Item 3 (M) IJB Pfa 22.5.24
North Lanarkshire Council · 21 August 2024
Back to IJB Performance, Finance and Audit Committee — 21 August 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 22nd May 2pm-4.40pm 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 Nauman Dar (Left 4pm) NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly (Left 4pm) North Lanarkshire Council Nominated Councillor Councillor Anne McCrory North Lanarkshire Council Nominated Councillor Brian Moore (Chair) 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 (Joined 3.45pm) NHSL Partnership/Staff Side Rep Harry Robertson Carer Representative Elizabeth Seaton (Left 3pm) Carers Together John Watson (Joined 2.20pm) Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Stacey Connor (Minutes) Governance Support Manager Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser (Left 3.30pm) Head of Adult Social Work Services Margaret Gibb Interim Chief Exec, VANL Third Sector Rep Jocelyn Lyall (Item 11) Chief Internal Auditor (NHS Fife, NHS Tayside, NHS Forth Valley, NHS Lanarkshire) Thomas Moan (Item 9) Senior Manager – Community Solutions Dr Lucy Munro (Left 4pm) Medical Director North HSCP Sharon Murray Interim Nurse Director North HSCP Fiona Owens Audit Scotland
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2 Maggs Thomson Head of Health NHSCP Maria Williamson Senior Manager, Quality Assurance Apologies: Paul Carey Audit Scotland Siobhan White NHS Lanarkshire Nominated Non Exec Director ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA (21st February 2024) 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 8 Financial Plan - Provision of smoke alarms- Work is taking place nationally linked to the change from digital to analogue phone lines. A report is going to the Adult Social work committee linked to community alarm- The committee agreed they would be content to receive a combined report. Item 6 IJB Self-Assessment Report- This topic will be built into a future liaison session including all members post summer. Item 5 Risk Register- This will be picked up at a liaison session to ensure benchmarking against other Boards is being undertaken in relation to risk mapping. Item 10 Performance Report- Update on Mosaic report is planned for June IJB. Future Meeting- Awaiting suitable dates from Chryston. Hub. 5. Prisoner Healthcare A paper was shared with the committee to inform them of the health service improvements undertaken in the prison, in compliance with the local Service Model Review, and in parallel with the HIS recommendations. The report notes on-going work and next steps for the service.
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3 In January 2022 a service model review was commissioned, 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. The Adult Health Support Unit (AHSU), in collaboration with Scottish Prison Service (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. 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 Maggs Thomson advised key challenges for the service are around cost pressures and prescribing; although to note we have limited control over these. The Core management group has signed off additional pharmacy support for the service and looking at other areas of improvement. Cllr Barclay noted an element of concern around seeking a partner for pharmacy given the challenges around this was there alternative options considered. Dr Lucy Munro noted that the previous supplier has a significant number of contracts in other areas. Discussions were undertaken at a National level so we were not fully aware of the details but if required local plans would have been considered. Phillip Couser asked when is the next inspection, it advised that the next cycle of inspections is 2027. He also asked around the increase in pharmacy costs and will we remain in partnership with this supplier if the costs increase any more. Ross McGuffie advised this will be continually monitored and we will consider any suitable alternatives. Brian Moore asked for some additional information around the pharmacy review. It acknowledged that the overspend for pharmacy in the service may be a potential risk for the committee in future. Maggs Thomson advised there is wider systems work that needs to be reviewed for this. In the meantime, the North HSCP has agreed additional pharmacy resources for a year to help manage.
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4 The IJB PFA agreed the following 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. 6. Prescribing: Sustainability and Value Programme 2023/24 Progress Update Dr Lucy Munro shared a report with the committee to update on the prescribing sustainability and value programme. 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 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. In North Lanarkshire, the prescribing overspends forecast for 2023/24 at March 2023 was £3.835M. 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 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. 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
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5 Lanarkshire’s high prescribing costs and to develop and implement change ideas with associated action plans. There is great instability around the Scottish drag tariff at the minute which is adding to the financial challenges in prescribing. To manage this poly pharmacy reviews are being undertaken to try and reduce the amount of items patients are prescribed. Also reviewing items that are of low therapeutic value with all prescribers in different services. Nauman Dar asked what sort of behavioural cultural training is being given to GPs to ensure holistic checking of medications is being undertaken regularly with patients. Dr Lucy Munro advised having these conversations in locality action groups, communications is being issued to GPs and also patients directly on a whole system approach. Encouraging prescribers to have conversations with patients to advise in some cases medication will be on a trial basis and not long term. Phillip Couser asked are we relying on GP practices actively participating in these conversations and is there any league tables to monitor it uptake. Dr Lucy Munro advised monitoring this through data on practices locally but don’t have a league table; looking at monitor on a locality basis. Brian Moore asked if the investment from the Primary Care Improvement Plan Fund (PCIP) is in place for pharmacy and in terms of script switches to cheaper items is this done across all practices. Dr Lucy Munro advised looking at script switch across all areas. The aim at the moment is to bring the pharmacotherapy and prescribing workstreams to together as part of the PCIP to work in synergy. The IJB PFA note: 1. The savings for the financial year 2023/2024 2. The project work stream activities planned for 2024/2025 7. Supporting Unpaid Carers and North Lanarkshire Carers Strategy 2024-2027 Morag Dendy presented a report which 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 the 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.
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6 The approach to both carer support and the Carers Strategy 2024-2027 continues 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. 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. 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. Harry Robertson provided some comments on the paper commenting that the carer strategy is clear and concise and very detailed. Cllr Barclay and Cllr Kelly both noted the positive direction of travel of the work but also aware a lot of work is still required. Cllr Kelly asked about the hospital discharges payment is there any feedback on this. Morag Dendy advised will produce learning from this but also looking at how to make carer budgets more available when needed. Maria Williamson provided some additional information around the funding available. All contracted services are due for review over the Summer, the review will be undertaken collaboratively with the services as the existing contract ends in February. Morag Dendy noted how do we ensure those who are carers know how to access resources as some people don’t always identify as a carer. Brian Moore noted for next PFA will request a report which breaks down the financial position for carers to offer clarity; Ross McGuffie noted this and will factor into the forward planner. RMcG
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7 Ross McGuffie advised through Self-Directed Support (SDS) framework we were already providing a carers budgets under cared for person’s package. So some work is now required to separate this out. Phillip Couser asked do we know where we are starting and are we able to identify some of the areas that require work. Maria Williamson advised within the carer oversight group terms of reference they have a responsibility to keep the work accountable, look at gaps and consider focus of resources. Brian Moore referred to ’Our Health Together’, NHS Lanarkshire Strategic Plan and stated that it was a missed opportunity not to reference the carers issues within health care provision particularly as some of the appendices referred to the health needs of carers. This was noted. Recommendations approved: (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. 8. Delivering for Communities – Engagement & Participation Since the last report to the 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. 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. 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. The 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. The IJB PFA committee: (1) Approve the North Lanarkshire Engagement & Participation Strategy 2024 -2027 (2) Endorse the approach and the contents of the report. 9. Community Solutions Programme Update
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8 Thomas Moan on behalf of VANL presented the committee with a report which updates on the community solution Programme to date. 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). 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.It also summaries continuing delivery of committed work during 2024- 25 and plans to review future commitments beyond March 2025. The report sets out the significant and increasing risks to CVS capacity to continue to deliver its vital services and presents the North Lanarkshire Community and Voluntary Sector Fair Funding Charter for initial consideration by the PFA Committee. A new high risk is 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. Thomas Moan offered to send any new members a briefing to explain how VANL is set up as a partnership programme; this was noted and members can contact Stacey Connor if required. Ross McGuffie acknowledged that to strengthen governance particularly, work has been undertaken to ensure this is fit for purpose and to offer assurance to the committee. Brian Moore asked about the extent of social prescribing for the service. Thomas Moan advised seeing an increase in this, there are number of projects on going that relate to social prescribing. Thomas advised that some funding to establish a social prescribing network was recieved and pull together key workers so all using same information to make the same connections.
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9 The IJB PFA agreed the following recommendations: (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. 10. Audit Scotland Annual Audit Plan (AAR) 2023 2024 Fiona Owens from Audit Scotland attended the committee to present the annual audit plan for 2023-2024. The Accounts Commission appointed Audit Scotland as the IJB’s external auditor for the five-year period from 2022/23. 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. 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. 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. Aiming to start Audit in mid-August with a planned signed off by 30th September in accordance with statutory requirements. The proposed annual audit fee for 2023/2024 is £33,360. Audit Scotland have not identified any wider scope risks, however they 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.
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10 The IJB PFA acknowledge the Annual Audit Plan 2023/24 which was shared under appendix 1 of the report tabled. 11. Internal Audit Plan 2024/2025 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. The proposed Internal Audit Plan for 2024/2025 was presented 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. 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. Brian Moore asked has the internal audit team been involved in Blueprint for Good Governance audits in the past and has there been any issues identified for partnerships as this is health boards based. Jocelyn Lyall advised she has just completed a compliance audit in NHS Fife looked at results from
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11 surveys and reviewing improvement plans to ensure they are being delivered to improve governance, no particular issued identified. The IJB PFA: (1) Approved the proposed Internal Audit Plan for 2024/2025 (Appendix 1); (2) Approved 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) Approved 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. 12. Financial Monitoring Amanda Kilburn shared a report which 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. 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. As detailed within the report the IJB final outturn was an underspend of £18.71m. 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. A summary of the main variances including financial challenges and key pressures are highlighted below: 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. 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. 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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12 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. 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. Children’s 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. 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. 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 of the report. The increase to reserves will continue to enable the IJB to meets its strategic objectives, and Scottish Government policy requirements. Phillip Couser asked how much of a factor is the ability to spend funding linked to how the Scottish Government allocate the funding. Amanda Kilburn advised majority of funding did not come in till quarter 4 this year which made spending more challenging. Going forward the Scottish Government has committed to 80% of ring fenced bundle letters being issued in quarter 1. Cllr Kelly asked do we need to look at the spend related to independent beds going forward. Ross McGuffie replied keeping a close eye on this related to balance of care data providing self-directed support budgets to older adults. Currently looking at savings plans linked with strategic direction of services. The next step is to look at how this works at a locality level based on an integrated approach.
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13 Cllr Barclay noted due to vacancy levels this leads to higher staffing costs through overtime and agency usage; she asked what is the current situation with this and what initiatives are in motion to assist filling posts. Ross McGuffie advised struggled with recruitment in certain areas that we are aware of. In higher education struggling to fill courses that were previously full which is adding to the pressure. There are some areas where there has been some improvement such as in home support which is linked to the winter business case. Services are doing all they can when recruiting new staff through different advertising methods. The IJB PFA agreed the following recommendations: (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. 13. Lanarkshire Winter Plan Debrief 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. 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. 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. 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. 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.
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14 Ross McGuffie noted some of the actions as part of lessons learned for 2024/2025 going forward a large amount of focus will be on length of hospital stays and work that can support the flow of patients. Considering having a digital front door for e triage not just for a hospital but for all services. Within the report under section 6.11 the discharge performance has been the best performance recently –largely kept delays in low 80s and 70s. Cllr Barclay queried can we see improvement with the Scottish Ambulance Service. Ross McGuffie noted this has been a challenging area but have had strong relations with the service to promote joint working and assist where possible. Brian Moore asked has there been significant impact on guardianship applications for Adults with Incapacity (AWIs) linked to reduced Mental Health officers (MHO) capacity. Ross McGuffie advised we have sessional MHOs to support the guardianship process, performance data shows an improved picture. Stood down planned date of discharge calls from daily to 3 times a week to allow staff more time to undertaken required work. The IJB PFA approved the following recommendation(s): - (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. 14. Q3 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 Adult Mental Health Medical Paediatrics Speech & Language Therapy Dietetics
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15 Adult Social Work Morag Dendy provided some detail related to each of the areas identified above. Brian Moore noted the challenges for Speech & Language Therapy (SLT) and that this is still a significant improvement journey required. Ross McGuffie added got monthly scrutiny panels to monitor performance and he added there is a programme of work behind improvement SLT. The service is moving on to trakcare soon. Focused reports for SLT alone will come to future committee meetings. The IJB PFA note the contents of the report and the appendix. RMcG 15. Category One Responder Update 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 Lanarkshire IJB/HSCP was well embedded in the Local Resilience Partnership structures. 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. The survey is included within the report and shows responses provided for further assurance that the IJB/ HSCP is meeting the requirements set out in the Civil Contingencies Act 2004. 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. Ross McGuffie added the West of Scotland Resilience Partnership (WosRRP) recognise that IJBs are fully embedded in resilience structure, going forward resilience reports will come through the IJB PFA to provide assurance. Phillip Couser asked have we tested resilience arrangements in place already to see if they are fit for purpose. Stacey Anderson advised undertaken a few exercise and been involved in resilience training across both partners with future exercises planned. The IJB PFA note the progress made in confirming identified resilience leads and note that local resilience plans are continually under review.
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16 16. Hatton Lea Closure Update Ross McGuffie provided a verbal update on the progress around the closure of Hatton Lea. He advised the work is on-going to access every individual patient in the facility to see if they still meet the criteria for a Hospital Based Complex Care HB CCC bed and if not they will be supported into a suitable alternative. A new ward in Udston Hospital has been identified for the patients and families will be contacted this week to be advised of this. To ensure the ward is fit for purpose some adaptions will be undertaken to make the ward Dementia friendly. Families will be invited to visit the site and the project will be support by the CAMHS service manager who managed a similar process. Cllr Barclay commended the team involved in managing this change which has been challenging. She asked do we see this being an issue with care home providers going forward will others follow this and withdraw their beds. Ross McGuffie noted the broader care home environment is more stable with the National contract being signed off for the year ahead. Maria Williamson added might see a change when national care home rates are reviewed. 17. Risk Register The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. The IJB currently has 17 risks identified on its IJB risk register with 10 risks rated as high or very high. There are 3 very high risks. Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 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. The 3 risks requested for review are: CAMHS Governance arrangements Unscheduled care Recommendations agreed by the IJB PFA: 1.1 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.
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17 1.2 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: 1.2.1 Delivery of CAMHs service, risk rating reduced from High to Medium 1.2.2 Ineffective Governance arrangements, risk rating reduced from Medium to Low. 1.2.3 Unscheduled Care, risk rating reduced from Very High to High. 18. Forward Planner The IJB forward planner was shared with the committee to allow members to see future planned agenda items. 19. Risk Brian Moore noted need to consider pharmacy pressure in prison services may need to consider a future risk and also a separate risk for adult care staffing. Ross McGuffie agreed to review this. 20. Date of Next Meeting 21st August 2024 9.30am-12pm