Community and Voluntary Sector’s (CVS) ability to deliver support in North Lanarkshire due to cost of living and funding challenges. (4) Endorse the North Lanarkshire Community and Voluntary Sector Fair Funding Charter appended to this report. (5) Agree that an EQIA is undertaken for the programme during autumn/winter 2024. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local 1
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2 Authority, the Health Board, to both, or that no direction is required Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Overview of the Community Solutions Programme 5.1.1 Community Solutions is a successful, cross-sector health and social care investment and improvement initiative, established in 2012. The programme’s aim is to improve people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources - with a focus on prevention and early intervention. 5.1.2 The programme is an innovative, effective, and respected partnership between: University Health and Social Care North Lanarkshire (UHSCNL) North Lanarkshire Children’s Services Partnership (NLCSP) NHS Lanarkshire The Scottish Government Voluntary Action North Lanarkshire the wider community and voluntary sector 5.1.3 The Community Solutions Strategy and Investment Plan 2022-25 was approved by the IJB in 2022 and delivery of which is supported through the following governance arrangements are supported as follows. Six Locality Consortia, convened and supported by the six Locality Hosts. A partnership Governance Group, convened and supported by VANL, with members including: o council and NHS staff o representatives of the locality hosts and consortia o representatives for carers and service users o VANL’s CEO and a trustee representative Participation in UHSCNL Strategy Leadership Team meetings and Integrated Joint Board (IJB). 5.1.4 Programme evaluation and accountability is supported through the following: A robust Performance Management, Evaluation, Learning and Improvement Framework and process that measures reach and impact and supports ongoing learning and improvement by funded projects and more widely. This also supports UHSCNL Human Learning Systems approach. Publication of Annual Programme Impact and Learning Reports and Impact and Learning Reports for specific funds Updates to IJB PFA and formal annual reports to IJB in autumn each year Formal reports to other funders Reporting to North Lanarkshire Council’s Adult Care and Social Work Committee, with the first report considered at its May 2024 meeting. 2
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3 5.2 Community Solutions Progress 2023-24 5.2.1 Between April 2023-and March 2024, VANL managed just over £4 million in funding for the programme, on behalf of several funders including: University of Health and Social Care North Lanarkshire (recurrent programme funding and fixed term funding for several initiatives including Community Connectors pilot) North Lanarkshire Council (Children and Young People’s Mental Health and Wellbeing Fund) Scottish Government (Communities Mental Health and Wellbeing Fund) 5.2.2 This funding supported delivery of the following, complementary elements of the programme during 2023-24, as outlined below. The Programme’s Annual Impact and Learning Report will be available in Sept. 2024 which will provide comprehensive information on the following: Funded projects reach and outcomes Capacity building work Programme improvements 5.2.3 This annual report will also be supplemented by the programme’s 2023-24 Finance report and 2024-24 budget. 5.3 Larger Funding Awards to Community and Voluntary Sector Organisations 5.3.1 Provision of funding awards to Community and Voluntary Sector (CVS) organisations during 2023-24 to deliver services to local people on a range of priority issues including those listed below, which is managed by VANL on behalf of funders and with support of partners: Anticipatory Care Support * Befriending Support * Carer Breather Fund - Phase Two Children, Young People and Families Mental Health and Wellbeing Fund - Phase Four Community Mental Health and Wellbeing Fund - Phase Two Community Transport * Hospital Discharge Support * 5.3.2 A review of several thematic funds (*) was scheduled for 2023-24. However, progress was delayed due to staffing capacity issues in VANL between Oct. 2023 and April 2024. This work has now been restructured to include an intense development programme involving external support from a charity “The Lens,” during May 2024. This work will explore the following areas and develop updated investment proposals, which will improve health, wellbeing, and inclusion, whilst reducing demand on public services: Our Community Connectors’ pilot scheme (see below). Continuation of our effective support for people discharged from hospital 3
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4 provided by the CVS. Support for unpaid carers – especially short breaks from caring – which is already demonstrating benefits. Strengthening CVS support for physical activity given the significant benefits to health that can be achieved through physical activity and the potential for the CVS to provide further support. Strengthening volunteer driver support for people attending health and social care appointments, to support access and inclusion more cost-effectively. Review of anticipatory care and befriending will be supported through a separate complementary process during summer/autumn 2024. 5.4 The Improving Lives Initiative 5.4.1 In February 2022 UHSCNL agreed an additional, fixed term investment through the Community Solutions Programme of £1.2 million to support community- based prevention and early intervention activities. In addition: UHSCNL and NHS Lanarkshire had secured in principle agreement with MacMillan Cancer Care for funding to support improved support for people with cancer across Lanarkshire NHS Lanarkshire, with support from VANL, had secured funding through NHS Charities Together to support further progress on social prescribing in North Lanarkshire. These funds were combined to establish the “Improving Lives Initiative” (ILI) – to be delivered through the Community Solutions programme in North Lanarkshire. 5.4.2 A proposal was collaboratively developed during 2022 by and with senior staff at VANL and UHSCNL with members of the Community Solutions Governance Group, Locality Hosts and others. This proposal was agreed in late 2022, with implementation commencing from April 2023. 5.4.3 The focal point of ILI is a pilot of Community Connectors using the “three conversations” approach to assist people in crisis to help them find support from community and voluntary groups and, if appropriate, refer them to sources of support from the public sector. This includes people with a diagnosis of cancer. 5.4.4 Ten connector posts are funded for two years through ILI. These posts are employed by North Lanarkshire Disability Forum, which has considerable relevant experience having previously employed advisors to assist people with self-directed support for over six years with national funding. Unfortunately, due to some challenges in reaching final agreement with MacMillan Cancer Care around the Connector posts, recruitment could not commence until summer 2023. However, the majority of Connector posts were filled by autumn 2023. 5.4.5 In addition to funding the ten Community Connector posts, the ILI funding also provides: Additional funding to the six Community Solutions Locality Hosts to promote the Community Connector service in their localities and provide other support to the Connectors. Additional funding for the six Locality Activity Funds Development and co-ordination funding to VANL 4
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5 5.4.6 To improve access to information about CVS support in North Lanarkshire, VANL is also supporting use of A Local Information Service for Scotland (ALISS). The Connectors will use ALISS to find sources of support for the people they are assisting. ALISS is also accessible to the general public to use as well as CVS staff and volunteers and UHSCNL staff. 5.4.7 Early progress reports from the Community Connectors indicates the approach is working well, with more comprehensive information available in autumn 2024. 5.5 Small Grants to Community and Voluntary Sector Organisations 5.5.1 The programme’s Local Activity Fund (LAF) provides small grants of up to £5,000 to local groups to support delivery of improved support for residents. LAF is managed by the six Community Solutions Locality Consorti and Hosts, with support from VANL 5.5.2 During 2023, new LAF Guidance was developed by VANL with Locality Hosts and the Governance Group and was issued in November 2023 to strengthen LAF management. 5.6 Capacity Building Carers’ Capacity Building 5.6.1 The programme provided a grant to North Lanarkshire Carer’s Together to support empowerment and engagement of carers in various ways, through a Carer’s Network and in other ways. Community and Voluntary Sector Capacity Building 5.6.2 The programme provided funding to VANL to support provision of specialist guidance to CVS organisations so they are more effective in delivering their Community Solutions funded work and in securing funding from other sources. This includes guidance on key issues such as governance, income generation, finance, HR, evaluation. Capacity Building Support for CVS Organisations Supporting Children, Young People and Families 5.6.3 The programme provides funding to VANL to support provision of specialist guidance to CVS organisations that assist children, young people and families. In addition to provision of the above organisational support, this also includes convening and a North Lanarkshire CVS Children Young People and Families Network which facilitates sharing of good practice, joint working and contributions to cross-sector working on key issues such as tackling child poverty, breast-feeding and mental health. Volunteering Capacity Building 5.6.4 The programme provided funding to VANL to support volunteering including: promotion of volunteering to increase the number of volunteers in health and social care support roles liaison with volunteer-involving organisations to increase the number of health and social care volunteer roles and to improve their volunteer management and support 5
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6 support to match volunteers to available roles 5.6.5 To support the above work, VANL also convenes the North Lanarkshire Volunteering Partnership to facilitate cross-sector working to implement our North Lanarkshire Volunteering Strategy, agreed by IJB in 2023. 5.7 Improvements to Programme Governance, Management and Support Locality Governance and Support 5.7.1 During 2023-24 VANL staff worked with members of the Programme’s Governance Group, Community Solutions Locality Hosts and consortia members to develop, agree and implement the following improvements: Clarification in the funding award letter for Locality Hosts that they also needed to support improved links between their support for Community Solutions and Community Planning in their locality. This was complemented by improved liaison between VANL staff supporting the programme and VANL staff supporting Community Planning and locality level. Improved Terms of Reference for Locality Consortia, implemented from November 2023 Updated membership guidance issued in November 2023, with refreshed membership completed for each consortia by end of March 2024. Updated LAF guidance issued in November 2023. Programme Management and Support 5.7.2 Improvement in the programem management and support has focused on: Development and agreement of a first SLA between VANL and North Lanarkshire Council for UHSCNL for the recurrent funding element for the Community Solutions Programme for 2023-25. This is supplemented by several “call of contracts” for fixed term funding. Development and agreement of a new SLA between VANL and NHS Lanarkshire for the Improving Cancer Journey funding. Implementation of the improved programme Performance Management, Evaluation, Learning and Improvement Framework, including development and publication of improved resources for funded projects and use of Care Opinion by funded projects. Development of a new Community Solutions website during 2023, with launch in March 2024. Strengthening of VANL’s funding management processes and data management. Development and agreement of a Community Solutions Feedback and Complaints Procedure. 5.8 Challenges Complaints 5.8.1 Between summer and autumn 2023, three complaints were submitted to VANL regarding the Programme’s Locality Host in Airdrie. These complaints were thoroughly and fairly investigated by a mix of designated VANL staff and an 6
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7 independent investigator commissioned by VANL. The complaints against the locality host were not upheld, with the exception of one aspect of one complaint regarding a process issue. The latter was partially upheld because the process failing was not due to the locality host but inadequate guidance to them through the programme – now corrected with the locality improvements cited above. 5.8.2 In December 2023, one complainant lodged a supplementary complaint against VANL for the delay in progressing the investigation into their complaint regarding the Airdrie Locality Host. This was upheld, with an apology and explanation provided in that the delay was due to the fact VANL staff were already investigating two other complaints submitted earlier and had staffing capacity issues. This was addressed by commissioning an independent investigator to complete their complaint. VANL Staffing 5.8.3 VANL experienced capacity challenges in its core Community Solutions team during 2023-24 due to sick leave and departure of two key members of staff. Three temporary posts have been recruited to provide necessary capacity between April 2024 and March 2025. A fuller review of VANL staffing needs to support delivery of the programme will commence in autumn 2025, linked to negotiations around the new SLA. 5.9 Looking Ahead to 2024-25 5.9.1 The core elements of the Community Solutions programme as set out above will continue to be delivered during 2024-25 with funding already in place until March 2025 - namely the: Improving Lives initiative pilot thematic funds Local Activity Fund Capacity building 5.9.2 VANL will continue to provide support for programme management evaluation, learning and improvement. 5.9.3 Proposals for future funding for the Community Connectors and key thematic issues beyond March 2025 will be developed through the process supported by “The Lens” and other reviews, as outlined above, with the aim of securing agreement on future funding from April 2025. 5.9.4 Recurrent funding for the Community Solutions Locality Hosts, Local Activity Fund, Capacity Building and VANL’s programme support role will be reviewed with UHSCNL colleagues from autumn 2024, with a view to securing agreement on a new SLA by April 2025. 5.10 Risk and Funding Issues for the Community and Voluntary Sector 5.10.1 The CVS is a vital part of our health and social care system and provides highly cost-effective support spanning prevention, early intervention, crisis and recovery and ongoing support. This has long been recognised by UHSCNL, which is why it has invested in the Community Solutions programme over the last 12 plus years, providing much-needed and welcome investment in our CVS 7
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8 to enable provision of cost-effective support and services to local people. However, Community Solutions provides project funding and so funded organisations also need to secure other funding to cover their general running costs. 5.10.2 There has been significant growth in the total funds awarded through the programme in the last two years due to the ILI fund and the Scottish Government Communities Mental Health and Wellbeing Fund. However, there has been very modest increase in the recurrent funding for the programme since it was established 12 years ago – c4% between 2022-24 - which, given inflation, is a significant cut in real terms. 5.10.3 More generally, the CVS, as for the public sector, is struggling with significant increases in operating costs in the last two years. This, combined with increasing demand for its services and inadequate funding overall, means the viability of many CVS organisations of all types and sizes, is at risk. Increasing numbers of CVS organisations are closing, are at risk of closing or are reducing their services. This applies to organisations of all sizes including large national charities and smaller community organisations. 5.10.4 In addition, because funding for the CVS by the public sector is classified as “discretionary” rather than statutory, at a time of pressure, removing or reducing funding from the CVS could be seen as an easy option, leading to greater demand on more expensive public sector services. North Lanarkshire IJB’s ongoing commitment to mainstreaming funding to VANL is imperative to the sector’s continued stability. 5.10.5 Also, where the CVS are providing “public services,” it is only fair that they receive adequate funding to do this. VANL worked with the CVS in North Lanarkshire during 2023 to develop a “Fair Funding” Charter which we launched in November 2023. (Our work also informed national agreement on shared principles of Fair Funding with the other 31 Third Sector Interfaces (TSIs) in Scotland who have launched their own local Charters. This is complemented by joint work between TSIs and Scottish Council for Voluntary Organisations (SCVO) to promote fair funding principles through government.) 5.10.6 VANL is formally sharing the North Lanarkshire Community and Voluntary Sector Fair Funding Charter with the PFA Committee for consideration, with a view to referring to the IJB for formal endorsement. 6. CONCLUSIONS 6.1 This report provides an overview of the positive progress delivered through the Community Solutions programme during 2023-24 with the annual report providing more comprehensive data on reach and impact to following in autumn 2024. 6.2 The report also summarises continuing delivery of committed work during 2024- 25 and plans to review future commitments beyond March 2025. 6.3 The report also sets out the significant and increasing risks to CVS capacity to continue 8
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9 to deliver its vital services and presents the North Lanarkshire Community and Voluntary Sector Fair Funding Charter for initial consideration by the PFA 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 ☒ 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) Please see details of governance arrangements for the Community Solutions in section 5.3.1 above. 7.3 FINANCIAL The following financial information on the Community Solutions Programme will be available in June 2024. 7.3.1 Community Solutions Programme Finance Report 2023-24 9
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10 7.3.2 Community Solutions Programme updated budget 2024-25 This paper has been reviewed by Finance: Yes No X N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Funding risks to the Community and Voluntary Sector Very High Senior management, Health and Social Care Senior A new high risk is also proposed relating to continuing funding for the Community Solutions programme from April 2025, given current funding agreements with HSCNL and other funders end in March 2024 and need to be renegotiated from autumn 2024 at a time when UHSCNL and other funders have significant financial pressures. 10
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11 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 The Community Solutions is a collaborative initiative involving multiple stakeholders in work which contributes to achievement of national outcomes. ☒ Provide stakeholders with information on how to get involved The Community Solutions provides information to stakeholders in multiple ways including: the Community Solutions website quarterly Community Solutions ebulletins through meetings and events ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs. The programme supports involvement of people who use services and carers in various ways including: consultation and other engagement activities through funded projects to assess needs and preferences networking, e.g. through the Carers’ Network participatory evaluation with people who use services funded by the programme ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services. CVS organisations applying to the programme for funding are asked to clarify how they have involved people who use services and/or carers in developing their proposal and/or in delivery. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery. Funded projects are asked to provide information on stakeholder engagement and participation as part of their project evaluation. 11
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12 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings. The Community Solutions Governance Group membership has expanded to include representatives of people who use services (from May 2024) who will be supported by VANL staff to participate in meetings effectively. VANL staff will also work with Locality Hosts to strengthen participation in locality meetings by carers and people who use services. ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff. The Community Solutions will promote and use guidance provided through UHSCNL and also support implementation of the forthcoming North Lanarkshire CommUnity Agreement, launched on 29th April 2024. The latter was collectively developed by North Lanarkshire Partnership partner organisation with the CVS. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership. The Community Solutions programme is supported by six locality consortia with membership including representatives from Community and Voluntary Sector organisations who also engage more widely with people who use services and carers. VANL is working with Locality Consortia and hosts to strengthen links to Community Planning at locality level. 12
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13 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No X N/A EQIA added to website: Yes No X N/A 8 BACKGROUND PAPERS 8.1 Community Solutions: please see the programme’s website for further information 8.2 CVS and Fair Funding: Please see Voluntary Action North Lanarkshire website for more information. 9 APPENDICES Appendix 1 North Lanarkshire Community and Voluntary Sector Fair Funding Charter CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Community Solutions: Thomas.moan@vanl.co.uk Fair Funding Charter: Kirsty.struthers@vanl.co.uk 13
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2 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Appendix 1 North Lanarkshire Community and Voluntary Sector Fair Funding Charter VANL (SCIO) is registered as Scottish Charity no. SC041224 Launched November 2023 14
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3 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter This charter sets out the principles of Fair Funding for the community and voluntary sector (CVS) in North Lanarkshire and across Scotland. The purpose of the charter is to increase understanding of the CVS’ funding support needs and improve funding provision and arrangements by public and other bodies that provide grant and other funding to our sector. Local Endorsement and Support We invite all public and other organisations which provide funding to the sector in North Lanarkshire to endorse the principles of this charter set out below, to demonstrate their commitment to implementing these fair funding principles within an agreed, reasonable timeframe. Where Voluntary Action North Lanarkshire (VANL) manages distribution of funds to the CVS on behalf of other funders, VANL will work with these funders to comply with the principles in this charter. Background Community and Voluntary Sector The CVS (also known as the Third Sector) consists of community groups, charities, development trusts and social enterprises. There are an estimated 45,000 CVS organisations across Scotland, with over 1,000 in North Lanarkshire, which provide a wide range of support and services for people of all ages and equality groups and for people and communities with diverse needs and issues. Our CVS helps to prevent problems arising; provides early and crisis support, as well as longer term assistance. The sector delivers high-value, impactful, cost-effective services in every community in North Lanarkshire and across Scotland, complementing those provided by statutory bodies such as the NHS and local authorities. (See Appendix for more information about the CVS in North Lanarkshire.) Local and National Development Our North Lanarkshire Fair Funding Charter was developed by Voluntary Action North Lanarkshire (VANL) in collaboration with the North Lanarkshire CVS Partnership Group and wider consultation with our local CVS. The draft text for our North Lanarkshire Fair Funding Charter supported discussions on fair funding at national level through the Third Sector Interface Network * and SCVO. The final text in our North Lanarkshire charter was informed by these national discussions and each TSI is now promoting the same Fair Funding principles in their area and this also supports SCVO’s national Fair Funding campaign. This collective effort will help us achieve Fair Funding for our vital and essential CVS. *VANL is a member of the TSI Network, which is made up of 32 TSIs in Scotland - one for each local authority area. Each TSI supports their local CVS, volunteering and partnership working with the public sector. Purpose 15
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4 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter 1. A Strategic Investment Approach Public sector organisations in North Lanarkshire should take a “strategic investment” approach to the North Lanarkshire CVS in recognition of its significant and cost-effective contribution to supporting improved quality of life and wellbeing; advancing equality and human rights; supporting community wealth building and action to tackle the climate and nature emergencies. And, through this contribution, supporting delivery of our Plan for North Lanarkshire; Local Outcome Improvement Plans; and linked strategies such as our: Action on Climate Together Plan Economic Regeneration Delivery Plan and linked Social Enterprise Framework Tackling Poverty Strategy Health and Social Care North Lanarkshire's Commissioning Plan and linked Community Solutions Strategy and Investment Plan NHS Lanarkshire Strategy Lanarkshire Mental Health Strategy A “CVS strategic investment” approach by the public sector involves the following: Pro-active, recurring and co-produced consultation and consideration as to whether certain public services could be effectively delivered by the CVS directly or in partnership with the public sector. Resource allocation decisions can be identified through effective public engagement and community planning processes, which must include CVS organisations; An appropriate commissioning process in accordance with Principle Two (below) – which, depending on the circumstances, may involve different approaches such as: open, competitive commissioning joint, partnership or collaborative commissioning involving several parties direct commissioning from an identified provider to meet specific, unique requirements Service users/beneficiaries are involved in co-designing and evaluating the commissioned service or activity Appropriate evaluation and reporting arrangements are agreed to provide accountability to the funder and the public, in accordance with Principle Four (below) Ongoing learning is supported to inform improvements to the commissioned service and more widely The funding provided is sufficient and secure in accordance with Principle Three (below). Principle One: 16
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4 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Accessible, Proportionate and Transparent Funding and Commissioning Processes Public sector and independent funders should provide accessible, proportionate, and transparent funding and commissioning processes by ensuring: their funding and commissioning opportunities are publicised appropriately clear guidance is available on what is required for funding applications, service proposals or bids information on how and when decisions will be made is provided funding applications, proposals or bids only require a level of detail proportionate to the funding – for example, smaller funding awards requiring less detail sufficient time between the opening and closing dates is provided to allow organisations time to prepare and submit their applications, proposals or bid clear processes for managing the end of contracts - giving a minimum of three months’ notice if funding is not to be continued to support fair and effective workforce planning. 2. Principle Two: 17
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5 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Adequate and Secure Funding Public sector and independent funders - whether they are delivering grant or ‘fee for service’ funding - should provide adequate and secure funding based on full cost recovery.* This should include the following. Sufficient funding to cover the full costs of the agreed work, including legitimate overhead costs and provision for annual increases in line with inflation; or an agreed contribution to the cost of the work if they are not the sole funder. Funding of sufficient duration. At least three years for “core” grant funding and delivery of ongoing services, or sufficient funding to cover the duration of fixed-term projects and activities. * Full Cost Recovery means recovery all the costs involved in running a project or service - direct costs such as staffing and indirect costs such as a proportion of the organisation’s overheads. Funders should fund direct and proportionate indirect costs that a CVS organisation incurs in delivering a project or service. Where there is a cap on the level of FCR overhead costs, we would encourage 20%. CVS, volunteering and partnership working with the public sector. 3. Principle Three: 18
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6 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Proportionate Evaluation and Reporting to Funders Public sector and independent funders should help the CVS organisations they fund to assess and report on the reach and impact of the work they are funded to do, in a proportionate and supportive way. The funding award should cover evaluation and reporting costs in addition to delivery costs. Evaluation and reporting requirements should be proportionate to the level of funding provided, with smaller awards requiring less in-depth reporting. Clear guidance should be provided on evaluation and reporting requirements - either at the application stage or once the funding has been agreed. 4. Principle Four: 19
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7 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Understanding the Community and Voluntary Sector What is it? The community and voluntary sector (CVS) refers to organisations that have a social purpose, do not operate for profit and are not the public or statutory sector. CVS organisations may generate a surplus and own asset but this must be used to support delivery of the social purpose of the organisation. The CVS is also known in Scotland as the “third sector” or “charity sector”. The term community and voluntary sector is used here as it is more descriptive and does not imply a hierarchy between the CVS, statutory and business sectors. (The latter being the first and second sectors – even though this term is not used for these sectors!) There are around 1,000 different CVS groups in North Lanarkshire Background 20
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8 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter The CVS in North Lanarkshire is large and diverse with around 1,000 different groups and organisations of different types and sizes, which provide a wide range of support and services. Local community groups, many run entirely by volunteers, often with little funding and often not registered as a charity. Despite their small size, such groups provide vital support to local people including: community lunch clubs; larders and food banks community sports groups play and toddler’s groups children and youth groups – some of which are branches of national charities such as Guides and Scouts. Small, medium and larger charities, which usually employ staff, involve volunteers and rely on regular and adequate funding, some of which may come from trading. This includes local charities and branches of regional and national charities. Churches are often registered charities. Further Education Colleges are also registered charities but are also funded by government and must operate within government regulations and guidance. “Social enterprises” – which are effectively “not-for-profit businesses” providing socially useful products and/or services. Some trading charities are effectively social enterprises but may not refer to themselves in this way. Housing associations and co-operatives are also a type of social enterprise but may not use this term and are regulated by specific legislation. Despite its diversity, the CVS is mostly small and local – it is of and for the community and supports “community wealth building”, community empowerment and participation. The term “voluntary” can be confusing as many CVS organisations employ paid staff as well as involve volunteers - as trustees and in service delivery or support roles. Also, all CVS organisations require some level of income to enable them to deliver their activities and achieve their purpose even if they do not employ staff. Local Community Groups Charities Social Enterprises 21
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9 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter The CVS in North Lanarkshire provides highly cost-effective “public services”, complementing those provided by public or statutory bodies such as the NHS and the council. The CVS provides a wide range of support and services for all ages and equality groups; and on diverse needs and issues. The sector help to prevent problems arising; provide early and crisis support when problems arise as well as longer term support. Employability and financial support for example through specialist employability charities like Routes to Work and Citizens Advice Bureaux Education and learning through New College Lanarkshire, community groups and charities Affordable goods through charity shops Environmental action for example through community environmental groups Examples of the support provided by North Lanarkshire CVS include: Community support through churches and faith-based charities Social housing through housing associations and co-operatives Health and social care services including residential and home care and community support such as befriending and community transport Strengths and Assets 22
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10 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter CVS organisations are set up by passionate, committed citizens who want to address a challenge and help make things better. Whilst CVS organisations’ mission and focus vary, they have a positive purpose of improving either human, environment and/or animal wellbeing. Most CVS organisations in North Lanarkshire are community-based with a focus on helping local people and support key values such as: Person-and community-centredness and responsiveness Community and user empowerment Inclusion, equality and human rights Some or our CVS organisations have a focus on environmental issues to improve bio-diversity and support climate action. Increasingly, other CVS organisations which do not have a primary environmental purpose are recognising their responsibility to operate in ways which protect the natural environment and help tackle the climate emergency. Mission-led and value-based 23
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11 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter CVS organisations provide positive social benefits and great value for money. The majority are well-run - with many fulfilling a range of legal and regulatory requirements and providing clear publicly accountability. Indeed, charities are more heavily regulated than many business organisations! All registered charities in Scotland must be run in accordance with charity law and other legal requirements and provide annual reports with financial information to the Office of the Charity Regulator (OSCR). Charities with income over £500,000 a year and/ or assets over £2.8 million must have an independent audit whilst those with income between £100,000 and £499,00 must have an Independent Examination. Also, most social enterprises in Scotland support the Scottish Social Enterprise Charter. Charities income over £500,000 pa or assets over £2.8 million between £100,000 and £499,000 pa The CVS is committed to achieving positive outcomes for service users, communities and wider society and many evaluate and report on the reach and benefits of their activities and services. For example: Many CVS organisations capture and share evidence to demonstrate their impact – in North Lanarkshire for example, all CVS organisations receiving funding through the Community Solutions programme are supported to provide regular evaluation reports CVS organisations providing formal health and social care services such as home or residential care, must be registered and assessed by the Scottish Care Inspectorate and regularly receive high assessment scores – commonly higher than public or private sector providers Increasing numbers of Scottish Charities follow the Scottish Code of Good Governance Practice Further Education Colleges are assessed through Education Scotland Increasing numbers of CVS organisations that employ staff are accredited through Investors in People and those that involve volunteers are increasingly accredited through the Volunteer Friendly scheme Increasing numbers of Scottish Charities follow the Scottish Code of Good Governance Practice. Our sector’s values mean most CVS organisations are keen to support fair work practices, however, our sectors’ long term funding challenges have prevented many from formal adoption of the living wage. CVS organisations often work collaboratively with other organisations to achieve common goals more effectively - within the CVS and/or with the public sector and business sector. The Community and Voluntary sector is effective, efficient and the foundation of civic society. independent examination independent audit Reach and Benefits 24
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12 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Income Needs As for any organisation, CVS organisations need sufficient income to function and achieve their purpose. For smaller community groups this may be relatively modest funding to support volunteers and pay for facilities, activities and goods. For example a volunteer lunch club will need to find income to cover: Larger CVS organisations will usually need a higher level of income to cover ongoing, core operating costs such as office costs and key staff costs and also - depending on their purpose and activities - may need income to support the direct costs of providing services or running activities. Income Sources CVS organisations secure their income from one or more of the following sources: Public donations Grants from the statutory sector and independent funding trusts Income Fees for services provided on behalf of the public sector, usually through a Service Level Agreement Trading income from selling goods and services Agreement Local Good Practice Highlight The North Lanarkshire Community Lottery was set up in 2022 to help raise public donations for our local CVS, especially for smaller, organisations which can find it very difficult to raise income given they are usually run entirely by volunteers and their profile is smaller. Volunteer travel costs Venue hire Food CVS Income 25
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13 North Lanarkshire Community and Voluntary Sector - Fair Funding Charter Income Challenges The CVS has to work very hard to secure its income which - for the majority of CVS organisations - is fragile and inadequate. Most CVS organisations struggle with insecure and inadequate income - made worse by the current cost of living crisis, with expenditure increasing and income falling. Grant Income Grant income remains an important source of income for the CVS and this comes from two main sources: the public sector – for example the Scottish Government, local councils and NHS independent funders such as charitable trusts Securing sufficient grant funding is very challenging for all CVS organisations due to three major challenges. Insufficient availability of grant funding public sector grant funding for the CVS has remained static or reduced over the last decade applications to funding schemes are often massively over-subscribed with many CVS organisations competing for access to the same source of funding, with many unsuccessful despite good funding applications Inadequate grant awards Even where a CVS organisation is successful in securing a grant award, the amount is often insufficient to fulfil or contribute to legitimate delivery costs; the duration of the funding is often only for one year; and where a grant is for more than one year, provision for inflation is rarely made Burdensome application and reporting requirements Many CVS organisations spend a great deal of time applying for funding and reporting to funders, using scarce resources to do so, which takes time away from providing their services and activities to achieve public benefit. Income for Commissioned Services Some CVS organisations receive “fee for service” income from the public sector to provide public services through a contract or “service level agreement” (SLA). SLAs are usually secured through a competitive tendering process although some are directly commissioned. SLAs usually cover a three- or five-year period with annual review. However, they may not always provide sufficient income to cover real delivery costs or cover inflationary costs over the duration of the contract. Also, public bodies often use competitive tendering when a strategic, collaborative commissioning approach may be more appropriate. 26
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REPORT Item No: 10 SUBJECT: Audit Scotland Annual Audit Plan (AAR) 2023/24 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Fiona Owens Audit Scotland DATE: 22 May 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides the Annual Audit Plan 2023/24 from Audit Scotland, the IJB’s appointed external auditors. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Audit Scotland ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA Committee: (1) Acknowledge the Annual Audit Plan 2023/24 at Appendix 1. 4. VARIATIONS TO DIRECTIONS Yes No N/A 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Accounts Commission appointed Audit Scotland as the IJB’s external auditor for the five-year period from 2022/23. 5.2 Audit Scotland’s Code of Audit Practice and International Standards on Auditing stipulate that areas to be examined and expected outputs to be produced by the external auditors require to be outlined each year in their annual planning document. 6. CONCLUSIONS 6.1 The formal Annual Audit Plan has now been completed and is at Appendix 1. 6.2 The plan provides an overview of key issues arising from the audit planning process including a summary of the proposed audit approach, consideration of key audit risks, how wider audit scope work will be carried out and a timetable for key audit outputs. 1
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6.3 Committee members should note that good professional practice requires the external auditor to communicate and discuss planned external audit activity with the senior management of a body and with those elected members charged with governance matters, but it is for the external auditor alone to determine the work considered necessary to fulfil their responsibilities. 7. IMPLICATIONS 7.1 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 ☒ 7.2 ASSOCIATED MEASURE(S) A comprehensive performance framework is established across the health and social work partnership to monitor progress in respect of the achievement of agreed outcomes. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 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. 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 □ Provide stakeholders with information on how to get involved 2
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□ Ensure a diverse range of engagement and participation and opportunities are in 3
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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 Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1- Audit Scotland Annual Audit Plan 2023/24 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk 4
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Appendix 1 North Lanarkshire Integration Joint Board Annual Audit Plan Prepared for North Lanarkshire Integration Joint Board March 2024 5
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Annual Audit Plan | 2 Contents Introduction 3 Annual accounts 5 Wider Scope and Best Value 9 Reporting arrangements, timetable, and audit fee 10 Other matters 13 6
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Introduction | 3 Introduction Summary of planned audit work 1. I, John Boyd, have been appointed by the Accounts Commission as external auditor of North Lanarkshire Integration Joint Board (North Lanarkshire IJB) for the period from 2022/23 until 2026/27. The 2023/24 financial year is therefore the second of my five-year audit appointment. 2. This document summarises the work plan for my 2023/24 audit. The main elements of the audit include: an audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement an audit opinion on other statutory information published with the financial statements in the annual accounts including the Management Commentary, the Governance Statement, and the Remuneration Report consideration of arrangements in relation to wider scope areas: financial management; financial sustainability; vision, leadership and governance; and use of resources to improve outcomes consideration of Best Value arrangements review North Lanarkshire IJB’s arrangements for preparing and publishing its Annual Performance Report. Respective responsibilities of the auditor and Audited Body 3. The Code of Au d it P ractice sets out in detail the respective responsibilities of the auditor and the North Lanarkshire IJB. Key responsibilities are summarised below. Auditor responsibilities 4. My responsibilities as appointed auditor are established by the Local Government (Scotland) Act 1973 and the Code of Audit Practice (including su p p lemen ta ry g u ida nce ) and guided by the Financial Reporting Council’s Ethical Standard. 5. Auditors in the public sector give an independent opinion on the financial statements and other information within the annual accounts. We also review and report on the wider scope arrangements in place at the North Lanarkshire IJB. In doing this, we aim to support improvement and accountability. 7
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Introduction | 4 North Lanarkshire IJB and Chief Officer responsibilities 6. North Lanarkshire IJB is responsible for maintaining adequate accounting records and internal controls, and preparing financial statements for audit that give a true and fair view. They are also required to produce other reports in the annual accounts in accordance with statutory requirements. 7. North Lanarkshire IJB has the primary responsibility for ensuring the proper financial stewardship of public funds, compliance with relevant legislation, and establishing effective arrangements for governance, propriety, and regularity that enable them to deliver their objectives. Adding Value We aim to add value by: tailoring audit work to the circumstances of North Lanarkshire IJB and the audit risks identified; being constructive and forward looking; providing independent conclusions; attending meetings of the Performance, Finance and Audit Committee; and by recommending and encouraging good practice. In so doing, we will help North Lanarkshire IJB promote improved standards of governance, better management and decision making, and more effective use of resources. 8
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Annual accounts | 5 Annual accounts Introduction 8. The annual accounts are an essential part of demonstrating North Lanarkshire IJB’s stewardship of resources and its performance in the use of those resources. The appointed auditor is required to perform an audit of the financial statements, consider other information within the annual accounts, and express a number of audit opinions in an Independent Auditor's Report in accordance with International Standards on Auditing (ISAs) in the UK, Practice Note 10 from the Public Audit Forum which interprets the ISAs for the public sector, and guidance from Audit Scotland. Our audit focuses on the areas of highest risk. As part of our planning process, we perform a risk assessment highlighting the audit risks relating to each of the main financial systems relevant to the production of the financial statements. Materiality The concept of materiality is applied by auditors in planning and performing the audit, and in evaluating the effect of any uncorrected misstatements on the financial statements. We are required to plan the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. The assessment of what is material is a matter of professional judgement over both the amount and the nature of the misstatement. Materiality levels for the 2023/24 audit 9. We assess materiality at different levels as described in Exh ibit 1 . The materiality values for North Lanarkshire IJB are set out in Exh ibit 1 Exhibit 1 2023/24 Materiality levels for North Lanarkshire IJB Materiality Amount Planning materiality – This is the figure we calculate to assess the overall impact of audit adjustments on the financial statements. Materiality has been set based on our assessment of the needs of the users of the financial statements and the nature of North Lanarkshire IJB operations. For the year ended 31 March 2024, we have set our materiality at 2% of gross expenditure based on the audited financial statements for 2022/23. £14.7 million Performance materiality – This acts as a trigger point. If the aggregate of errors identified during the financial statements audit exceeds performance materiality, this could indicate that further audit procedures are required. Using our £11.025 million 9
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Annual accounts | 6 professional judgement, we have assessed performance materiality at 75% of planning materiality. Reporting threshold (i.e. clearly trivial) – We are required to report to those charged with governance on all unadjusted misstatements more than the ‘reporting threshold' amount. £735 thousand Source: Audit Scotland Significant risks of material misstatement to the financial statements 10. Our risk assessment draws on our cumulative knowledge of North Lanarkshire IJB, its major transaction streams, key systems of internal control, and risk management processes. It is informed by our discussions with management, meetings with internal audit, attendance at committees, and a review of supporting information. 11. Audit risk assessment is an iterative and dynamic process. Our assessment of risks set out in this plan may change as more information and evidence becomes available during the progress of the audit. Where such changes occur, we will advise management, and where relevant, report them to those charged with governance. 12. Based on our risk assessment process, we identified the following significant risks of material misstatement to the financial statements. These are risks which have the greatest impact on our planned audit procedures. Exh ibit 2 summarises the nature of the risks, management’s sources of assurance over these risks, and the further audit procedures we plan to perform to gain assurance over the risks. Exhibit 2 2023/24 Significant risks of material misstatement to the financial statements Significant risk of material misstatement Management’s sources of assurance Planned audit response 1. Risk of material misstatement due to fraud caused by management override of controls As stated in ISA (UK) 240, management is in a unique position to perpetrate fraud because of Owing to the nature of this risk, assurances from management are not applicable in this instance Agreement of balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports / ledger / correspondence. Assurances will be obtained from the auditors of NHS Lanarkshire and North Lanarkshire Council over the completeness, accuracy and 10
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Annual accounts | 7 Significant risk of material misstatement Management’s sources of assurance Planned audit response management’s ability to override controls that otherwise appear to be operating effectively. allocation of income and expenditure. Review of significant adjustments at year-end where we consider there to be greatest risk of material misstatement through management override of controls. Review of financial monitoring reports during the year. Assess the adequacy of controls in place for identifying and disclosing related party relationship and transactions in the financial statements Evaluate any significant unusual transactions outside the normal course of business. Source: Audit Scotland 13. As set out in International Standard on Auditing (UK) 240: The auditor’s responsibilities relating to fraud in an audit of financial statement, there is a presumed risk of fraud over the recognition of revenue. There is a risk that revenue may be misstated resulting in a material misstatement in the financial statements. We have rebutted this presumed risk in 2023/24 as, while the possibility of fraud exists, we do not judge it to be a significant risk due to the revenue streams coming from the partner bodies of NHS Lanarkshire and North Lanarkshire Council. 14. In line with Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom, as most public-sector bodies are net spending bodies, the risk of material misstatement due to fraud related to expenditure recognition may in some cases be greater than the risk relating to revenue recognition. Due to the nature of the North Lanarkshire IJB’s expenditure, we have also rebutted the significant risk of material misstatement due to fraud in expenditure in 2023/24. 11
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Annual accounts | 8 15. Assurances over the accuracy and completeness of IJB transactions will be obtained from the auditors of North Lanarkshire Council and NHS Lanarkshire. We have not, therefore, incorporated specific work into our audit plan in these areas over and above our standard audit procedures. Other areas of audit focus 16. As part of our assessment of audit risks, we have not identified any other areas of specific audit focus. 12
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Wider Scope and Best Value | 9 Wider Scope and Best Value Introduction 17. Reflecting the fact that public money is involved, public audit is planned and undertaken from a wider perspective than in the private sector. The Code of Audit Practice sets out the four areas that frame the wider scope of public sector audit, and requires auditors to consider and conclude on the effectiveness and appropriateness of the arrangements in place for each wider scope area in audited bodies. 18. In summary, the four wider scope areas are: Financial management – this means having sound budgetary processes. We will consider the arrangements to secure sound financial management, including the strength of the financial management culture, accountability, and arrangements to prevent and detect fraud, error, and other irregularities. Financial sustainability – we will look ahead to consider whether the body is planning effectively to continue to deliver services, also comment on financial sustainability in the medium (two to five years) to longer term (longer than five years). Vision, leadership, and governance – we conclude on the clarity of plans in place to deliver the vision, strategy, and priorities adopted by North Lanarkshire IJB. We also consider the effectiveness of the governance arrangements to support delivery. Use of resources to improve outcomes – we will consider how North Lanarkshire IJB demonstrates economy, efficiency, and effectiveness through the use of financial and other resources. Wider scope risks 19. We have not identified any wider scope risks, however we recognise the challenges facing the IJB and the importance of ensuring it strategically plans the delivery of health and social care services within the area in a sustainable way. We will conclude on our wider scope work in our Annual Audit Report Best Value 20. Auditors have a duty to be satisfied that bodies that fall within section 106 of the Local Government (Scotland) Act 1973 have made proper arrangements to secure Best Value. We will consider how North Lanarkshire IJB demonstrates that it is meeting its Best Value responsibilities and we will report our findings as part of our Annual Audit Report. 13
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Reporting arrangements, timetable, and audit fee | 10 Reporting arrangements, timetable, and audit fee Reporting arrangements 21. Matters arising from our audit will be reported on a timely basis and will include agreed action plans. Draft reports will be shared with the relevant officers to confirm factual accuracy. 22. We will provide: an Independent Auditor’s Report to North Lanarkshire IJB and the Accounts Commission setting out our opinions on the annual accounts the North Lanarkshire IJB and the Accounts Commission with an Annual Audit Report containing observations and recommendations on significant matters which have arisen during the audit and conclusions on wider scope areas. 23. Exh ibit 4 outlines the target dates for our audit outputs set by the Accounts Commission. In determining the target reporting date, due regard is paid to the dates for approving the annual accounts set out in regulations of 30 September 2024. 24. We plan to issue our Independent Auditor’s Report and Annual Audit Report by the target date. Exhibit 4 2023/24 Audit outputs Audit Output Target date IJB Committee Date Annual Audit Plan 31 March 2024 20 February 2024 Independent Auditor's Report 30 September 2024 September 2024 Annual Audit Report 30 September 2024 September 2024 Source: Audit Scotland 25. All Annual Audit Plans and the outputs detailed in Exh ibit 4, and any other outputs on matters of public interest, will be published on our website: www.au d it - sco tla nd .g ov.u k. 14
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Reporting arrangements, timetable, and audit fee | 11 Timetable 26. To support an efficient audit, it is critical that the timetable for producing the annual accounts for audit is achieved. We have included a proposed timetable for the audit at Exh ibit 5 that has been discussed with management. 27. We will continue to work closely with management to identify the most efficient approach as appropriate and will keep timeframes and logistics for the completion of the audit under review. Progress will be discussed with management and finance officers over the course of the audit. Exhibit 5 Proposed annual accounts timetable Latest submission date for the receipt of the unaudited annual accounts with complete working papers package. June 2024 Latest date for final clearance meeting with the Director of Finance (or equivalent) 13 September 2024 Issue of draft Letter of Representation and proposed Independent Auditor’s Report 20 September 2024 Agreement of audited and unsigned annual accounts 20 September 2024 Issue of Annual Audit Report to those charged with governance. By 30 September 2024 Signed Independent Auditor’s Report By 30 September 2024 Source: Audit Scotland Audit fee 28. In determining the audit fee, we have taken account of the risk exposure of North Lanarkshire IJB and the planned management assurances in place. Fee levels are also impacted by inflation which increases the cost of audit delivery. The proposed audit fee for 2023/24 is £33,360 as set out in Exh ibit 6 . Exhibit 6 Audit fees (including VAT) Fee component Fees (£) External Auditor Remuneration 36,150 Key stage Provisional Date 15
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Reporting arrangements, timetable, and audit fee | 12 Pooled costs 1,320 16
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Reporting arrangements, timetable, and audit fee | 13 Fee component Fees (£) Contribution to Performance and Best Value 7,720 Sectoral Cap Adjustment (11,830) Total 2023/24 fee 33,360 Source: Audit Scotland 29. In setting the fee for 2023/24, we have assumed that North Lanarkshire IJB has effective governance arrangements and will prepare a comprehensive and accurate set of annual accounts for audit in line with the agreed timetable for the audit. The audit fee assumes there will be no major change in respect of the scope of the audit during the year and where our audit cannot proceed as planned, a supplementary fee may be levied. 17
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Other matters | 13 Other matters Internal audit 30. North Lanarkshire IJB’s internal audit function is provided jointly by the internal audit teams of NHS Lanarkshire and North Lanarkshire Council. 31. While we are not planning to place formal reliance on the work of internal audit in 2023/24, we may consider aspects of internal audit’s work in respect of our wider audit dimension responsibilities. Independence and objectivity The audit team are independent of North Lanarkshire IJB in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. This standard imposes stringent rules to ensure the independence and objectivity of auditors. 32. Audit Scotland has robust arrangements in place to ensure compliance with Ethical Standard including an annual ‘fit and proper’ declaration for all members of staff. The arrangements are overseen by the Executive Director of Innovation and Quality, who serves as Audit Scotland’s Ethics Partner. The Ethical Standard requires auditors to communicate any relationships that may affect the independence and objectivity of the audit team. We are not aware of any such relationships pertaining to the audit of North Lanarkshire IJB. Audit Quality 33. Audit Scotland is committed to the consistent delivery of high-quality public audit. Audit quality requires ongoing attention and improvement to keep pace with external and internal changes. A document explaining the arrangements for providing assurance on the delivery of high-quality audits is available from the Au d it Sco tlan d web site . 34. The International Standards on Quality Management (ISQM) applicable to Audit Scotland for 2023/24 audits are: ISQM (UK) 1 which deals with an audit organisation’s responsibilities to design, implement and operate a system of quality management (SoQM) for audits. Our SoQM consists of a variety of components, such as: our governance arrangements and culture to support audit quality, compliance with ethical requirements, ensuring we are dedicated to high-quality audit through our engagement performance and resourcing arrangements, and ensuring we have robust quality monitoring arrangements in place. Audit Scotland carries out an annual evaluation of our SoQM and has concluded that we comply with this standard. 18
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Other matters | 14 ISQM (UK) 2 which sets out arrangements for conducting engagement quality reviews, which are performed by senior management not involved in the audit to review significant judgements and conclusions reached by the audit team, and the appropriateness of proposed audit opinions of high-risk audit engagements. 35. To monitor quality at an individual audit level, Audit Scotland also carries out internal quality reviews of a sample of audits. Additionally, the Institute of Chartered Accountants of England and Wales (ICAEW) carries out independent quality reviews. 36. Actions to address deficiencies identified by internal and external quality reviews are included in a rolling Quality Improvement Action Plan which is used to support continuous improvement. Progress with implementing planned actions is regularly monitored by Audit Scotland’s Quality and Ethics Committee. 37. Audit Scotland may periodically seek your views on the quality of our service provision. The team would also welcome feedback more informally at any time. 19
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Other matters | 15 38. North Lanarkshire IJB Annual Audit Plan 2023/24 Audit Scotland’s published material is available for download on the website in a number of formats. For information on our accessibility principles, please visit: www.audit-scotland.gov.uk/accessibility For the latest news follow us on social media or subscribe to our email alerts. Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit-scotland.gov.uk www.audit-scotland.gov.uk AS.4.0 20
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1 REPORT Item No: 11 SUBJECT: Internal Audit Plan 2024/2025 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Ken Adamson, Chief Officer (Audit and Risk) (North Lanarkshire Council) Jocelyn Lyall, Chief Internal Auditor (NHS Lanarkshire) 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: Chief Officer (Audit and Risk) (North Lanarkshire Council) and Chief Internal Auditor (NHS Lanarkshire) ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Approve the proposed Internal Audit Plan for 2024/2025 (Appendix 1); (2) Approve the recommendation by the Chief Financial Officer that the joint working arrangements between the North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) Internal Audit teams continue in order to deliver the IJB Internal Audit Service; and (3) Approve the delegation of authority to the Chief Finance Officer to agree with the Chief Officer (Audit and Risk) (NLC) and the Chief Internal Auditor (NHSL) the scope of the audit assignments in the Internal Audit Plan for 2024/2025 including the allocation of responsibilities for completion of assignments. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Public Sector Internal Audit Standards set out the need to establish risk based plans to determine the priorities of the internal audit activity, consistent with the organisation’s goals. The Internal Audit Plan is designed to provide the Chief Officer (Audit and Risk) of North Lanarkshire Council (NLC) and the Chief Internal Auditor of NHS Lanarkshire (NHSL) with sufficient evidence to form an opinion on the adequacy and effectiveness of internal controls. It therefore includes the delivery of standard products required each year and is further based on professional judgement of audit need based on the IJB’s risk environment. In addition, account is taken of assurance which can be provided to the IJB based on work performed under the Internal Audit Plans of both parties. The Internal Audit Plan describes how the available resources will be utilised during the year. The Integrated Resource Advisory Group (IRAG) Finance Guidance states that it is the responsibility of the IJB to establish adequate and proportionate internal audit arrangements. This will include a review of the adequacy of the arrangements for risk management, governance, and control of the delegated resources. Yes ☐ No ☒ N/A ☐
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3 A joint internal audit arrangement is in place for the North Lanarkshire IJB with input from Internal Audit teams at both NLC and NHSL. The internal audit programme of work and the annual Internal Audit Opinion are therefore delivered jointly by the Chief Officer (Audit and Risk) of NLC and the Chief Internal Auditor of NHSL. 6. CONCLUSIONS The proposed Internal Audit Plan for 2024/2025 is attached at Appendix 1 for approval. The Committee is asked to delegate authority to the Chief Financial Officer to agree with the Chief Officer (Audit and Risk) of NLC and the Chief Internal Auditor of NHSL the scope of the audit assignments in the Internal Audit Plan for 2024/2025 including the allocation of responsibilities for the completion of assignments. Internal Audit Plan 2024/2025 The Internal Audit Plan aims to reflect the key objective of the Internal Audit service to deliver a programme of work that informs the annual Internal Audit opinion on the overall adequacy and effectiveness of an organisation’s framework of governance, risk management and control arrangements. The Internal Audit Plan also takes account of assurances which will be provided to the IJB based on work performed under the Internal Audit Plans of both NLC and NHSL for 2024/2025. The proposed Internal Audit Plan for 2024/2025, which totals 60 days, is attached as an appendix for approval. We have reviewed the extant strategic risks of the organisation and we have consulted the Chief Officer and Chief Finance Officer to ensure the substantive audit assignments in 2024/25 add maximum value. The IJB’s Internal Auditors will flexibly adjust the plan as required if risks change throughout the year Of the 60 days available, 27 days relate to standard audit deliverables namely audit planning, audit management, the provision of the annual internal audit report and the follow-up of previously agreed actions. Progress reports will be presented to the PFA Committee during the year. The Committee is asked to delegate authority to the Chief Financial Officer to finalise the Internal Audit Plan for 2024/2025, including the scope of the proposed internal audit reviews and the allocation of responsibilities for completion of assignments. The Chief Officer and the Chief Financial Officer will consult with both partners.
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4 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) The Performance, Finance and Audit Committee and both partners are required to ensure effective governance arrangements are in place. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The management of risk is an integral part of the development of the Internal Audit Plan. The Internal Audit Plan 2024/2025 has also been informed by the draft Internal Audit Opinion 2023/2024 and an assessment of current and ongoing risks. 7.5 ENGAGEMENT & PARTICIPATION The Chief Officer and the Chief Financial Officer have both been consulted in respect of the preparation of the Internal Audit Plan 2024/2025.
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5 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 N/A ☐ Provide stakeholders with information on how to get involved N/A ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs N/A ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services N/A ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery N/A ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings N/A ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff N/A ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership N/A 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A
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6 EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1– Internal audit plan 2024/25 CHIEF FINANCE OFFICER Members seeking further information about any aspect of this report, please contact the following: Ken Adamson, Chief Officer (Audit and Risk) (North Lanarkshire Council) - adamsonk@northlan.gov.uk Jocelyn Lyall, Chief Internal Auditor (NHS Lanarkshire) – Jocelyn.lyall2@nhs.scot
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7 Appendix 1 Internal Audit Plan 2024/25 Ref Audit Indicative Scope Strategic risk Days Target Audit Committee NL01-25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. Full IJB risk register considered 2 May 2024 NL02-25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. N/A 10 Ongoing NL03-25 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. N/A 5 December 2024 NL04-25 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. Full IJB risk register considered 10 June 2024 NL05-25 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. IJB.10.21 Ineffective governance arrangements 13 October 2024 NL06-25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. IJB.19.2023 Service Sustainability IJB.11.21 Oversight of performance activity 20 March 2025
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REPORT Item No:12 SUBJECT: Financial Monitoring Report 2023/24 TO: IJB 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: 22 May 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the financial year 2023/24 and to seek approval for the transfer of funds to reserves. 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 year-end financial position for 2023/24; and (2) Approve the proposed transfer to General Reserves at para 9.2 and 9.3 of this report. 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 The budget monitoring throughout 2023/24 has shown the IJB projecting an underspend, prior to the transfer of year-end balances to General Reserves at the financial year-end. 6.2 As detailed in the table at para 6.4, the IJB final outturn was an underspend of £18.71m.
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6.3 Once all ring-fenced balances have been transferred to the relevant reserve in line with Scottish Government guidance, the revised outturn was an underspend of £5.344m. 6.4 The table below shows the 2023/24 outturn position for North Lanarkshire IJB before and after the transfer of Scottish Government ring-fenced funding to reserves: Care Group Annual Budget 2023/24 In Year Drawdown From Reserves Revised Budget 2023/24 Year End Spend 2023/24 Year End Variance 2023/24 Less Ring- Fenced Underspend Revised Year End Variance 2023/24 £m £m £m £m £m £m £m Health Care Services 536.062 26.84 562.902 547.523 15.379 (13.365) 2.014 Social Care Services 250.917 5.027 255.944 252.614 3.331 3.331 TOTAL 786.979 31.867 818.846 800.136 18.710 (13.365) 5.344 6.5 Subject to IJB approval this underspend will be allocated to manage, on a non- recurring basis, ring-fenced commitments, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2023/24 FINANCIAL PERFORMANCE 7.1 The financial outturn for 2023/24 was an underspend of £18.71m relating to various under and overspends across the whole integrated budget mainly in relation to ring-fenced Scottish Government funding. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – underspend of £12.008m As highlighted throughout 2023/24, there are continuing challenges in terms of recruitment and retention across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. 7.1.2 Payments to Other Bodies (PTOB) – overspend of £0.448m 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 care plans is 1,457 resulting in a overspend of £0.447m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,805 care plans for 2023/24. In line with the IJB strategy to address the demand pressures within the financial plan, a drawdown of £1.194m from the social care demand reserve was utilised to offset the 2023/24 overspend. An action plan is currently underway which focuses on overdue client reviews and ensuring outcomes and budgets are aligned. 7.1.3 Transport – overspend of £0.424k The overspend is attributed to an increase in running costs associated with the home support additional pool cars that were purchased during 2023/24 along with an increase in staff mileage claims.
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7.1.4 Prescribing – overspend of £1.781m The 2023/24 overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. 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 from the prescribing reserve was utilised in-year. 7.1.5 North Lanarkshire Hosted Services – underspend of £5.063m The main variances within North Lanarkshire hosted services relate to: Mental Health – underspend of £6.662m which includes £4.389m Scottish Government ring-fenced funding for use in 2025/26. The remaining underspend is in relation to vacant posts across the service. Children and Adolescents Mental Health Services (CAMHS) – underspend of £0.883m is in relation to a high level of vacant posts across the service. Continence Services – overspend of £0.991m which is related to increases in product and delivery costs. Childrens Services – overspend of £1.128m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. Prisoner Healthcare – overspend of £1.002m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. 7.1.6 Addiction Services – underspend of £3.597m The total underspend is in relation to Scottish Government ring-fended funding which will be carried forward for use in 2025/26. 7.2 The table below shows the 2023/24 year-end financial position for each client group including the revised year end variance after Scottish Government ring- fenced funding has been removed: Care Group Revised Budget 2023/24 Year End Spend 2023/24 Year End Variance 2023/24 Less Ring- Fenced Underspend Revised Year End Variance 2023/24 £m £m £m £m £m Locality and Other Services 67.471 59.671 7.800 (4.277) 3.523 Addiction Services 7.551 3.954 3.597 (3.597) 0.000 Medical and Nursing Directorate 4.639 4.105 0.534 (0.692) -0.159 Prescribing 76.661 78.442 -1.781 -1.781 Out of Area Services 4.318 4.585 -0.267 -0.267 Area Wide Services 8.054 7.621 0.433 (0.341) 0.092 Hosted Services 195.779 190.715 5.063 (4.457) 0.606 Family Health Services 123.854 123.854 0.000 0.000 Set-Aside Budget 74.575 74.575 0.000 0.000 Social Care Services 255.945 252.614 3.331 3.331 TOTAL 818.846 800.136 18.710 (13.365) 5.344
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7.3 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 during 2023/24: Scottish Government Allocations 2023/24 £m Additional Staffing Band 2-4 1.093 Alcohol and Drug Partnership 3.173 Childcare Flu Vaccines 1.264 Child Death Review 0.024 Dementia Post Diagnostic Support 0.430 Digital Therapy Posts 0.111 Distress Brief Intervention 3.019 District Nursing 0.682 Family Nurse Practitioner Funding 1.196 Hospital at Home 0.527 Learning Disabilities Health Checks 0.246 Long Covid Support Fund 0.260 Meningitis C 0.106 Mental Health Action 15 1.478 Mental Health Community Perinatal 0.456 Mental Health Infant and Maternity 0.476 Mental Health Outcomes Framework 6.965 Mental Health Support Veterans 0.126 Multi-Disciplinary Teams 2.661 Neonatal Psychological Interventions 0.138 North Lanarkshire Council Provider Sustainability Payment 0.220 Outcomes Framework 2.770 PCR Prison Care Nursing Roles 0.013 School Nursing Posts 0.840 Shingles Vaccines 2.446 Specialist Doctor Contracts 0.194 TOTAL 30.914 8. SAVINGS 8.1 Within 2023/24 prescribing budget, the UHSCNL had an action plan that included our contribution to the health board-wide efficiency measures, including drug switches and prescribing improvement projects resulting in a savings target of £2.7m. 8.2 A wide range of work commenced in March 2023, ranging from reducing waste and inefficiencies to changing prescribing practices and culture. The impact of this work has recorded savings during 2023/24 totalling £2.138m. This savings measure will continue into 2025/26 and will be incorporated into the North Lanarkshire IJB two year saving delivery plan.
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8.3 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 progress 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. Review of discretionary spend and supplementary staffing. Updates on saving planning in significant areas of budget pressures. Various service reviews across the partnership. Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 8.4 The two year saving delivery plan will commence from April 2024. Regular updates on progress against each agreed savings will be reported to the IJB within the quarterly financial monitoring reports during 2024/25 and 2025/26. 9. GENERAL RESERVES 9.1 It is important 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 statue and is part of a range of measures in place to ensure that s106 public bodies do not over-commit themselves financially. 9.2 In closing the annual accounts and in line with the IJB Reserves Policy, the PFA is asked to approve the transfer of an additional £18.71m to IJB reserves as detailed in appendix 5. The increase to reserves will continue to enable the IJB meets its strategic objectives, and Scottish Government policy requirements. Summary Year End Transfer to Reserves (Pending PFA Approval) £m Scottish Government Ring-Fenced Reserves 13.365 Earmarked Reserves 0.524 Contingency Reserves 4.821 Total Year End Transfer to Reserves 18.710 9.3 The table below shows the final summary position for 2023/24 adjusted for the drawdown of reserves in year and pending approval of year end transfer of reserves detailed in appendix 5: 2023/24 Prescribing Savings (£m) SAVINGS ACHIEVED 2.138 SAVINGS TARGET 2.700 0.000 0.500 1.000 1.500 2.000 2.500 3.000
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LEAD SUMMARY Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 £m £m £m £m £m NHSL Ring-Fenced Reserves 25.593 12.818 (14.297) 24.114 (1.479) NLC/NHSL Earmarked Reserves 32.767 0.936 (12.727) 20.976 (11.791) NLC/NHSL Risk-Based Reserves 12.952 10.973 (6.880) 17.045 4.093 NHSL Contingency Reserves 8.060 5.330 0.000 13.390 5.330 NLC/NHSL Closed Reserves 18.574 (11.347) (7.227) (0.000) (18.574) Total 97.946 18.710 (41.132) 75.525 (22.421) 9.4 A detailed list of all reserve movement during 2023/24 is at appendix 6 including a key guidance table showing how the reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 9.5 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. VACANCY POSITION 2023/24 10.1 The table below shows the full time equivalent (FTE) vacancy numbers at 31 March 2024 within each service compared against their budgeted establishment: Service Establishment FTE Actual FTE Vacancies FTE North West Locality 395.19 350.09 45.10 North East Locality 332.09 301.47 30.62 Adult Services 291.14 284.81 6.33 Children Services 594.07 557.65 36.42 Mental Health 1,195.44 1,152.75 42.69 Social Care Services 986.90 795.06 191.84 Home Support 1,000.17 968.32 31.85 Other 207.82 209.63 -1.81 TOTAL 5,002.82 4,619.78 383.04 10.2 To help cover the vacant posts throughout 2023/24, agency staff, bankaide, overtime and excess part time hours were used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7. SERVICE Costs As At 31 March 2024 Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.147 0.041 0.769 0.239 1.196 North East Locality 0.072 0.024 0.495 0.068 0.658 Adult Services 0.073 0.097 0.350 0.190 0.710 Children Services 0.216 0.082 0.638 0.085 1.021 Mental Health 0.498 0.076 3.348 4.623 8.545 Social Care Services 1.201 - - 0.376 1.578 Home Support 4.702 - - - 4.702 Other 0.030 0.020 0.085 - 0.135 TOTAL 6.939 0.339 5.685 5.581 18.544
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11. IMPLICATIONS 11.1 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 ☒ 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 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 Prevention and Detection of Fraud, Bribery and/or Corruption Low Ross McGuffie 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 11.5 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
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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. 11.6 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 12. BACKGROUND PAPERS None. 13. APPENDICES Appendix 1 - North Lanarkshire IJB 2023/24 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 – Final Outturn 2023/24 – Transferred to Reserves Appendix 6 – North Lanarkshire IJB General Reserves 2023/24 Appendix 7 - 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.
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North Lanarkshire IJB Revenue Budget Position 2023/24 Expenditure Budget 2023/24 £m Actual 2023/24 £m Variance 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 67.471 7.551 4.639 76.661 4.318 8.054 195.779 123.854 74.575 562.901 59.671 3.954 4.105 78.442 4.585 7.621 190.715 123.854 74.575 547.522 7.800 3.597 0.534 (1.781) (0.267) 0.433 5.063 0.000 0.000 15.379 Social Care Services 256.442 253.463 2.979 Social Care Services Gross Expenditure Social Care Services Gross Income (3.647) (3.998) 0.351 Social Care Services Net Expenditure 252.796 249.465 3.331 Housing Revenue Account 2.599 2.599 0.000 Transport Services Account 0.551 0.551 0.000 Social Care, Housing and Transport Services Net Expenditure 255.945 252.614 3.331 Total Expenditure - NHSL and NLC 818.846 800.136 18.710 Funded By: Annual Budget 2023/24 £m NHS Lanarkshire Funding (536.061) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.961) Transfer from Reserves (Approved) (26.840) Total Funding - NHSL (617.255) NLC Funding - Social Care Services (193.415) NLC Funding - Housing Services (2.599) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) (5.027) Total Funding - NLC (201.591) Total Funding - NHSL and NLC (818.846) Appendix 1
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Hosted Services Hosted Services South Lanarkshire IJB - 48% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 3.958 3.134 0.824 1.363 1.297 0.067 4.825 4.765 0.060 3.638 3.565 0.073 5.634 5.478 0.155 0.431 0.322 0.109 4.310 4.070 0.240 2.211 2.238 (0.027) 11.145 11.146 (0.001) 37.515 36.015 1.500 North Lanarkshire IJB - 52% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 4.288 4.288 0.000 1.477 1.477 0.000 5.227 5.227 0.000 3.941 3.941 0.000 6.103 6.103 0.000 0.467 0.467 0.000 4.669 4.669 0.000 2.395 2.395 0.000 12.074 12.074 0.000 40.641 40.641 0.000 Led by the South Partnership South Hosted Services 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m Community Dental Services 8.246 7.422 0.824 Brain Injury Unit 2.840 2.773 0.067 Out of Hours Services 10.052 9.991 0.060 Palliative Care Services 7.580 7.507 0.073 Physiotherapy Services 11.737 11.581 0.155 Primary Care Services 0.899 0.790 0.109 Occupational Therapy Services 8.978 8.739 0.240 Diabetic Services 4.606 4.633 (0.027) Primary Care Improvement Fund 23.219 23.220 (0.001) TOTAL 78.156 76.656 1.500 South Lanarkshire IJB - 48% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 1.661 1.661 0.000 1.187 1.187 0.000 2.721 2.721 0.000 3.426 3.426 0.000 6.975 6.975 0.000 6.410 6.410 0.000 0.272 0.272 0.000 2.115 2.115 0.000 2.405 2.405 0.000 0.982 0.982 0.000 0.833 0.833 0.000 1.773 1.773 0.000 43.706 43.706 0.000 74.466 74.466 0.000 North Lanarkshire IJB - 52% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 1.800 1.908 (0.108) 1.286 2.278 (0.991) 2.948 3.093 (0.145) 3.712 3.369 0.342 7.556 6.673 0.883 6.944 8.072 (1.128) 0.295 0.529 (0.234) 2.291 2.038 0.254 2.605 2.468 0.137 1.063 2.065 (1.002) 0.902 0.834 0.068 1.920 1.595 0.326 47.348 40.686 6.662 80.671 75.608 5.063 Led by the North Partnership North Hosted Services 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m Sexual Health Services 3.461 3.569 (0.108) Continence Services 2.473 3.465 (0.991) Immunisation Services 5.670 5.815 (0.145) Speech and Language Therapy Services 7.138 6.796 0.342 Children and Adolescents Mental Health Services 14.531 13.648 0.883 Childrens Services 13.354 14.482 (1.128) Integrated Equipment and Adaptations Store 0.567 0.801 (0.234) Dietetics Services 4.406 4.152 0.254 Podiatry Services 5.010 4.873 0.137 Prisoner Healthcare Services 2.045 3.047 (1.002) Blood Borne Viruses Services 1.735 1.667 0.068 Hospital at Home 3.693 3.367 0.326 Mental Health and Learning Disability Services 91.054 84.393 6.662 TOTAL 155.137 150.074 5.063 Appendix 2 Appendix 3
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North Lanarkshire IJB Budget Reconciliation 2023/24 2023/24 NLC Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 190.677 NLC Funding - Housing Services 2.095 NLC Funding - Transport Services 0.551 Pay Award Drawdown from Reserves 3.176 NLC Financial Allocation at 02 February 2024 196.499 Budget Adjustments Posted in Month 12 1.851 Pay Award Drawdown from Reserves Pay Award Recurring Budget Uplift 2.738 NLC Funding - Housing Services 0.504 NHSL Financial Allocation at 01 March 2024 201.592 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 Budget Adjustments Posted in Month 10 0.625 Draw Down From Reserves Increase to Notional Set-Aside Budget 4.035 Other Budget Adjustments 0.112 NHSL Financial Allocation at 31 January 2024 612.331 Budget Adjustments Posted in Month 11 0.695 Draw Down From Reserves Non-Recurring Income Various 0.464 Increase in Hosted Services Led by South 0.024 Other Budget Adjustments 0.034 NHSL Financial Allocation at 29 February 2024 613.548 Budget Adjustments Posted in Month 12 0.625 Draw Down From Reserves Childcare Flu & Shingles Vaccines Funding 2.288 Hospital at Home Funding 0.801 Other Budget Adjustments -0.008 NHSL Financial Allocation at 31 March 2024 617.254 Appendix 4
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APPENDIX 5 IJB FINAL OUTTURN 2023/24 - Transferred to Reserves Scottish Government Ring-Fenced Reserves £m Realignment to Existing Reserves £m Increase to Existing Contingency Reserves £m Total Underspend 2023/24 £m Alcohol and Drug Partnership Funding 3.597 3.597 Blood-Borne Viruses Services 0.068 0.068 District Nursing 0.292 0.292 Family Nurse Practitioner Funding 0.072 0.072 Fraility Nursing 0.401 0.401 Hospital at Home Services 0.424 0.424 Learning Disabilities Health Checks 0.245 0.245 Long Covid Pathways 0.233 0.233 Mental Health Action 15 0.154 0.154 Mental Health Covid Clinicians (Cossette) 0.052 0.052 Mental Health Diagnostic Support Dementia Post 0.430 0.430 Mental Health Digital Therapy Post 0.111 0.111 Mental Health Distress Brief Intervention 3.397 3.397 North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 2.719 PCR Prison Care Network Transforming Nursing Posts 0.013 0.013 Pharmacy Mental Health & NES Training 0.341 0.341 School Nursing 0.622 0.622 Specialist Doctor Contracts 0.194 0.194 Adaptations Fund 0.309 0.309 Adult Protection Post (shared between Children & Families and NHSL) 0.034 0.034 Advocacy Services 0.013 0.013 Planned Date of Discharge – Locality Social Worker Post (0.015) (0.015) Staff Training Academy 0.183 0.183 Contingency Balance Held by NHSL 2.014 2.014 Contingency Balance Held by NLC 2.807 2.807 Total Transferred to Reserves 13.365 0.524 4.821 18.710
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North Lanarkshire IJB Appendix 6 Movement on Reserves Audit Trail NHSL & NCL LEAD RING-FENCED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 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 3.597 (2.926) 3.597 0.671 ✓ ✓ 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 0.068 (0.046) 0.194 0.023 ✓ ✓ 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 (0.134) 1.164 (0.134) ✓ ✓ 1, 4, 5 NHSL District Nursing 0.376 0.292 (0.376) 0.292 (0.084) ✓ ✓ 1, 2, 3, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.072 ✓ 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 0.401 0.401 ✓ 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.621 0.425 (0.084) 0.962 0.341 ✓ ✓ 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.246 0.245 0.491 0.245 ✓ ✓ 2, 3 NHSL Long Covid Pathways 0.764 0.016 (0.547) 0.234 (0.530) ✓ ✓ 2, 3, 4, 5 NHSL Mental Health Action 15 3.930 0.155 (3.356) 0.729 (3.201) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Covid Clinicians (Cossette) 0.200 0.052 (0.200) 0.052 (0.148) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.751 0.430 (0.209) 0.972 0.221 ✓ ✓ 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.111 0.111 ✓ 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 3.155 3.397 (3.155) 3.396 0.241 ✓ ✓ 1, 2, 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 (0.026) 0.074 (0.026) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 (0.811) 1.029 (0.811) ✓ ✓ 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 & Multi-Disciplinary Teams 0.933 2.719 (0.933) 2.719 1.786 ✓ ✓ 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming Nursing Rolls 0.013 0.013 0.013 ✓ 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.341 0.341 0.341 ✓ 1, 2, 3, 4, 5 NHSL School Nursing 0.622 0.622 0.622 ✓ 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 0.194 0.194 0.194 ✓ 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 ✓ 3 NHSL Third Sector Initiatives To Improve Health 0.306 (0.059) 0.247 (0.059) ✓ ✓ ✓ 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 3.120 (0.330) 2.790 (0.330) ✓ 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.033 (0.006) 0.027 (0.006) ✓ ✓ 3 TOTAL RING-FENCED RESERVES 25.593 12.818 (14.297) 24.114 (1.479) LEAD EARMARKED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 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 0.408 (0.388) 0.308 0.019 ✓ ✓ 2, 4 NLC Adult Protection (share with C&F and NHSL) 0.050 0.034 (0.034) 0.050 0.000 ✓ ✓ 1, 2, 4, 5 NLC Advocacy Services 0.118 0.013 (0.066) 0.065 (0.053) ✓ ✓ 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.828 (0.123) 0.705 (0.123) ✓ ✓ 1, 2, 5 NLC Business Case - Non-Recurring NLC Costs 3.811 0.001 (2.493) 1.319 (2.492) ✓ ✓ 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.643 0.058 (0.105) 2.596 (0.047) ✓ ✓ ✓ 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 (0.307) 0.107 (0.307) ✓ ✓ 3 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 ✓ 1, 5 NHSL Dietetics Services - Double Running Costs 0.110 (0.046) 0.064 (0.046) ✓ ✓ NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.588 (0.123) 0.465 (0.123) ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.776 (0.077) 3.699 (0.077) ✓ ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Other 0.566 (0.177) 0.389 (0.177) ✓ ✓ NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 0.000 ✓ 2, 3 NLC Financial Strategy - Changes to LA Services Muirpark 1.099 (0.311) (0.761) 0.027 (1.072) ✓ ✓ NHSL Health Inequalities - Screening 0.071 (0.027) 0.044 (0.027) ✓ ✓ 2 NHSL Health Visiting Students/Trainees 0.484 0.090 (0.263) 0.311 (0.173) ✓ ✓ 3 NLC Home Support Resilience (2 year funding) 3.498 0.148 (2.990) 0.656 (2.842) ✓ ✓ 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 (0.215) 0.360 (0.215) ✓ ✓ 1, 4, 5 NHSL Kylepark Works 1.578 (1.444) 0.134 (1.444) ✓ ✓ 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.069 0.120 (0.027) 0.162 0.093 ✓ ✓ 3, 4 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 ✓ 2, 4 NHSL Minor Capital Works 1.162 (0.135) 1.027 (0.135) ✓ ✓ 3 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 (0.100) 0.450 (0.100) ✓ ✓ ✓ 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 ✓ 3 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.881 (0.312) 0.569 (0.312) ✓ ✓ 1, 2, 3 NLC Planned Date of Discharge - Discharge To Assess 0.304 (0.195) 0.109 (0.195) ✓ ✓ 1, 5 NHSL Podiatry Services - Foot Screening 0.426 (0.076) 0.350 (0.076) ✓ ✓ 1, 2 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 (0.050) 0.020 (0.050) ✓ ✓ 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 ✓ ✓ 3 NHSL Scottish Clinical Leadership Fellowship 0.100 (0.040) 0.060 (0.040) ✓ ✓ 3 NHSL Sexual Health Services - Forensic Medical 0.175 0.035 (0.058) 0.152 (0.023) ✓ ✓ 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 (0.073) 0.087 0.084 ✓ ✓ 3 NLC/NHSL Staff Training Academy 2.400 0.183 (0.541) 2.042 (0.358) ✓ ✓ ✓ 3 NHSL Vulnerable and Complex Cases - Test of Change 1.092 (0.276) 0.816 (0.276) ✓ ✓ 5 TOTAL EARMARKED RESERVES 32.767 0.936 (12.727) 20.976 (11.791)
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(22.421) Appendix 6 Continued LEAD RISK-BASED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 31 March 2024 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 7.138 (3.045) 12.684 4.093 ✓ ✓ ✓ 2, 4 TOTAL RISK-BASED RESERVES 12.952 10.973 (6.880) 17.045 4.093 LEAD CONTINGENCY FUND RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 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 Contingency Balance Held By NHSL 8.060 5.330 13.390 5.330 ✓ ✓ TOTAL CONTINGENCY FUND RESERVES 8.060 5.330 0.000 13.390 5.330 LEAD CLOSED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 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 - Local Implementation Plan 0.167 (0.167) 0.000 (0.167) ✓ 1, 2, 4, 5 NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 (0.255) 0.000 (0.255) ✓ 1, 2, 4, 5 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 (0.123) 0.000 (0.123) 1, 2, 4, 5 NHSL Area Wide Services - NES Training 0.132 0.006 (0.138) 0.000 (0.132) ✓ 3 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 (0.034) 0.000 (0.034) 1, 2, 4, 5 NHSL Assistive Technology Contract x 12 months (ATC) 0.008 (0.008) 0.000 (0.008) 3, 4 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 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, Promise & Public Potection Joint Resourcing Funding 0.172 (0.172) 0.000 (0.172) 1, 2, 4, 5 NHSL Covid-19 Funding 0.007 (0.007) 0.000 (0.007) ✓ 2, 3, 4, 5 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 (0.107) 0.000 (0.107) 3 NHSL Distinction Awards 0.036 (0.036) 0.000 (0.036) 3 NHSL Forensic Band 3 x 5 WTE 0.147 (0.147) 0.000 (0.147) 3 NHSL GPIT Reprovisioning Gap 0.181 (0.181) 0.000 (0.181) 1, 2, 4, 5 NHSL Integrated Authority Support 4.926 (4.926) 0.000 (4.926) 1, 2, 3, 4, 5 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 (0.118) (0.000) (0.118) ✓ 3 NLC Local Government Pay Award 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 Pharmacy Recovery Plan 0.175 (0.175) 0.000 (0.175) ✓ 1, 2, 4, 5 NHSL Mental Health Perinatal, Infant, Maternity and Neonatal 0.005 (0.005) 0.000 (0.005) ✓ 1, 2, 4, 5 NHSL Mental Health Psychology Posts 0.670 (0.528) (0.142) 0.000 (0.670) ✓ 1, 2, 3, 4, 5 NHSL NES SLA Pharmacy Training 0.173 (0.173) 0.000 (0.173) ✓ 3, 4 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.077 (0.015) (0.062) 0.000 (0.077) ✓ 3 NHSL Psychology Posts 2 x Band 6 0.098 (0.098) 0.000 (0.098) 3 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 Stigma Free Lanarkshire (3 year funding) 0.450 (0.450) 0.000 (0.450) ✓ 2, 4 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 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 (0.030) 0.000 (0.030) ✓ 1, 2, 4, 5 TOTAL CLOSED RESERVES 18.574 (11.347) (7.227) (0.000) (18.574) TOTAL RESERVES 97.946 18.710 (41.132) 75.525 (22.421) KEY Ambition Statement & Performance 1 Do the right thing first time. 2 Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. 3 Develop and support a workforce for the future. 4 Improve mental health and wellbeing. 5 Supporting people through a whole family approach.
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Analysis of Additional Employee Costs 2023/24 Period BANKAIDE COSTS YEAR TO DATE North West Locality £ North East 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 48,587 33,879 22,401 41,949 234,626 5,411 386,853 11 48,967 43,102 18,134 50,434 256,743 5,637 423,017 12 50,014 51,512 21,266 60,547 311,718 3,877 498,934 TOTAL 769,031 494,785 350,369 637,974 3,347,900 84,889 5,684,948 Period AGENCY COSTS YEAR TO DATE North West Locality £ North East 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 1,081 355,250 40,989 425,193 8 17,479 - 21,870 - 367,171 47,998 454,518 9 31,763 10,274 14,935 - 337,877 41,651 436,500 10 12,763 12,594 15,304 - 379,646 24,639 444,946 11 9,208 5,205 23,130 - 327,419 11,714 376,676 12 7,268 3,949 13,745 652 423,528 8,319 457,461 13 41,576 41,576 TOTAL 239,238 67,590 189,611 85,420 4,622,914 376,242 5,581,015 Period OVERTIME COSTS YEAR TO DATE North West Locality £ North East 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 11,273 6,246 5,950 12,955 32,012 99,595 319,748 737 488,516 11 7,700 6,736 4,926 11,511 31,410 55,090 359,500 1,452 478,325 12 7,317 7,074 7,098 12,878 37,634 102,611 373,566 3,929 552,107 13 199,562 691,512 891,074 TOTAL 147,362 71,511 73,052 215,829 497,934 1,201,389 4,701,642 30,339 6,939,058 Period EXCESS PART TIME COSTS YEAR TO DATE North West Locality £ North East 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 2,066 2,110 6,562 6,723 7,858 876 26,195 11 2,205 1,086 6,650 7,554 4,940 1,083 23,518 12 2,600 1,751 6,808 8,712 6,013 1,323 27,207 TOTAL 40,699 24,121 96,970 81,561 76,405 19,549 339,305 Appendix 7
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1 REPORT Item No: 13 SUBJECT: The Lanarkshire Winter Plan 2023/24 - Debrief TO: IJB Performance, Finance, Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Craig Cunningham Head of Commissioning and Performance DATE: 22 May 2023 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: ☐ Stacey Anderson, Services Support Project Manager on behalf of Craig Cunningham, Head of Commissioning and Performance 3. RECOMMENDATIONS The IJB PFA is asked to approve the following recommendation(s): - [recs] (1) Note the content of the winter 2023/ 2024 debrief. (2) Note the actions for inclusion in Winter Plan 2024/ 2025. (3) Seek a copy of the winter plan 2024/ 2025 in December 2024.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Winter 2022/23 was one of the most challenging in the history of the NHS, where NHS Lanarkshire was operating under significant pressure and had been through aa sustained period of ‘Black Status’ and accordingly, required a significant improvement plan. Through 2023/24 NHS Lanarkshire invested in a whole system redesign through Operation Flow 1 - Stabilise, 2 - Redesign for winter 2023/24 and worked towards 3 - Reform for early 2024. 5.2 This work, which relied heavily on North and South Lanarkshire HSCPs involvement in a ‘Whole Lanarkshire’ approach, enabled the system to come out of ‘Black Status’ and to gain confidence that the system could improve. The improvement programme of Operation Flow strengthened the whole system approach with focused investment and matrix working with a Task and Finish Transformation programme which was aligned with prioritised investment. 5.3 Significant system change takes time, and the resilient leadership and cultural shift required was a key factor in the success achieved. It was also recognised that there is still significant work to be done in these elements in order to achieve and sustain the key end points required. 5.4 As such, winter 2023/24 was significantly better than the previous winter with robust planning and escalation approaches developed and embedded. These supported a greater system resilience with the front door performance ranking moving up significantly when benchmarked with peers – of note in December NHS Lanarkshire had a very positive position going into Christmas. 5.6 The system learning in 2023/24 cannot be underestimated and the key actions to reduce demand, expedite timely discharges and support people to remain well at home - taking into account the key elements and learning from the winter of 2023/24 - will be built into future plans. 6. Summary of Key Issues 6.1 National Feedback 6.1.1 In previous years, NHS Boards – alongside IJB partners - were asked to complete a template to provide a commentary on each of the key parts of the Yes ☐ No ☒ N/A ☐
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3 system, outlining those areas that worked well, those that could have been improved and areas for future learning for subsequent winter planning. Whilst such a template has not been issued, there has been a request asking for any key learning points. The points highlighted below are the main issues arising from the winter debrief session held in March 2024 and associated learning. A number of the action points have been noted as ‘full year’ issues which will be supporting flow as part of the Operation Flow 3 work. 6.2 Multi-agency approach to planning 6.2.1 As well as the ‘Whole Lanarkshire’ approach which has been adopted in previous years, there was a greater emphasis on utilisation of the wider Local Resilience Partnership (LRP) in the preparation of the report. In particular, undertaking a ‘winter breach’ exercise with scenario planning associated with a significant flooding event and how to manage same. The event, hosted in South Lanarkshire Council HQ, included all members of the LRP and provided for good learning. Beyond that, the winter plan was prepared in conjunction with the Health Board, two IJBs and two Councils thereby again offering the ‘whole Lanarkshire’ shared approach to support wider system pressures across the winter period. 6.2.2 The plan also took account of areas covered in the national preparing for winter event at which key officers were well represented. 6.2.3 Action for 2024/25 – continued maximisation of LRP in shared planning. 6.3 Operation Flow 6.3.1 A conscious decision was taken to focus efforts on maximising ‘flow’ as opposed to establishing additional ‘surge’ beds this winter. This worked well in so far as it reduced ‘safari’ ward rounds, reduced the numbers of patients ‘stuck’ in surge beds out with the normal flow systems – for both NHS and Social Work staff, and in turn, meant a lower number of Delayed Discharges across the system than in previous years. 6.3.2 The increased presence of Senior Clinical Decision Makers in the Flow Navigation Centre (FNC) to provide a ‘Call before you Convey’ pathway for Scottish Ambulance Service (SAS) teams and associated ‘Consultant Connect’ for Primary and Community Care services also facilitated reduced hospital attendance and, where necessary, supported direction to the right service at the right time, first time. 6.3.3 There continued to be promotion of greater awareness of respective roles across acute, community and social care such that as far as possible, people were cared for in the most appropriate setting. This has also been assisted by greater numbers of community/social care staff participating in the daily calls and ward based MDTs to identify people who could be discharged safely. 6.3.4 The concept of ‘discharge to assess’ has also been promoted strongly and there is further scope to extend this practice over the coming year in preparation for next winter. Similarly, the ‘Pathway 4’ team has also
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4 contributed to many patients on a palliative care journey being able to be discharged from hospital and managed safely in their own homes in accordance with their wishes. 6.3.5 Work continues in the enactment of both acute and community flow foundation bundles and, in particular, setting realistic Planned Date of Discharge (PDD) dates and seeking to honour same and reducing late cancellation of planned discharges. 6.3.6 The daily multi agency calls, along with the establishment of site / sector based Flow Oversight Boards (FOBs) to provide weekly reports to Core Executive Flow Oversight Board (EFOB) and Core FOB meetings have also assisted in early identification of any issues and respective action planning. 6.3.7 Actions for 2024/25 will be developed and delivered though the reform and transform programme and will include: a) Optimisation of Unscheduled Care by: 1. reducing LOS and hospital occupancy achieved with improved ward efficiency 2. implementation of flow foundation bundles, 3. creation of digital front door through eTriage 4. increased redirection from our system access points, 5. increased scheduling of minors, 6. expansion of FNC+ Plus to facilitate speciality direct admission, 7. creation of frailty front door a) Reduction in core physical beds with increased virtual capacity and wearables co-ordinated/monitored through FNC+ Plus and b) Enhanced interface between primary, community and acute services to maximise appropriate access and pathways along with escalation and de- escalation of care. c) Continued development of Operation Flow programme and governance structures to co-ordinate, monitor, support and scrutinise development and implementation. 6.3.8 It is helpful to note the work associated with the creation of the FNC + model in more detail. Management of unscheduled care demand is a key element to reducing hospital occupancy and thereby improving unscheduled care performance and management of established staffing levels. The essential role that our FNC has undertaken to date in managing urgent and unscheduled care across our system is recognised, however there are significant opportunities to upscale the existing model. A Vision Session, involving some 70 senior clinical and managerial leaders across the whole
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5 system was held in March 2024 to ensure a consensus on the development of FNC+ Plus through 2024. 6.3.9 FNC+ Plus aligns to the principles of a NHS Lanarkshire Operational Command Centre. This is a key component in managing demand across the system and is underpinned by a consistent Senior Clinical Decision Maker (SCDM) presence 24/7 in the FNC. The key areas of focus for FNC+ Plus are to: • Manage GP demand • Manage Home Care demand • Maximise ED redirection • Co-ordination and monitoring of increased virtual capacity • Maximise redirection and non-conveyance from SAS, NHS 24/111 • Facilitate rapid/support discharge 6.3.10 The planning assumptions that the additionally that FNC+ Plus will provide includes: co-ordination of acute and community Outpatient Anti-biotic Treatment (OPAT) capacity; connection to locality response to support escalation or escalation of care; co-ordination and monitoring of new virtual bed capacity (including wearables); facilitating direct admission booking to reduce lengthy waits in Emergency Departments (ED) and support direction of patients; creating GP hub capability to develop pathways for access to diagnostics; and redirection from ED/Minor Injuries through new pathways to treatment rooms and scheduling to minors where appropriate. Given that managing demand is key to improving Unscheduled Care performance, there is a commitment to delivering the first phase of FNC+ Plus by Quarter 2 (July 2024). 6.4 Maximising Use of Staff 6.4.1 There was a greater understanding of staff pressures such that there was a more proactive approach to aligning staff to service need – including multi- sectorial cross working to support system-wide flow. This also saw a reduction in the negative impact felt when there are too many staff off across the main public holiday periods at Christmas and New Year. 6.4.2 Of specific note was the additional social work staff in and around the hospitals over the peak public holiday period and weekends through January to ensure as many patients as possible were able to be discharged without delay. 6.4.3 Also, as described in 3.8 below, staff were also transferred from the vaccination service during the peak winter period to support acute hospital sites.
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6 6.4.4 Action for 24/25 – continue to ensure effective planning of staff annual leave/Public Holiday leave. 6.5 Joint Working with other groups 6.5.1 Scottish Ambulance Service (SAS) - Continued to strengthen and develop increased joint working between SAS and NHSL in relation to maximising shared pathways – as described at 3.4.2 above, and better utilisation of advanced skills. These ‘advanced skills’ were available in ED as well as the Primary Care Out of Hours (PCOOH) service on a rotational basis. This also saw maximising use of Hospital Ambulance Liaison Officers (HALOs) across the period as well as the regular participation of SAS on the daily calls. 6.5.2 Community Pharmacies - Greater alignment between community pharmacy and hospital pharmacy aided speedier discharge. This was a really good example of effective joint working and will be built upon for next winter. 6.5.3 Actions for 2024/25 – seek to maximise working with other staff groups to expand available resources to manage peak demand. 6.6 Support from GPs at Public Holidays and Weekends in January 6.6.1 Local GPs again provided services at key Public Holidays and Saturdays through January. Across the period this winter, this resulted in 2,882 patients being managed via their own GP as opposed to potentially being seen in PCOOH or ED. 6.6.2 Specifically, in relation to the NHSL PCOOH service, they were able to re- direct 183 patients to their own GP on the two public holidays and a further 480 patients on the Saturdays through January. In turn, this assisted in PCOOH being able to manage the increased demand on the service at that time thereby negating the need to transfer patient overflow to ED as may have been required had the additional support not been available. 6.6.3 Whilst the scheme continues to be successful, it is still possible to increase wider awareness of this such that more patients know they can access their own GP when required to seek urgent care. 6.6.4 Action for 2024/25 – Plan to continue to offer service with wider comms of availability. 6.7 Vaccination Programme 6.7.1 Public vaccination uptake was generally in keeping with national averages and above average for those in the poorest SIMD areas. There however continues to be a need for greater uptake of NHS staff vaccination, this despite a number of developments from the previous year to improve accessibility for NHS staff. This will require further review in the coming year to seek to maximise uptake.
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7 6.7.2 Council owned accommodation that had previously been available to support the vaccination programme is no longer available as it has been re-purposed back to its original use. Since the turn of the year, there has been a reduction in uptake of other vaccines due to the vaccination centres not being as locally accessible as previously. This will require to be addressed prior to winter 2024/25. A number of the vaccination staff also transferred temporarily to other posts – predominantly in the three acute hospitals, to provide additional support to ward/other staff from mid-December through to March to assist in the management of winter pressures. 6.7.3 Action for 2024/25: a) Develop plans to maximise increased staff uptake of vaccinations b) Identify alternative accommodation with a view to maintaining at least national average uptake c) Continue to work with acute colleagues to facilitate staff transfer from vaccinations to provide additional support to hospital sites. 6.8 Infection Prevention and Control (IPC) 6.8.1 Whilst there was not a significant direct issue of high Covid prevalence, there were significant pressures from other winter pathogens e.g. a peak in flu in Jan (although less than last year) but also high levels of respiratory syncytial virus (RSV), mycoplasma and especially norovirus. In a few areas, there continued to be some legacy practice which resulted in a higher level of Covid lateral flow testing being undertaken than necessary which affected flow. This appeared to be due to an over sensitive approach being taken with Covid despite other respiratory infections also being prevalent at this time of year. 6.8.2 This involved asymptomatic patients being tested ‘just in case’, albeit not being isolated whilst awaiting test results. In turn, other respiratory conditions which would previously have been subject to ‘point of care’ testing were going un-noticed. 6.8.3 IPC colleagues raised this with respective acute hospital management teams to take corrective action. 6.8.4 It was also evidenced that visitors were responsible for bringing infection into the sites and there needs to continue to be an emphasis around education in this regard next winter. 6.8.5 Actions for 2024/25: a) Encouragement of ‘point of care’ testing as the default approach for respiratory infections. b) Communications campaigns focused on educating visitors not to attend if having any symptoms, e.g. respiratory infections.
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8 6.9 Use of Data 6.9.1 Using real time data assists significantly in relation to flow management. This has shown improvement across the winter period albeit there is still some further work required to ensure timeous entry to patient management systems. In turn, this would help inform the understanding of likely pressure points to support the agreement of appropriate mitigating actions. 6.9.2 Action for 2024/25 – Continue to increase real time data entry to support awareness of system pressures and potential mitigation of same. 6.10 Communications 6.10.1 There was a regular flow of public messaging across the winter period – heightened at times of greatest pressure. This covered all main aspects of the winter plan from preparing for winter, encouraging uptake of vaccinations and utilising Winter Health Hub to assist in reducing attendances to ED. 6.10.2 Beyond that, the communications plan saw specific work with local pharmacies, NHS 24 and the creation of bespoke videos to be used when EDs were particularly busy with a view to assisting to provide alternative care destinations. 6.10.3 Action for 2024/25 – Prepare winter communications programme to address all respective areas. 6.11 HSCP Performance 6.11.1 Delayed discharge performance is always a key metric focused on during winter and it has not been uncommon to see the number of delays sitting at over 100, with peaks of around 130, during peak winter pressures in recent years. 6.11.2 Through the work of Operation Flow and the major developments set out within the IJB’s Strategic Commissioning Plan such as the roll out of Home Assessment Teams, performance throughout winter 2023/24 has been much more stable. In previous years, North Lanarkshire sat in the top 3-4 partnerships in terms of rate of delay, but the partnership has sat consistently below the Scottish average throughout the winter and other peak pressure periods such as the Easter fortnight. 6.11.3 This is well demonstrated by the Delayed Discharge bed days recorded over the last 12 months:
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9 Figure 1: On-site bed days delayed Figure 2: Off-site bed days delayed
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10 Figure 3 - ***Management data*** - Referrals, discharges and end of week delay position Figure 4 – national comparison – rate of delay 7. IMPLICATIONS 7.1 Employee Implications As workforce supply challenges persist across health and social care, this has led to increased competition for recruitment and retention at local, regional and national level. This poses an ongoing risk and emphasises the need to develop new and transformational roles in response to growing demand across health and social care to ensure there will be a sustainable supply of workforce to meet future health requirements of an ageing population in Lanarkshire, and across Scotland.
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11 7.2 Financial Implications The winter plan was delivered within the anticipated budget levels. It should be noted that the scope for use of reserves or other sources of funding will be reduced in 2024/25. 7.3 Climate Change, Sustainability and Environmental Implications There is no climate change, sustainability, and environmental implications within this report. 7.4 Other Implications 7.4.1 The Winter Plan highlighted the significant risks which were likely to be encountered and the need for the respective mitigations which were put in place. Respective risks have been downgraded as the winter period has passed. 7.4.2 The learning points and actions arising from the winter 2023/24 debrief will form part of the winter plan for 2024/25. In so doing, the various measures currently used for measuring wider system performance will continue to be utilised and refined if required. 7.5 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 ☒ 7.6 ASSOCIATED MEASURE(S) 7.7 FINANCIAL This paper has been reviewed by Finance:
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12 7.8 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.9 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 ☐ 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 7.10 INEQUALITIES & FAIRER SCOTLAND DUTY Yes ☐ No ☐ N/A ☒
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13 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS N/A 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Craig Cunningham, Head of Commissioning and Performance Ext:3704 (Phone: 01698 453704) Email: craig.cunningham@southlanarkshire.gov.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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14 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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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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23
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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
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1 REPORT Item No: 15 SUBJECT: IJB Category 1 Responders in Civil Contingencies Act 2004 TO: IJB Performance Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Stacey Anderson, Services Support Project 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: ☐ By the Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to note the progress made in confirming identified resilience leads and note that local resilience plans are continually under review.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 The Civil Contingencies Act 2004 was established with the aim of minimising disruption in the event of an emergency and to ensure that UK as a whole is better prepared to deal with a range of emergency situations. 5.1.2 Part 1 of the Act provides a focus on local arrangements for civil protection, establishing the statutory framework of roles and responsibilities for local responders. 5.1.3 Part 2 of the Act focuses on emergency powers and establishes a framework for the use of special legislative measures that may be required to deal with exceptionally serious emergencies. 5.1.4 On 24th September 2020, the Cabinet Secretary for Health and Sport wrote to confirm the intention of the Scottish Government to pass legislation that will include Integration Joint Boards as Category 1 Responders under Schedule 2 of the Civil Contingencies Act, 2004. 5.1.5 The North Lanarkshire IJB responded to the consultation, noting the positive local relationships and the importance of IJBs and HSCPs being central to the resilience response in local partnerships. 5.1.6 On 15th January 2021, the Cabinet Secretary for Health and Sport wrote to confirm the intention to include IJBs as Category 1 Responders on conclusion of the consultation. 5.1.7 The Chief Officer of the IJB has been a long-standing member of the Local Resilience Partnership (LRP) and this has continued since the changes to the Act were confirmed. In addition, the Chief Officer now attends the West of Scotland Regional Resilience Partnership (WosRRP). 5.1.8 Through the WoSRRP, a short-term working group was convened with IJB Chief Officers and West of Scotland leads to gain assurance around the IJBs’ preparedness and integration into the wider resilience community following their categorisation as Category One organisations in 2021. 5.1.9 In March 2023, a report was presented to the IJB, detailing an overview of a survey that was conducted with all West of Scotland IJB’s and Local Resilience Partnerships to gain assurance that the IJBs were now fully embedded within the local resilience structures, in line with the expectations set out in the Act. The results of the survey demonstrated that the North Yes ☐ No ☒ N/A ☐
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3 Lanarkshire IJB/HSCP was well embedded in the Local Resilience Partnership structures. 5.2 Progress Update 5.2.1 A follow up survey was issued by WoSRRP in October 2023 to help track progress and ensure that IJBs continued to embed with local resilience structures. 5.2.2 Within the Lanarkshire Resilience Partnership, a collaborative process was undertaken to complete the survey in conjunction with the two councils, NHS Lanarkshire and the two IJBS. 5.2.3 As set out in Appendix 1, the North Lanarkshire IJB / HSCP continues to embed in the Local Resilience Partnership Structures at both strategic and operational levels. The North Lanarkshire IJB / HSCP continues to review continuity plans, has worked in partnership to implement new resilience processes and systems and has played an active role in a number of planning exercises and encouraging H&SCP staff to attend resilience related training (Loggist training, Crisis Management and Continuity Planning). 5.2.4 The aim for North Lanarkshire Health and Social Care Partnership in 2024 is to develop a partnership resilience guidance document that can be used by both Health and Social work staff, with the objective of understanding levels of responsibility across the partnership and providing clear direction and guidance on implementing resilience plans. 5.2.5 Appendix two outlines the WoSRRP analysis of the returns, which is very positive. While some concerns were identified in the original survey in 2022, the most recent survey has demonstrated significant progress around the areas of gaps. 5.2.6 Most importantly, it was recognised that IJBs are now represented at all three levels of command – operational, tactical and strategic – and based on this progress, it was agreed at the April meeting of WoSRRP that there is no further requirement to repeat this exercise. 6. CONCLUSIONS 6.1 The North Lanarkshire IJB and HSCP have positive local arrangements in place that have seen the IJB fully embedded into the local resilience partnership process. 6.2 The attached survey responses provided further assurance that the IJB/ HSCP is meeting the requirements set out in the Civil Contingencies Act 2004.
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4 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 This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Service Sustainability High Ross McGuffie Workforce Sustainability High Ross McGuffie Oversight of Performance Activity Low Ross McGuffie Yes ☐ No ☐ N/A ☒
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5 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 ☐ 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 ☒
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6 EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 Integration Joint Board Category 1 Responder Questionnaire 2023. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Support Services Project Manager Stacey.Anderson3@lanarkshire.scot.nhs.uk Yes / Date added ☐ No ☐ N/A ☒
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7 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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8 Appendix 1 Integration Joint Board Category 1 Responder Questionnaire 2023. 1. Name of the Integration Joint Board Responding North Lanarkshire IJB. Given the close working arrangements in place in Lanarkshire, we have collaborated with our partners in South Lanarkshire in the development of our response. 2. Since the Integrated Boards became Category 1 responders in April 2021, how have they been represented within the LRP, at a strategic and tactical/operational level? Yes 3. Does the HSCP have up to date business continuity plans and when were these last reviewed? Yes. These are reviewed on an ongoing basis and put into practice. BCP reviews have been undertaken by all partners to ensure all learning is identified and form part of the agenda for the resilience meetings facilitated by the Chief Officer. 4. Are the roles and responsibilities of the IJB/HSCP fully embedded within the LRP multi-agency emergency plans, and how have you described these? Yes. The role the H&SCPs have in providing community health and social care support to emerging issues forms a core part of the multi-agency plans. The roles are described in the respective elements and are reviewed through our risk and governance structures. 5. How does the IJB/HSCP take part in assessing risk, writing plans, delivering exercises, debriefs and learning lessons with the resilience partnership? The H&SCP has a risk register that is shared with both the Council and NHS Lanarkshire. There is also a series of linked BCP planning review sessions, e.g. most recently Black start re loss of power and the two H&SCPs have contributed singularly and collectively to shared exercises. The H&SCP have also developed links to a Network within NHS Lanarkshire to help strengthen resilience in the event of a cyber-attacks.
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9 6. During a major incident and subsequent multi-agency response, how will the IJB/HSCP be alerted and what role will they take? Both H&SCPs are core members of the respective CMT and governance structures. There is also a 24/7 on call system that means the respective officers can be called to participate at all hours. The role the IJB/H&SCP will take will be dependent on the issue in question. For example, during the Wannacry Cyber- attack, the H&SCPs took a lead role in ensuring all general practice and other independent practitioners were protected as far as possible and also a supporting role in so far as they were part of the overall decision making structure that sought to identify where best to place resources to mitigate the impact of the event. As described earlier, the H&SCPs have taken a lead role in the response to Covid, with a series of lead roles across specific groups and particular responses, e.g. establishment of Community Covid Assessment Centres; creation of PPE hubs; development of Care Home and Care at Home Assurance structures; and managing the Covid and associated vaccines programme on behalf of the LRP. 7. Given the IJB/HSCP role in delivering health and social care services, how has the LRP linked in with the IJB/HSCP to develop local Care for People arrangements? (e.g., coordinating psychosocial services). Both H&SCPs are core members of the LRP and key players in the ‘Care for People’ arrangements described above. This ranges from direct provision of services, supporting rest centres, staffing MIST teams and so on. The HSCPs also have strong links with third sector organisations who provide vital supports as part of the care for people arrangements in any crisis response situation. 8. Do HSCP staff fully participate in LRP training? (please provide practical examples). Yes. HSCP staff participate in training organised by the council and by the NHS. the series of Black start and Exercise Steeple training exercises is the most recent of these, notwithstanding the lived experience of the last two years. 9. As the newest member of the Category 1 group of agencies, how can the IJB/HSCP better support the LRP and are there any clear gaps that need to be addressed? In Lanarkshire, both H&SCPs have been core members of the Lanarkshire LRP and associated structures. We are not aware of any gaps that need addressed.
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10 10. Since the introduction of IJBs as Category 1 responders, have you had to enact your resilience plans and what learning was identified (beyond Covid- 19)? There have been a few occasions where LRP arrangements have been utilised, these include the joint response to the arrival of Supported Asylum Seekers and Ukrainians and the need to mobilise services accordingly.
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11 Date: 25/04/2024 Agenda Item No: 10a Integration Joint Boards; Synopsis of Short terms Working Group Survey Purpose: FOR NOTING Background At the meeting of the West of Scotland RRP Strategic Group held on 31 March 2022, a short- term working group, comprising of IJB Chief Officers and others, was commissioned to conduct a survey of the partnership’s constituent IJB/HSCPs. Their task was to apprise the partnership of their resilience preparedness and integration into the wider resilience community following their categorisation as a Category One organisation in 2021. As part of the findings of this group, it was decided that the consultation would be repeated 12 months hence, to monitor progress and identify challenges that may have come to light in the preceding months. It was agreed that an additional questionnaire would be sent in November 2023 and that the question set would remain unchanged. Of the thirteen IJB’s in the West of Scotland RRP area, eleven responded. Question 1: ‘Since the Integration Joint Boards became Category 1 responders in April 2021, how have they been represented within the LRP, at a strategic and tactical/operational level?’ In keeping with the first questionnaire, there is evidence that all IJBs are represented at all three levels of command. Chief Officers continue to attend strategic groups, and in some cases delegate to senior colleagues. Examples were provided of integration in action, where the IJB’s have been involved in home care challenges, care for people planning, disruptive weather events and training and exercising events alongside LRP and agency partners. Question 2: ‘Does the IJB have resilience related risks reflected in its risk register and are these consistent across the LRP’ This is an area which shows improvement on how resilience has been incorporated into the IJB’s risk landscape. All the respondents confirmed that resilience specific risks were included in their risk registers, with many detailing the rigorous scrutiny mechanisms in place to ensure mainstreaming and governance. Although these processes vary across the IJB’s, there is evidence that resilience is now part of the planning process in each of the IJB’s that responded. Question 3: ‘Does the HSCP have up to date business continuity plans and when were these last reviewed?’ All respondents confirmed they had current business continuity plans, all of which appear now to have a 12-month review cycle, the latest of which was listed as April 2023. Evidence was provided that demonstrates these plans to be up to date and relevant in terms of the recognised national risks faced by public bodies, including disruptive weather and national power outage. Allied to this process is a commitment to incorporate Business Continuity into
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12 any relevant training and exercising opportunities which may avail themselves throughout the year. Question 4: ‘Are the roles and responsibilities of the IJB/HSCP fully embedded within the LRP multi- agency emergency plans, and how have you described these?’ All the respondents confirmed that IJB/HSCPs are fully embedded into their plans, primarily through the role of the HSCPs as the delivery arm of the IJBs. Evidence was provided that demonstrated an inclusion within civil contingencies planning and the development of Multi- Agency Response Guides (MAIRGs). The role of the IJB/HSCP in providing community health and social care forms an important part of any multiagency plan and is replicated in, broadly, similar ways across the LRPs, primarily within the Care for People arena. Although much progress appears to have been made in this area, there are still some challenges around IJB’s being seen as a ‘full planning partner’ within one of the LRP’s, however, this has been identified and will, no doubt, be progressed locally. Question 5: ‘How does the IJB/HSCP take part in assessing risk, writing plans, delivering exercises, debriefs and learning lessons with the resilience partnership?’ All the respondents highlighted a series of activities which demonstrated cooperative working with partners. This included participation in debriefs, the development and inclusion in exercises and simulations; membership of Contingency Planning Liaison Groups (CPLGs); inclusion in BCP reviews involving shared risk registers amongst partners and regular invitations to HSCP members to attend training and exercising opportunities within the LRPs. One respondent highlighted their inclusion in ‘Lunchtime Learning from Incidents’ which allowed partners to share lived experience from real incidents in an informal peer to peer environment. Evidence was also provided of the heightened use of Resilience Direct and the adoption of offline data storage to combat the impacts of a cyber or power related incident. Question 6: ‘During a major incident and subsequent multi-agency response, how will the IJB/HSCP be alerted and what role will they take?’ In keeping to their response to the first questionnaire, the respondents outlined a variance in the mechanisms of major incident response notifications. Several respondents articulated a clear understanding of tried and tested processes, typically routed through their Chief Executives/Officers or civil contingencies teams. Although no specific ‘on-call’ arrangements were evidenced, many highlighted that existing ‘on-call’ provision within the wider local authority structures would facilitate notifications of emergencies etc. Question 7: ‘Given the IJB/HSCP role in delivering health and social care services, how has the LRP linked in with the IJB/HSCP to develop local Care for People arrangements?’ All respondents highlighted established and well-developed local processes to address this question. Their ‘Care for People’ plans, either as a standalone or as part of wider multi-agency response plans forms the nucleus of their involvement. Evidence was provided of many IJB’s/HSCP’s being part of LRP Care for People Groups and taking part in exercising and training events, in addition to their inclusion within the LRP itself.
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13 Question 8: ‘Do HSCP staff fully participate in LRP training?’ All respondents commented that HSCP personnel are included within the training and exercising programme of their respective LRPs. This has included HSCP personnel being trained as Council Incident Officers, Loggists and Care for People managers. In addition, they have been included in a wide range of scenario-based learning including Cyber, National Power Outage, Terrorism, Mass Casualty / Fatality and Lithium Ion fires. Question 9: ‘As the newest member of the Category 1 group of agencies, how can the IJB/HSCP better support the LRP and are there any clear gaps that need to be addressed?’ All respondents were confident that well established relationships, fostered, in many cases, prior to the categorisation of IJBs, were working well and provide the necessary conduits between the respective organisations. There are numerous pieces of work ongoing at present to develop these, and partners are critically examining current processes to identify areas for improvement. The appointment of HSCP members as LRP sub-group chairs, additional resources being deployed to assist in the planning process, work to map out HSCP out of hours services and the critical services they deliver and research looking at diverting nursing staff and GPs to treatment facilities during incidents are just some examples cited by respondents in this developing area. Question 10: ‘Since the introduction of IJBs as Category 1 responders, have you had to enact your resilience plans and what learning was identified (beyond Covid-19)?’ All but one of the respondents have confirmed activation of their plans at some point during the previous twelve months. These have included Business Continuity plans in respect of Health & Social Care demands, particularly around care homes, ‘conventional resilience’ issues such as fires, residential evacuations, disruptive weather events, gas explosion and transportation disruption. In all the examples quoted, reference was made to the debriefing process and its utility in highlighting learning and identifying best practice. One respondent outlined their recognition of a potential gap in their data security process and how they were actively relocating key data to an offsite facility to mitigate the risk. Question 11: ‘Have you identified any specific actions to progress as a consequence of completing this self-assessment?’ Whilst most of the respondents did not identify specific actions, one highlighted that they have included the themes from this questionnaire into their annual Governance Assurance certificate, ensuring that strategic oversight is maintained. Another respondent identified a more operational action to address a potential shortage of loggists within their organisation.
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14 Conclusion & Recommendation This is the second resilience consultation to be conducted amongst IJB’s in as many years and it shows a steady improvement in how resilience is being mainstreamed. For all respondents, Civil Contingencies now plays an important part of the IJB/HSCP planning cycle, and significantly, IJB/HSCPs play an important part in the Civil Contingencies community in the West of Scotland RRP area. Despite the considerable demands on health and social care nationally, the respondents have provided evidence which shows their integration at Operational, Tactical and Strategic levels of the partnership. They are routinely involved in the mainstream planning processes and are beginning to take up key roles within the LRP structures. While IJB Chief Officers have been included in the distribution lists for RRP strategic correspondence for some time and HSCP reps too within LRP distribution lists for tactical/operational work locally, there was an acknowledged gap in HSCP reps not being routinely copied into tactical/operational correspondence from regional coordinators through the Business Coordination Group (BCG) – this gap has now been addressed with nominated HSCP reps for each IJB now added to all BCG level correspondence. Although not included in this summary report, the responses of the 11 IJB’s who took part can be found on Resilience Direct. Members are invited to note the contents of this report.
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1 REPORT Item No: 17 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: 22nd May 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.
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2 1
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3 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. 3.2 Following a review of the risks detailed within the IJB Risk Register, it is recommended that the risk ratings of the following risks are reviewed following the completion of the actions associated with the risk: 3.2.1 Delivery of CAMHs service, risk rating reduced from High to Medium 3.2.2 Ineffective Governance arrangements, risk rating reduced from Medium to Low. 3.2.3 Unscheduled Care, risk rating reduced from Very High to High. 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 took place in 2023 as part of the risk strategy review and in line with the developments and changes being 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
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4 receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. 5.4 Following on from the risk report presented at the IJB meeting on the 19th March 2024, alongside the financial update report, it was agreed by the board that the Financial Challenges risk rating would increase from High to Very High. 6. CONCLUSIONS 6.1 The IJB currently has 17 risks identified on its IJB risk register with 10 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 6.3 Due to a number of risk actions being implemented across the partnership, it is recommended that the risk rating of three risks detailed within the IJB Risk Register are reviewed and de-escalated.
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5 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 centered 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 ☒
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6 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
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7 □ 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.
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8 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
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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 7
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10 Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls 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. HIGH 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 North and South 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 Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023‐26 and reserves strategy 2023‐24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget VERY HIGH Medium Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.06.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and updated Jan 2024. Reviewed and updated March 2024. 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. IJB02. 21 Financial Reputational 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.08.24 Previously IJB6. Reviewed and updated on March 2023. Reviewed and Updated Oct 2023, (previously title ineffective governance arrangements). Reviewed May 2024
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11 ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions 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 at the IJB PFA. Report Prepared by Stacey Anderson on behalf of the Chief Officer
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12 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls 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 CONTROLS 1. There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place. ACTIONS 1. The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend for current and future years. HIGH M EDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024. IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. In line with the Scottish Governments Integrated Resources Advisory Group 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. Actions 1. Agree with South regularly report cycle as part of IJB work plan, aligning to requirements of audit. M EDIUM M EDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed Jan 2024 Reviewed and updated May 2024 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 CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare Products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.06.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed Jan 2024 Reviewed May 2024 IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1. The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. 2. Updated SLA with VANL nearing completion LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.08.24 Previously IJB16. Reviewed May 2024
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13 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 4. Communications with employees, patients and service users may be ineffective. 5. There will require to be changes to the working environment including remote working and working from home. 6. There is a reduced ability to protect the wellbeing of employees, patients and service users. 7. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM 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 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 is being carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse events 3. Completion of IJB Self‐ Audit M EDIUM LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.08.24 Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. Reviewed May 2024. IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. 2. Face to face Q3 performance reviews taking place throughout May 23 with sectors/units LOW LOW Ross McGuffie Morag Dendy SLT, IJB PFA, IJB 31.06.24 Reviewed and updated May 2024. 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 Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub(www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation 4. Audits of adherence to sickness absence policy being undertaken 5. Update provided to IJB in March 2024. HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.08.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and updated May 2024. IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. All care homes advised to use PPE in line with national addendum. 4. Development day on 12th May 23 to agree structures and approach for year ahead medium medium Ross McGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 28.06.2024 Reviewed and updated Oct 2023 Review and updated May 2024. .
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15 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls 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 Controls ‐ 1. Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised 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 national investment to fully implement new service model 4. Active 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 75% of gap by end of May 2023 6. Continuous review and validation of the waiting list High medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and updated May 2024. Action 1. Incremental implementation of the new service model 2. CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion 3. Refurbishment of North Lanarkshire facilities commences early summer 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 CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living 4. NLC approved cost of living contract increases in May 2023 High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed May 2024. ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered 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 CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA (last update Jan 2024) ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups 3. SG/COSLA working groups being established ‐ local reps nominated for each High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 31.08.24 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. Reviewed and updated May 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 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 6. Regular updated to IJB Very High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.06.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023
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16 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. Reviewed Jan 2024. Reviewed and updated May 2024.
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17 IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls 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 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 Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 28.06.2024 Reviewed and updated June 2023. Reviewed Oct 2023. 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 Reviewed Jan 2024. Reviewed May 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 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. High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.06.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. Reviewed and updated May 2024 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.
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18 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 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 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. High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.08.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24 Reviewed and updated May 2024.
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NL H&SCP Risk Overview Report Meeting Name – IJB PFA Reporting Period: IJB PFA Risk Register – May 2024
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NL HSCP IJB Risk – Dashboard February 2024 Executive Summary Risk Register Number of Risks IJB 17 NL Council NHS Lanarkshire 21 Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 9 1 10 Risk Score Trend IJB06/21 PrescribingActivityand Costs VH IJB 17/22 Unscheduled Care VH IJB.01/21 Financial Challenges VH 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 IJB Risk Register – IJB and IJB PFA Level 2‐ Core Risk Overview Process NL H&SCP
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Level 3‐ Very High and High Risks ‐Summary IJBID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel (Current) Risklevel (Target) RiskOwner RiskRegister Lead Assurance Source NextReview Date ClosedDate IJB.01/ 21 Financial Strategic 01/04/2021 FinancialChallenges 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 settlementfrom the Scottish Government. 2. The IJB is dependent on funding from bothpartners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. NewScottish 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. Eachpartner may be unable to maintain theirfinancial contributions to the IJB in future yearswhich would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns arenot implemented in full and in line withthe original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Futuresavings targets will continue to be challenging and are likely to impact on essential coreservices. 13. The IJB Financial Plan cannot be adhered toand 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 VERY HIGH MEDIUM AmandaKilburn AmandaKilburn SLT, IJB PFA,IJB 28.06.2024 Previously IJB2, IJB7, IJB10and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and Updated Jan 2024. Reviewed and risk increased March 2024.
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IJB ID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate IJB04. 21 Financial Strategic 01/04/2021 NotionalSet‐AsideBudget 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 tosupport maintaining people athome e.g.transitional care models. VERYHIGH HIGH MEDIUM RossMcGuffie AmandaKilburn SLT, IJB PFA,IJB 28.026.2024 Reviewed and Updated May 2023. Reviewed Oct2023. Reviewed Dec2023 Update being provided to IJB in Jan2024. ReviewedMay 2024 IJB06. 21 Financial Operational 01/04/2021 PrescribingActivity and Costs The cost of prescribing is growing due toissues in supply chains driving increased wholesaler costof medicines, advance treatment developments resulting in the need formore 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 portsin the UK and the EEA before goods, including medical products, can cross the border. New customs checks arerequired when moving medicines between the EEAand the UK. Medium VERYHIGH LOW RossMcGuffie AmandaKilburn SLT, IJB PFA,IJB 28..06.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024
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IJB.12. 21 Performance 30/08/2021 StaffHealth & 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 forfurther staff redeployment due to winter planning contingency arrangements. medium HIGH low RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB, SC&CG,AH&SC 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec2023. Report on Staff Health and Wellbeing due to IJBin March 2024 Reviewed and updated May 2024
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IJB ID Category Opened Date Description of Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date Closed Date IJB.14. 2022 Strategic& Performance 30.04.22 CAMHS‐ There is a risk that the CAMHS servicecannot 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 isimpacting 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 RossMcGuffie MoragDendy IJB,PF&A, SLT 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec2023. Reviewed and updated March 2024 Reviewed and updated May 2024 IJB.15. 2022 Strategic& Performance 05.09.22 Costof Living There is a risk that the IJB's StrategicCommissioning 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 oflife 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 RossMcGuffie RossMcGuffie SLT, IJB 30.06.2024 Reviewed and Updated May 2023. Reviewed Oct2023. Reviewed and updated March 2024. Reviewed and updated May 2024 IJB.16. 2022 Strategic 05.09.22 NationalCare Service There is a risk that the ongoing workaround a National Care Service could destabilise currentservice delivery due tosignificant 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 RossMcGuffie SLT, IJB PFA,IJB, ASWC&WB 31.06.24 Reviewed and Updated May 2023. Reviewed and Updated Oct2023. Updated being provided Jan 2024. Reviewed and updated May 2024. IJB.17. 2022 Strategic& Performance 05.09.22 UnscheduledCare There is a risk that we cannot sustain whole system patient flow through peak winter pressuresdue to increased frontdoor demand; hospital workforce capacity; delays inonward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading toreduced 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 RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.026.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024. Reviewed and updated May 2024
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IJBID Category OpenedDate Descriptionof Risk Risklevel(initial) Risklevel(Current) Risklevel(Target) RiskOwner RiskRegisterLead Assurance Source NextReview Date ClosedDate IJB.18. 2022 Strategicand Performance 05.09.22 CommunityAlarms There is a risk that the community alarmsystem will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarmusers not getting a response when required. High Medium Low Diane Fraser RossMcGuffie SLT, IJB PFA,IJB, ASWC&WB 28.06.2024 Reviewed and updated June 2023. Reviewed Oct2023. Reviewed Jan 2024. Reviewed May 2024 IJB.19. 2023 Performance 27/02/2023 ServiceSustainability 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 RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.06.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024. IJB.20. 2023 WorkforceSustainability Itis becoming increasingly difficult to recruit toparticular roles across Health and Social Care. Gaps in the workforcecan result in reduction of service provision, increase in staff workload and inability to deliver the strategicplan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving fromthe EEA and non‐EEA countries are subject tothe same immigration rules. The new points‐based immigration system makes exceptions forthe majority of health care professionals with an NHSjob offer and for qualified social workersvia a new fast‐track visa route, known asthe Health and Care WorkerVisa. There are however no exceptions made for other social care roles, such as careworkers. The Mutual Recognition of Professional Qualifications Directive isan EU‐wide directive that allows professional regulatorsin 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 RossMcGuffie RossMcGuffie SLT, IJB PFA,IJB 28.06.24 Reviewed and Updated May 2023 Reviewed and updated Oct2023. Reviewed and updated Jan 24 Reviewed and updated May 2024
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Delivery of CAMHS Service 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 andchallenges recruiting to new posts identified through the national recovery and renewal fund. This isimpacting 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 andreputation of the IJB. RMc MD Current 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 with 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 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. 4.Close working with health improvement and GP reps 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. Current –High Target – Medium
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted ina failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. Newor amended legislation and Scottish andUK Government guidance may not be adopted effectively and timeously. 3. Ineffective information governance controls could lead to databreaches and an impact on the General Data Protection Regulations. 4. Communications with employees, patients and service users maybe ineffective. 5. There will require to be changes to theworking environment including remote working and working from home. 6. There is a reduced ability to protect the wellbeing of employees, patients and service users. There may be adverse media coverage locally, aloss of public confidence and reputational damage. 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 forthe use of MSTeams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Riskregisters are in place for the IJBand each partner. Each partner has aspecific HSCP Covid‐19 Risk Register in place. 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'sWorking 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. Risk Trend Risk Level Reduced and details updated The risk was originally created in April 2021 and detailed concerns around the ineffective governancearrangements 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 level can be reviewed. Target ‐ low Current medium
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Risk in Focus – De‐escalated Risk Description Risk Owner Risk Lead Unscheduled Care There is a risk that we cannot sustainwhole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays inonward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading toreduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. RMc RMc Current Controls CONTROLS 1. CareHome Assurance Group and associated supports forcare homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Careat Home Assurance group and associated activityto try to support and sustain independent sectorprovision 3. NHSCMT and Covid response group oversight ofperformance 4. DailyPDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole systemapproach 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. NewCSW roles in District Nursing teams toproactively 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 aswell as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all sixLocalities to support rehab in the community and reduce long‐term service demand 8. 5Task and Finish groups now established toroll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) 9. Firebreak implemented Jan 2024. 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. Target‐ Medium Current –VH
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Risk in Focus – Review Risk Description Risk Owner Risk Lead Service Sustainability Dueto competing service priorities and workforce/ operational and financial challenges there is a risk thatthe IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategicaims of theIJB poses a risk on operational service delivery and the achievement of financial balance andpatient safety 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 NHSFinance Departments. 4. Regular budget meetings with Chief Executives and Directorsof 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. 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. Target‐ Low Current – High
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Risk in Focus – Review Risk Description Risk Owner Risk Lead Workforce Sustainability Itis becoming increasingly difficult to recruit toparticular 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 strategicplan. 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 tothe same immigration rules. Thenew points‐based immigration system makes exceptions for the majority of health care professionals with an NHSjob offer and for qualified social workers via a new fast‐track visa route, known asthe Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. TheMutual Recognition of Professional Qualifications Directive isan 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 theEEA for at least two years after thetransition period ends. This however is nota reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. RMc RMc Current Controls CONTROLS 1. Allsuccessful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, aone‐off charge levied against arrivingmigrant 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 rulesare in law as part of the Immigrationand Social Security Co‐ordination (EU Withdrawal) Act2020. As such, from 1 January 2021,they apply to all workersarriving to work inthe 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 SettlementScheme which will guarantee their right towork in the UK indefinitely. 2. Inrespect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to reviewfuture 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 NLCto support key priority areas of recruitment such as Mental Health and Home Support Actions ACTIONS 1. Annual workforce plan being prepared 2. NHSLprogramme underway to support international recruitment 3. Onthe day recruitment events being trialed inHome Support 4. Useof university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 5. Recruitment of 15 Modern Apprenticeships within the H&SCPworking within Business Admin, Comms and Health CareSupport. 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. Target‐ Low Current – High
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Risk in Focus – National Care Service Risk Description Risk Owner Risk Lead NationalCare Service There is a risk that the ongoing workaround a National Care Service could destabilise current service delivery due tosignificant change activity, time demands around theco‐design process, staff uncertainty and partner organisations having to focus inwardly due to theimpact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved bythe IJB and the Strategic Commissioning Plan for 2023‐26. RMc RMc Current Controls CONTROLS 1. NLCestablishing NCS working groups 2. KeyHSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA Actions ACTIONS 1. IJBresponse submitted on proposed Bill 2. Strongpartnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLAworking groups being established ‐ local reps nominated for each Risk Trend Risk Review Thisrisk was initially created in September 2022. Although the North Lanarkshire IJB has little control over the National Care Service, work is ongoing to ensure NL IJB is involved in the decisions has much as possible. NL IJB received an update paper on the National Care Service on the 24/01/24., with a recommendation for the IJB to review the current National Care Service risk to ensure it fit for purpose. Target‐ Low Current – High
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North Integration Joint Board Draft Papers Forward Planner IJB 19th June 2024 Membership Update PCIP Update Unaudited North Lanarkshire IJB Annual Accounts 2023/24 Declaration of Interest Forms Climate Change Update Code of Conduct IJB Directions Governance Report Records management plan Public Sector Equality Duty Mosaic Update including dynamic scheduling Mental Health Strategy Refresh Public Health Annual Report Risk Update 25th September 2024 Financial Monitoring Audited Accounts External Audited Accounts CAMHS Recovery & Renewal Paediatric Modernisation SLT Improvement Trauma Informed Practice Care Academy Annual Accounts Annual Performance Report Quality Assurance Annual Report Whistleblowing Annual Update Community Solutions Annual Report Tackling Poverty Team Report Strategic Commissioning Plan Progress Risk Update 4th December 2024 Financial Monitoring Terms of Reference Annual Review Support Care & Clinical Governance Update Risk Update TBC Cost of living helpline update TBC Ethical Commissioning TBC Palliative Care
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IJB PFA 21st August 2024 Q4 Performance Report Improving Cancer Journey Our Health Together Risk Update 23rd October 2024 GIRFE Community Nursing Review Digital Technology & System Developments Annual Climate Report Q1 Performance Report Risk Update