ITEM 10 Our Health Together
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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REPORT Item No: 10 SUBJECT: Our Health Together TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Jacqui McGeough Deputy Director of Planning, Property & Performance, Hospital Management DATE: 21 August 2024 1. PURPOSE OF REPORT The purpose of the report is to: - present the new NHS Lanarkshire healthcare strategy ‘Our Health Together Living Our Best Lives in Lanarkshire’ 2024-2031 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: South IJB NHS Board ☒ 1
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3. RECOMMENDATIONS The Integration Joint Board performance, finance and audit is asked to approve the following recommendation(s): - 3.1 To endorse the new NHS Lanarkshire healthcare strategy, ‘Our Health Together Living Our Best Lives in Lanarkshire’ 2024-2031 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Our Health Together (OHT) sets out the NHS Board’s strategy for the period dating from 2024 to 2031. The strategy was developed following an extensive stakeholder engagement programme that ran from April to August 2023 and involved patients, carers, our staff and local communities, including children and young people. 5.2 OHT provides the overarching strategic direction and is aligned to the Transformation and Reform programme that is already underway. The strategy also reflects both local and national priorities. The four reform groups referenced as the priority areas of focus within the document will become the delivery arm of ‘Our Health Together’ going forward. These groups will develop implementation plans for the short to medium term and will continue to engage and involve key stakeholders in their work. 5.3 The draft strategy was shared with a wide number of stakeholder groups ahead of sign-off at the March 2024 NHS Board meeting, with final approval at the June 2024 NHS Board meeting. 5.4 Driving efficiency and delivering best value is an underlying principle of Our Health Together and this should be evident throughout the document. All aspects therefore promote effective and efficient use of resources to ensure that future health care provision is sustainable and represents best value. 2
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5.5 During the engagement programme, stakeholders described their ambitions for NHS Lanarkshire. To address stakeholders’ ambitions, the strategy describes actions to be taken to: • address service access challenges so that services can be accessed in a timely manner • provide the necessary supports/resources to promote wellbeing & independence (this includes prevention and early intervention) • deliver care in an appropriate setting (this includes support for people to stay at home as long as possible) • deliver person centred care – people are more than a demographic • improve access to community based mental health supports for younger people • enhance staff health and wellbeing • optimise the use of digital technology, with the flexibility to tailor support based on patient needs/abilities/wishes • ensure ongoing engagement with stakeholders is undertaken • optimise opportunities for Healthier communities – educational & employment opportunities 6. CONCLUSIONS In conclusion the IJB PFA is asked to note our health together strategy and to receive updates when appropriate. 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 ☒ 3
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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: 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 ☒ 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 4
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□ 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 NHS Lanarkshire has completed a comprehensive and wide ranging engagement programme with stakeholders as part of the development of the new healthcare strategy which took place during 2023. More recently further engagement has taken place with Strategic Delivery Team, Area Clinical Forum, Area Partnership Forum and Planning, Performance & Resources Committee to inform the final draft. 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 EQIAs A series of EQIAs have been completed as part of the development process of the OHT strategy. This included all workstreams who have input to the development of the document. Additionally, an EQIA was carried out for the communications and engagement programme that was completed in 2023. Looking forward to implementation, it is anticipated that the reform groups would develop an EQIA for each of the constituent areas. 5
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8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Our Health Together Strategy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Jacqui McGeough Jacqui.McGeough@lanarkshire.scot.nhs.uk 6
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Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-10 2 Report Title Our Health Together 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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Our Health Together 2024–2031 Appendix 1 8
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Our Health Together 2024–2031 Table of Contents 01: Welcome 02: Introduction 03: Why We Need to Change 04: What You Told Us 05: Transformation in Practice 06: Next Steps 07: Measuring Success 08: Summary and Conclusions 09: Acknowledgements 010: Supporting Documents 9
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Our Health Together 2024–2031 01: Welcome A message from Martin Hill, Chair & Professor Jann Gardner, Chief Executive We are incredibly proud of NHS Lanarkshire’s role in providing care every day and helping to improve the health and wellbeing of our communities. This new healthcare strategy lays out our plan for the future as we work alongside our communities to address current and future challenges. We know we need to do things differently. Reforming how we provide care will help develop sustainable, affordable services; modernise; embrace innovation; and improve how we perform as a Board. In doing this we will deliver a better experience for our patients and service users. We listened to your feedback and know we need to take action. This ranges from improving access to our services to considering the impact of wellbeing on our staff and communities. As well as reforming our services, we must continue to work closely with partners. These include Local Authorities and Voluntary Sector. We will work with these partners to improve health outcomes, focus on health improvement and reduce the health inequalities that exist across Lanarkshire. We continue to build on previous successes, delivering improvements that are important to you. We must do this while being sustainable and financially viable. Rising costs and COVID-19 hit our communities hard and continues to affect people who live and work in Lanarkshire. Our services were also affected and we continue to face challenges every day. Our whole system is working together to improve access and return to our pre-pandemic position. We have experienced unprecedented rises in the cost of goods, services and utilities. Therefore, we must identify opportunities to improve efficiency, deliver best value and achieve financial balance. This may mean that, together, we have to make some decisions that change the way we deliver services. We will do this through collaboration and innovation. Planning is well underway for our new hospital which will replace University Hospital Monklands around 2031/32. Redesigning aspects of our work is fundamental to this, and will ultimately transform how we provide care. We will take the learning from this work and our internal reform programmes to help improve services. We will redesign primary care, with a focus on the range of services delivered by our GP practice colleagues. Much of our engagement feedback related to GP access and this was raised by our communities and staff who work in the service. There is a pressing need to address the significant issues facing General Practice. We must consider how the broad range of primary care services are positioned to deliver better care for our patients. Our journey is only beginning. With your support we will continue to develop plans to transform care as we work to address the challenges that exist. We would extend our thanks to those who engaged to inform our strategy and assure you that there will be further opportunities for you to help shape the future of NHS Lanarkshire. 10
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Our Health Together 2024–2031 02: Introduction Our new healthcare strategy, ‘Our Health Together – Living Our Best Lives in Lanarkshire’ is a route map that starts us on a journey to deliver positive change. We will work with our staff, communities and partners to explore together how we can reform to deliver sustainable, affordable services that provide person centred high quality care. We have already started this process, and our communities and staff were involved in a far reaching engagement process during 2023 where we sought to understand what matters to people who use our services, or staff and the wider community. A lot has changed since we published our previous strategy, ‘Achieving Excellence,’ in 2017. The pandemic and cost of living crisis `impact has been greatest on our most vulnerable groups. To deliver What are we aiming to achieve? a better patient experience, we must transform our models of care, improve performance and ensure we make best use of resources to achieve best value. This includes taking action to promote good health. We have identified 4 priority areas of focus – Urgent and Emergency Care, Planned Care (including outpatients and surgery), Mental Health and Primary Care (which includes general practice). The exciting development to replace the University Hospital Monklands provides opportunities to explore ideas for innovation and service redesign. Adopting new approaches for health care provision across our whole system will deliver a better experience for our patients and service users. Delivering the best quality of care is at the heart of all we do as an organisation and our Quality Strategy 2023-2029 sets out the key principles of person centred, safe and effective care at its core. We will prioritise the national Population Health Plan commitments, building on local work underway to mitigate inequalities and support our communities to thrive. We know we can make our healthcare system more efficient and better for our patients by delivering care in the right place. Right care, Right place, Right time, First time 11
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Our Health Together 2024–2031 Our Aims & Objectives We know we need to do things differently to deliver a health and care model that continues to deliver affordable and sustainable services now and in the future. NHS Lanarkshire has a track record of delivering positive change and improvement and we want to build on this, strengthen existing partnerships and work together to create the conditions that can help to improve the health and wellbeing of our population. We have developed four overarching objectives that underpin everything we do in Lanarkshire. These are our ‘Corporate Objectives’: 1. Better Health – Our health and social care teams will work together to improve the health and wellbeing of our local communities through prevention and early intervention. We will also take steps to address the health inequalities that we know impact significant sections of our population. 2. Better Care – We will re-design and reform our services to improve access, outcomes and patient experience, and to ensure we deliver resilient and sustainable services. 3. Better Value – Improving efficiency will ensure we make best use of our limited resources, delivering services that add value. We will do this within our allocated budget. 4. Better Workplace – Our staff are our most valuable resource. We will identify opportunities to improve their day to day experience delivering services and healthcare to our population. Through our role as an ‘Anchor Organisation’ we can influence the wellbeing of the local community beyond the delivery of healthcare which helps address inequalities. The term “anchor” means that we deliver crucial services, employ large numbers of local people, who form a significant proportion of our workforce and use our resources for the benefit of our communities. Our Vision To enable healthier, longer lives. We will deliver compassionate, innovative, sustainable and high- quality health and care services that empower people and reduce inequalities 12
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Our Health Together 2024–2031 03: Why We Need to Change There are challenges we need to plan for and exciting opportunities to explore, innovate and develop. Our services face major challenges and we must deliver a modern service that meets the needs of our communities. Our current position is very different to where we were pre- pandemic despite the recovery we have made so far. 1. Our Population is Changing From 2021 to 2031… Lanarkshire’s population will increase by: People ages 75+ are expected to increase Children under 15 will decrease by: approximately 3,000 That’s over 0.5% over the next 10 years approximately 14,000 That’s 25.7% by 2031 approximately 10,000 That’s approx. 9.1% fewer 0–14s by 2031. Population projections are modelled from census data and subject to change Lanarkshire has experienced a fluctuation in the number of births each year. Across Scotland, an increase in caesarean sections and an increase in the average age at which mothers give birth can bring more complexities to pregnancy care due to health care needs. Additionally, we will have more elderly people and less people of working age across our communities. Many of our older population will live healthy, engaged and independent lives, supporting their families and communities. However, we also know that an aging population means we will have more people who: need support with their health issues; have more than one long term health condition and have complex medical needs which will increase demands on our services. 13
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Our Health Together 2024–2031 2. More People Experiencing Poorer Health Factors that impact on health and wellbeing are complex and are closely linked with social and environmental circumstances. We have higher than average levels of deprivation, more children living in poverty and life expectancy is below national levels. Life expectancy and ‘healthy’ life expectancy (the average life spent with good health) are closely linked with poverty and other societal factors. We know that in the most deprived areas in Scotland, people will spend more than a third of their lives in poor health which is not a positive outcome for them and increases demand for our services. We have a growing gap between the most and least deprived: • A large proportion of our population are negatively impacted by the cost of living crisis • We have the second lowest life expectancy in Scotland • We have more areas of deprivation than other areas of Scotland • We were affected more by the pandemic than other areas of Scotland • We have a higher rate of pre-term babies than other areas of Scotland • More children are delayed reaching developmental milestones following the pandemic Populations living in areas with most deprivation have over 3 times the levels of multiple long term conditions than those living in areas of least deprivation. The largest forecasted annual ill health impact is on those aged 65 to 85 years. 21% Annual impact of ill health is forecast to increase by 21% over the next 20 years. This is equivalent to the entire 2019 disease burden caused by cancer Our Commitment: We will continue to build on our existing strong partnerships and support each other to make the changes and improvements that can deliver a reduction in health inequity that we know exists across Lanarkshire. 14
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Our Health Together 2024–2031 3. Make the Best Use of Our Resources It is vital that we make best use of our resources – finance, workforce and property - for the benefit of our patients, carers and communities. Our services must be efficient, deliver value for money and be sustainable for future generations. We will work together with our staff and communities to ensure that we optimise and make best use of our limited resources. Finance NHS Lanarkshire has managed our services and financial position positively over a number of years. However, as population needs change, types of treatment options evolve and costs increase, managing the needs of our population within a fixed budget becomes more challenging. To address these challenges, we MUST improve efficiency and effectiveness. We will: Align our priorities to meet the needs of our population- o Prioritise delivery of core services o Re-invest in what makes a difference, focusing resources where they make a difference to health and the quality of life Optimise the use of resources to achieve best value Ensure that we deliver services that are resilient, sustainable and affordable Transform, reform, innovate and modernise care £ 15
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Our Health Together 2024–2031 Workforce It is positive that most of our staff live in the local area, and many are long term employees. Like other Boards, we are facing high levels of staff turnover and have challenges filling some roles. In some instances, we have to rely on agency and locum staff. Our staff have told us that they continue to experience stress and burnout and optimising wellbeing remains a key priority. The age profile of our staff is increasing and this will impact on our future workforce planning, particularly as we are facing increasing demand for our services in future Property Our premises, which include hospitals, health centres, stores, laundry, office facilities and green spaces, are central to the provision of safe modern healthcare. We have a combination of newer and older buildings, all of which require to be maintained. On occasion some need to be re-designed or replaced to accommodate changing service needs. We need to use our properties efficiently and flexibly as this enables us to accommodate growing patient populations, new models of care and new technologies. Our communities can continue to access our green spaces as part of our drive to improve wellbeing. Our new University Hospital Monklands gives us an incredible opportunity to modernise and to embrace technology and innovation. We will also continue to collaborate with our Local Authority partners, exploring opportunities for joint developments that local communities can enjoy. Our facilities, and the services we deliver from them, impact climate change. We need to adapt and invest to improve energy efficiency and reduce the waste we produce. Our Net Zero ambitions are laid out in our Su stain ab ility & Climate Ch an ge Strategy. 16
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Our Health Together 2024–2031 Page 10 of 34 4. Medical Advances and Innovation The way we see and treat our patients is very different compared to a few years ago. Advances in medicine and technology have changed the way we deliver care to our patients and service users, increasing the number of people we can help and delivering better outcomes. This has led to a better quality of life for many people who live across Lanarkshire. We expect this trend to continue with new technologies offering opportunities to access and receive care differently. Medicine, technology and research advances deliver many opportunities: Using technology to support diagnosis & provide care - remote monitoring, decision support and patient consultations Development of new medicines and therapies Better sharing of information through Information Technology Advances in robotic assisted technology Developments in understanding of genetics - causes of disease, and tailored therapies so patients get the treatments and advice that works best for them. Our recently published Digital Plan sets out how we will utilise digital technology to support delivery of person centred, safe and effective care. 17
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Our Health Together 2024–2031 Page 11 of 34 04: What Matters to you - Stakeholders as Part of our Development Process We have adopted a new approach to stakeholder engagement to inform the development of our strategy. Historically, we ‘consulted’ on plans which had already been developed. As part of our new approach, we have engaged and involved our stakeholders at an earlier stage, involving patients, unpaid carers, our staff and local communities. Your feedback has helped us to identify priorities and shape the design of our services. What did we ask our stakeholders? We developed a number of topics we wanted to gather stakeholders’ thoughts about. These were: Factors that impact on health and well being Ways we can best support our communities to stay well Access to our services The role of digital developments in healthcare We have used this information to: Identify common themes understand what is working well and what needs to improve Identify gaps in our services Shape our priorities. How we engaged Between April and August 2023, we spoke to our staff and communities to learn what matters to people who live and work in Lanarkshire. A variety of methods were used to capture views which included: online events; digital and offline surveys; in person meetings and presentations. It was important that our engagement with stakeholders was as inclusive as possible. Our voluntary sector partners and Health Improvement Team helped us to reach residents and services users who don’t normally engage in this type of process. We did this through a series of community and staff engagement events, voluntary sector partner engagement, attending community groups/meetings, MSP/MP briefing sessions. We also held a focused period of engagement with children and young people. Over the course of our engagement programme we reached almost 2000 people. 18
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Our Health Together 2024–2031 Page 12 of 34 What you told us We learned that: There is broad support for self-management of health conditions. This includes education courses, community support networks, mental health resources (including for younger people) and remote or digital options. There is general comfort with digital approaches. Willingness to engage with digital technology was high among our staff and the public. There were a range of views captured and the feedback can be summarised into 4 key themes: Address Service Access Challenges – Delays and challenges accessing our services was the single biggest issue raised by our stakeholders. We need to improve GP access, reduce long waits and remove barriers. This includes extended provision for patient appointment scheduling and digital outreach. Improve Patient Experience – Our patients want to feel heard, understood and cared for. Care should be delivered in an appropriate setting, with people supported to stay at home as long as possible. We need to provide flexible appointment systems and use virtual appointment options or online appointments appropriately. Stakeholders also asked that we reduce the need for multiple appointments with different specialties. Enhance Mental Health & Wellbeing in Communities – Poor mental health and wellbeing was highlighted as a concern by both the public and staff. Improving surroundings, green spaces & access to community networks was flagged as a means of improving mental wellbeing. Working with our voluntary sector and local authority partners will be key to improving the mental health and the physical health of our population. Improve Staff Wellbeing and Morale – Our staff are central to our organisation and need to feel valued and supported. Optimising wellbeing remains a key priority to address stress and burnout. Achieving a good work life balance and building in time for reflection and learning is desirable. This is an area we know we can improve. 19
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Our Health Together 2024–2031 Page 13 of 34 What matters to you? – The impact of inequalities Through our engagement programme we reached out to communities who do not traditionally engage, and as a result we were able to hear about the impact that life circumstances have. We heard that some of our population experience challenges accessing services. These challenges could be financial, physical, cultural or as a result of life circumstances Choice – You have told us that inequalities mean choice is often removed or reduced. Respect – You have told us you want us to be more empowering and supportive Dignity – Our systems and administration arrangements present difficulties for some of our patients without support from others. This is a particular issue for those with a physical or mental disability. Digital solutions could help to increase independence. Despite the barriers that were described, we were encouraged to hear from the same groups that small changes can make a difference. How did we ensure that our engagement programme was the correct approach? It was important that our engagement programme reflected good practice and was inclusive. To give assurance that this was the case we adopted a three-stage assessment/review process: Good Practice – we shared our process with Health Improvement Scotland (HIS) Community Engagement, our Health Improvement Team and our Inequalities Team Independence – our survey was conducted and evaluated by an independent company. Evaluation of the Programme – the engagement survey work was verified by a secondary external party. Based on the feedback our stakeholders have told us we should: Create an ongoing feedback loop by listening, learning and leading change. When we can’t make the changes requested, we should be clear and honest, sharing relevant information. Communicate the benefits and outcomes to the widest possible audience. Use simple language that everyone can understand. Text messaging with a wider range of stakeholders 20
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Our Health Together 2024–2031 Page 14 of 34 What we do now 05: Transformation in Practice Refreshing our Focus NHS Lanarkshire has a long history of modernising and reforming services to the benefit of our patients and service users. We will continue to build on this. We will be informed by your feedback and will work alongside our communities to plan together how to best address the challenges. We will embed resilience to ensure the future service can withstand challenge and disruption. A lot has changed since we published our previous healthcare strategy ‘Achieving Excellence’. The pandemic, closely followed by the cost of living crisis, has increased costs beyond what we can afford within our allocated budget. This means we need to look at our spending and reduce costs to manage within our budget. We know there are efficiencies we can deliver, but the challenge is significant and it is likely that we will need to make some difficult decisions around how and where we deliver care. We will need to prioritise core services that make the biggest difference to the health of our communities. We need to consider how to balance what our stakeholders have told us against our own corporate objectives and the priorities identified by the Scottish Government. What we do now We are responsible for delivering health services to over 654,000 people across Lanarkshire. We deliver care in a variety of settings, from community-based centres, acute hospital wards and secure settings, to services delivered in people’s own homes or via video. Dentists, Opticians and Pharmacies support NHS Lanarkshire in the delivery of health and care services across our localities. 21
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Our Health Together 2024–2031 Page 15 of 34 Our Corporate Objectives Better Health • Tackle access issues our service users are currently facing • Maximise health improvement activities • Target services to those most in need to help reduce health inequity • Maximise the uptake of screening and vaccination programmes • Reduce the climate impact of our services • Empower people to manage their own health conditions where this is appropriate Better Value Better Care • Ensure care is delivered in the right place, navigating appropriately • Reduce the waiting list backlog • Streamline care by adopting a more person centred approach • Maximise opportunities to deliver care as close to home as possible • Reduce/remove interventions that have minimal clinical value • Remove unnecessary hospital stays • Minimise the length of time people have to stay in our hospitals • Optimise efficiency • Make best use of and rationalise our estate • Improve the energy efficiency of our buildings • Reduce reliance on agency and locum staff • Streamline corporate processes/functions • Reduce levels of sickness absence £ Better Workplace • Support our staff to improve their day to day experience • Optimise opportunities to improve health and wellbeing • Deliver flexible working practices • Maximise opportunities for learning and development • Provide support to improve attendance rates We must reform our services to address our challenges and make best use of our available resources. Delivering the same services in the same way is not sustainable. This will not improve the health and wellbeing of our population. To deliver the change required and address the priorities noted above, we have identified four key areas to focus on. These are Primary Care, Mental Health, Planned Care and Urgent & Emergency Care. 22
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Our Health Together 2024–2031 Page 16 of 34 Developing our Reform Programme Our stakeholders shared what matters to our communities. Based on this feedback, and in consideration of the challenges ahead, we have developed a new approach and established four Transformation and Reform groups. They will oversee the development of proposals for change in the following areas: Primary Care (including General Practice) Mental Health (young people and adult) Urgent and Emergency Care (“Operation FLOW”) Planned Care (scheduled clinics and treatment) Delivering change Our Transformation and Reform groups will address our system pressures. In taking this forward they will be asked to: Consider the feedback and reflect how we can address the issues highlighted. Work with our stakeholders to develop plans for reform. This includes optimising health improvement opportunities, adopting the principles of realistic medicine and considering the financial and capacity challenges. Develop a workforce model that is sustainable and affordable Identify leadership to plan for the future and deliver our ambitions We need to consider ways to do things differently and prioritise where we focus our resources. We want to ensure we continue to deliver high quality services for our patients and carers. We need our patients to use our services in a different way. This includes: Supporting and empowering patients to maintain good health and manage their own health conditions as far as possible Creating online resources and education materials for patient use Modernising approaches to patient access and appointments Being seen by the appropriate health care professional, based on need 23
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Our Health Together 2024–2031 Page 17 of 34 Primary Care Primary Care is where most patient contact occurs. It is usually the first access point for person-centred care, and includes a broad range of services. Examples of the professionals who deliver Primary Care General Practice is central to the delivery of health care across Lanarkshire. Our General Practices are individually managed through a Scotland-wide General Medical Services (GMS) contract. There has been considerable investment in General Practice as part of the national Primary Care Improvement Plan to enable our GPs to deliver appropriate care to patients. This funding has been used to recruit Multi-Disciplinary Teams who provide care. A General Practice Multi-Disciplinary Team consists of a wide range of professionals including Practice Nurses, Community Link Workers, Pharmacists, Advanced Nurse Practitioners, Physiotherapists, Occupational Therapists and Phlebotomists (bloods). Funding was also used to transform our Vaccination Programme and establish our Community Treatment & Care (CTAC) network which delivers services such as Phlebotomy and wound care management. Through our engagement we know that many patients across Lanarkshire are concerned about access to their GP. We also know that general practices are faced with significant demands and risks in relation to their sustainability. To address this, we need to ensure that our patients access the most appropriate professional for their needs. This means that the expertise of staff within general practices is focused on those patients whose needs they can best meet. 24
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Our Health Together 2024–2031 Page 18 of 34 We have also started to develop plans for our Primary Care reform programme which will focus on the continued development of: General Practice Multi-Disciplinary Teams Flow Navigation Centre (virtual Emergency Department) and access collaboration (to improve wait times), including our Out of Hours Service (OOHs) Digital innovation Redesigning primary care services in partnership with patients and carers We will work with partners (including Colleges and Universities) to help us to understand the current and future demand and need for primary care services. This work and a further engagement programme will enable us to design a future Primary Care service based on population need. As part of this reform programme we will: Promote the sustainability of all general practices. This includes helping with the recruitment and retention of GPs and other practice staff. Ensure stability and development of other valued NHS primary care contractor groups – community dentistry, community optometry and community pharmacy. Strengthen the working relationships between primary care and acute hospital based care. We recognise that the public must have confidence that they can access appropriate primary care services when needed. This will be crucial to success. 25
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Our Health Together 2024–2031 Page 19 of 34 Mental Health & Wellbeing It is vital that we do all we can to support and improve the mental health and wellbeing of our population. We all have both physical and mental health needs and we know that there is a direct link between them. Demand for mental health services has increased as a result of the pandemic. Providing support and creating ways that improve mental health and wellbeing was identified as a key feature from our stakeholders. We know people’s needs for mental health support and care vary. Some people may be able to manage their mental health needs themselves (self-management). Some will require social and/or community support. Others will need more formal interventions to manage their diagnosed mental health conditions, in the community or hospital. Social inequalities and environment have a direct impact on mental health and wellbeing. It is essential that we continue to work with our partners to address the social factors that effect and worsen mental health. We must also address the stigma and discrimination that exists. By working in partnership, together we can raise awareness of how poverty, deprivation, addiction, homelessness and social isolation impact. Following extensive engagement with key stakeholders, Lanarkshire developed Scotland’s first Mental Health and Wellbeing S trategy (2019-2024). The 2019-2024 strategy has successfully delivered a comprehensive change programme. However, there is still much work to be progressed. We will continue to work with our partners, recognising that “mental health is everyone’s business”. With our Community Planning Partners we will continue to develop and implement local mental health & wellbeing (MHW) priorities. We will ensure that these align with the Scottish Government/COSLA Mental Health and Wellbeing Strategy (June 2023) and use work that is developing nationally to inform the development of our local MHW Delivery Plan. Good Mental Health for All –Delivery Plan priorities: Addressing Mental Health inequalities Early intervention and preventing mental health conditions Improving/increasing access to Mental Health Supports and Services Children and Young People’s Mental Health and Wellbeing Services Specialist Mental Health Services 26
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Our Health Together 2024–2031 Page 20 of 34 Tackling Stigma Good Mental Health For All Our Children and Young People’s Mental Health Service (CAMHS) have benefitted from investment and we opened our new Children’s Centre at Udston Hospital in September 2022. This new facility provides a valuable resource supporting delivery of our CAMHS and Neuro Developmental Services. This was co-designed by service users and their families. Supporting ‘Good Mental Health for All’ can only be delivered with positive collaboration across sectors, including support for prevention and early intervention. This is important given the increased demand for support along with the need to operate within budget. A number of initiatives are already underway which will support us to continue to evolve and improve mental health services and access. Review Ligature Reduction across the inpatient estate Specialist Mental Health Services Review of the Custody Suite Model of Service Delivery Develop and Deliver a dedicated Adult Neurodevelopmental Pathway Service Model Review of Theraputic Emotional Support Services (TESS) Extend roll out of Neuro Development Service projects in schools. Children & Young People Improving transition to adult mental health services Embedding Choices and Partnership Approach model Neuro Developmental Service open access workshops for families while they wait Digital innovations Prioritising patients with long waits between teams University partnerships Class based activities Improved Access Peripatetic team to support areas and reduce geographical inequity Waiting list clinics Mentally healthy infants, children & young people Menally healthy later life Mentally healthy environments & communitites Mentally healthy employment Reducing prevalence of suicide, self-harm, distress & common MH problems 27
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Our Health Together 2024–2031 Page 21 of 34 Urgent and Emergency Care Urgent and emergency care is delivered across our whole healthcare system 24 hours a day 7 days per week in a variety of settings. Urgent care needs can be met in communities by our pharmacists, dentists, opticians and through general practice. Emergency care for our sickest patients is delivered in our 3 emergency departments. We launched our whole system redesign of unscheduled care, ‘Operation FLOW’, at the start of 2023. The work is a collaboration between NHS Lanarkshire, University Health and Social Care North Lanarkshire, South Lanarkshire University Health and Social Care Partnership and the Scottish Ambulance Service. The aim of Operation FLOW is to ensure that our patients receive the care they need in the right setting, reducing pressure on our emergency departments. Where emergency care is needed our patients should receive treatment quickly and be discharged from hospital without delay. 28
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Our Health Together 2024–2031 Page 22 of 34 Key to enhancing patient experience is improving their journey through our hospitals. We have invested in additional staff and put new structures in place that would allow us to reform and improve our emergency and urgent care pathways through our services. The initial focus is on frailty and rehabilitation to reduce the number of patients delayed in our hospitals. Rehabilitation services support quicker recovery. They also reduce the time people need to spend in hospital. We know that we have some patients in hospital for longer than they should be. Reducing delays and ensuring patients return home timeously, reduces risks which may include falling, catching infections and reduced mental and physical wellbeing. This is a particular risk to our elderly population. Reducing occupancy levels provides a number of additional benefits which would include: enhanced quality of care for patients reduced pressure on staff maximise care delivered in the community closer to patients’ homes. opportunity to review the configuration of our beds allows us to use our resources more efficiently 29
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Our Health Together 2024–2031 Page 23 of 34 Planned Care Planned care is the provision of services with planned appointments, such as outpatient appointments or surgical procedures. Our planned care services were particularly affected by the pandemic and we continue to work to reduce long waits for our patients. We also know that the demand for more specialist care and surgery will grow in the future due to the changing age profile of our communities and an increasing elderly population. Our focus is to: • Reduce waiting times for our patients back to pre Covid levels • Maximise the use of the National Treatment Centres such as the Golden Jubilee National Hospital to support a reduction in waiting times • Reduce longest waits for patients waiting over one year • Improve cancer outcomes through better prevention and diagnostics To deliver against these aims we need to review all aspects of our planned care pathways: Workforce Maximise non-doctor roles to free up consultant capacity (Surgical Care Practitioners, Surgical First Assistants) Develop the theatre workforce Protect Planned Care (hospital within a hospital) Optimise Theatre booking and scheduling Consider options for high volume hub Right procedure - Right Place In patient and Day Case Clinical triage (prioritisation) and advanced vetting to assign more appropriate pathway Review of return appointments - maximise use Patient Initiated Returns where appropriate Standardise pre-operative assessment to reduce uneccessary face to face appointments Outpatient Redesign 30
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Our Health Together 2024–2031 Page 24 of 34 We need to consider the planned care provision across NHS Lanarkshire and how to get the best out of the limited capacity, ensuring we use our resources to best effect. This includes our staff, clinic accommodation and our operating theatres. Through our engagement we learned that our patients are concerned about long waits. We also learned that they are willing to travel if it means quicker access to treatment. This gives us opportunities to look at where and how we deliver services and to consider different options and models that we see working effectively in other health care systems. Current areas of reform include: Surgery Increase activity through our Day Surgery Units Embed the 23 Hour Care model (extended time for recovery) Maximise use of robotics in surgery Optimise theatre use and implement digital solutions Outpatients One-stop Gynaecology out-patient clinics (see and treat) Redesign of Neurology services, increasing outpatient capacity and nurse led-activity Embed an approach where patients can make follow-up appointments for the same condition when required. (Patient Initiated Review) Cancer Our active cancer reform programme is focused on a number of areas: Detecting Cancer Early Programme Rapid Cancer Diagnostic Service Development of a Urology Hub Improved validation & multi-disciplinary team input Active Patient Tracking Introduction of Cancer Care Navigators to Breast, Upper GI & Lung. Embedding Prehabilitation sessions to focus on physical, psychological and nutritional health behaviour change Introduce Advanced Nurse Practitioner-led virtual clinics for low risks cancer patients 31
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Our Health Together 2024–2031 Page 25 of 34 06: Next Steps We have engaged and listened to what is important to our service users, the wider community and our staff. We have also considered the challenges and need to deliver sustainable and affordable services. We will now progress a programme for transformation and reform which will support us to deliver our stakeholders’ ambitions. Our Commitment to Deliver Stakeholders’ Ambitions You said… We will… Address service access challenges so that services can be accessed in a timely manner Establish Transformation and Reform groups that will oversee the development of proposals for change. Work with primary care providers to improve access to GP services Reduce our hospital waiting times for outpatient clinics, diagnostic tests and surgery Ensure our hospital teams plan for discharge from admission and work with community partners to reduce length of stay and improve transitions of care Implement theatre optimisation programmes Explore the provision of direct access for GPs to refer appropriate patients to hospital services Deliver on the ambitions of the new Unscheduled Care Improvement Programme (Operation FLOW) to reduce hospital occupancy and improve access to Emergency Departments Our commitment We will continue to involve patients, carers & staff, as we work together to develop reform plans that deliver the best possible outcomes within our available resources. We will work together with planning partners to identify opportunities that support improvement in the health and wellbeing of our population. 32
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Our Health Together 2024–2031 Page 26 of 34 You said… We will… Provide the necessary supports/resources to promote wellbeing & independence (this includes prevention and early intervention) Support our services to create user friendly resources and educational programmes to support self- management. This work is already underway for Rehabilitation, Falls and Children & Young People services In partnership with the voluntary sector and community partners deliver a range of supports that prevent illness, improve health and wellbeing and reduce health inequality o Physical Activity programmes both in and outdoors, o Smoking Cessation support, o Weight Management & Healthy Eating, o Breastfeeding support o Stress control classes Promotion of physical activity and leisure services, Get Walking Lanarkshire programme and outdoor opportunities as part of “Our Natural Health Service” promote the use of information resources and directories that provide information on available supports within the community Signposting to NHS Inform resources Deliver care in an appropriate setting (this includes support for people to stay at home as long as possible) Design a state-of-the-art hospital with new clinical models that include delivering some services in the community Deliver the new rehabilitation model Work with our Local Authority partners to create shared community spaces (e.g. Chryston Hub, re-purposing of the existing University Hospital Monklands) Flow Navigation Centre model developed to facilitate direction of patients at the right time and in the right place Deliver on the review findings of the Hospital @ Home service to focus on admission avoidance and step down for complex patients Increased access and use of NHS Inform, NHS24 mental health helpline, on-line resources and dedicated mental health hub with access to onward referral to those in distress and crisis Develop specialist community and outreach teams to support people at home 33
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Our Health Together 2024–2031 Page 27 of 34 You said… We will… Deliver person centred care – people are more than a demographic Access to community based mental health supports for younger people Staff health and wellbeing Deliver on the requirements of the ‘UN Convention on The Rights of the Child’ Encourage annual review and care co-ordination for people with multiple chronic health conditions Explore opportunities to expand shared decision making with consideration of patients’ wider needs Consider opportunities across our service to highlight and action what our stakeholders have told us Review communications to our patients and look for opportunities to improve our approach Increase the number of polypharmacy reviews (reviews for patients on more than five medications) Improve processes for young people transitioning to adult mental health services taking a trauma informed approach Development of Neuro Developmental Service (NDS) open access workshops for families whilst they wait, or if they have self-identified any need Undertake two NDS projects in schools to focus on a whole school approach to ND need, identification, assessment and support. The second project will focus on transition of children between Primary and secondary school. Work with pupils will start in P6 and progress with the pupils to S2 Develop a directory of mental health services and supports for children and young people to ensure the right support is available at the right time for the whole family across ages and stages of a young person’s life Deliver our Staff Health and Wellbeing Plan Create more opportunities for our wider staff group to be involved in the design and delivery of our services Progress the work of the Staff Equality Networks - Ethnic Minority Employee Network, Lesbian Gay Bisexual and Transgender + (LGBT+) Employee Network and Disability Network Deliver Resilience and Wellbeing in the workplace sessions to staff across NHSL Deliver an annual staff wellbeing week Optimise the use of digital technology, with the flexibility to tailor support based on patient needs/abilities/wishes Work with staff and patients to co-design digital approaches which will improve access to services and health information within the new Monklands hospital Develop systems which support the sharing of patient records between healthcare professionals Continue to roll out innovations which enable remote monitoring of patients with long term conditions Optimise remote monitoring of patients 34
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Our Health Together 2024–2031 Page 28 of 34 You said… We will… Promote closer to home consultations using Near Me (including community supported Near Me) that will reduce health miles Accelerate delivery of the digital prescribing programme Ongoing engagement with stakeholders is highly valuable Healthier communities – educational & employment opportunities Ongoing engagement to co-design the new Monklands hospital through Design Development Workshops, Monklands Engagement Forum and NEXTGEN Events focused on young people. Utilise feedback from School Nursing engagement exercise, Children and Adolescent Mental Health Services engagement, engagement around Children’s Services Plans in North and South Lanarkshire to inform future developments Deliver Falls Prevention Pop Up engagement events with the public to provide opportunities for discussion and advice on medication side effects, eyewear, footwear/foot health, blood pressure and falls Utilise the Mental Health and Wellbeing Strategy Communications and Engagement Reference Group to ensure that there is ongoing meaningful involvement with all communities impacted by poor mental health and wellbeing, particularly those with lived experience Continued engagement and involvement with our voluntary sector partners Stakeholder engagement to inform a new model for Primary Care Deliver on our Anchor Plan Build on our existing educational partnerships with our local schools and academic partners (University of the West of Scotland, New College Lanarkshire, Strathclyde University, Glasgow Caledonian University, West College Scotland) Continue to be a major local employer: o run employability initiatives including modern, graduate and foundation apprenticeships; graduate internships and pre-employment programmes including Project Search, Kickstart and NHS Demonstrator Project o participation in NEXTGEN Events which aim to give Young People a better understanding of the wide range of careers available across the NHS o the new Monklands hospital project will support our commitment to deliver employment, economic, environmental and societal benefits and opportunities across the communities it serves. 35
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Our Health Together 2024–2031 Page 29 of 34 You said… We will… o work with Local Authority and Community partners to ensure we maximise the use of our combined green spaces, improving these and extending access to local communities. Community hospital garden groups established across a number of sites Continue to be active alongside North Lanarkshire and South Lanarkshire Community Planning Partnerships to focus efforts on what we can do together to improve health Address Climate Change Challenges Building upgrades to improve energy efficiency o upgrade of old light fittings to LEDs o installation of solar power systems throughout community sites o improve insulation Electronic Vehicle (EV) replacement programme in place with all small fleet vehicles scheduled for replacement by 2025 Explore options to improve biodiversity in our green spaces, e.g. wild meadows West of Scotland Laundry heat recovery projects and solar panel installation Upgrade building management systems Continue to expand our hospital garden project work with our clinical teams to support changes to clinical practice reduce reliance on single-use supplies reduce waste and increase recycling 36
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Our Health Together 2024–2031 Page 30 of 34 07: Measuring Success Monitoring our achievements and measuring what they deliver for patients and our communities is a vital part of running our whole system. This can help us to identify opportunities and risk in our plans. It can also help us to see where pressures, gaps in resource and changing demands are impacting. This means we can continue to find solutions and develop future strategies that should benefit our patients and the teams. How will we do this? There are several ways we look at how our whole system is performing. Performance Targets - There are a series of performance targets set by the Scottish Government and our Board. They help us to quickly identify where our system is not performing as we would hope and direct us to focus on areas for improvement. These are intended to give guarantees as to what people should expect when they access services. Performance & Benchmarking - We use performance and benchmarking information for a number of reasons which would include • Measure the impact of what we are doing • Benchmark against high performing health systems • Determine achievement of targets • Measure improved access Population and community outcomes - We also have broader and more aspirational areas where we want to improve: • Patient experience • Staff experience • Health outcomes • Healthy life expectancy • Community Mental Health & Wellbeing Measuring if we achieve these high-level outcomes is complex. Lots of different things will influence our achievements and each work programme will agree measures to assess whether or not the work and actions they identify makes a difference. 37
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08: Summary & Conclusion Page 31 of 34 ‘Our Health Together – Living Our Best Lives in Lanarkshire’ has set out NHS Lanarkshire’s ambitions to deliver the positive change needed. This will ensure we have a modern fit for purpose services that meet the needs of our communities now and in the future. We have listened to our staff, communities and partners and explored together how we can support improvements to health and wellbeing. Together we will continue to identify opportunities for positive change that we will deliver through development of an ambitious reform programme. Delivering best value and maximising efficiency will be essential if we are to address the significant challenges facing our services. By striving to become a high performing organisation we will create the conditions that support us to deliver a quality healthcare model. This will enhance patient experience and continue to deliver this for future generations. While we reform to address our current challenges, we will work with our partners to create the conditions that support health improvements helping to address our future demand. We must ensure services and programmes are proportionately targeted to those most in need with a view to reducing the health inequity that currently exists. We are proud of our role as an ‘Anchor Organisation’ and will continue to use this to influence the wellbeing of local communities beyond the delivery of healthcare. As a major local employer, we know that our staff are our most valued resource. By ensuring that we look after their health and wellbeing we can be recognised as an exemplar employer and continue to attract new people to our health and social care family. As we implement our healthcare strategy, we will ensure that any changes to our services deliver against our ambitions. We know that we are operating in a challenging environment, but it remains our aim to achieve better outcomes and improvements for everyone in our communities. 38
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Page 32 of 34 09: Acknowledgements We would like to extend our thanks to everyone who contributed to the development of Our Health Together. We are very grateful to our staff, service users and residents who contributed to our successful engagement programme during 2023. Your willingness to commit time and enthusiasm to the process was much appreciated and has informed and enriched the vision and aspiration for our future service. This would not have been possible without the support of our partners in Voluntary Action North Lanarkshire (VANL) and Voluntary Action South Lanarkshire (VASLAN) and our Health Improvement Team who helped us to reach stakeholders who don’t normally engage in this type of process. Thank you 39
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Page 33 of 34 10: Supporting Documents NHS LANARKSHIRE STRATEGIC PLANS/REPORTS Digital Plan 2023 - 28 Quality Strategy 2023-2029 Research & Development Strategy 2023-2026 Sustainability & Climate Change Strategy Director of Public Health Annual Report 2022–2023 STRATEGIC COMMISSIONING PLANS University Health & Social Care North Lanarkshire (UHSCNL) - Strategic Commissioning Plan 2023-2026 South Lanarkshire University Health & Social Care Partnership (SL UHSCP) - Strategic Commissioning Plan 2022-2025 CHILDREN’S PLANS NHS Lanarkshire - Children and Young People’s Health Plan, Lanarkshire 2021-2023 North Lanarkshire Council - Childrens Services Plan 2021-2023 South Lanarkshire Council - Children's Services Plan 2021-2023 North Lanarkshire Council – Child Poverty Action Report 2022-2023 South Lanarkshire Council – Child Poverty Action Report 2022-2023 The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Act 2024 40
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Page 34 of 34 LOCAL AUTHORITY PLANS North Lanarkshire - The Plan for North Lanarkshire - Live Learn Work Invest Visit North Lanarkshire Council – Towards A Fairer North Lanarkshire, Tacking Poverty Strategy 2023 – 2026 South Lanarkshire - South Lanarkshire Community Plan 2022 - 2032 NATIONAL PLANS National Mental Health and Wellbeing Strategy June 2023 National Mental Health and Wellbeing Strategy: Delivery Plan Nov 2023 New Dementia strategy for Scotland: Everyone's Story New Dementia strategy for Scotland: Delivery Plan 2024 Women's Health Plan 41