Combined Agenda Pack - 21 August 2024
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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A meeting of the IJB PFA will be held on Wednesday 21st August 2024 at 9.30am-12pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB PFA ( 22nd May 2024) For Approval Attachment Chair 4. Matters Arising/ Rolling Action List For Discussion Attachment Ross McGuffie Strategic Planning & Development 5. Community Alarms Service For Noting Attachment Diane Fraser 6. Home Support Service For Noting Attachment Diane Fraser 7. Home Assessment Team/Discharge without Delay Programme Update For Noting Attachment Diane Fraser 8. Self-Directed Support Update For Endorsement & Noting Attachment Diane Fraser 9. Improving The Cancer Journey For Noting Attachment Morag Dendy 10. Our Health Together For Noting Attachment Jacqui McGeough 11. North Lanarkshire Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 For Approval Attachment Morag Dendy
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Performance & Finance 12. Internal Audit Annual Report 2023-24 For Approval Attachment Jocelyn Lyall Paula Hendry 13. Q4 Performance Report For Noting Attachment Morag Dendy 14. Supporting Unpaid Carers – Carers Support Allocation For Endorsement Attachment Morag Dendy Governance & Policy 15. A Shared British Sign Language Plan for Lanarkshire 2024- 2030 For Noting Attachment Stacey Anderson 16. Risk Management For Approval Attachment Stacey Anderson For Noting 17. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 18. A.O.C.B All 19. Date of Next Meeting 23rd October 2024 For Noting
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 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
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update to be provided after year-end figures. Combined report linked to community alarms on August PFA agenda 18. 31.8.22 Item 6 IJB Self- Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Ongoing – future Liaison session topic- Planned for Nov Liaison 23. 18.10.23 Item 5 Risk Register R McGuffie Ross to provide briefing document to offer the committee assurance that risk are reviewed against other boards Bring to future Liaison session
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2 25. Future Meeting R McGuffie Host a future meeting face to face in Chryston hub Looking at Dec IJB –confirming arrangements ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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3 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 1. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided March 2022 June 2022 Complete
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4 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care Community Alarms (Analogue to digital) National Care Service September 2022 Complete 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. June 2021 November 2021 – deferred to IJB December 2021 Complete Reserve strategy presented to IJB PFA on 16th
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5 Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding deferred to March 2023. Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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6 the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. hosting arrangements. 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action.
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7 February 2022 – update on progress noted with further updates to be presented Ongoing Complete 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. March 2021 September 2021 December 2021 Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23- Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final
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8 business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete. 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 Complete Ongoing updates on progress scheduled into forward plan for PFA
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9 benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives August 2022 MAT standards update given to Feb IJB PFA Further update on October PFA agenda 6. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB March 2022 – draft guidance shared with NLC and awaiting comment December 2021 December 2022 Ongoing – update planned for sept 23 IJB Complete 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 On agenda Tabled at June PFA 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie Reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute and also review current risk register Update planned for March 2023 IJB Liaison session planned to review Complete 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda Update on October agenda Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT paediatrics and speech and On April 2023 agenda
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10 language Complete 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore Topic at 8th Nov Liaison session Complete 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report Tabled @ May PFA
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1 REPORT Item No: 5 SUBJECT: Community Alarm Service TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) NL HSCP Author(s) of Report John McGeough, Service Manager Hugh Holt, Senior Officer DATE: 21 August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been prepared by the Community Alarm Service Management Team. Prepared By: John McGeough, Service Manager Hugh Holt, Senior Officer ☒ Reviewed By: Margaret Flavell, Senior Manager Adult Social Work ☒ Endorsed By: Diane Fraser Chief Officer, Adult Social Work ☒
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Acknowledge the contents of this Community Alarm Service update report. (2) Acknowledge the ongoing work being undertaken to support the transition from analogue to digital and the work completed to date. (3) Acknowledge the progress and challenges of progressing the move to the new digital ARC platform and the extensive work completed to date in preparation for this. (4) Acknowledge the positive Care Inspectorate grading that the service received from the Care Inspectorate. (5) Acknowledge the position with current and future charging for the service. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Community Alarm Service operates 24 hours per day, 7 days a week, 365 days per year. When the individual activates the alarm, a signal is sent via the telephone line to the alarm receiving centre in North Lanarkshire which is staffed 24 hours a day, 365 days a year. A Response Advisor (call handler) speaks directly to the person to find out what kind of assistance is required. 5.2 The service currently provides support to 7,724 people in North Lanarkshire with the confidence that they can call for help at any time of the day or night, every day of the year and is an essential service when people experience difficulties such as a fall or sudden illness. 5.3 The number of people supported by the community alarm service has remained relatively static since the previous report submitted in May 2023 with a slight increase in numbers , with most service users living within their own home however the service also provides cover to all tenants living within NLC Sheltered Housing Complexes during out of hours and variously to registered social landlords across North Lanarkshire. 5.4 The Community Alarm Service currently provides a telecare service currently to 6,158 service users using dispersed analogue and or digital community alarms and to 1,566 users within sheltered accommodation. 5.5 The service on average receives around 130 new requests per month for Community Alarm installations, the number of new referrals received per month has remained consistent with the figures from 2023/24. Yes ☐ No ☒ N/A ☐
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3 5.6 In addition to the basic button and box which people associate with Community Alarms, there are over 1,000 pieces of assistive technology programmed through to the alarm receiving centre. This ranges from door contacts to hard wired smoke detectors for individuals with cognitive impairment, This has remained static since the previous report. 5.7 Within the last report to committee the service was planning to conduct a wide- ranging service review, however following feedback from various stakeholders and improved Care Inspection grades it was evident that the service was effective, staff were committed, and service users satisfied with the support provided therefore the scope of the review was adjusted, to focus on the staffing element of the service. A more detailed breakdown of service user engagement and participation is discussed later within the report. 5.8 The staffing resource aligned to the service has not been reviewed for a significant number of years and given the ongoing work of transitioning the service from analogue to digital, as well as increased call activity within the alarm receiving centre the decision was taken to review the staffing resource aligned to this aspect of the service. 5.9 University North Lanarkshire Health and Social Care Partnership (UNL HSCP) and North Lanarkshire Council (NLC) have invested significantly in early intervention and supported self-management for over a decade, with support for change and investment across all sectors which focus on wellbeing. The Community Alarm Service is a key part of supporting self-management with technological advancements creating the opportunity to move from being a crisis response service to being more proactive and preventative. 5.10 The above circumstances summarise the importance of the Community Alarms Service, the changes to the digital infrastructure and need to review the staffing compliment to ensure we realise the priorities and ambitions of the North Lanarkshire Health and Social Care Strategic Commissioning Plan. Analogue to Digital Transition 5.11 Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout was scheduled to be completed by the end of 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. 5.12 Telecommunication suppliers are well on their journey to making this switch to ‘IP networks.’ Any systems relying on analogue lines, such as telecare, will be affected by this change. Individuals who have been provided with Analogue telecare equipment from North Lanarkshire Council must have their equipment updated to Digital ready devices to continue to receive a safe and reliable service.
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4 5.13 Recent updates from Telephony providers such as British Telecom, have outlined they now expect all customers to be migrated over to a digital line by January 2027, other companies are also in the process of reviewing their timescales. 5.14 Despite the potential change in dates that will impact on the analogue to digital switchover, the community alarm service will continue to progress the digital upgrade as planned and hope to ensure that all service users in receipt of the community alarm service are fully digitised by the end of 2025. 5.15 North Lanarkshire as outlined in its previous report has been working closely with the Digital Office for Scottish Local Government. Across Scotland, most current solutions use analogue dial-up protocols to carry status and alarm signalling between the alarms devices in users’ homes and the Alarm Receiving Centres (ARC) - North Lanarkshire’s ARC is based in the Dalziel Building in Motherwell. Digital IP telephone lines are not designed to support these analogue protocols meaning that there is a risk that telecare alarm signalling will not operate reliably. This may result in a higher number of failed calls and redials being seen by the Community Alarm responders on the ARC system. 5.16 The plan for North Lanarkshire Council’s community alarm service is to transition to the new national digital ARC, this will ensure that the Alarm Receiving Centre (ARC) is fully digitised and will meet the digital requirements of our service while minimising the risks to analogue failures as the decommissioning of these old analogue lines progress. 5.17 This will allow the Partnership to adopt a new Digital Solution that will meet future requirements and can be customised to our specific operational requirements. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. At the time of writing several local authorities have successfully transitioned over to the new digital ARC that will be supported by Chubb and Sky Response. 5.18 The transition to digital has required the service to review all alarm devices that are in place within homes in the community and sheltered house residences and replace these current analogue devices with digital ready alarm devices. There will also be a requirement for digitally enabled peripherals such as falls detectors, door contacts etc, to be thoroughly tested to ensure that they are compatible with the new digital alarm receiving centre and alarm device. The ability to connect existing interconnected fire/smoke detectors via the digital alarm is currently not available. The Scottish Government are working with manufacturers on solutions to connect these devices to remove the need for multiple detectors to be in the same room. 5.19 The service has already changed around 3000 analogue alarms to a Hybrid digital ready unit which do not use the analogue telephone line, with a further 1000 planned to be exchanged by November 2024.
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5 5.20 North Lanarkshire currently runs PNC 8.1 an analogue ARC provided by Tunstall Healthcare (UK) Ltd on servers within the NLC infrastructure. The current contract was due to end on the 31st of March 2024, however due to delays in the contract being awarded for the new digital ARC, an interim solution was required due to the current contract ending, as well as the current Tunstall Infrastructure and servers coming to the end of their life. 5.21 Work was undertaken by colleagues from the council’s IT infrastructure team who concluded that to reduce the potential risks to North Lanarkshire Council it was agreed that the services digital voice recorders would be switched off reducing risks of unsupported equipment failure occurring until a more robust plan could be put in place in the interim. 5.22 The Interim Software as A Solution (SAAS) has been procured from Tunstall because of the current servers that support the current Alarm Receiving Centre end of life. Colleagues from Infrastructure had determined that to do nothing would pose a real threat to the Community Alarm Service and the wider Council IT infrastructure, therefore an interim solution has been agreed. 5.23 The service has entered a 1-year contract for the SAAS solution with an option for a further year if required. The total contract amount is £107,000, however the service has a 90-day notice period to cancel the contract early, should the service be able to move to the new digital ARC, therefore reducing the costs of the overall contract. 5.24 Housing have undertaken an upgrade of all Sheltered Housing developments to a new Warden Call system that will be fully digital ready when the Digital ARC is implemented and are installing equipment in the remaining developments (which were upgraded a few years ago) to have a Digital connection available in readiness for the move to Digital. 5.25 The Community Alarm Service and the Technology team have supported housing colleagues throughout this process, ensuring hybrid digital alarms were placed in residents’ homes to ensure no loss of support throughout these works being completed. 5.26 There has been an increase in failing calls from Analogue devices identified across the UK because of the ongoing upgrades to Digital Telephony infrastructure we have seen this within our own Community Alarm Service where the primary number used to connect fails, but the backup number then successfully connects. This is being investigated with IT colleagues to identify what further resilience can be put in place to reduce these failures. Data Migration 5.27 The current data held on the Tunstall PNC system has over 25,000 client records, of which only 7700 are current users. With the current PNC system there is no facility to “batch” delete the 18,000 archived records. When the
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6 service migrates to the Digital ARC, we will be charged per client record, therefor it is imperative that only the current records are migrated to the new system. 5.28 Significant work has been undertaken to try and retrieve this data from the current PNC system, however as the service has no direct access to the databases on the PNC system, we are reliant on Tunstall providing this to us in a usable status. 5.29 The digital ARC provider has also recently developed a piece of software that they advise will do this conversion for us from the raw data but will have an associated cost yet unknown and will also require the same interrogation and verification required as the direct data from Tunstall noted above. Capital Spend 5.30 Capital monies have been set aside to support the transition from analogue to digital within the Community alarm Service. 5.31 During the course of the financial year 23/24 £325,000 had been spent purchasing 1500 hybrid alarms. 5.32 Due to ongoing testing of digital devices, it was decided after extensive testing by the technology team that 1000 LeGrande alarm devices be purchased, however due to delays with internal procurement processes, these will be purchased from the 2024/25 budget. 5.33 It is anticipated that £1,275,000 will be available to continue with the purchase of hybrid digital alarms in this financial year. 5.34 There is a projected increase in cost therefore a funding gap for future years that requires to be sourced. Community Alarm Service Review 5.35 Following the previous report submitted to committee in 2023 there had been discussions in relation to a whole service review in relation to the Community Alarm Service. 5.36 As part of the services efforts to have meaningful engagement with service users and wider stakeholders, the service engaged with the third sector to arrange a number of events across North Lanarkshire, Several dates and venues were confirmed with events advertised on the council’s social media pages, X, Facebook etc, unfortunately, there was no uptake to allow the events to go ahead. 5.37 Following the poor uptake of events advertised across North Lanarkshire, the service then resorted to engaging with our service user base through arranging forums within Sheltered Housing Complexes, Integrated Day Services so that
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7 the service was able to gauge service users views of the community alarm service. 5.38 During the last 12 months the service has attended various events and spoke directly to 202 Service users at a variety of events across North Lanarkshire. 5.39 Feedback from service users was very positive, with many advising that having the Community Alarm provided them with reassurance should they experience a fall, required reassurance or required support with personal care. 5.40 The service also issued a questionnaire seeking service users feedback on the Community Alarm service, 124 questionnaires were returned. The findings of the questionnaire were that service users were satisfied with the service provided and that staff were helpful, polite and treated people with dignity and respect. 5.41 The service recently held an awareness day for Health and Social Care staff, stakeholders and third sector organisations over a 2-day period to provide more information and insight into the Community Alarm Service and how the service operates and functions. 5.42 Over the course of the 2 days, more than 200 people attended, with most leaving with a better understanding that the community alarm service is more than a button and box, type service. People were genuinely interested as to how the service operated and how we support service users who activate the community alarm. 5.43 Several focus groups were held with community alarm staff over a number of weeks in late 2023, each focus group was provided with an open platform to share their feedback, views, knowledge, and insight into the community alarm service. 5.44 The feedback was grouped into themes and further analysed to identify several important issues. Overall staff were incredibly positive about their roles/responsibilities and proud of the impact that their service had on individuals needing support from the community alarm service. 5.45 The key role benefits that staff described were the variety, flexibility, a strong team ethos, job satisfaction and most staff found the role to be rewarding. 5.46 There were some operational issues identified and most of them were resolved following the sessions. The main operational concern staff raised was the Community Alarm transport as this was becoming aged and unreliable due to age and mileage of these vehicles. Staff also raised some concerns regarding the shift patterns. 5.47 Both of these issues have subsequently been addressed with the Community Alarm Services ageing fleet of vehicles having been replaced in March 2024.
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8 The shift pattern concerns outlined by response advisors has also been addressed with a change to start and finish times for each of the three responder shift patterns resulting in a better work life balance and consistent work schedule. 5.48 It is evident that all staff employed within the community alarm service are committed and this has been evident with how staff across the service have responded with the introduction of new digital technology into the service. 5.49 The Assisted Technology Team have worked closely with the service and worked to support the response advisors as the new digital alarm platforms have come onstream. 5.50 The Care Inspectorate, the services regulator conducted an unannounced inspection of the community alarm service in April 2023, following the inspection the service was graded as follows: How well do we support people wellbeing - Grade 5 Very Good How good is out Leadership - Grade 4 Good How Good is our staff team - Grade 5 Very Good 5.51 Following the Inspection Care Inspectors were complimentary on the service provided across North Lanarkshire by the community alarm service and feedback obtained during the inspection process from both service users and staff was positive and this was reflected in the grades awarded. All previous requirements had been met and the service has currently no requirements. 5.52 The service recognises that the staffing resource has not been reviewed within the community alarm service since its inception, however given the service growth as well as prioritising the move from an analogue to digital solution as well as the introduction of new digital technology it is evident that a review of the staffing structure is required. 5.53 The alarm receiving centre is manned 24hrs per day, Response Advisors respond to all incoming and outgoing activity in relation to community alarm and take calls for the Social Work Emergency Service (SWES) from 1.30am till locality offices open or when the team come on site at weekends. 5.54 The alarm receiving centre typically has more than over 40,000 call episodes per month, however most of these calls are to provide reassurance to service users within their own homes. 5.55 A Benchmarking exercise has been completed with other Alarm Receiving Centres in terms of response advisors manning the service 24 hours per day, North Lanarkshire has 3 response advisors on shift at any given time, however when compared to other Local Authorities our staffing numbers are on the lower end for staff resources.
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9 5.56 Response advisors are a crucial part of the community alarm service; however, the establishment of this staff group has never been reviewed and during 2023 the service required to cover 900 additional shifts due to staff planned and unplanned leave. 5.57 Response advisor staffing is currently being reviewed as part of the wider engagement of the Home Support structure as it is recognised that additional staffing is required within this aspect of the service. 5.58 From the 1st April 2024, the new Health and Care (Staffing) (Scotland) Act 2019 came into force. When enacted it revoked section 15 of the Public Service Reform (Scotland) Act 2010 and brings legislation requirements and guiding principles for those who commission and deliver health and social care services. 5.59 The Act also places a statutory duty on care service providers to ensure that, always, suitable qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of people using the service, and the provision of safe and high-quality care and in so far as it affects those matters the well-being of staff. Community Alarm Charging 5.60 Since the charge for community alarm was reintroduced in September 2020 a charge of £3.40 per week (49p per day) was agreed and the rate charged for the service has remained static during this period. Any calls made to the response centre are also billed as normal telephone calls by the person’s telephone company. 5.61 The charge for the community alarm service increased to £3.57 per week 51p per day) from the 1st April 2024, despite the slight increase being applied the charge for the community alarm service within North Lanarkshire remains one of the lowest when compared to all other local authorities across Scotland. A benchmarking exercise was undertaken to further understand charging across the country. 5.62 Despite the small increase in the charge no service users have handed back the alert alarm nor has the service received any complaints regarding the increase in charging. 5.63 The service continues to receive on average of 130 new referrals for installation of community alarms on a monthly basis. Those being referred to the service are aware of the charge and should be offered a referral to the tacking poverty team to ensure their income is maximised by the referring agency or service. 5.64 The number of service users in receipt of the Community Alarm service has remained stable, at 7,700. A significant amount of data cleansing was undertaken when the charge was reintroduced.
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10 5.65 The data cleansing exercise completed at the onset of the charge found that a significant number of service users had passed away, had moved into sheltered housing or had moved into a care home. The council’s data custodian supported the service with identifying these service users so that the data could be cleansed and updated to reflect actual service users in receipt of the community alarm. 5.66 Service users who had expressed concerns regarding the reintroduction of the charge were offered support to ensure that their income was maximised from the council’s financial inclusion team as it was known at the time. 5.67 It was recognised that the agreed charge would support the Council and the Integration Joint Board to continue to deliver this service to a high standard through having the appropriate staffing and financial resources to meet the needs of those who use the service. It would be damaging to the service and the partnership to reverse the current charging arrangements. 5.68 It should also be noted that the transition from Analogue to Digital alarms will continue to attract further operating costs as each alarm will have as a minimum one roaming SIM card, however two may be required if there is no home broadband connection that can be used as a primary connection to the ARC. Current costs for these roaming SIM cards are £4.00 per month per unit, the cost of which could increase annually in line with inflation. The Digital Office have indicated that they will engage with Telecom suppliers to try and negotiate a Social Tariff, however this has not progressed yet. Based on a current installed estate of 7,700 alarm units this will bring an operating cost of between £360,000 and £450,000 per annum (based on £4.00 per month current charge or an anticipated £5.00 per month) to support the new digital alarms. 5.69 The income generated from the charge for community alarms is important to the continued development of the service and increased operating costs associated with digital advancement. It is however important to note that the Council had not pursued the recovery of debt and as noted in previous Committee Reports, given the vulnerability of people using the service, individual community alarms will not be cut off due to non-payment. 5.70 Invoices generated within the financial year 2023/24 amounted to £998k for the Community Alarm charge, however £202k remained outstanding at the end of year finance reporting period. This represents around 20% of invoices remaining outstanding. Outstanding invoices can be for several factors and the service is not always notified e.g. service user deceased, moved to sheltered housing, hospital or care home admission, unknown reason and nonpayment choice. The actual income received to date for financial year 23/24 amounts to £796k.
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11 5.71 A sundry debt write off exercise is currently underway which will result in £137k of the outstanding debt being written off up to April 2022 as it has been deemed uneconomical to pursue. 5.72 At the point of the Charge being reintroduced in 2020 all recipients of the community alarm service were offered a review of their income by the financial inclusion team to ensure all benefits had been fully maximised. 5.73 Any recipient of the Community Alarm Service who make contact with the service to advise of financial difficulties in paying the charge is referred to the tackling poverty team (formerly financial inclusion team), however we would not remove someone’s alarm for nonpayment of the charge. 5.74 The service is continuing to review the number of non-payments that have accrued, and officers are working through information held within the mySWIS system. 6. CONCLUSIONS 6.1 This report gives an update on the Community Alarm Service. It highlights the work undertaken for the transition of analogue to digital; both the challenges and progress are noted. Additionally, the positive Community Alarm Service gradings from the Care Inspectorate are recognised. From engagement and consultation, it is agreed that the service staffing resource requires review. Finally, it notes the service charging position. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒
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12 Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) NA 7.3 FINANCIAL Financial implications contained within the report. 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 Analogue to Digital Transition Medium Graeme Cowan 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 Regular engagement in a variety of ways – face to face sessions, newsletters, questionnaires ☒ Provide stakeholders with information on how to get involved As above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs As above ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Ongoing
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13 ☐ 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 Info through governance structures 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 8. BACKGROUND PAPERS None.
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14 9. APPENDICES Appendix 1 – Analogue to Digital EQIA CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Hugh Holt, HoltH@northlan.gov.uk John McGeough, McGeoughJ@northlan.gov.uk
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15 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/0821-05 2 Report Title Community Alarm Service 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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16 Appendix 1 Document Text Name of Policy / Budget Saving Analogue to Digital Transition Project Author Robert McClung Contact details McClungR@northlan.gov.uk Owner Diane Fraser FraserDi@northlan.gov.uk EqIA version number EqIA status Complete X Incomplete If Incomplete please say why ‐ for instance pending further consultation / research
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17 Section 1. About the Policy 1.1 Name of the policy / strategy / function / procedure: Is this a: - A new policy /strategy / function / procedure / service Budget saving Review of policy /strategy / function / procedure Review of Service Other (please specify) Community Asset Transfer Is this is a key strategic decision subject to the Fairer Scotland Duty Yes No 1.2 Person Responsible for the policy etc. Name: Robert McClung Job Title and Service / Team: Senior Officer Analogue to Digital project Lead (Adult Services) 1.3 What is the scope of the assessment? Detail where appropriate Whole of the organisation Service specific Discipline specific Other
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18 1.4 What is the policy/ strategy/ function/ saving trying to achieve / do? Analogue to Digital Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started, and the rollout is scheduled to be completed by 2025. As of 2021 services can no longer sell analogue services such as BT and Virgin, and by and escalated process by 2023 no analogue tech nology can be sold also by any company. Analogue to Digital in Community Alarm Current telecare solutions in use in Scotland use analogue technology. This means that they send signals between the alarm device and Alarm Receiving Centre (ARC) by making a dialup phone call and sending a series of audible tones. Analogue signalling does not work reliably when sent over the digital phone lines that are being installed in user’s homes, grouped schemes, and ARCs Telecare is digital when signalling traffic is carried end-to-end (from a user’s alarm device to the ARC) in a digital format. This device is not connected to the user’s telephone line, instead it contains a SIM card that allows it to connect to the mobile telephone networks. This means that the Alarm Receving Centre, alarm devices and peripherals will now need to be digitally enabled to meet the future needs of the service users within our community. This project fits directly into the council’s ambition priority to - Improve the health and wellbeing of our communities. North Lanarkshire Health and Social Care partnership and North Lanarkshire Council is looking to develop a strategic business plan for the analogue to digital transition through the review and analysis of current service provision and their users. This project will look to have an in-depth look at understanding of current technology in place, current HSCNL digital workstreams and their impact on this project and collaboration, engagement of community alarm users, engagement of HSCNL staff in respect of technology and community alarm service and appraisal of alternative technology for future use within the partnership
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19 This project will look to provide our communities with the ability for self- management, proactive responses from services and for a holistic person- centered basis for a person’s wellbeing using technology. This project will have produced a strategic business plan for the analogue to digital transition along with all relevant risk assessments. Following the strategic business plan, this project will then focus on implementing the organizations transition from analogue to digital. This will come in the form of procuring a new alarm receiving center through a cloud hosted based system or hardware-based system, to replace our current analogue alarm receiving center. This will then allow for us to look at digitally enabled devices to replace our current analogue community alarms. 1.5 If this is a budget saving, how will the saving be achieved? This project will not focus on budget savings. Section 2. What do I know now? 2.1 Who are the stakeholders and beneficiaries? The stakeholders will be our residents within North Lanarkshire Council areas who are provided with a community alarm service or a telecare service. Other stakeholders will be employees who work for the community alarm service and Health and Social care who assess and prescribe telecare equipment. 2.2 What data, consultation, research and other evidence or information is available relevant to this assessment? (This is a desktop exercise) Digital Telecare National Briefing Document (2020) gives an overview of the work done by telephony providers around the transition of their analogue copper lines to new fibre digital lines. This was done without consultation of the public or any organisation. This document also outlines
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20 An estimated timeline with an in-depth breakdown of the timescales to complete key operational components of the transition. Estimated resources and costings for the transition. Information on the impact that the transition will have on service users. Potential benefits and opportunities of a digital telecare service. Risks to be considered. Recommendations that telecare service providers should follow to minimise disruption to their service users. Information on resources available from the Digital Telecare Programme which will support the transition journey. North Lanarkshire have also enlisted a third part organisation to carry out reviews of the community alarm service which details peoples experience of using this alarm system. 2.3 Considering the information in Section 1 and 2.1 and 2.2 2.3.1 If this policy is subject to the FSD what does it suggest about the impact or potential impact on socio-economic disadvantage? (please refer to FSD Interim Guidance) Low income People in receipt of a community alarm are now in the process of being charged for this. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Low wealth Material deprivation Area deprivation 2.3.2 Are any of the people communities listed below likely to be more affected by this policy than others? People who share one or more of the protected characteristics of the Equality Act 2010 Yes Details No Details Don’t Know Age (a particular age or range of ages) X 78.1% of community alarm users are aged 70 years and over.
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21 Disabled people and people with long term health conditions X Most users of the community alarm service fall within this characteristic. We are unable to pull statistics for this. Women and men, girls and boys X People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Pregnant women and new mothers (including breastfeeding women) X Lesbian, gay and bisexual people X People transitioning from one gender to another X People of different religions or beliefs or non-beliefs X Other groups Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Carers will be affected due their possible requirement to use the community alarm systems to
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22 summon support fore the person they are providing the care Asylum seekers X Employees – full and part time. Including SES, MAs etc. X Staff who work within the service will be affected by changes to their operating systems and procedures. Others 2.4 Do you have evidence or reason to believe that this policy will, or may potentially affect the Council’s duty to: (Please tick all that apply). Yes No Don’t Know 1. Eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Equality Act 2010? X 2.Advance equality of opportunity between people who share a relevant protected characteristic and those who do not X 3. Foster good relations between people who share a protected characteristic and those who do not? X 4. Protect and promote human rights? X 5. Reduce socio-economic disadvantage X Please provide details.
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23 Section 3. What else do I need to know /find out? 3.1 Further consultation – Please use the table directly below to say who you will consult with (tick Yes or No). Consider those groups from section 2.3 where you ticked yes or don’t know. Once consultation has taken place provide the details below. People and communities Yes No Describe what you did, with whom and when. Please provide a brief summary of the responses gained and links to relevant documents, as well as any actions Age (a particular age or range of ages) X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Disabled people and people with long term health conditions X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Women and men, girls and boys X People defined by their race, colour and nationality, ethnic or national origins. X Married people and civil partners X Pregnant women and new mothers and breastfeeding women. X Lesbian, gay and bisexual people X People transitioning from one gender to another X
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24 People of different religions or beliefs or non-beliefs X Other groups X Children and families X Homeless people X Looked after and accommodated people X Care leavers X Carers – paid / unpaid, family members X Information relating to the digital transition will be passed to all relevant users of the community alarm service. This will be done in conjunction with our communications team to ensure that the most up to date information is sent and is accessible for all. Asylum Seekers X Trade Unions X Employee Equality Forum X Others X 3.2 What additional research or data is required? At this time all research and data has been provided by the Digital Office for Scotland as this is a nationwide activity being completed by external telephony providers which will affect all areas.
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25 3.3 What does the additional research and data tell you about potential or known effects? N/A Section 4. Assessing the impact and strengthening the policy Considering all the evidence you now have from section 1-3, how will the policy affect different people and communities in relation to equality, socio-economic disadvantage and human rights? 4.1 How does/will the policy and resulting activity affect those with the characteristics listed below (including employees)? Please use the table below to provide details. Detail any Positive impact Detail any adverse impact If adverse how can we mitigate this? Where no mitigating action is planned please say why not Age (a particular age or range of ages) The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Ensure that benefits have been maximised. Disabled people and people with long term health conditions The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. Due to the digital upgrade and the Ensure that benefits have been maximised.
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26 This will also allow for further technology which could enhance care and independence to be introduced. enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Women and men, girls and boys People defined by their race, colour and nationality, ethnic or national origins. Married people and civil partners Pregnant women and new mothers (including breastfeeding women) Lesbian, gay and bisexual people People transitioning from one gender to another People of different religions or beliefs or non- beliefs
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27 Other groups Children and families Homeless people Looked after and accommodated people Care leavers Carers – paid / unpaid, family members The introduction of digital telecare will allow for better call function (clarity/speed/reliability/quality. This will also allow for further technology which could enhance care and independence to be introduced. Due to the digital upgrade and the enhance cost of equipment and alarm receiving centre this will further affect cost of this service. Support is provide to ensure the person they care with has their benefits maximised to allow them to keep this service. Asylum Seekers Employees – full and part time. Including SES, MAs etc. The introduction to the digital telecare should provide a better working platform for staff with better call reliability and handling. This should reflect in their ability to take and field calls more efficiently A new way of working may need to be introduced which will require further training and support for staff to follow Support will be provided throughout the project. Others
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28 4.2 What measures could be taken to strengthen the policy / strategy to help advance equality of opportunity, foster good relations, promote human rights and reduce socio-economic disadvantage. North Lanarkshire could look to build on its use of community alarm service reviews to carry out a more holistic in-depth review of a person’s needs. This would allow the service to maintain and enhance its relationship with the users of the alarm service. 4.3 Considering questions 4.1 and 4.2 what actions / measures will be put in place before introducing this policy please provide details. Action Timescales Responsible Officer Review details (include timescales) Section 5. Monitoring, evaluating and reviewing 5.1. How will you monitor the impact and effectiveness of the new policy? This will be reviewed at the beginning of the transition and throughout the implementation of the digital equipment. The full project will be subject to a review as in line with North Lanarkshire’s project management policy. Section 6. Making a decision and sign-off Recommendation Tick Comment (where applicable, please give more information e.g. where to pilot, what modifications, etc.) Timescales Introduce the policy New policy and procedures will be put in place once digital transformation of the service is complete 12 Months
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29 Adjust the policy then introduce Introduce the policy with justification regarding potential adverse impact Stop and withdraw the policy Name of Policy Head of Service /Senior Manager sign-off: Name Job title and division/ team Date Signature For further information please contact: Name: Hugh Holt Job title: Senior Officer Service: Adult Services Contact details: Holth@northlan.gov.uk
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1 Item No: 6 SUBJECT: Home Support Service TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser, Chief Officer Adult Social Work Services NL HSCP Author(s) of Report Karen Workman, Senior Manager Adult Social Work DATE: 21 August 2024 1. PURPOSE OF REPORT 1.1 In North Lanarkshire there has been a sustained approach to supporting people to live safely and independently at home, connected to their family, friends and local community for as long as possible. Whilst we have a range of social care supports available to support people in North Lanarkshire, the Home Support Service is key to ensuring that people can remain at home and contributes to the sustained efforts to maintain a positive balance of care in the North Lanarkshire. 1.2 This report will inform the progress on the implementation of the redesign of the Home Support Service which was approved in 2018. It will outline the work that has been undertaken following the recovery from the pandemic focusing on areas such as demand, complexity of support, workforce challenges, new models of delivery from acute setting and changing demographics. This will demonstrate that the model approved in 2018 remains fit for purpose and aligns with the current aims and objectives of the Strategic Commissioning Plan. 1.3 This paper is coming to the Integration Joint Board Performance, Finance and Audit Committee, For Approval: ☐ For Endorsement: ☐ To Note: ☒
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2 2. ROUTE TO THE BOARD This paper has been: Prepared By: Donna Bridges Karen Workman ☒ Reviewed By: Diane Fraser ☒ Endorsed By: ☒ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA Committee: 3.1.1 Acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model. 4. VARIATIONS TO DIRECTIONS? 4.1 This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Health and Social Care Partnership are committed to ensuring individuals who are referred for a needs-based assessment to enhance their daily living get the right support, at the right time and in the right place. To maximise an individual’s independence and resilience, reablement and rehabilitation services are key to this process. 5.2 The plan for the new operating model to deliver Home Support was agreed by the IJB in March 2018. The model was based on the outputs of the Cross−Party Working Group, the advice from support officers and wider officer research, the proposed new model focuses on five major elements: Integrated Model (Discharge to Assess in Localities) Same Day Response/Reablement/First Support (Intensive and time limited) Specialist Teams (e.g. supporting people with frequently changing needs and end of life / Palliative Care) Ongoing Paid Support (allocation of an individual budget to deliver individual outcomes as part of SDS) Quality Assurance (improving standards of care) Yes ☐ No ☒ N/A ☐
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3 5.3 The plan outlined that the Home Support Service was to be a functional model based on two elements; assessment and planning (overall assessment and planning activity or the service) and long-term service delivery which will be referred to as the Living Well Service (providing support to those with complex health and social care needs). 5.4 The implementation of the new operating model commenced prior to the pandemic which included the centralisation of the management and administration of the service. Although elements were progressed, the pandemic had a significant impact on the Services’ ability to fully implement the model. 5.5 In response to the pandemic a number of changes had taken place to enable the service to operate during very challenging circumstances. Social care provision faced considerable workforce challenges as well as significant changes to the way care and support was delivered. To support recovery there was significant investment which was reported through the Winter Planning and Enhanced Support Business Case. The investment in a range of activities including Home Assessment, Reablement and Rehabilitation was key to delivering key elements of prevention and early intervention which accelerated elements of the Home Support model. The success of the new model is also predicated on the investment and delivery of new systems Mosaic and dynamic scheduling system to modernise the service. Following this period of recovery, a review was agreed in 2022 to ensure that the model agreed in 2018 remained fit for purpose. 5.6 This report will outline the work undertaken to engage staff and those who receive services as well as the partnership work that has been undertaken with Home Support Workforce Assessment and Planning Living Well Service Enabling Approach
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4 the Care Inspectorate to improve the quality of service being delivered in North Lanarkshire to improve outcomes for people who need support. 5.7 Report 5.7.1 The service currently supports 2,235 individuals. Data gathered and used to inform changes highlights the significant growth in multi worker visits whereby 33.5% of all visits require two or more workers to support service users at each visit. This upward trajectory (Graph1) displays evidence of some of the challenges that are currently facing the service. Work is in the early stages of exploring single handed care, which will be of significant benefit to the service once this is fully embedded and supported in the future. Graph1 5.7.2 Over the last financial year, the service received 3,800 requests for assistance from people not known to the service. The number of care hours delivered has risen steadily since the pandemic (Graph2) and remains significantly higher than the hours delivered pre covid.
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5 Graph2 5.7.3 Despite the increase in the hours provided, the number of service users have fallen in the corresponding time frame. The service users that are now supported present with more complex health and social care needs. As the number of individuals in the community with complex care needs continues to rise, the requirement for specialist provision becomes more apparent. 5.7.4 North Lanarkshire has, for many years, had a positive balance of care, a term which is used to refer to the balance of support and care available within the community- based settings compared with support within residential settings. This is supported by the continued investment in community – based supports and a long standing commitment to self-directed support. This is underpinned by community support which is co-designed with individuals and their carers/ families. This approach has resulted in a high proportion of individuals remaining at home. 5.7.5 Local Government Benchmarking Figures 2022/23 report that 65% of individuals over the age of 65 with long term needs receiving 10 or more hours of home care per week which is above the Scottish average of 61%. Along with other providers, NLC Home Support Service is a key resource within North Lanarkshire to enabling individuals to remain at home and retain a positive balance of care.
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6 5.7.6 In line with the five key elements outlined by the cross-party working group integrated care remains a priority. The operating model for localities in UHNL HSCP is underpinned by an enabling approach which is being embedded through robust screening, assessment and resource allocation. This approach will ensure that individuals, carers and families have a support plan that is co- designed, with good information, utilising local resources and alternative support which is proportionate. 5.7.7 Assessment and Planning The development of an integrated approach through the establishment of Home Assessment Team working closely with Reablement and Integrated Rehabilitation Team builds on the work to deliver discharge to assess and same day response. This aligns the home support workforce with locality health and social work teams and will provide a range of resources to facilitate assessment and planning. By adopting this approach, it will ensure that when someone needs longer term support it is based on thorough assessment and support planning. This will be for people whose needs are more complex, including end of life care, within their own home. 5.7.8 The performance of both the Home Assessment and Reablement Team demonstrate that consistently more than 50% of people leave without ongoing support. In the last quarter 58% of people left reablement with no services or a reduction. The growing evidence highlights that short term assessment and reablement increases independence and reduces dependency on further care and support. 5.7.9 This work has also contributed to the improved discharge planning at both University Hospital Monklands and University Hospital Wishaw. Ongoing actions to maintain flow are essential to reduce readmissions and demand for long-term care and support, including the sustainability of the Home Support Service. A shift of focus to same day discharge and assessment and rehabilitation at home will improve outcomes and support quicker recovery. 5.7.10 Living Well Service When people need ongoing paid support, it is essential that waiting times are minimal and people have options as to how this will be delivered. Following assessment and support planning, individuals will have the option of NLC home support delivered by the Living Well Service. Supported people can consider how their support is delivered through the 4 options as outlined in the self- directed support legislation. At the point of review, options will be discussed including individual budgets or direct payments which can be used flexibly to meet identified outcomes.
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7 5.7.11 The home support workforce in North Lanarkshire, provides essential support and care to individuals, carers and families. The Living Well Service will continue to provide care and support to individuals who require longer term, planned support. Due to the changing demographics and complexity of individuals requiring support, the workforce will be able to provide a responsive, flexible approach to those with fluctuating needs. 5.7.12 The workforce establishment and structure need to be finalised to allow for the model to be fully operational. This work will be ongoing with business partners and trade unions. 5.7.13 Workforce There are approximately 1,387 staff employed by NLC Home Support Service, with a worker profile of 6% male, 16.99% age 60 and over and 6.48% age 30 and under. This includes Home Support Workers in Reablement, Home Assessment Team, Intensive, Community Alarm and Living Well Service. The management and support roles were reviewed, and a new structure implemented in 2019. These roles support with scheduling visits, carrying out reviews, supervision and training. 5.7.14 Recruitment of Home Support Workers remains a challenge due to the high turnover of staff. However, the recruitment of staff to assessment and planning has been prioritised to support the operational model. 5.7.15 The need for a competent, confident workforce which is supported by a sustainable learning and development programme is key to ensuring safe, high- quality practice by motivated staff. The service has invested in dedicated staff to support learning and development through training, including refresher cycles, and investment in workforce development to provide high quality care. 5.7.16 An overall training plan has been created and has been made available to managers within the service. The plan ensures key activity is progressed including monitoring mandatory training for Home Support Workers as well as. highlighting registration requirements for all staff to deliver quality driven service offering flexibility and focused on service user outcomes. The below Graph 3 provides information relating to the increase of staff members undertaking core training.
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8 Graph 3 5.7.17 The service has been reporting higher levels of absence over the past 12 months which has an impact on service delivery. There is ongoing work with Employee and Policy Officers to review the current situation. 5.7.18 It is important to note that the agreed model intended to deliver a more financially viable service. The budget allocation for 2024-2025 is £48.083m. The shift of resources to focus on prevention and early intervention is essential to assist in managing demand to ensure people get the right support at the right time. There are a number of key actions for the service to create efficiencies and they include the introduction of a dynamic scheduling tool which is a key development. 5.7.19 Dynamic scheduling system Individuals regularly request support and care at key points in the day and this can place pressure on the service. The current shift patterns of staff do not always match with the demand. The dynamic scheduling tool will assist with this but due to the number of different shift patterns that exist it will be necessary to consider how we address this to ensure a more efficient service. 5.7.20 A key aspect of service efficiency and improvement is the implementation of a dynamic scheduling tool to benefit Home Support Workers in the community and for those who schedule and plan work. It is an essential development to aid back-office staff to efficiently and effectively schedule support and adapt quickly with changing needs. The tool is vital due to the current contract with
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9 Advanced/Kirona expiring on 31st October 2024, with no further option to extend as the current product is end of life. Following a procurement exercise Access CM were awarded the contract. 5.7.21 The contract to provide a dynamic scheduling tool will offer a wider range of benefits to staff and service users alike with the ability to produce accurate reports which will help to inform future demand upon the service. The tool will improve consistency, reduce missed visits, and incorporate travel time accurately. For the first time, the service will be able to monitor care delivery in real-time and monitor quality indicators such as punctuality, continuity and service duration. The tool will demonstrate how person-centred support improves quality of life and measures the effectiveness of care delivered. 5.7.22 Work patterns for frontline staff require to be reviewed. This will be essential to ensure any efficiencies arising from the implementation of a dynamic scheduling tool can be implemented. The workforce workstream have identified gaps in service provision that require to be addressed through the review. 5.7.23 Ongoing work continues for data cleansing and transfer as well as identifying training programmes in preparation for the new tool including the implementation of Mosaic (new case management system). 5.8 Engagement 5.8.1 An important aspect in the review of the service model was to involve both staff and individuals who use the service by offering opportunities for them to shape the service by active participation. 5.8.2 Consultation with the workforce and stakeholders was undertaken through a series of events including face to face meetings across all locality areas and surveys to capture views and experiences of the current and future model. During each consultation event operational issues were captured and addressed which included ‘You Said, We Listened’. 5.8.3 Staff highlighted areas for improvement and issues that impacted on their work. They also had the opportunity to explore various options. Common themes reported by staff: Not having enough travel time. Having difficulty contacting their managers. Waiting time for the Out of Hours Service and not always having enough time to undertake required tasks. Impact of current work pattern on continuity and consistency of care including, lack of staff working backshifts, downtime at various points in the day and not having enough staff at peak times resulting in over time being utilised to ensure service delivery.
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10 5.8.4 The engagement with supported people and their cares/ families highlighted recurring themes and included the need for continuity of care with consistency of carers and timing of visits however many reported that carers were respectful and courteous. 5.8.5 Following consultation with the workforce and stakeholders, benchmarking was undertaken with eight local authorities including Renfrewshire, East Dunbartonshire, South Lanarkshire, Inverclyde, Falkirk, Fife and Glasgow to gain a more in-depth knowledge and understanding of other Health and Social Care Partnerships, how they operate and manage Care at Home and Home Support provisions. This included gathering data across key areas of service delivery including preventing hospital admissions, facilitating hospital discharge, managing demand, cost and system. 5.8.6 The information collated has allowed the service to identify best practice and useful learning from others to develop a structure for the Home Support Workforce. A workforce plan is being finalised. 5.9 Improving Quality 5.9.1 The proposed changes will ultimately ensure people have a high quality, safe and compassionate care and support, which is sustainable and maintained across all localities. 5.9.2 The service continues to work closely with the Care Inspectorate to meet requirements and make the improvements that have been identified through the inspection process. Challenges from staff absence and recruitment of appropriately skilled individuals have previously impacted on direct delivery and management teams, however, the service is starting to see an improving picture.
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11 5.9.3 The key issues and risks now arising from inspections are lack of consistency of support, system issues relating to the recording of missed visits and incorporating travel time, lack of training in developmental areas and outdated reviews and personal support plans. Good progress has been made in four of the teams, with two teams being high-risk areas for staffing and performance, particularly in relation to outstanding reviews and personal support plans. Improvement plans have been devised to progress the significant work, which is overseen by the Senior Social Work Manager. The full implementation of a dynamic scheduling tool will reduce missed visits, incorporate accurate travel time (both walking and driving) and improve consistency of scheduled care. 5.9.4 A demonstration has been provided to all Inspection Officers to give an overview of the main project benefits/goals, modules involved and examples of reduction in missed visits, improving efficiency and stronger continuity of care which have been consistently highlighted by the Care Inspectorate as areas for improvement. 5.9.5 The new inspection year commenced in April 2024 and the service has been advised each team will receive a full inspection during follow up visits, and will now involve three inspection officers, with a lead officer identified for each team. In addition, there are plans to conduct a separate review of recruitment processes during 2024, distinct from the ongoing inspections in localities. 6. CONCLUSIONS 6.1 This report outlines the progress that has been made to implement the operating model for the Home Support workforce establishing a functional model. This will focus the workforce on distinct areas and ensure a delineation between assessment and planning and provision. 6.2 The impact of change detailed in the report will improve the quality and consistency of care and support, improve recruitment and retention, address impaired staff morale, improve Care Inspectorate grades and maximise efficiencies and capacity within the service. This will be supported by good governance, clear infrastructure, a skilled workforce and improved culture and environment. 6.3 There has been an incredible amount of work undertaken to ensure that the operating model is fit for purpose and can adapt into the future as we respond to whole system changes. A further update will be provided with the finalised operating model and associated workforce establishment.
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12 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES. Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The following measures of success have been identified: 7.2.1 Improving the wellbeing of supported people’s outcomes. 7.2.2 Evidence of reablement reducing service users’ dependence on long term home support, working collaboratively with the Assessment and Planning teams to ensure that we continue to support individuals’ independence and rehabilitation. 7.2.3 Improved discharge response from Lanarkshire and Glasgow Hospitals. 7.2.4 Prioritised resources for ongoing longer-term support which will include the upskilling of the home support workforce to support service users with complex health and social care needs within their own homes. 7.2.5 A flexible and responsive service with evidence of improved quality of care, support and service delivery resulting in increased Care Inspectorate grades, staff, and service user satisfaction. 7.2.6 A competent and confident workforce, fully staffed teams with minimal turnover. 7.2.7 Ensure a sustainable financial model.
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13 7.2.8 Have a service which can respond to future demand, with a workforce that can provide a flexible, responsive, outcome-based approach to supporting people at home. 7.3 FINANCIAL 7.3.1 Currently working with Finance Business Partners to determine any financial implications to implement the operating model and associated structure. 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 7.5.1 Engagement and participation with all stakeholders are of utmost importance for this piece of work. As such a detailed communication and engagement plan is being developed to ensure that all stakeholders are kept informed throughout the remainder of this project. 7.5.2 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 Events to be arranged for staff, service users and all relevant stakeholders. ☒ Provide stakeholders with information on how to get involved Information leaflets to be issued/ quarterly information bulletins. ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Questionnaires will be issued. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Information will be provided bi- monthly in the form of newsletters
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14 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Tablets are available at the events where a survey can be completed (QR codes available). ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS N/A 9. APPENDICES None. Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Karen Workman, Service Manager Adult Social Work. workmank@northlan.gov.uk
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15 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-06 2 Report Title Home Support Service 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 7 SUBJECT: Home Assessment Team/Discharge without Delay Programme Update TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser, Chief Officer, Adult Social Work Services NL HSCP Author(s) of Report Margaret Flavell, Senior Manager, Adult Social Work Sharon Simpson, Health and Social Work Manager Ian Nicol, Programme Manager DATE: 21 August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒ Ian Nicol, Programme Manager Margaret Flavell, Senior Manager Adult Social Work Diane Fraser, Chief Officer, Adult Social Work 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: 1. Acknowledge the report. 2. Endorse the strategic direction of HAT and the implementation of HAT across North Lanarkshire.
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2 3. Acknowledge the significant development in HAT practice across North Lanarkshire 4. VARIATIONS TO DIRECTIONS? 5 BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In September 2021 the IJB approved the establishment of a Change Fund to create additional capacity and support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire Health and Social Care Partnership, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan: Do the right thing first time Provide a range of community services and supports to people to live well in connected communities Focus on what matters to people Be at the forefront of technical and sustainable solutions Promote prevention and early intervention Ensure North Lanarkshire is the best place to work, volunteer and care 5.2 Priorities for the use of the Change Fund were identified as: Prevention and early intervention, targeting spending on helping people to live healthier and safer lives and maintaining their independence at home or in the community. This means less spending is required on hospital or specialist care later. Empower individuals and communities, involving them in service design and delivery. This should result in services that match what people need and want. Improve efficiency by adopting a whole system approach to improve and deliver services. 5.3 A Winter Planning & Increased Capacity Business Case was developed, and this set out a total recurring investment of £6.759m in three main categories: Assessment and planning capacity Direct provision of services and supports Infrastructure capacity 5.4 Home Assessment sits within the first of these categories and is the approach that North Lanarkshire is taking to implement what is known nationally as Home First. Yes ☐ No ☐ N/A ☒
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3 5.5 It is recognised that being in hospital disconnects people from their family, friends and social network and can result in a sense of isolation, loss of confidence and depression. Older people in particular experience functional decline as early as 72 hours after admission and are more likely to have an episode of delirium or infection. Every unnecessary day in hospital increases the risk of an adverse outcome for the individual, drives up the demand for institutional care and reduces the level of investment that is available for community support. (PubMed - Swinnerton, Price, ‘Recognising, Reducing and Preventing Deconditioning in Older People’. 2023). 5.6 Discharge without Delay (DWD) is a vital component of the Scottish Government’s Unscheduled Care Programme with a Home First approach fundamental to its success. The aim is to prevent delay to discharge where an acute medical issue has been addressed. Reducing delay for people who can be assessed within their own homes rather than a hospital ward is an essential element of reducing the length of hospital stays and thus releasing unnecessarily consumed capacity. This approach requires a shift in mind-set to; “Why not home? Why not now?” and has been proven to result in more positive individual outcomes for people. (SCIE, ‘Hospital Discharge and Preventing Unnecessary Admission, 2022). 5.7 North Lanarkshire’s Home Assessment Team, (HAT), is a multi-disciplinary social work, health and social care resource which applies a whole system approach to planning and preparation for hospital discharge and admission avoidance by facilitating both assessment and intervention within each person’s own home. HAT will support by adjusting the balance of care both at the front door and back door of hospitals. 5.8 To enable timely discharge from hospital and prevent unnecessary admissions, HAT provides: Rapid access to the support that people require to enable them to return home or avoid admission to hospital. Time-limited support to enable an assessment of each person’s immediate and longer-term support needs in their own home, taking into account and optimising use of personal and community networks. A designated workforce focused on enabling discharge and maximising function in the home environment by increasing the number of timely post- discharge assessments and providing a rapid community response to prevent hospital admission. A robust discharge pathway for those who require home assessment and rehabilitation following discharge from both hospital front door and wards. Flexibility to deploy the workforce across the sectors. Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?). Clear leadership and presence within discharge arrangements services. Close links with individuals involved in the Planned Date of Discharge process to identify appropriate patients for the HAT pathway.
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4 Close working relationships with Rehab Team, District Nurses, Acute, Allied Health Professionals, Hospital at Home and Hospital Discharge Support Programme (3rd sector) with access to the equipment store to support hospital admission avoidance and discharge arrangements. 6 PROGRESS AGAINST WORK PLAN 6.1 HAT Roll-out Phase 1: Wishaw and Cumbernauld fully implemented Phase 2: Motherwell and Airdrie fully implemented Phase 3: Coatbridge and Bellshill: Coatbridge commenced December 2023 although not fully staffed yet with work ongoing to progress. Bellshill not yet fully operational, but utilising Motherwell-based HAT Home Support staff to support discharges via HAT. 6.2 Service Model Standard Operating Procedure agreed. Workshops held to map pathways, review and agree pan-Lanarkshire referral criteria with all key stakeholders in the MDT including transfers of care into reablement, mainstream /longer term home support and rehab services. HAT staff accommodation secured in university hospitals and community. Induction programme established. 6.3 Data and measurement Data spreadsheet developed to record activity and enable monitoring of performance and outcomes. This continues to be revised according to activity and developments. 6.4 Recruitment Recruitment to HAT ongoing to build capacity and roll out across all NL localities. The pressures within the system regarding workforce are widely acknowledged and adjustments continue to be made to skill-mix. Several recruitment campaigns have been progressed across health and social care to recruit across the team including Home Support, Physiotherapy and Occupational Therapy staff. Several Home Support Workers have expressed an interest in transferring to HAT. This will be facilitated as soon as their posts have been backfilled. It is the intention for existing staff to be able to work flexibly across sectors as required to meet demands. 6.5 Leadership and Operational Management Interim operational management of HAT has been delegated to two Locality Social Work Managers, aligned to the 2 hospital sites of University Hospitals
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5 Monklands and Wishaw, and an NHS Service Manager, working closely with the discharge arrangements and the hospital social work teams. This will be rolled out across the six localities. They are reviewing the operational structure of the HAT and holding regular meetings with Team Leads including Allied Health Professionals and IRT to take forward any outstanding work to establish HAT. Strategic management is also undergoing a review to ensure integration into the new GIRFE/Enabling Approach arrangements. 6.6 Risks and challenges 6.6.1 The implementation and embedding Home Assessment practice presents with several risks. Risk Mitigation The release of a substantial number of Home Support Workers from the mainstream/longer term service will impact on the delivery of long-term home support including disruption of existing care packages and potential increase in unmet need Working closely with in-house home support and the independent home care providers across the sector to create the capacity required to release this resource. People are not supported as required due to ineffective, inefficient and inconsistent reablement activity Ring-fenced reablement teams established to meet need Regular weekly Reablement meetings between Home Support and Rehab Teams across 6 localities to target reablement activity and achieve practice consistency Lack of trust in HAT process Targeted engagement activities between HAT, ward and community staff to develop trust and confidence in assessment at home Patients’ outcomes may be poorer due to deconditioning in the hospital setting which ultimately leads to increased dependency on formal supports or transfer to long term care home placement Promote earlier discharge from hospital and assessment at home Planned Date of Discharge (PDD) is not fully embraced Refreshed PDD process Low referral rate to HAT HAT presence in hospital settings to develop further trust and confidence
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6 Recruitment challenges Planned, phased and strategic recruitment Low Pharmacy input Ongoing pharmacy input and medication training across relevant staff Limited access to pool cars Further purchase of pool cars Lack of capacity on Acute sites to support HAT Accommodation and space identified for HAT staff 6.6.2 Other challenges: Timely movement of people into services, if required, including Reablement, IRT, long-term home support. Funding for non paye costs to be agreed and sourced as not included in the initial business plan. 6.7 Embedding the approach 6.7.1 As HAT has developed, further synergies have been identified with other key programmes of work to improve our prevention and early intervention response. This includes Getting It Right for Everyone (GIRFE), the Frailty Strategy, Home Support Refresh, the Back to Basics Enabling approach and the Operation FLOW Optimal Discharge Planning Target Operating Model. 6.7.2 The interface with other parts of a person’s journey is critical. Whilst some individuals will not require any statutory support, there will be those who would benefit from further intervention. Therefore, while we ensure FLOW through the acute hospital sites, this is also required within community settings and timely access to reablement, and rehabilitation will be critical to enable people to maximise their potential and ensure that they receive the support that is right for them. 6.7.3 Reablement provision was significantly impacted during the pandemic due to capacity and workforce issues. Subsequently, there have been changes within the Home Support Service and Integrated Rehab Teams (IRT) to ensure that Reablement can be fully remobilised. This entails a separation of assessment and planning functions, including Reablement, HAT and IRT, and a long-term “Living Well” Service. 6.7.4 Weekly meetings have been established between relevant staff in HAT, Home Support, Reablement and Rehab Teams to facilitate effective communication regarding individual service users and reablement activity and subsequent goal setting supported by a standard operating procedure. 6.7.5 Each locality is developing a multi-disciplinary enabling approach to ensure an effective and timely response that taps into community resources, where
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7 appropriate, through our recently appointed third sector community connectors. 6.8 Next Steps Embed HAT across North Lanarkshire whereby Home First becomes the norm in Acute and Community and align with the Target Operating Model to optimise discharge. Conclude recruitment and complete roll-out across localities. Communication and engagement activities continue including staff briefing sessions. Ensure Lanarkshire-wide referral criteria are widely known. HAT process and patient/service-user pathways used in everyday practice. HAT patients/service users to be discussed on Planned Date of Discharge (PDD) call. Full remobilisation of Reablement. Improved interface with the Equipment Store and Assistive Tech Team and subsequent service delivery. Ensure HAT is embedded in whole system approach aligned to GIRFE principles and Back to Basics Enabling Approach. Undertake a test-of-change in Airdrie/Wishaw which will aim to: - Identify the range of preventative and early intervention services. - Build on the prototypes developed through the Partnerships involvement in the national GIRFE Pathfinder Programme. - Improve access through changes to first point of contact. - Put in place robust screening and allocation through an MDT and enabling approach. - Reduce waiting times through embedding the team around the person, working to a single, shared plan and eradicating unnecessary referrals. Establish key linkages within the Health & Social Care Whole System Dashboard and track wider impacts of the service on Delayed Discharge performance, and capacity of the Home Support Service. 7 DATA ON ACTIVITY AND IMPACT 7.1 Since its inception in April 2022 to 2nd July 2024, 2,119 patients in total had been referred to and supported by the Home Assessment Team. 7.2 As illustrated by the Chart 1 below, there has been a natural, gradual build and expansion of the team as staff have been recruited and trained. This is reflected in the gradual build-up in the volume of referrals. Whilst all localities are not yet fully operational, an average of 120 new individuals are currently supported by the service every month. Those people who are referred to HAT are also being discharged quicker from hospital to be fully assessed in their home environment, with 82% of individuals referred to HAT and discharged from hospital on the same day.
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8 Chart 1 7.3 As HAT has become established the team has been able to accept more complex cases and fully support the multi-disciplinary team working that is required to support a “Home First” approach for individuals. We can see below in Chart 2 that over time, as more complex cases were being accepted in financial year 2023/24, that the proportion of people recorded as completing the service with no further service required decreased; however, we know from our monitoring of delayed discharges that the HAT approach is improving flow. Chart 2 Of the those requiring a further service, the service with the highest number was the Community Alarms Service (16% of total completing). This was followed by Home Support Reablement (13%), then Integrated Rehab Team (IRT) - Physio and Mainstream Home Support (both 11%) and IRT – Occupational Therapy (10%).
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9 Service at Completion Home Support - Reablement 13% Locality SW Referral 1% Home Support - Mainstream 11% Integrated Day Service 0% Integrated Rehab Team - Physio 11% LSS 0% Integrated Rehab Team - OT 10% District Nurse 6% Rehabilitation - Other 1% NL Leisure 0% Community Alarms 16% Third Sector 3% 7.4 The contribution of the Home Assessment Team also appears to be having an indirect impact on the Partnership’s overall performance in relation to patients’ discharge being delayed in hospital. The below (Chart 3 & Chart 4) illustrate the significant reduction in the number of bed days delayed per week in both acute sites and off-site wards, particularly towards the end of 2023 and into early 2024. Chart 3
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10 Chart 4 8 CONCLUSIONS 8.1 This report provides an update on the establishment of HAT in North Lanarkshire, which includes background, progress to date, plans, recruitment update, successes, risks and next steps. 8.2 The delivery of high-quality support is critical to support individuals who are at risk of admission to a hospital or who have complex discharge needs. The improvement work to establish the Home Assessment Team (HAT) is critical to the delivery of the Plan for North Lanarkshire and the University Health and Social Care North Lanarkshire Strategic Commissioning Plan. 8.3 HAT provides assessment at home with a focus of complementing established practice and supporting service redesign and streamlining of other key areas of work including the longer-term vision of the development and implementation of an enabling hub approach across the North Lanarkshire Health and Social Care Partnership. 9 IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People can look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☒
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11 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) Data spreadsheet developed to record activity and enable monitoring of performance and outcomes. This continues to be revised according to activity and developments. 9.3 FINANCIAL The funding for HAT provided via the Winter Planning & Increased Capacity Business Case has been incorporated into baseline budgets and as such is part of routine financial management arrangements. A funding gap has been identified for non-PAYE (Pay as You Earn) costs therefore this cost impact requires to be resolved through the current financial sustainability arrangements. This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Home Support Programme Board High Margaret Flavell As outlined in Risk under section 6.6.61 9.5 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 Extensive engagement with service-users and staff has taken
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12 outcomes place in relation to the Redesign of Home Support and getting it Right for Everyone (GIRFE) ☒ Provide stakeholders with information on how to get involved See above ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs See above ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Ongoing and linked to partnership engagement and participation work and GIRFE testing ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Regular contact/engagement with families, workers and partners, the production of service-user and staff newsletters ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings See above ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff See above ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership See above 9.6 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 10 BACKGROUND PAPERS None
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13 11 APPENDICES N/A Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Margaret Flavell, flavellm@northlan.gov.uk Sharon Simpson, sharon.simpson@lanarkshire.scot.nhs.uk
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14 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/0821-07 2 Report Title Home Assessment Team Discharge without Delay Programme Update 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 8 SUBJECT: Self-Directed Support Update TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser Chief Officer Adult Social Work NL HSCP Author(s) of Report Andrea Breen Senior Manager Adult Social Work Lisa Barbour Service Manager Adult Social Work DATE: 21 August 2024 1. PURPOSE OF REPORT This report provides an update on the progressive implementation of Self-Directed Support (SDS) nationally and the position locally with reference to the Self-Directed Support Framework of Standards updated by Social Work Scotland in May 2024. The report will reinforce the whole system approach to continuing to promote maximum choice and control for people living in North Lanarkshire. For approval ☐ For endorsement ☒ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Lisa Barbour Service Manager Adult Social Work ☒ Reviewed By: Andrea Breen Senior Manager Adult Social Work ☒ Endorsed By: Diane Fraser Chief Officer Adult Social Work ☒
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA: 1. Acknowledge the progress made in North Lanarkshire to promote choice and control through Self-Directed Support 2. Note that a future report will be brought to detail the findings of a Self- Evaluation and associated Action Plan 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES: Background 5.1 Self-Directed Support in Scotland has its origins in North Lanarkshire. The opportunity to maximise choice and control for people and their families was recognised locally as far back as 2007 where concepts and approaches were tested on a small scale and evaluated through Lancaster University and form the basis of the work being done today. 5.2 Early drivers of a more personalised approach, including individualising funding to promote choice and control, recognised the increasing gap between assessed need for support services and available resources to deliver. At the time it was noted that there was a risk of being pushed down a route that limited access to resources to meet critical and substantial need only, missing the opportunity to intervene more proactively and prevent difficulty or crisis arising. 5.3 The fiscal challenges of today being experienced at a system wide level; within specific services and across the range of provision; and for individual people and their families; make the original drivers for change even more important. A whole system approach is being progressively implemented to mitigate as far as possible, the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. 5.4 A personalised approach, which includes the individual allocation of financial resource where that is needed, remains the preferred operating model for the whole system in North Lanarkshire and is being supported by some key actions described in the report. Yes ☐ No ☐ N/A ☒
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3 Legislation and National context 5.5 The Self-Directed Support (Scotland) Act 2013 promotes equality, autonomy and improves lives for people who need support. It is a crucial piece of legislation for children, adults and carers in Scotland, emphasising choice, control, and dignity in care and support. 5.6 Since the act was implemented in April 2014 both the Care Inspectorate and Audit Scotland have produced reports on Self Directed Support stating that whilst there is evidence of positive progress, there is an inconsistency of practice and process across Scotland (Care Inspectorate Thematic Review of self-directed support in Scotland: Transforming Lives June 2019; Audit Scotland 2017 progress report Self-directed Support). 5.7 In March 2021 the national framework of eleven standards for the implementation of Self-directed Support was developed and published by Social Work Scotland. The standards and action statements were developed to ensure consistency of outcomes and approaches in SDS practice across Scotland experienced by supported people (children and adults) and carers, building up a framework of good practice in assessment for support, support planning and in provision of care and support resources. The framework of standards was then updated in 2022 to become 12 standards and has been updated again in May 2024. 5.8 The foundation of the framework of standards is that Self-directed Support is not new or something to learn, it is not about resource allocation frameworks, and it is not only about an offer of the four SDS options. Crucially, SDS is about the implementation of core social work/practitioner values of human rights and relationships in practice, and it empowers social workers/practitioner to be autonomous in exercising their professional judgement, and using their own knowledge, skills and abilities, in partnership with supported people. The alignment of the framework of standards with the approach in North Lanarkshire reflects the direct involvement of key officers in their design and development. 5.9 Alongside the development of the standards, Social Work Scotland are finalising the format of self-evaluation to inform local improvement plans. As enthusiastic early adopters of this approach, it is the intention to work with all local stakeholders to undertake a self-evaluation in late summer / autumn. Honest reflection on strengths and challenges will define clear actions which are expected to maintain and strengthen the whole system approaches to promoting choice and control in North Lanarkshire. North Lanarkshire Profile 5.10 In 2024/25 3,029 people benefited from support arranged through the principles of self-directed support. The adults, children, young people and their families, were able to excerpt choice and control through understanding the resource available to them and making decisions about how best to use that resource to support the achievement of their outcomes.
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4 5.11 Information provided to Public Health Scotland as part of the Annual Return Summary demonstrates the spread across ages in Figure 1 below. Figure 1 5.12 The individual budgets put in place are outlined below in the number of people opting to manage a direct payment, direct their own support or have the local authority put arrangements in place. Figure 2 offering the detail of the numbers of people across localities and Figure 3 providing the financial information. Figure 2 Figure 3
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5 5.13 As previously reported to the Committee Mosaic will replace SWIS as the line of business operating platform. The design work is taking into account the benefits of enhanced data analysis and significantly improved reporting capacity. 5.14 The number of people and financial values indicated above all represent unique stories and significant achievements in supporting people with complex needs in the community. Individual arrangements range from people who have support at all times of the day and night, to people who receive more modest supports over small parts of the day. Support arrangements include non- standard use of resources in the form of bespoke purchases to meet need reflecting genuinely individualised nature of planning and intervention. Future reporting will increasingly be able to show the breadth and depth of information to practitioners, localities, commissioning staff as well as to the governing committees. Partnerships 5.15 Self-directed support at times becomes synonymous with individual budgets but it is much more of an overarching approach to people living well connected lives within their communities, which may or may not include the need for an individual budget. 5.16 Third and voluntary sector partners play a crucial role in supporting the whole system response. Inspiring Scotland who were the fund manager of the Scottish Government Support in the Right Direction monies facilitated the opportunity for the North Lanarkshire Disability Forum, Equals Advocacy and Voluntary Action North Lanarkshire to empower people and carers to be equal partners in their care ensuring real choice and control over their lives including how they live and the services/supports they receive; participating in fulfilling activities and in their communities, and pursuing employment if that was what was important. 5.17 The fund of £460,000 between 2019-2024 supported 2,576 people to be Better prepared and more confident in participation in assessment Informed and listened to Creative and flexible in the plans around their life Confident in the management of their own support and individual budgets Generally, more knowledgeable and understanding of self-directed support principles and options for them 5.18 The experience and learning from the SIRD achievements has directly influenced the creation of the Community Connector role which increases the capacity to support people in the community to be resourceful and use their own resources well, as well as support people to participate as equal partners in the more formal responses to their support where needed. 5.19 The Community Connectors role, also hosted by the North Lanarkshire Disability Forum utilises £600k identified through the Winter Planning and Enhanced Support funding stream as well as the Improving Cancer Journey
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6 monies. The capacity to support the work in each locality is significantly enhanced through 10 Community Connectors. 5.20 The importance of whole life planning is being explored through the Getting It Right for Everyone (GIRFE) Pathfinder work North Lanarkshire is engaged with. The role of the third and voluntary sector is crucial in supporting a broader approach to helping people plan for the long term without “medicalising” or “clientising” into more formal services and supports before that is needed, but equipping people well for when that is the right response. 5.21 Self-directed support also needs resilient communities that are welcoming and inclusive. Community Solutions works to the principles of self-directed support and promotes the ambition of people having well connected lives through all the work undertaken through their themed work as well as through their community consortia. 5.22 Work with Enterprise colleagues is exploring opportunity through community wealth building within health and social care. Using the NHSL and Council anchor status and considering community wealth building will not only promote choice and control for people who have support needs but will draw a focus on employee-owned business, small provider development, entrepreneurship and supporting existing providers. 5.23 The vast majority of the £93m supporting people to live full and active lives involves support through independent sector providers. The 10-year framework agreement supporting individualised funding arrangements is an important example of ethical commissioning with strong partnerships and active participation in the development of responses in North Lanarkshire. There are currently 56 providers on the framework supporting genuine choice. 5.24 The quality of provision remains high and is subject to separate, more detailed reporting. 5.25 The cost-of-living pressures, recruitment and retention of a skilled and flexible workforce remains a challenge for the independent sector in the same way that it impacts in other parts of the whole health and social care partnership. Work to support the sector has included the allocation of non-recurring resources through the Winter Planning, Enhanced Support monies to impact on infrastructure responses and capacity building which has been welcomed by the sector. 5.26 Partnership working with independent sector providers is also supporting the achievement of the Coming Home work, a welcome approach to supporting people locally rather than in hospital or out of authority resources disconnected from family and friends. 5.27 The successes of a truly self-directed support approach to care and support and the examples of how people’s lives have been transformed continues to inspire and build confidences. There are a relatively small number of people in North Lanarkshire who sit on the Coming Home register, and work continues to
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7 successfully supports people to move from institutional, buildings based services to arrangements which much better take account of individual lifestyles, communication styles and support of positive behaviours. 5.28 Increasingly the complexity of people’s health care needs in the community involves interesting discussion about the design and delivery of safe care, including, but not limited to ventilation and respiratory care and supporting people with end-of-life care. The development of safe operating procedures and active care management remains a fluid and learning environment to getting it right for everyone. 5.29 The importance of the partnership approach to achieving the best possible outcomes for people is being further strengthened within the review of overarching meeting structures and governance. The active participation of representative from Scottish Care, People’s own voice, Communities, Carers and Trade Unions will be strengthened at all levels. Resilient workforce 5.30 Scottish Government Self-directed Support Implementation Study 2018. Report 3: Self-directed Support Case Studies included analysis of the North Lanarkshire approach as one of the case studies. The report noted that whilst the four self-directed support options are a gateway to choice and control, evidence was that equally important was: The quality of assessment, including a genuinely ‘good conversation’; The degree to which there is a focus on outcomes; The budgets available to meet these outcomes and the availability of local providers able to deliver the support required; and The enabled creativity and authority of supported people, practitioners and the care market to find solutions to meet those outcomes. 5.31 Whilst there is good progress on many reflections from this report, a Self- Evaluation against current standards will help channel actions to greatest impact. In the meantime, there have been some key developments achieved. 5.32 A learning and development plan is in place to support new and existing practitioners, team leaders and seniors, managers and wider stakeholders. Practitioners, people who have support arrangement in place, family carers, independent sector providers and third and voluntary sector providers are also actively involved in the delivery of more formal training as well as in the ongoing refresh of the plan. 5.33 Work is ongoing with colleagues involved in the delivery of both local authority and independent sector Home Support service to Increase choice and control through individualising arrangements and planning with people to meet changing needs flexibly and responsively, understanding the focus on frailty. 5.34 In keeping with a place-based approach to empowering localities and facilitating decision making closest to the person, changes to the authorisation of individual budgets within an enabling approach to localities has been introduced. This
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8 approach has increased the speed of decision making, empowered practitioners and leaders, and increased the creativity and flexibility that underpins good SDS. 6. CONCLUSIONS: 6.1 Self-directed support is the approach threading through all of the wok of the Health and Social Care partnership. The ability to respond to people uniquely and continue to individualise responses including where an individual budget supports choice and control will remain the route to mitigate the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. 6.2 The priority of work over the next 12 months, informed by the completion of a Self-Evaluation will be building resilience and sustainability: In communities – helping people to help themselves first, ensuring the best information, advice and access to self-assessment / self help In the Sector – recognising the importance of partnerships with all stakeholders, articulating that through good market facilitation and a focus on community wealth building In the workforce – training and development, fully using the care academy and developing the role of Scottish Care 7. IMPLICATIONS Financial 7.1 Balancing the available resources with demand is a key feature of supporting local decisions about best use of resources and supporting the flexible and imaginative use of the resource available. 8. NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒
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9 Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9. ASSOCIATED MEASURE(S) 10. FINANCIAL 10.1 Measures described throughout the report are being introduced to support the demand and ensure equitable distribution of allocated funding. Future reporting will demonstrate the impact of changed ways of working. This paper has been reviewed by Finance: 11. RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner N/A Choose an item. 12. ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Representative on all forums exploring the ongoing improvement of SDS in North Lanarkshire ☐ 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 Partnership working underpins all of the work supporting SDS and is undertaken in a range of ways to maximise engagement and impact ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is Yes ☒ No ☐ N/A ☐
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10 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 13. INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 14. BACKGROUND PAPERS None. 15. APPENDICES None. Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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11 Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) FraserDi@northlan.gov.uk
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12 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-08 2 Report Title Self-Directed Support 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 9 SUBJECT: Improving the Cancer Journey TO: Integration Joint Board Performance Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Morag Dendy, Chief Officer Planning, Performance and Quality Assurance DATE: 21 August 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 1.2 This paper provides an update on the Improving Cancer Journey service in North Lanarkshire. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: HSCP CORE team Endorsed By: Chief Officer Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒
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2 3. RECOMMENDATIONS 3.1 The IJB PFA Committee is asked to: (1) Note the progress in the provision of support for people with a cancer diagnosis and those affected by a diagnosis to improve the cancer journey for individuals, their carers, their families and friends. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In June 2021 the North Lanarkshire IJB endorsed Phase 1 of a two-part application to the fund to scope the local approach in partnership with VANL. In March 2023 Phase 2 of the application was approved supporting access to funding of £2m to improve the cancer journey across Lanarkshire, this paper offers an update of progress since the launch of the service in March 2024. 5.2 The Improving Cancer Journey (ICJ) approach aligned to Community Solutions, Improving Lives mobilising the community voice around cancer as well as wider long-term conditions to complement the national approach to inclusion, promote successful engagement with more deprived communities and facilitate volunteering models. 5.3 The Phase 2 Application outlined the resource provided by Macmillan, which was equivalent to employ 3.5 whole time equivalent staff, which was matched against the funding within the Improving Lives Initiative (ILI) of £412,800 to employ a combined team of 10 Community Connectors. This approach was designed to ensure everyone in North Lanarkshire diagnosed with cancer can easily access the support they need, when they need it to enable them to live as well and as independently as possible. 5.4 The service began with a small pilot with a specific cohort of people attending a post treatment lung cancer clinic. This pilot allowed for the testing of pathways and processes. Now referrals are accepted referrals for anyone affected by any cancer. Yes ☐ No ☒ N/A ☐
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3 5.5 The ICJ service in North Lanarkshire is based within North Lanarkshire Disability Forum and supports people diagnosed with cancer with their non-clinical needs utilising a holistic needs assessment discussing “what matters.” The service is supported by a central point of administration which triages and coordinates all referrals across the whole of Lanarkshire, thus creating a pan-Lanarkshire hub. The help people need is easily accessed through the hub or directly through the Disability Forum by making just one call or email or completing a single page online form. 5.6 The launch event, on the 20th March 2024 brought key stakeholders, staff and people using the services together to celebrate the service being fully staffed and operational. The event was kicked off by X- Factor star Nicholas McDonald before participants saw videos of a clinician reflecting on the cancer nurse specialist service and heard from one of patients and carers who have been going through the service. 5.7 Chris shared his experience at the launch event. Chris is currently going through the Improving the Cancer Journey. He said: “I would certainly recommend the service to anyone going through cancer treatment. From my first conversation with my link worker Natalie, I could tell she was a good person. She listened to everything I said and she was sympathetic and empathetic. I felt comfortable talking to her about my life and we quickly built up a rapport. I can’t speak highly enough about her dedication. She worked with my cancer nurse specialist regarding my housing and compiled reports for other organisations and further support. I’ve found the emotional support side of it is just as important, especially when I hadn’t told a lot of people about my cancer. Natalie is frequently in touch with me to let me know how things are progressing which means I’m not waiting on hearing updates. That takes away another layer of worry.” 5.8 The Community Connectors will have a meaningful conversation with the person affected by cancer, their carer or family member about what matters to them and then help them to gain access to or signpost them to appropriate support and resources already available in the local community. 5.9 When people affected by cancer access the ICJ, they will have a conversation about their needs and concerns. They will be offered a Holistic Needs Assessment (a conversation to understand what matters to the person) and based on this; an individual support plan will be developed to ensure people are offered all the support they need. This might be financial
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4 information about benefits they may be entitled to or addressing feelings of isolation and loneliness by signposting to community organisations. 5.10 The Improving the Cancer Journey Lanarkshire Quarterly Report April 2024- June 2024 is attached at appendix 1 5.11 Future reporting on the ICJ work will be incorporated into a broader report on the whole system work within communities, including the wider benefit of Community Connectors. 6. CONCLUSIONS This report captures the progress to date on establishing and realising the ICJ work in North Lanarkshire which is impacting positively on the lives of people with or affected by cancer. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.2.1 Quarterly and annual monitoring arrangements are in place to demonstrate key outputs and outcomes.
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5 7.3 FINANCIAL The funding profile is detailed in the report to the IJB in March 2023 This paper has been reviewed by Finance: The work of the ICJ is supported by clear governance arrangements both Pan Lanarkshire and North Lanarkshire specific, this includes the governance of financial commitment and spend which remains on the agreed trajectory. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner The investment opportunity is non- recurring for a fixed period of five years overall but a 2-year period in relation to Phase 2. It was therefore deemed essential that the funding opportunity enhances already embedded approaches which will be sustained into the future. Low Head of Planning Performance and Quality Assurance 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details Yes ☐ No ☐ N/A ☒
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6 ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The impact on people affected by a cancer diagnosis and their carers will be monitored throughout the duration of the ICJ approach. ☒ Provide stakeholders with information on how to get involved Information about the service and being involved is circulated widely and in multiple formats ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Equalities monitoring forms a key component of the overall approach ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services The model has been introduced through testing and experimenting through the 2 phase funding agreement ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 The Cancer Research UK Screening Inequalities Report Deprivation and Cancer Inequalities in Scotland was presented to the IJB PFA on the 14 February 2023 The report highlights the significant impact of deprivation on cancer incidence, diagnosis and outcomes. With NHS Lanarkshire identified as the third most deprived Health Board in Scotland, the findings of the report are highly concerning. 7.6.2 Cancer incidence is 33% higher in the most deprived populations in Scotland in comparison to the least deprived areas. It is estimated there are around 4,900 extra cancer cases every year in Scotland attributable to deprivation, with lung cancer contributing nearly half of these.
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7 7.6.3 Further that cancer mortality is 74% higher in the most deprived population compared to the least deprived. This gap has narrowed slightly since the Covid- 19 pandemic, which may relate to people from more deprived areas being more likely to die from Covid-19. 7.6.4 The report notes that barriers to seeking help are more likely to exist for those living in more deprived communities. A range of difficulties such as getting access to an appointment, getting an appointment at a convenient time, being able to discuss health problems remotely, confidence to talk about symptoms or thinking symptoms were related to an existing condition are all significantly more prevalent in those from the most deprived communities (particularly around being able to access appointments with health professionals). 7.6.5 This development and Phase 2 of the funding application seeks to improve access to help, advice and support across the localities of North Lanarkshire and target resources at those experiencing the highest inequality. EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Improving the Cancer Journey Lanarkshire Quarter Report Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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8 Morag Dendy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy at dendym@northlan.gov.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-09 2 Report Title Improving Cancer Journey 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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10 Appendix 1 Improving the Cancer Journey Lanarkshire Quarter Report April 2024-June 2024 Donna Bruce Macmillan Programme Manager
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11 1.Breakdown of Referrals to ICJ Service 1.1 Total Referrals and Referral Type A total of 412 referrals to the ICJ service were received between April 2024 – June 2024. The month with the highest number of referrals was April (141 referrals, 34%) this increase could be a result of the official launch taking place in March. This continues to show a steady increase from last quarter (341 total referrals). The most common referral type in this period was clinical (78%). Amongst the clinical referrals Cancer nurse specialists account for 60% of those referrals followed by the cancer navigators (28%).
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12 1.2 Total Referrals by Locality
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13 1.3 Total Referrals by Gender Below is the breakdown of ICJ referrals by gender. More referrals were made for women (58%) than men (38%). 1.4 Pathway Stage The most common pathway stage for referrals to the service was at initial diagnosis (28%) and palliative/transitioning to palliative care (38%)
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14 1.5 Cancer Type The most common cancer type was lung cancer (25%). Followed by breast (17%). 1.6 Referral by SIMd In the last 3 months from the 412 referrals there were 14 referrals that come from the top 5% areas of deprivation and 47 from the top 10% the 47 includes the 15 from the 5%. 1.7 Declined Referrals 7 out of a total 421 referrals were declined by the person. Below are the reasons given for declining the ICJ service. The most common reason for declining the service was the support was not required at that time (57%).
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15 Activity 2.1 ICJ Tasks Below is a summary of the ICJ tasks completed during the period. 4217 total tasks were completed. This is a 27% increase in activity since last quarter. 2.2 Total Onward Referrals 241 onward referrals were made to other services.
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16 Below is a summary of the most common organisation’s onward referrals were made to. Maggie’s and Money advice services remain our largest referrals. 3. Holistic Needs Assessment 3.1 Clients are offered the choice of where they would prefer the assessment to be carried out. Last quarter half the clients preferred initial assessment to be carried out in their own home. 37% of clients chose to meet in a community setting while only 5% requested telephone.
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17 3.2 The table below outline’s the main concerns identified by people on assessment. Finances remains’ our top concern. 3.3 Concerns are grouped into our 5 key areas of wellbeing. The below table outlines the number of referrals received for each. Clinic 5% Community 37% Home 51% Paper 2% Telephone 5% Setting 69 59 61 106 89 66 57 86 57 58 64 0 20 40 60 80 100 120 Complementary therapies Eating, appetite or taste Health and wellbeing Money or finance Moving around (walking) Pain or discomfort Patient or carer's support groups Tired, exhausted or fatigued Transport or parking Uncertainty Worry, fear or anxiety Top 10 Concern Types
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18 426 157 955 695 20 52 0 200 400 600 800 1000 1200 Emotional concerns Family concerns Physical concerns Practical concerns Religious and Spiritual concerns (blank) Total Referrals by Concern Type
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3. Experience Survey Results An experience survey was issued by link workers to people supported through the service. Six responses were received, with the following results. How would you rate the service you received from the Improving Cancer Journey Team? The ICJ service and my wellbeing practitioner made me feel better supported. The ICJ service has connected me with appropriate services to support my concerns. If no, which concerns have not been addressed? The ICJ service has made me feel more able to manage my condition. The support I received through the ICJ service was at the right time. The support I received through the ICJ service was the right frequency of contact. If no, how could this support have been improved? Is there anything else about your experience you would like to share? Excellent Yes Yes Somewhat Yes Yes Very friendly team, who kept and regular, called when they advised they would. Excellent Yes Yes No Yes Yes "quite happy with Tom" Tom is the only person out of all the agencies that I trust Excellent Yes Yes Yes Somewhat Yes Not at this time
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Spoke to sister on behalf of F Excellent Yes Yes Yes Yes Yes Excellent Yes Yes Yes Yes Yes Natalie has been a real help, Natalie has reassured me, Natalie got me a blue badge Excellent Yes Yes Somewhat Yes Yes Very friendly team, who kept and regular, called when they advised they would.
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4. Case Studies Case Study A Abstract (provide a brief summary describing your case study: 120 words max.) NM was referred to Macmillan improving the cancer journey service by a clinical nurse specialist. NM was diagnosed with Renal cancer with multiple lung, bone, lymph node and pelvic metastatic tumors, she is a young mum with 2 very young children. Background (what were the problems you tried to resolve? Why did it happen?) NM was contacted by Macmillan ICJ community connector to discuss concerns with NM about herself and her children. NM spoke about their concerns while the practitioner completed an online holistic needs assessment over the telephone, The conversation and Holistic assessment identified that NM is now receiving palliative care and worried that she won’t be able to cope with the treatment or benefit from it, she shared that she is also anxious that this will impact on her role as a mum. NM confided that they are also concerned that their children being so young won’t remember her. NM went on to say that she is currently in a lot of pain and exhausted due to her diagnosis and the side effects of her treatment. NM continued to say that even although she knows her prognosis she is determined to stay positive and continue her role as a mum as best as she can. Action (what did you do and how?) Macmillan ICJ community connector made a referral to The Haven to allow NM some complimentary therapies that would help with her wish to continue looking after her children as best she can. She was also referred to a Children’s and Young adults support group with the same organisation to allow her kids to attend groups and sessions.
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Result (what has the improvement been, what impact has it had and how do you know this?) Macmillan ICJ community connector continues to follow up with NM on a weekly basis. She has confirmed that The Haven practitioners have been telephoning and organising sessions for her and the children which she shared she is happy with. Learning Lessons (what lessons can you share with others trying to do this? How translatable is this idea to other areas?) I have learned that the cancer journey is different for everyone, it can be affected by our environment, the people around us for support, family, past experiences, and what stage of cancer we have, it has made me aware how we need to be more vigilant to changes in our body no matter what our age. Case Study B Abstract (provide a brief summary describing your case study: 120 words max.) Mr. T diagnosed with Lung/Liver cancer & Parkinsons disease faced significant challenges in maintaining his independence due to mobility and bending issues, His sister approached our MacMillan cancer stand at Monklands seeking assistance to improve his quality of life. Mr. T health conditions not only affecting his physical abilities but also took a toll on his emotional well-being. Despite his resilience he struggled with daily tasks and did not feel comfortable relying on others for assistance. Background (what were the problems you tried to resolve? Why did it happen?) During the writer’s first interaction with Mr. T at his home, it’s worth noting that initially his unwavering pride was shining through as he initially declined offers of funding etc. He shared his desire for independence and highlighted a need for a simple grabber tool which would help him pick up from the floor and a telescopic ramp to facilitate loading his scooter into his car. These items would enable him to pick up clothes, and other objects. The ramp would enable him to continue driving
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independently. In turn he could attend appointments and engage in social activities without relying on others. Action (what did you do and how?) Sourced a telescopic grabber “a simple tool” to help pick items from low level. Referral to Well-Being Group at Outpatients St Andrews. Accompany him on his first visit to outpatients & chat with staff. Attempted to source the Telescopic ramp as an assistive equipment but faced challenges. Recognising the importance of enhancing his independence and what matters to him I tried to secure funding for the ramp. Result (what has been the improvement, what impact has it had and how do you know this?) Recognising the importance of enhancing his independence and what matters to him The writer was successful in obtaining a telescopic Grabber device, which he confirms has been useful and enhanced his independence. He has also started his Tuesday well-being group independently and enjoys all aspects of the group. Mr T newfound independence positively impacted his overall well-being, fostering a sense of empowerment and control over his life despite his health challenges. He has expressed his gratitude and confirms a significant improvement in his independence. He also self-purchased a telescopic ramp so he could attend the well- being group independently in his own car. He can now load his scooter into his car allowing him to travel to the outpatients at St Andrew’s. He is running errands and participating in social activities with confidence and autonomy. Mr. T updates the writer on his newfound sense of freedom and self-sufficiency. He now needs my help with developing a “Traffic Light” system weekly planner! Learning Lessons (what lessons can you share with others trying to do this? How translatable is this idea to other areas?) Mr. T’s story highlights the importance of addressing the unique individual needs/wants of our clients facing complex health conditions. It was also a beautiful reminder that our main objective should be to promote independence and focus on
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what matters to the client. By doing this we can significantly improve the quality of life and individuals like Mr. T, enabling them to live with dignity and autonomy. Breaking through Mr. T unwavering pride required a delicate approach –listening and validating his feelings, empathy & rapport building recognising the significance of his pride. When facing a challenge with the referral route for well-being group, by rallying together as a wider team like we did, we can make significant difference in the lives of those like Mr. T. Financial constraints, Despite the apparent need, Mr. T was not eligible for grants because he had been diligently saving neither was the simple modification available from other sources. Case study C Abstract (provide a brief summary describing your case study: 120 words max.) Mrs X was referred by the lung cancer navigator. Mrs X was at home and not for treatment but for best palliative care. Mrs X was very anxious and upset at her diagnosis and worried about how she would cope. The wellbeing practitioner supported Mrs x with two home visits, phone calls and a community visit. The connections made meant physical, emotional and information outcomes improved. The support was carried out over a 3 month period. Background (what were the problems you tried to resolve? Why did it happen?) Mrs X felt isolated and did not know where to turn. During the holistic conversation and assessment, it was apparent that Mrs X was likely not receiving full benefits, did not have mobility aids or a blue badge and had previously benefited from complementary therapy. Mrs X did not have much of an appetite and was not eating much. Mrs X was also worried about what would happen to her cat. Action (what did you do and how?) The wellbeing practitioner: Made a referral to money matters. Passed Mrs X details to Macmillan volunteer complementary therapist.
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Completed a blue badge application. Made a referral to Occupational therapy. Provided Macmillan information on the Building up diet Made a referral to Morphfit gentle movement programme Provided information on SPCA forever care service. At a later date: Contacted DWP to inform them that Mrs X was in hospital. Result (what has been the improvement, what impact has it had and how do you know this?) During follow up calls with Mrs X, the wellbeing practitioner was advised that she received full attendance allowance which allowed her to use taxis more to get out. She received a blue badge which helped when her friend and daughter would take her to the shops. She received complementary therapy at the library which she enjoyed and helped manage her anxiety. Mrs X received mobility aids to make her safe at home and a wheelchair to allow her to get out for longer and to different places with her daughter. Unfortunately Mrs X did not manage to take part in the exercise programme due to her health deteriorating and a family friend took her cat but the information helped her anxiety around what would happen. Learning Lessons (what lessons can you share with others trying to do this? How translatable is this idea to other areas?) The services I referred to were all in touch quite quickly so it was a lot of calls and information at the same time, possibly staggering referrals thinking about priorities to prevent this would be preferable for someone so anxious. Mrs X and her daughter did not know a lot of these services were available and would never have applied for benefits or a blue badge without the support of ICJ so it emphasises the importance of the service.
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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 ☒
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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.
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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 ☒
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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
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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.
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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
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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
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OurHealthTogether2024–2031 Appendix 1
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OurHealthTogether2024–2031 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
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OurHealthTogether2024–2031 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.
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OurHealthTogether2024–2031 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
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OurHealthTogether2024–2031 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
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OurHealthTogether2024–2031 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.
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OurHealthTogether2024–2031 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.
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OurHealthTogether2024–2031 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 £
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OurHealthTogether2024–2031 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.
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OurHealthTogether2024–2031 Page10 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.
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OurHealthTogether2024–2031 Page11 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.
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OurHealthTogether2024–2031 Page12 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.
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OurHealthTogether2024–2031 Page13 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
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OurHealthTogether2024–2031 Page14 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.
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OurHealthTogether2024–2031 Page15 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.
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OurHealthTogether2024–2031 Page16 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
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OurHealthTogether2024–2031 Page17 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.
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OurHealthTogether2024–2031 Page18 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.
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OurHealthTogether2024–2031 Page19 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
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OurHealthTogether2024–2031 Page20 of 34 TacklingStigma 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 SpecialistMental HealthServices ReviewoftheCustody Suite Model of Service Delivery Develop and Deliver a dedicated Adult Neurodevelopmental Pathway ServiceModelReviewof Theraputic Emotional SupportServices(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 Prioritisingpatientswith long waits between teams University partnerships Class based activities ImprovedAccess Peripateticteamto support areas and reduce geographical inequity Waitinglist clinics Mentally healthy infants, children & young people Menally healthy later life Mentally healthy environments & communitites Mentallyhealthy employment Reducing prevalence of suicide, self‐harm, distress & common MH problems
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OurHealthTogether2024–2031 Page21 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.
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OurHealthTogether2024–2031 Page22 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
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OurHealthTogether2024–2031 Page23 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 Maximisenon‐doctorrolestofreeup consultant capacity (Surgical Care Practitioners,SurgicalFirstAssistants) Developthetheatreworkforce 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
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OurHealthTogether2024–2031 Page24 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
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OurHealthTogether2024–2031 Page25 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… Wewill… Address service access challenges so that services can be accessed in a timely manner EstablishTransformationandReformgroupsthat willoverseethedevelopmentofproposalsforchange. 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 reducehospitaloccupancyandimproveaccess to EmergencyDepartments 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.
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OurHealthTogether2024–2031 Page26 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
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OurHealthTogether2024–2031 Page27 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
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OurHealthTogether2024–2031 Page28 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.
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OurHealthTogether2024–2031 Page29 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
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OurHealthTogether2024–2031 Page30 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.
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08: Summary & Conclusion Page31of 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.
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Page32of 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
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Page33of 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
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Page34of 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
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REPORT Item No: 11 SUBJECT: North Lanarkshire Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 TO: Integration Joint Board, Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy Chief Officer of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 21 August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ADP Support Team ☒ Reviewed By: Strategic Lead for the ADP ☒ Endorsed By: ADP Chair and Core Team ☒
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3. RECOMMENDATIONS The IJB PFA is asked to approve the below recommendations: (1) Note the content of the report (2) Approve the Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 for submission 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Alcohol and Drug Partnership (ADP) Annual Reporting Survey is designed to collect information from all ADPs across Scotland on a range of aspects relating to the delivery of the National Mission during the financial year 2023/24. 5.2 The data collected is used to better understand the challenges and opportunities at the local level and the findings will be used to help inform the following nationally: • The monitoring of the National Mission; • The work of a number of national groups including the Whole Family Approach Group, the Public Health Surveillance Group and the Residential Rehabilitation Working Group, amongst others; and • The priority areas of work for national organisations which support local delivery. 5.3 Once the data is analysed and findings are published at an aggregate level as Official Statistics on the Scottish Government website 5.4 The detail in the Annual Reporting Survey reflects the positive work reported through the IJB in March 2024 and through the PFA in October 2023.
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6. CONCLUSIONS 6.1 NLADP continues to deliver on the National Drugs Mission objectives and ADP strategic priorities targeting resources appropriately and measuring impact. 6.2 The ADP has appropriate structures and governance arrangements in place to support decision making around spend and offering best value. 6.3 The right mechanisms in place to offer assurances that as much as possible is being done to tackle harms from substances and reduce deaths. 6.4 There’s a wide variety of supports in place for individuals and families who are impacted by substance use. The current commissioning approach will support efforts to improve the quality and availability of support across statutory and community/voluntary services. 6.5 There’s a strong focus on learning and development across the ADP linked to listening to stakeholder views and involving those with lived and living experience across each area of work and sub-group.
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7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The ADP Board monitors performance on a quarterly basis. 7.3 FINANCIAL The ADP Finance Sub Committee ensures tight governance of the financial resource ensuring best practice, best value and greatest impact.
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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 & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Regular stakeholder engagement takes place through the ADP subgroup structures with people with lived and living experience (including families) involved in shaping the decisions around tackling alcohol and drug related harms. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire.
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☐ 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 ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☒ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; John Holleran, Strategic Lead, North Lanarkshire Alcohol and Drug Partnership (NLADP) john.holleran@lanarkshire.scot.nhs.uk
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Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-11 2 Report Title ADP Annual Reporting Survey 2023 24 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix 1 Alcohol and Drug Partnership (ADP) Annual Reporting Survey: 2023/24 This survey is designed to collect information from all ADPs across Scotland on a range of aspects relating to the delivery of the National Mission on drugs during the financial year 2023/24. This will not reflect the totality of your work but will cover areas where you do not already report progress nationally through other means. The survey is composed of single option and multiple-choice questions with a limited number of open text questions. We want to emphasise that the multiple-choice options provided are for ease of completion and it is not expected that every ADP will have all of these in place. We do not expect you to go out to services in order to respond to questions relating to activities undertaken by them in your area. Where questions refer to service level activities, we are interested in the extent to which you are aware of these at an ADP level. We are conscious that some of the data we are now asking for may appear to have been supplied through other means (e.g. MAT Standards reporting). After careful review, we found the data supplied via these means is not in a form that allows for consistently tracking change over time at a national level and so have included a limited number of questions on these topics. The data collected will be used to better understand progress at local level will inform: National monitoring of the National Mission on Drugs; The work of advisory groups including the Whole Family Approach Group, the Public Health Surveillance Group and the Residential Rehabilitation Working Group, amongst others; and The work of national organisations which support local delivery. The data will be analysed and findings will be published at an aggregate level as Official Statistics on the Scottish Government website. You can find the report on the 2022/23 ADP survey responses here. All data will be shared with Public Health Scotland to inform drug and alcohol policy monitoring and evaluation, and excerpts and/or summary data may be used in published reports. It should also be noted that the data provided will be available on request under freedom of information regulations and so we would encourage you to publish your return. The deadline for returns is Friday 28 June 2024. Your submission should be signed off by the ADP and the IJB. We are aware that there is variation in the timings of IJB meetings so please flag if this will be an issue. If you require clarification on any areas of the survey or would like any more information, please do not hesitate to get in touch by email at substanceuseanalyticalteam@gov.scot.
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Cross-cutting priority: Surveillance and Data Informed Question 1 Which Alcohol and Drug Partnership (ADP) do you represent? Mark with an ‘x’. [single option] Aberdeen City ADP Aberdeenshire ADP Angus ADP Argyll & Bute ADP Borders ADP City of Edinburgh ADP Clackmannanshire & Stirling ADP Dumfries & Galloway ADP Dundee City ADP East Ayrshire ADP East Dunbartonshire ADP East Renfrewshire ADP Falkirk ADP Fife ADP Glasgow City ADP Highland ADP Inverclyde ADP Lothian MELDAP ADP Moray ADP North Ayrshire ADP x North Lanarkshire ADP Orkney ADP Perth & Kinross ADP Renfrewshire ADP Shetland ADP South Ayrshire ADP South Lanarkshire ADP West Dunbartonshire ADP West Lothian ADP Western Isles ADP
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Question 2 Which groups or structures were in place at an ADP level to inform surveillance and monitoring of alcohol and drug harms or deaths? Mark all that apply with an ‘x’ – if drug and alcohol deaths are reviewed at a combined group, please select both ‘Alcohol death review group’ and ‘Drug death review group’. [multiple choice] X Alcohol death review group X Alcohol harms group X Drug death review group X Drug trend monitoring group/Early Warning System None Other (please specify): Question 3 3a. Do Chief Officers for Public Protection receive feedback from drug death reviews? Mark with an ‘x’. [single option] Yes X No Don’t know 3b. If no, please provide details on why this is not the case. [open text – maximum 500 characters] Question 4 Please describe what local and national structures are in place in your ADP area for the monitoring and surveillance of alcohol and drug harms and deaths, and how these are being used to inform local decision making in response to emerging threats (e.g. novel synthetics)? [open text – maximum 2,000 characters] Chief Officers and Public Protection have assurances via the ADP strucutres and governance arrangements that the appropraite processes and procedures are in place to review DRDs and incoproate relevant learning. Chief Officers and Public Protection have assurances via the ADP strucutres and governance arrangements that the appropraite processes and procedures are in place to review DRDs and incoproate relevant learning.
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The Drug Death Prevention Group (strategic and operational) reviews and monitors data/surveilance from a number of sources locally and nationally to help target our response to reduce harms and deaths from drugs. Similary, the reducing alcohol harms group has the same approach and both structures are accountable to the ADP Partenship Board. These are charied by Public Health Colleagues. All learning from each groups is fed back thought the the wider ADP sub-groups and stakeholders, where appropraite. There is a SOP in place for monitoring emerging threats with links to RADAR/PHS nationally - PHS colleagues are part of the DTMG. The ADP and all groups within, including those cited above have good
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representation from Police, Health, Social work, Housing, Education, Youth services, Community/voluntary sector and people with lived experience. The Drug Death Prevention Group (strategic and operational) reviews and monitors data/surveilance from a number of sources locally and nationally to help target our response to reduce harms and deaths from drugs. Similary, the reducing alcohol harms group has the same approach and both structures are accountable to the ADP Partenship Board. These are charied by Public Health Colleagues. All learning from each groups is fed back thought the the wider ADP sub-groups and stakeholders, where appropraite. There is a SOP in place for monitoring emerging threats with links to RADAR/PHS nationally - PHS colleagues are part of the DTMG. The ADP and all groups within, including those cited above have good
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Question 5 5a. In response to emerging threats, e.g. novel synthetics, have you made specific revisions to any protocols? Mark with an ‘x’. [single option] X Yes No 5b. Please provide details of any revisions [open text – maximum 500 characters] representation from Police, Health, Social work, Housing, Education, Youth services, Community/voluntary sector and people with lived experience. We have developed a specific SOP to review/monitor new and emerging threats - this has been developed in partnerships with RADAR and colleague at PHS. This is also linked to the National Drug Deaths Incident Management Team. We have developed a specific SOP to review/monitor new and emerging threats - this has been developed in partnerships with RADAR and colleague at PHS. This is also linked to the National Drug Deaths Incident Management Team.
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Cross-cutting priority: Resilient and Skilled Workforce Question 6 6a. What is the whole-time equivalent1 staffing resource routinely dedicated to your ADP Support Team as of 31 March 2024. [numeric, decimal] Total current staff (whole-time equivalent including fixed-term and temporary staff, and those shared with other business areas) 8.50 Total vacancies (whole-time equivalent) 0.00 6b. Please list the job title for each vacancy in your ADP Support Team as at 31 March 2024 (if applicable). [open text – maximum 500 characters] Question 7 Please describe any initiatives you have undertaken as an ADP, or are aware of in the Strategic Lead, Development officer - x 3, Information research Officer, Administrator, Higher Clerical Officer, Peer support worker Drug Death Information Office (0.5 WTE) Strategic Lead, Development officer - x 3, Information research Officer, Administrator, Higher Clerical Officer, Peer support worker Drug Death Information Office (0.5 WTE)
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services you commission, that are aimed at improving employee wellbeing (volunteers as well as paid staff). [open text – maximum 2,000 characters] 1 Note: whole-time equivalent (WTE) is a unit of measurement that indicates the total working hours of employees in relation to a full-time position. It helps to standardise and compare staffing resource across different teams or organisations. A full-time employee is equal to one whole-time equivalent. For part-time employees, divide their hours by the whole-time equivalent. For example, if a part-time employee is required to work 7.5 hours per week and a ‘full-time’ position is considered to be 37.5 hours, the WTE would be 0.2 (7.5 hours / 37.5 hours).
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Cross cutting priorities: Lived and Living Experience Question 8 Do you have a formal mechanism at an ADP level for gathering feedback from people with lived/living experience who are using services you fund? Mark all that apply with an ‘x’. [multiple choice] X Experiential data collected as part of MAT programme x Feedback / complaints process X Lived / living experience panel, forum and / or focus group X Questionnaire / survey No formal mechanism in place Other (please specify): Question 9 How do you, as an ADP, use feedback received from people with lived/living experience and family members to improve service provision? Mark all that apply with an ‘x’. [multiple choice] Lived/living experience Family members Feedback is integrated into strategy X X Feedback is presented at the ADP board level X X
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Feedback used in assessment and appraisal processes for staff X X
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Feedback used to inform service design X X Feedback used to inform service improvement X X Other (please specify) LLE Peer Researchers LLE Peer Research Question 10 10a. In what ways are people with lived and living experience able to participate in ADP decision-making? Mark all that apply with an ‘x’. [multiple choice] x Through ADP board membership X Through a group or network that is independent of the ADP X Through an existing ADP group/panel/reference group X Through membership in other areas of ADP governance (e.g. steering group) Not currently able to participate X Other (please specify): Embedded through ADP commissioned services/Programmes 10b. In what ways are family members able to participate in ADP decision-making? Mark all that apply with an ‘x’. [multiple choice] X Through ADP board membership X Through a group or network that is independent of the ADP X Through an existing ADP group/panel/reference group X Through membership in other areas of ADP governance (e.g. steering group) Not currently able to participate Other (please specify): Question 11 What mechanisms are in place within your ADP to ensure that services you fund involve people with lived/living experience and/or family members in their decision making (e.g. the delivery of the service)? Mark all that apply with an ‘x’. [multiple choice] Prerequisite for our commissioning X Asked about in their reporting X Mentioned in our contracts None X Other (please specify): Service Level Agreements set out LLE engagement requirements
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Question 12 Please describe how you have used your ADP’s allocated funding for lived/living experience participation2 in the last financial year. Within your answer please indicate which activities have been most costly. [open text – maximum 2,000 characters] Cross cutting priorities: Stigma Reduction Question 13 Within which written strategies or policies does your ADP consider stigma reduction for people who use substances and/or their families? Mark all that apply with an ‘x’. [multiple choice] X ADP strategy, delivery and/or action plan X Alcohol deaths and harms prevention action plan X Communication strategy Community action plan X Drug deaths and harms prevention action plan X MAT standards delivery plan x Service development, improvement and/or delivery plan None Other (please specify): Question 14 14a. Please describe what work is underway in your ADP area to reduce stigma for This has been used to fund Peer Research training and engagement linked to MAT standards and wider LLE activities, events and training. In addition, the ADP has recruited a Peer Support Worker to take forward our LLE work alongside locally commissioned services. This has been used to fund Peer Research training and engagement linked to MAT standards and wider LLE activities, events and training. In addition, the ADP has recruited a Peer Support Worker to take forward our LLE work alongside locally commissioned services.
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people who use substances and/or their families. [open text – maximum 2,000 characters] 2 The funding letter specified that “£0.5 million is being allocated to ADPs to ensure the voices of people with lived and living experience are heard and acted upon in service design and delivery at a local level. This includes decisions about prioritisation, commissioning and evaluation of services.”
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14b. What data does your ADP have access to that could be used to capture the impact of the work described in 14a? (Please indicate if this is not currently possible). [open text – maximum 500 characters] NLADP works closely with Stigma Free Lanarkshire to ensure stigma associated with substance use is included in their work. NLADP stigma work, in relation to substance use, will be linked to the rights-based approach in 2024. Five individuals have completed an SVQ's in Rights Based Advocacy with Reach Advocacy, this was funded by the ADP and SG, they will support the development of our stigma work this year. In addition, over 30 staff attended advocacy training workshops delivered by Reach in 2023/24. This is the first phase of our stigma plans - we will continue to work with Reach Advocacy to offer more SVQs and sessions in 2024 to develp our stigma action plan with the LLE groups and commissioned services. NLADP works closely with Stigma Free Lanarkshire to ensure stigma associated with substance use is included in their work. NLADP stigma work, in relation to substance use, will be linked to the rights-based approach in 2024. Five individuals have completed an SVQ's in Rights Based Advocacy with Reach Advocacy, this was funded by the ADP and SG, they will support the development of our stigma work this year. In addition, over 30 staff attended advocacy training workshops delivered by Reach in 2023/24. This is the first phase of our stigma plans - we will continue to work with Reach Advocacy to offer more SVQs and sessions in 2024 to develp our stigma action plan with the LLE groups and commissioned services. Feedback from individuals, case studies from quarterly reporting from commissioned services, Peer Worker Blogs and peer researchers linked to the Recovery Community, MAT standards and the Living Experience groups led by SDF. Feedback from individuals, case studies from quarterly reporting from commissioned services, Peer Worker Blogs and peer researchers linked to the Recovery Community, MAT standards and the Living Experience groups led by SDF.
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Fewer people develop problem substance use Question 15 How is information on local treatment and support services made available to different audiences at an ADP level (not at a service level)? Mark all that apply with an ‘x’. [multiple choice] In person (e.g. at events, workshops, etc) Leaflets / posters Online (e.g. websites, social media, apps, etc.) Non-native English speakers (English Second Language) People from minority ethnic groups People from religious groups People who are experiencing homelessness People who are LGBTQI+ People who are pregnant or peri-natal People who engage in transactional sex People with hearing impairments and/or visual impairments People with learning disabilities and literacy difficulties Veterans Women
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Question 16 Which of the following education or prevention activities were funded or supported3 by the ADP? Mark all that apply with an ‘x’. [multiple choice] 0-15 years (children) 16-24 years (young people) 25 years+ (adults) Campaigns / information X X X Harm reduction services X X X Learning materials X X X Mental wellbeing X X X Peer-led interventions X X X Physical health X X X Planet Youth X X Pregnancy & parenting X X Youth activities X X Other (please specify) 3 Note: ‘supported’ refers to where the ADP provides resources of some kind (separate from financial,
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which is covered by “funded”). This could take the form of knowledge exchange, staffing, the supply of materials (e.g. learning templates, lending them a physical location), etc.
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Risk is reduced for people who use substances Question 17 In which of the following settings are selected harm reduction initiatives delivered in your ADP area? Mark all that apply with an ‘x’. [multiple choice] Supply of naloxone Hepatitis C testing Injecting equipment provision Wound care Community pharmacies Drug services (NHS, third sector, council) X X X X Family support services X General practices Homelessness services X X X Hospitals (incl. A&E, inpatient departments) X Justice services X Mental health services Mobile/outreach services X X X X Peer-led initiatives X Prison X X Sexual health services X X Women support services Young people’s service x None Other (please specify)
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Question 18 19a. Which of the following harm reduction interventions is there currently a demand for in your ADP area? (Either where the intervention is not currently provided or where demand exceeds current supply). Mark all that apply with an ‘x’. [multiple choice] Drug checking X Drug testing strips Heroin Assisted Treatment Safer drug consumption facility Safer inhalation pipe provision Safe supply of substances Other (please specify): 19b. Please provide details, e.g. scale of the demand. [open text – maximum 500 characters] We have request from individuals liked to ADP commissioned service for drug testing strips for Nitazene/New Synthetic Opioid detaction. We have request from individuals liked to ADP commissioned service for drug testing strips for Nitazene/New Synthetic Opioid detaction.
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People most at risk have access to treatment and recovery Question 19 Which partners within your ADP area have documented pathways in place, or in development, to ensure people who experience a near-fatal overdose (NFO) are identified and offered support? Mark all that apply with an ‘x’. [multiple choice] NFO pathway in place NFO pathway in development Community recovery providers X Homeless services X Hospitals (including emergency departments) X Housing services X Mental health services X Police Scotland Primary care Prison Scottish Ambulance Service X Scottish Fire & Rescue Service Specialist substance use treatment services X Third sector substance use services X Other (please specify) Question 20 Which, if any, of the following barriers to implementing NFO pathways exist in your ADP area? Mark all that apply with an ‘x’. [multiple choice] Further workforce training required Insufficient funds x Issues around information sharing Lack of leadership Lack of ownership Workforce capacity X None Other (please specify):
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Question 21 In what ways have you worked with justice partners4? Mark all that apply with an ‘x’. [multiple choice] Strategic level X ADP representation on local Community Justice Partnership X Contributed to strategic planning X Coordinated activities between justice, health or social care partners X Data sharing X Justice organisations represented on the ADP (e.g. COPFS, Police Scotland, local Community Justice Partnership, local Justice Social Work department, prison) X Provided advice and guidance Other (please specify): Operational level X Provided funding or staff for a specialist court (Drug, Alcohol, Problem Solving) X Raised awareness about community-based treatment options (partners involved in diversion from prosecution or treatment-based community orders) X Supported staff training on drug or alcohol related issues Other (please specify): Service level Funded or supported: X Navigators for people in the justice system who use drugs X Services for people transitioning out of custody X Services in police custody suites X Services in prisons or young offenders institutions X Services specifically for Drug Treatment and Testing Orders (DTTOs) X Services specifically for people serving Community Payback Orders with a Drug or Alcohol Treatment Requirement Other (please specify): 4 Note: ‘justice partners’ includes Community Justice Partnerships (CJPs), Justice Social Work
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departments, Prisons and Young Offender Institutes, Police, Crown Office and Procurator Fiscal Service (COPFS), Scottish Courts and Tribunals Service (SCTS), Sacro, and third sector organisations that specifically serve people involved with the criminal justice system.
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Question 22 Which activities did your ADP support at each stage of the criminal justice system? Mark all that apply with an ‘x’. [multiple choice] Pre- arrest5 Inpolice custody6 In courts7 In prison8 Upon release9 Advocacy or navigators X X X X X Alcohol interventions X X X X X Drug and alcohol use and treatment needs screening X X X X X Harm reduction inc. naloxone X X X X Health education & life skills X X X X X Medically supervised detoxification X X X Opioid Substitution Therapy X X X X Psychosocial and mental health based interventions X X X X X Psychological and mental health screening X X X X X Recovery (e.g. café, community) X X X X X Referrals to drug and alcohol treatment services X X X X X Staff training X X X X X None Other (please specify) 5 Pre-arrest: Services for police to refer people into without making an arrest. 6 In police custody: Services available in police custody suites to people who have been arrested. 7 In courts: Services delivered in collaboration with the courts (e.g. services only available through a specialist drug court, services only available to people on a DTTO).
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8 In prison: Services available to people in prisons or young offenders institutions in your area (if applicable). 9 Upon release: Services aimed specifically at supporting people transitioning out of custody.
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Question 23 24a. Does your ADP fund or support any residential services that are aimed at those in the justice system (who are who are subject to Community Payback Orders, Drug Treatment and Testing Orders, Supervised Release Orders and other relevant community orders)? Mark with an ‘x’. [single option] Yes X No Don’t know 24b. If yes, please list the relevant services. [open text – maximum 500 characters] Question 24 24a. For individuals who have had a court order given to them in relation to their substance use, do you have testing services available in your ADP area10? Mark with an ‘x’. [single option] X Yes No Don’t know 24b. If yes, please describe the type of monitoring that takes place (e.g. sampling with handheld devices, spit tests, electronic monitoring) and who provides these services (e.g. private, third sector, statutory). [open text – maximum 500 characters]. Statutory Services - Jusice social work, DTTO with links to the Addiction Recovery Teams (ART)
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10 We are including this question on behalf of Scottish Government Justice colleagues to better understand substance testing for orders and licences in Scotland. Statutory Services - Jusice social work, DTTO with links to the Addiction Recovery Teams (ART)
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People receive high quality treatment and recovery services Question 25 What screening options are in place to address alcohol harms? Mark all that apply with an ‘x’. [multiple choice] X Alcohol hospital liaison X Arrangements for the delivery of alcohol brief interventions in all priority settings X Arrangement of the delivery of alcohol brief interventions in non-priority settings Pathways for early detection of alcohol-related liver disease None Other (please specify): Question 26 What treatment options are in place to address alcohol harms? Mark all that apply with an ‘x’. [multiple choice] X Access to alcohol medication (e.g. Antabuse, Acamprase, etc.) X Alcohol hospital liaison X Alcohol related cognitive testing (e.g. for alcohol related brain damage) x Community alcohol detox (including at-home) X In-patient alcohol detox X Pathways into mental health treatment X Psychosocial counselling X Residential rehabilitation None Other (please specify):
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Question 27 27a. Which, if any, of the following barriers to residential rehabilitation exist in your ADP area? Mark all that apply with an ‘x’. [multiple choice] Availability of aftercare X Availability of detox services X Availability of stabilisation services Current models are not working Difficulty identifying all those who will benefit Further workforce training required Insufficient funds Insufficient staff Lack of awareness among potential clients X Lack of capacity X Lack of specialist providers X Scope to further improve/refine your own pathways X Waiting times None Other (please specify): 27b. What actions is your ADP taking to overcome these barriers to residential rehabilitation? [open text – maximum 500 characters] Question 28 28a. Have you made any revisions in your pathway to residential rehabilitation in the last year? Mark with an ‘x’. [single option] No revisions or updates made in 2023/24 Yes - Revised or updated in 2023/24 and this has been published NLADP is in the process of evaluating out Residential Rehab Pathways with engagement with those who have been referred for assessment/places within the last 12 months. HIS Self-Assessment also supported improvement measures and a Resi-Rehab steering group is in place, accountable to the ADP Partnerhsip Board. NLADP is in the process of evaluating out Residential Rehab Pathways with engagement with those who have been referred for assessment/places within the last 12 months. HIS Self-Assessment also supported improvement measures and a Resi-Rehab steering group is in place, accountable to the ADP Partnerhsip Board.
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X Yes - Revised or updated in 2023/24 but not currently published 28b. If yes, please provide brief details of the changes made and the rationale for the changes. [open text – maximum 500 characters]
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To build on the learning from a programme of work led by Scottish Recovery Consortium in 2023 and to increase awareness and understanding of our local pathways for staff, people accessing support and wider community. To build on the learning from a programme of work led by Scottish Recovery Consortium in 2023 and to increase awareness and understanding of our local pathways for staff, people accessing support and wider community.
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Question 29 29a. Which, if any, of the following barriers to implementing MAT exist in your area? Mark all that apply with an ‘x’. [multiple choice] Accommodation challenges (e.g. appropriate physical spaces, premises, etc.) X Availability of stabilisation services Difficulty identifying all those who will benefit x Further workforce training is needed Geographical challenges (e.g. remote, rural, etc.) Insufficient funds Insufficient staff Lack of awareness among potential clients Lack of capacity X Scope to further improve/refine your own pathways Waiting times None Other (please specify): 29b. What actions is your ADP taking to overcome these barriers to implementing MAT in your ADP area? [open text – maximum 500 characters] There is a WTE Impovement Manager in post to oeversee all aspects of MAT standards implementation (since May 2023). This role is incorporated into statutory addiction services and works closely with the ADP team and community voluntary supports. There is a MAT steering group that oversees all work required to implement and fully embed the standards - this group met fortnightly throughout 2023 with representation from the MIST team from PHS for numerical/processes and experiential elements. There is a WTE Impovement Manager in post to oeversee all aspects of MAT standards implementation (since May 2023). This role is incorporated into statutory addiction services and works closely with the ADP team and community voluntary supports. There is a MAT steering group that oversees all work required to implement and fully embed the standards - this group met fortnightly throughout 2023 with representation from the MIST team from PHS for numerical/processes and experiential elements.
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Question 30 Which of the following treatment and support services are in place specifically for children and young people using alcohol and / or drugs? Mark all that apply with an ‘x’. [multiple choice] Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Alcohol-related medication (e.g. acamprosate, disulfiram, naltrexone, nalmefene) x Diversionary activities X X X Employability support X X Family support services X X Information services X X X Justice services X Mental health services (including wellbeing) X X X Opioid Substitution Therapy X Outreach/mobile (including school outreach) X Recovery communities X X School outreach X X X Support/discussion groups (including 1:1) X X X Other (please specify) Question 31 Please list all recovery groups11 in your ADP area that are funded or supported12 by your ADP. [open text – maximum 2,000 characters] 11 ‘Recovery group’ includes any group that supports recovery and/or wellbeing in your local area. This could be local recovery cafés; peer support groups; wellbeing groups that support people affected by Recovery Scotland - across all 6 localities on NL and supported recovery activities in Shotts Prison. Recovery Scotland is formally commissioned to lead on all Recovery Scotland - across all 6 localities on NL and supported recovery activities in Shotts Prison. Recovery Scotland is formally commissioned to lead on all
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substance use; or more established recovery networks, hubs or organisations. If some of these are covered by umbrella groups, please list both. 12 Note: ‘supported’ here refers to where ADP provides resources of some kind (separate from financial, which is covered by “funded”). This could take the form of knowledge exchange, staffing, the supply of materials (e.g. learning templates, lending them a physical location), etc.
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Quality of life is improved by addressing multiple disadvantages Question 32 Do you have specific treatment and support services in place for the following groups? Mark all that apply with an ‘x’. [multiple choice] Yes No Non-native English speakers (English Second Language) X People from minority ethnic groups X People from religious groups X People who are experiencing homelessness X People who are LGBTQI+ X People who are pregnant or peri-natal x People who engage in transactional sex X People with hearing impairments and/or visual impairments X People with learning disabilities and literacy difficulties X Veterans X Women X Question 33 33a. Are there formal joint working protocols in place to support people with co-occurring substance use and mental health diagnoses to receive mental health care? Mark with an ‘x’. [single choice] x Yes No 33b. Please provide details. [open text – maximum 500 characters] Recovery community development activitiy, sucessful after a competitive tendering process. Recovery community development activitiy, sucessful after a competitive tendering process. The screening for MH and susbstance use co-occuring diagnosis takes place within the Urgent Response Team for same day access to treatment as part of the delivery of MAT standard 1.
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The screening for MH and susbstance use co-occuring diagnosis takes place within the Urgent Response Team for same day access to treatment as part of the delivery of MAT standard 1.
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Question 34 What arrangements are in place within your ADP area for people who present at substance use services with mental health concerns for which they do not have a diagnosis? Mark all that apply with an ‘x’. [multiple choice] Dual diagnosis teams Formal joint working protocols between mental health and substance use services specifically for people with mental health concerns for which they do not have a diagnosis X Pathways for referral to mental health services or other multi-disciplinary teams X Professional mental health staff within services (e.g. psychiatrists, community mental health nurses, etc) None Other (please specify): Question 35 How do you as an ADP work with support services not directly linked to substance use (e.g. welfare advice, housing support, etc.) to address multiple disadvantages? Mark all that apply with an ‘x’. [multiple choice] X By representation on strategic groups or topic-specific sub-groups X By representation on the ADP board X Through partnership working X Via provision of funding Not applicable Other (please specify):
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Question 36 Which of the following activities are you aware of having been undertaken in ADP funded or supported13 services to implement a trauma-informed approach? Mark all that apply with an ‘x’. [multiple choice] X Engaging with people with lived/living experience X Engaging with third sector/community partners X Provision of trauma-informed spaces/accommodation X Recruiting staff X Training existing workforce X Working group None Other (please specify): Question 37 37a. Does your ADP area have specific referral pathways for people to access independent advocacy? Mark with an ‘x’. [single option] X Yes No Don’t know 37b. If yes, are these commissioned directly by the ADP? Mark with an ‘x’. [single option] X Yes No Don’t know
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13 Note: ‘supported’ refers to where the ADP provides resources of some kind (separate from financial, which is covered by “funded”). This could take the form of knowledge exchange, staffing, the supply of materials (e.g. learning templates, lending them a physical location), etc.
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Children, families and communities affected by substance use are supported Question 38 Which of the following treatment and support services are in place for children and young people affected by a parent’s or carer’s substance use? Mark all that apply with an ‘x’. [multiple choice] Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Carer support X X X Diversionary activities X X X Employability support X Family support services X X X Information services X X X Mental health services X X X Outreach/mobile services X Recovery communities X School outreach X X x Support/discussion groups X X Other (please specify) Question 39 Which of the following support services are in place for adults affected by another person’s substance use? Mark all that apply with an ‘x’. [multiple choice] X Advocacy X Commissioned services X Counselling X One to one support X Mental health support X Naloxone training X Support groups X Training None Other (please specify):
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Question 40 40a. Do you have an agreed set of activities and priorities with local partners to implement the Holistic Whole Family Approach Framework in your ADP area? Mark with an ‘x’. [single option] X Yes No Don’t know 40b. Please provide details of these activities and priorities for 2023/24. [open text – maximum 500 characters] Question 41 Which of the following services supporting Family Inclusive Practice or a Whole Family Approach are in place in your ADP area? Mark all that apply with an ‘x’. [multiple choice] Family member in treatment Family member not in treatment Advice X X Advocacy X X Mentoring X X Peer support X X Personal development X X Social activities X X Support for victims of gender based violence and their families X X Youth services X X Other (please specify) Question 42 42a. Are any activities in your ADP area currently integrated with planned activity for the Whole Family Wellbeing Funding in your Children’s Service’s Planning Partnership All family support activites are linked to the work led by Scottish Families, the ADP Whole family support sub-group priorities and the ealry intervention and prevention sub-group. Our work is linked to the chidren services plan and the Joint Strategic Needs Assessment to ensure all cross-cutting priorities are evidenced and linked together. All family support activites are linked to the work led by Scottish Families, the ADP Whole family support sub-group priorities and the ealry intervention and prevention sub-group. Our work is linked to the chidren services plan and the Joint Strategic Needs Assessment to ensure all cross-cutting priorities are evidenced and linked together.
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area? Mark with an ‘x’. [single option] X Yes No Don’t know
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42b. If yes, please provide details. [open text – maximum 500 characters] All ADP activities target towards families is recognised in the Childrens Planning and cited in the Joint Strategic Needs Assessment. The ADp is represented in the family support planning group with cross representation in the ADP Whole Fmily approach and Early Intervention and Prevention Sub-Groups. All ADP activities target towards families is recognised in the Childrens Planning and cited in the Joint Strategic Needs Assessment. The ADp is represented in the family support planning group with cross representation in the ADP Whole Fmily approach and Early Intervention and Prevention Sub-Groups.
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Additional question Question 43 Please list all services / organisations commissioned by your ADP during 2023/24 and the amount of funding provided for 2023/24. If the final year-end position is not yet known, please include the projected spend amount. For part-funding, please only include the amount contributed by your ADP. Service / organisation name [open text] Amount of funding provided £ [number] Addiction Pyschology NHS 108000.00 Barnardos 298364.00 NLC Contextual Safeguarding 57000.00 NLC SW DTTO Justice Throughcare 98000.00 NLC Equal Say Advocacy 120000.00 Equals Advocacy, Older People 40000.00 GBV Services 39000.00 IPS SAMH 90000.00 NLC Kickstart 35000.00 NLC Children in Conflict with the law 85000.00 Phonenix Futures Prison Link Worker 40000.00 NLC Enchanced Diversionary Youth Work 156975.00 NLC/Barnardos x 3 Projects Under Whole Family App 118000.00 NLRC Recovery Community 175000.00 Phoenix Futures 2 x ContractsFamily & Individuals 446346.00 SDF Addiction Worker Training Program&Peer Resrch 49000.00 Turning Point Scotland 650000.00 Acute Navigators Medica Against Violence 80000.00 NLC Youth Bridges 64632.00 Harm Reduction NHSL Staff & Foils 50000.00 Substance Misuse Liason Nurses NHS 53511.00 Barnardos/Phoenix CORRA Match funding 68812.00 Landed 81818.00 NLC SW Alcohol & Drug Porlbem Solving Court TOC 92000.00 NLC/NHS Addiction Recovery Team 260858.00
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Confirmation of sign-off Question 44 Has your response been signed off at the following levels? [multiple choice] X ADP x IJB Not signed off by IJB (please specify date of the next meeting in dd/mm/yyyy format): Thank you Thank you for taking the time to complete this survey, your response is highly valued. The results will be published in the 2023/24 ADP Annual Survey Official Statistics report, scheduled for publication in autumn 2024. Please do not hesitate to get in touch via email at substanceuseanalyticalteam@gov.scot should you have any questions. [End of survey]
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1 REPORT Item No: 12 SUBJECT: Internal Audit Annual Audit Report 2023/2024 TO: Integration Joint Board Performance Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NL HSCP Author(s) of Report Paula Hendry Acting Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall Chief Internal Auditor, NHS Lanarkshire DATE: 21 August 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Performance, Finance and Audit Committee (PFAC): For approval For endorsement To note 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Acting Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire. ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA: (1) Endorse the opinion of the Chief Internal Auditors that Reasonable Assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control for the year ended 31 March 2024. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to comply with the accounts and audit regulations and legislation under section 106 of the Local Government (Scotland) Act 1973. The Integrated Resources Advisory Group (IRAG) guidance sets out that IJBs should make appropriate and proportionate arrangements for audit provision, including arrangements to review risk management, governance, and control of delegated resources. A professional and objective joint internal audit service has been established in accordance with recognised internal audit standards and practices as laid out in the revised Public Sector Internal Audit Standards (PSIAS), in order to comply with article 7 of the Local Authority Accounts (Scotland) Regulations 2014. The internal audit arrangements for the IJB are provided jointly by the internal audit teams of North Lanarkshire Council and NHS Lanarkshire. Appendix 1 is the IJB Internal Auditors’ 2023/24 Annual Internal Audit Report. This report is produced annually to provide the IJB PFAC with an independent view of the overall adequacy and effectiveness of the framework of governance, risk management, and control within the IJB. In turn, this informs the compilation of the IJB’s draft Annual Governance Statement, which forms part of the IJB’s Annual Accounts. 5.1 The Internal Audit Annual Audit Report 2023/2024 is based on a body of work contained within the partner organisation Internal Audit Plans for 2023/2024 and also takes cognisance of the outcomes of the internal audit review of North Lanarkshire IJB governance arrangements and the assessment of action taken to address previous internal audit actions, issued on 11 July 2024. 6. CONCLUSIONS 6.1 The Internal Audit Annual Audit Report for 2023/2024 provides a high-level overview of the activity undertaken by the Internal Audit teams during the year, as reflected in the annual opinion. 6.2 Based on the work undertaken directly on behalf of the IJB and being informed by internal audit work undertaken independently by each respective internal audit function within North Lanarkshire Council and NHS Lanarkshire, it is concluded that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management, and internal controls for the year ending 31 March 2024. 6.3 Internal Audit will, as part of the agreed 2024/2025 workplan, develop and agree arrangements to undertake follow-up work on the implementation of actions agreed in response to relevant audit recommendations and report on this work to the PFAC during 2024/2025. 7. IMPLICATIONS 7.1 National Outcomes Link(s) to National Health and Wellbeing Outcomes:
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3 People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 Associated Measure(s) The PFAC and both partners are required to ensure effective governance arrangements are in place. 7.3 Financial There was no charge for the provision of internal audit work as joint working arrangements have been developed to deliver this service. This paper has been reviewed by Finance: Yes No N/A 7.4 Risk Assessment/Risk Management The management of risk is an integral part of the development of the Internal Audit Plan. The IJB risk register was reviewed as part of year end assurance work. The ‘Ineffective Governance arrangements’ risk rating was reduced from Medium to Low during 2023/24. The mitigating controls include work being carried out to embed governance processes within the Health & Social Care Partnership including risk review, complaints, patient feedback, adverse events and completion of the IJB Governance Self-Assessment. 7.5 Engagement & Participation The Chief Officer and the Chief Financial Officer have both been consulted on the preparation of the Internal Audit Annual Report 2023/2024. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes N/A ☐ Provide stakeholders with information on how to get involved N/A ☐ Ensure a diverse range of engagement and participation and opportunities are in N/A
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4 place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services N/A ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery N/A ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings N/A ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff N/A ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership N/A 7.6 Inequalities & Fairer Scotland Duty EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Internal Audit Annual Report 2023/2024 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Paula Hendry, Acting Chief Officer (Audit and Risk), North Lanarkshire Council: hendryp@northlan.gov.uk Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire: Jocelyn.lyall2@nhs.scot
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5 INTERNAL AUDIT ANNUAL AUDIT REPORT 2023/2024 Appendix 1 1 Purpose of Report 1.1 To report the activities undertaken by Internal Audit on behalf of the IJB for the year 2023/2024, and to present an independent annual opinion on the adequacy and effectiveness of the IJB’s internal controls based on the work undertaken during the year. 2 Background 2.1 Internal Audit is an independent and objective assurance function designed to add value and improve the IJB’s operations. It helps the IJB accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of the IJB’s risk management, internal control and governance processes thereby assisting the IJB, the Performance, Finance and Audit Committee (PFAC), and the Senior Management Team to effectively discharge their role and responsibilities. 2.2 Internal Audit reports its outputs to the PFAC which also approves the Internal Audit annual audit plan and monitors the performance of the function. 2.3 Internal audit activity is planned to enable an independent annual opinion to be given by the Chief Internal Auditors on the adequacy and effectiveness of internal controls within the IJB, including the systems that achieve the corporate objectives of the IJB, and those that manage the material risks they face. It should be noted, however, that the presence of an effective internal audit function contributes towards, but is not a substitute for, effective control. It is primarily the responsibility of line management to establish internal controls so that the IJB’s activities are conducted in an efficient and well-ordered manner, to ensure that management policies and directives are adhered to, and that any relevant assets and records are safeguarded. 3 High level overview of Internal Audit activity during 2023/2024 3.1 Both internal audit functions operated throughout 2023/2024 in accordance with the Public Sector Internal Audit Standards (PSIAS). 3.2 Internal Audit completed a review of the IJB Governance Checklist self-assessment and provided an adequate level of assurance. The review concluded that the arrangements in place for reviewing and assessing the governance framework are largely satisfactory and that this framework is generally consistent with legislative requirements and expected good practice. We identified the need to ensure that all improvement actions identified from the self-assessment are carried forward to the Annual Governance Statement and thereafter tracked and monitored to completion. This review also assessed the extent to which management have implemented those actions previously committed to, in response to both recommendations contained in previous internal and external audit reports and improvement actions identified by management in previous years Annual Governance Statements. Whilst reasonable progress has been made, there is a need to ensure that outstanding actions are timeously progressed to completion. 4.2 In addition, the North Lanarkshire Council and NHS Lanarkshire internal audit teams undertook a range of audit work within their respective organisations. For North Lanarkshire Council this included work undertaken on a range of systems and activities in the areas of including procurement, creditors, petty cash and payroll which also provide assurance in respect of North Lanarkshire Council operations for which the IJB has delegated responsibility. 4.3 Of particular note for NHS Lanarkshire were the Internal Control Evaluation and Annual Internal Audit Report, both of which provided a holistic view of the adequacy and effectiveness of Internal Controls across NHS Lanarkshire, including delegated functions. Whilst these reviews provided positive assurance, they highlighted the demand, financial and workforce challenges facing the Board and the need for a strategic response to be developed, with partners. Other relevant areas covered by NHS Lanarkshire included resilience, adverse
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6 event management, staff governance, clinical governance, risk management, health strategy, and financial sustainability reviews. 4.4 Audit work undertaken within North Lanarkshire Council and NHS Lanarkshire support a generally positive view of the IJB’s governance and internal control arrangements. 4.5 The results from our work suggest that there are no matters that we require to highlight no significant weaknesses, areas of concern, material frauds or irregularities resulting in financial loss to the IJB were identified in 2023/2024 that require to be brought to your attention. 4 Annual Internal Audit Opinion 5.1 There is a formal requirement for the Chief Internal Auditors to prepare an annual opinion on the organisation’s internal control system. The opinion is presented to members of the PFAC and the Chief Officer, North Lanarkshire Health and Social Care Partnership and is intended to provide independent and objective assurance to these different stakeholders as to the adequacy and effectiveness of internal controls within the IJB. 5.2 The evaluation of the control environment is informed by a number of sources, and primarily by validation of the governance checklist self-assessment. In bringing these together, consideration has been given to whether there is evidence that any key controls are absent, inadequate or ineffective and whether the existence of any weaknesses identified, taken independently or with other findings, significantly impairs the IJB’s overall systems of internal control. Wider issues relating to the IJB’s corporate governance and risk management arrangements have also been considered. 5.3 We would like to thank all IJB staff who have assisted Internal Audit during the course of our work throughout 2023/2024. Basis of Opinion The evaluation of the control environment is informed by: Validation of the IJB governance self-assessment checklist. Our wider knowledge of the IJB’s corporate governance, risk management and performance management arrangements. Relevant reports issued by NHS Lanarkshire and North Lanarkshire Council Internal Audit teams during 2023/2024. Reports issued by the IJB’s External Auditors during 2023/2024, together with reports from other external review and inspection bodies. Opinion It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the North Lanarkshire Health and Social Care Integration Joint Board’s framework of governance, risk management, and internal control for the year ended 31 March 2024.
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7 LEVEL OF ASSURANCE DEFINITION Audit Grading Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion Level of Assurance Definition Substantial assurance Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Adequate assurance The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited assurance The systems for risk, control and governance have some satisfactory aspects, but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse. Recommendation priority Priority Definition Red Significant weaknesses which management needs to address to achieve objectives. Amber Weaknesses which require prompt action to avoid exposure to risks in achieving objectives. Green Action advised/area for improvement to enhance control or improve efficiency.
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1 REPORT Item No: 13 SUBJECT: Performance Update – Quarter 4 (January – March 2024) TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 21 August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Note the contents of the report and the appendix. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. 6. CONCLUSIONS The areas for improvement and corrective action are attached as Appendix 1. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ Yes ☐ No ☐ N/A ☒
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3 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low Ross McGuffie NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved Yes ☐ No ☐ N/A ☒
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4 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings The performance information, with the corresponding improvement and corrective actions will enable stakeholder representatives to participate in wider discussion about performance. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership The performance information, with the corresponding improvement and corrective actions supports locality planning. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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5 None. 9. APPENDICES Appendix One - Areas for Improvement (Quarter 4, January – March 2024) CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk
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6 1. Cervical Screening Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 71.8% 71.2% RED Narrative & Corrective Action Data from MiLan was used in an analysis of cervical screening uptake across Lanarkshire. The graph below illustrates the cervical uptake rate for North Lanarkshire, showing a slight decline in performance across 5 localities and stability in the remaining 6th locality. No locality achieved the recommended target of 80%. Despite the decline in performance, North Lanarkshire performs better than the Scottish average for this indicator; NL performs better than Lothian, GGC and many of the best performers, such as Highlands, have a very different population base to NL. As the decline is a national trend, Public Health Scotland have been carrying out research and analysis, looking particularly at the decline in younger people, which was emerging as a trend prior to the Covid 19 pandemic.
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7 2023 /24 Quarter 1 June Quarter 2 September Quarter 3 December Quarter 4 March Target Airdrie 69.1% 69.2% ↑ 68.8% ↑ 68.8% ↔ 80.0% Bellshill 70.7% 70.9% ↑ 70.6% ↓ 70% ↓ 80.0% Coatbridge 71.5% 71.2% ↓ 70.4% ↓ 69.1% ↓ 80.0% Motherwell 72.6% 72.8% ↑ 72.2% ↓ 71.9% ↓ 80.0% 69.1% 70.7% 71.5% 72.6% 75.8% 71.8% 69.2% 70.9% 71.2% 72.8% 75.7% 71.5% 68.8% 70.6% 70.4% 72.2% 75.3% 70.9% 68.8% 70.0% 69.1% 71.9% 74.8% 70.4% 62.0% 64.0% 66.0% 68.0% 70.0% 72.0% 74.0% 76.0% 78.0% 80.0% 82.0% Airdrie Bellshill Coatbridge Motherwell North Wishaw % uptake Axis Title North 2023/24 Quarterly Uptake by locality 2023 /24 Quarter 1 June 2023 /24 Quarter 2 September 2023 /24 Quarter 3 December 2023 /24 Quarter 4 March 2023 /24 Target
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8 North 75.8% 75.7% ↓ 75.3% ↓ 74.8% ↓ 80.0% Wishaw 71.8% 71.5% ↓ 70.9% ↓ 70.4% ↓ 80.0% Analysis for the period 1st January 2024 – 31st March 2024 – Quarter 4 There has been no statistically significant change in uptake across localities. Of the 50 GP practices in North Lanarkshire, only 2 achieved the 80% target in quarter 4 Airdrie (6 practices) – no practices achieved the 80% uptake target Bellshill (9 practices) – no practices achieved the 80% uptake target Coatbridge (6 practices) – no practices achieved 80% uptake target Motherwell (6 practices) – no practice achieved above 80% uptake target North (12 practices) – 2 practices achieved 80% or above Wishaw (11 practices) – no practices achieved the 80% uptake target Throughout the 12 months there have been 3 practices consistently performing well against the cervical screening target of 80%. In the last quarter 1 practice has slipped below 60% uptake. Following discussions at the April scrutiny panel it was highlighted that once Sector Management meetings are re‐established, there is a clear need to reengage the Cluster Leads and Service Managers as they are key stakeholders in driving appointment availability and capacity within their systems; we know from experience that this type of local engagement will drive performance. Access to primary care appointments is a known barrier to women accessing their cervical screening. Activity Improving and maintaining cervical screening uptake is complex. Several multidisciplinary actions are in place, with a particular focus on inequalities. These are described in the Inequalities in Screening Action Plan General awareness raising. During Cervical Cancer Awareness Week (Jan 24), NHS Lanarkshire Facebook reached up to 28,074 people, X/Twitter 1806 impressions and Instagram 2,183 impressions. In addition, a further 5000 people were reached by partners reposting and sharing the media. Targeted work in the community. In Bellshill, the “Culture Junction” 6‐month evaluation report highlighted good levels of community engagement in their community workshops (8 workshops reaching 79 individuals) and their follow‐up focus groups (1 groups with 20 individuals). Although individuals were not asked to provide any equality monitoring, intelligence from the workshops indicates that there was engagement with groups living with a physical or learning disability, from ethnic minority populations, LGBTQ+ groups and those living in SIMD 1 and 2 areas. The workshops have increased awareness and understanding about cervical screening and provided a rich source of local data about barriers to engaging with cervical screening. In Airdrie, the commissioned community project has engaged with over 60 individuals, although staff absence has impacted on the progress of the project. This is expected to improve in the next quarter. To help target communications and awareness with younger women (who are less likely to attend for screening), a meeting with Health Improvement Early Years topic leads has been arranged to help identify and disseminate information to the Early Years staff networks and further explore opportunities to target younger women. Health Improvement Team Leaders have agreed with North Lanarkshire Community Boards to present at their upcoming meetings where screening will be presented as a substantive agenda item; an input will be provided by HI in order to raise awareness of the 3 main screening programmes, including cervical. Targeted work in Primary Care. Five GP practices in North Lanarkshire are participating in a 3‐month project providing additional time‐limited funding to assist practices in identifying and then targeting those on the defaulters list and then providing additional cervical screening appointments to encourage uptake. These practices were
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9 identified as serving populations in lower SIMD areas and had average screening uptakes rates between 60.5% and 69.%. The evaluation of this initiative will be available in Quarter 2 2024/25. A successful pilot in South Lanarkshire practices where treatment rooms nurse received additional training, allowing them to raise the issue of screening with their existing patients will also now be delivered in North Lanarkshire. 2. Childhood Immunisations Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 90.6% 90.1% RED Narrative & Corrective Action Action is being conducted at the level of the individual; a “deep dive” of every child’s journey is conducted within localities and for those non‐attenders, a number of factors are being considered to improve performance for this indicator. Where a “hold” on consent is in place, this is being interrogated and the reasons for the hold being investigated and an accurate rationale recorded. As there have been issues identified with the use of the SIRS hold, such as incorrect holds placed on those children transferring in to Lanarkshire, these holds are removed and the individual case investigated to ascertain the current position for that child. At every stage of the pathway contact is made and targeted contact is made pre‐immunisation to confirm attendance; if non‐attendance is likely, alternative options and appointments are offered. For non‐attendance, colleagues are making contact and engaging with the family to understand if there are barriers, such as boundary/travel, or vulnerabilities that are preventing their attendance. Where a child has a non‐complete immunisation record, this information is shared promptly with their GP. This information sharing has prompted further consideration of the wider public health implications of immunisation, particularly in light of the recent Measles outbreak across Europe. Fortunately, the known cases in Scotland have not been in Lanarkshire, however it is likely that transmission will extend to Lanarkshire, whether through holiday travel, or otherwise. National intelligence suggests that the prevalence of Whooping Cough is likely to pose a similar challenge for Boards. To improve uptake of the Measles vaccine there have been multiple clinics held and opportunities offered to families for children to receive the vaccine. These additional clinics were planned and held during any additional free time that could be identified as suitable and the team will continue to utilise such time to hold additional vaccination clinics. Health Visiting Teams have been actively pursuing an offer of vaccination where this has previously been declined. Health Visitors are discussing vaccinations at every pathway visit and a specific script was developed to assist staff nurses when calling and talking with families. There has been some feedback from families of having received multiple approaches and vaccination offers, which has the potential to impact negatively and this situation will be monitored to ensure that no negative effect will be experienced. The table below shows the volume of cases initially identified as having outstanding MMR vaccination and number of those to date that have now been given the vaccine:
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10 No. Identified by Child Health Given after revisiting Bellshill 160 43 Motherwell 184 68 Wishaw 24 Shotts 9 Coatbridge 221 114 Airdrie 263 (35 duplicates) 228 142 North 299 145 Given the resource and operational implications of any outbreak, such as the use of PPE, work is being delivered in collaboration with Public Health colleagues to prepare the workforce, including recording the vaccination status of staff and conducting immunity testing. Additionally, there is targeted engagement with our GP and Primary Care partners. This engagement will extend to Social Care partners and Public Health communications will mirror the advice given nationally by NHS Inform. 3. 6 – 8 Week Reviews Target 2023/24 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6‐8 week review 90% 79.9% 81.3% RED... Narrative & Corrective Action Performance data for the most recent two quarters is not available; this data is normally presented one quarter in arrears, however the most recent quarter per the expected schedule is not currently available. It has recently been established that this performance metric has been incorrectly reported in the recent past (post‐Covid),
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11 as reviews have been counted as complete if either the HV or GP return has been received. The change that is now being implemented will mean that reviews will only be counted if both the HV and GP parts are complete, restoring the metric to pre‐Covid definition. The expectation is that the percentage of completed reviews will decrease due to this, however the extent of the impact is presently unknown. Work continues to establish UHVP as a high priority for Morse implementation as an area of need and risk. This sits alongside wider engagement nationally to support a national digital recording solution. In addition, scoping work continues regarding the Elsie App, which is used in other healthcare settings to reduce DNA through more dynamic communication, reducing manual processes and increasing productivity of colleagues. Further updates will be provided as the service engages with stakeholders regarding the SBAR proposal for the introduction of the Elsie App. This indicator reflects on the wider Home Visit/ Universal Home Visit Pathway and previous “deep‐dive” analysis identified the inconsistency in practice across GP practices and less effective communication between Health Visitors and some GP practices as playing some part in the decline in performance. Work is being progressed with GP Practices NHS Lanarkshire‐wide to support the completion and return of forms; this works supports the regular engagement with GP practices on the importance of communicating any non‐attendance and specific engagement with GP and their Practice Managers to discuss the processes in place to ensuring CHSP forms are collected and delivered. At a locality level the service continues to implement practical actions to address the immediate concerns around missed reviews, and incomplete or missing records. Specific testing is being undertaken in Airdrie on improvements to the process and it is hoped that this can be scaled and spread, providing a consistent approach across each locality. With regard to the wider Health Visiting workforce, this is monitored using the PRAG recording tool, which continues to identify and highlight challenges in some areas; the service is responding with sector‐wide support and where possible, flexing the available resource to meet demand. 4. Reablement and Rehabilitation Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement ‐ % Of New or Increased Home Support Packages Which Are Reablement 70% 70.0% 60.8% RED Reablement ‐ % Of People With No or Reduced Home Support Service Required At End Of Process 70% 58.8% 58.5% RED Balance Of Care ‐ % Of People (Age 65+) 45% 34.0% 36.4% RED IEAS ‐ % Deliveries Achieved Within 7 Working Days Quarterly 80% 53.5% 63.4% RED Narrative & Corrective Action
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12 Reablement / Home Assessment Team The aim of rehabilitation and reablement services is to ensure that our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities, including preventative approaches, self‐management and choice over supports and services. In addition, the shift in the balance of care toward delivering services by Self‐directed Support, allowing people to have greater choice and control in their own lives, requires that further consideration is required as to the performance indicators that might best represent how the delivery of services is changing. Working in these new ways, there is an associated increase in system capacity and improvement in patient flow by reducing the occupied bed days caused by Delayed Discharge. The development of the Reablement service is interdependent with work to develop Home Assessment Teams, the ongoing Review of Home Support services and the development of Locality Enabling Hubs. This is further dependent on the work to ensure that Reablement and Rehabilitation practice is cohesive across HAT, Home Support and Integrated Rehab Teams. Whilst recruitment remains a challenge for such services, with HAT teams not fully staffed and therefore little capacity to mitigate the impact of any sickness absence and annual leave, significant progress has been made. As well as raising awareness and understanding of HAT, the practice of assessment at home and a “Home First” approach embedded in everyday practice, tests of change are currently underway in UHM (Wards 14 & 20) and UHW (Ward 7) to introduce Non‐Prescriptive Referrals for Home Support. This follows analysis of data and information showing discrepancy between prescribed discharge care plans and the actual care that patients required post‐discharge, leading to a reduction in care provided. The purpose of the ToC is to increase the accuracy of Home Support Referrals and improve patient outcomes by adopting non‐prescriptive referrals, whereby potential referrals are screened by Home Support Team Leads and support is delivered on basis of need‐led input and available resources are optimised. The Team Leads will be deployed to proactively identify potential referrals for home care within the ward. Their role will involve providing guidance, coaching, and overall management of the situation, ensuring that the size of care packages is appropriate based on the individual patient's needs. It is hoped that evidencing a reduction in care required and provided will assist and influence clinicians and Allied Health Professionals to reassess their risk tolerance levels and adapt their approach accordingly. The data, particularly the outcomes for patients, will be analysed to identify further improvements and the potential to scale the approach. Further work to adopt a model of pre‐ PDD interface is planned in the coming months.
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13 For 2023/24, the longer‐term trend was for more service users to complete the Reablement process, however in March there was a reduction in those completing from previous months. Looking at the change in service provision for Q4 following completion of the Reablement process, we can see that in Cumbernauld there has been a long‐term trend for an increase in the number of people completing the Reablement process with no service.
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14 The most recent reporting details that the total number of referrals accepted by HAT is 1935. 133 referrals were accepted in April 2024, which is the highest monthly figure recorded, to date. The volume of referrals to HAT in a calendar month is now regularly >100; this is the eighth month in the last year that the total accepted referrals has been over 100. In the last year, Wishaw had 27% of all referrals, with Airdrie, Motherwell and Cumbernauld having between 19% and 22%. The volume of referrals for Bellshill and Coatbridge have increased over the last three months with Coatbridge now accepting similar volumes to the more established Motherwell team. 0102030405060708090 Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Deceased Decreased Hours Increased Hours No Service Same Hours Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw Q4 ‐ Service users completing reablement process by change in service 0 20 40 60 80 100 Cumbernauld ‐ Service users completing reablement process by change in service Decreased Hours Increased Hours No Service Same Hours
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15 There is little movement in percentage terms for the origin of referrals since the last reporting; overall UHW Wishaw has generated more referrals than UHM. Monklands 876 45% Wishaw 1002 52% Other 58 3% The majority of referrals received related to females (59%), with the largest number in the age range 75‐84 years old (39%). Under 65s only accounted for 9% and there is no one aged under 18 recorded.
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16 The majority of cases have up to two Social Care services in place at the time of HAT referral. The largest input service remains Home Support, followed by OT, which is consistent across the last 12 months. 95% of people were recorded as completing the HAT process. 37% of those completing HAT were recorded as requiring further service. Some data issues will be addressed in future HAT reporting, as the definition of ongoing service is being reconfigured to not include referrals being made to other certain services, such as NL Leisure. At the end of the HAT process 64% required no further service.
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17 Significant effort continues to be applied to reduce discharge delays and in Q4, there was a notable decrease in the number of delays with reduction in both onsite and offsite bed days lost due to delayed discharges. This is a positive trend and more coordinated approach to the work of the Flow Boards and concise monthly planning should see sustained impacts on overall system performance. IEAS Change and Improvement work within the Equipment & Adaptation Service is governed by the Equipment & Adaptation Service (EAS) Governance Board. This ensures coordinated planning and communication, particularly in relation to performance management. Following a recruitment process, a new Equipment & Adaptation Service Manager has been appointed and is now in post, completing an induction process, local training and familiarisation. The MICES Replacement Project is on track, with a “Go Live” date of 05/08/24 for ELMS2, to be known as “Lanarkshire Equipment Ordering Service” to replace the outgoing MICES system. A full programme of training is in delivery and the introduction of the new system will facilitate improved management and performance information and easier integration of data with wider partnership systems. 5. CAMHS Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 72.6% 58.7% RED Service at Completion HS ‐ Reablement 12% HS ‐ Mainstream 11% IRT ‐ Physio 11% IRT ‐ OT 11% Rehabilitation ‐ Other 1% CAS 16% Locality SW Referral 1% IDS 0% LSS 1% District Nurse 6% NL Leisure 1% Third Sector 3%
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18 Narrative & Corrective Action The RTT performance decreased during Q4. The data prior to 2022 shows higher RTT% performance, however it does not reflect the increasing number of Children and Young People (CYP) waiting for first assessment. The reduced capacity to see new patients resulted in more routine/return activity, which in turn resulted in decreased RTT performance. Although RTT performance has significantly decreased since the second half of 2022, this is because the number of patients seen for first assessment has increased, meaning in turn they have breached the timescale to be seen for intervention within 18 weeks. May and June saw some recovery of position but did not establish a continued pattern in July. It is important to highlight that at the time of writing, over 200 waits had been removed from the waiting list in April 2024, those children having received a “Choice” appointment. The trajectory for long waits is a 40% and then a further 25% reduction in the coming months, with the end goal of having no initial wait for an appointment. This activity will inevitably result in a reduction in RTT as those who have been waiting are prioritised; the Scottish Government have been briefed on the approach, continuously monitor the position for CAMHS and are both comfortable and supportive of the approach taken in North Lanarkshire. There is now evidence beyond anecdote to support the drop‐off in activity at times of the year when there are concentrated school holidays. This is due to a combination of reduction in staff capacity and children not being brought for appointments. January 2024 reported a significant drop in performance. This was expected and anticipated. The operational management team have highlighted this pattern, along with similar “dips” that occur at Easter and Summer.
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19 As a result, work is being undertaken with Team Coordinators to encourage flexibility in capacity, giving more consideration to patterns of appointments that children and young people would most likely attend at these times. If it is choice, then a flexing up of choice capacity will be provided in those weeks. If it is partnership, then choice will be flexed to a higher proportion of appointment capacity in weeks pre and post these identified challenging weeks. This will remain under review to ascertain if there is any improvement. The further drop in performance in February was unanticipated and themes have emerged from analysis of the data: ‐ Choice Appointments not meeting demand due in part to increased demand from emergency presentations. Choice appointment capacity not being protected within model of care delivery. As a result, the Senior Management and Service Improvement Team have reassumed full responsibility of CAPA job planning rounds. There is a plan to bring performance back in‐line with trajectory by focussed clinical choice appointment activity in April 2024. This has been planned noting the potential impact of school holidays, anticipated staff availability (low annual leave and training commitments), waiting list and admin support, and support from unscheduled care colleagues and functional teams. This will be further progressed by clinical activity based on discharge to create additional flow and additional capacity for PRL waiting list. Psychiatric Consultant capacity continues to be challenged. Additional capacity pre‐Christmas had been provided by a consultant led waiting list initiative. This proved to be highly successful and reduced the growing bottleneck of referrals for children and young people who required a consultant‐level assessment. Since Christmas, the service has been successful in recruiting 1 WTE locum consultant, a further 0.6 WTE NHS locum in February and a third in April. A colleague has moved on from the service but there has already been interest in the post and it is hoped that recruitment to the post will be quick. A number of key actions are in place within CAMHS at various stages of progress with the aim of reducing the waiting list and addressing the RTT performance: ‐ Establishment of a psychiatry waiting list clinic to address consultant psychiatry capacity – Operating during November and December 2023, reviewing patients with severe and/or complex presentations. This waiting list has now been able to be paused due to recruitment of new consultant into a locum position. Locality waiting list initiative – now superseded by local review of CAPA appointment capacity. Introduction of CAPA service model – improved data and information allowing for demand/capacity modelling. Introduction of group therapy in several specialist areas
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20 Additional support from the wider CAMHS workforce (AHP groups, Pharmacy), as well as centralised to provide additional scheduled and unscheduled support to locality teams. West of Scotland collaborative work to build a broader unscheduled intensive workforce to support care provided at home. Appointment of Head of CAMHS and NDS Psychology and two Clinical Mangers to focus on quality assurance and efficiency. 6. Adult Mental Health Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 82.5% 78.1% RED Consultant Outpatient WT ‐ Adult Mental Health ‐ 12wks (NHSL) (NORTH HOSTED) 90% 40.4% 37.7% RED Consultant Outpatient WT ‐ Older Adult Psychiatry ‐ 12wks (NHSL) (NORTH HOSTED) 90% 77.8% 74.7% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) There has been a slight decline in the RTT performance, however it remains within the expected range against the modelling carried out by the internal analyst. The service continues to refresh and monitor the modelling; the position remains that without any significant change in staffing, the service should continue to report ~80% RTT. This figure assumes retaining all current staff in post, maintaining the current ratio of patient contact, no changes to DNA patterns, stable funding and digital services remaining in scope of RTT.
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21 A number of factors contribute to the inability to meet the RTT target, most notably the WTE establishment; at end of March 24, the service had 23.2 WTE vacancies within the service. The scenario modelling above illustrates the likely impact of a loss of capacity/funding within the service, with the impact shown of R&RF 1 = 13.655 WTE, RR&F 2 = 9.55WTE. In Q4, several exceptional data points were noted. In terms of the number of referrals received by PT services, January 2024 was the highest recorded in a January month since the Covid‐19 Pandemic. Despite the high number of referrals, the number of completed waits (including digital therapies) in January 2024 was also the highest recorded in a January month since the Covid‐19 Pandemic. In January 2024, 965 patients started treatment compared to 779 in January 2022. The waiting list The waiting list declined from 2,671 in December to 2,646 in January, the biggest decline between months since September to October 2022. In 2023, Lanarkshire PT services received 15,006 referrals, 48.1% of which were for online, digital therapies. By comparison, in 2022 there were 15,159 referrals, 52.2% of which were for digital therapies. As a result, there were 532 more referrals to PT services in 2023 requiring clinical time and resources. Recent changes to Neuropsychology service criteria, as well as the projected change in waiting times guidance regarding the management of Digital Self Help, will further impact on reported performance. There has been focussed effort to reduce the longest waits, with those patients waiting greater than 18 weeks for treatment being targeted, however such work impacts the ability to achieve the RTT target, which is likely to continue to fluctuate between the high seventies and low eighties until the desired reduction in the number of patients waiting longest and over 18 weeks is achieved. Consultant Outpatient WT ‐ Adult Mental Health ‐ 12wks (NHSL) (NORTH HOSTED) The vacancy level for General Adult Psychiatry remains at approximately 66% in North Lanarkshire and the staffing position for General Adult Psychiatry in North Lanarkshire is mostly unchanged since autumn 2024, with the exception of the loss of one further locum consultant from the service at the end of last month. In South
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22 Lanarkshire, there has been a substantive appointment to one consultant position in General Adult Psychiatry during that time, allowing the release of the locum doctor who was covering that post. The Programme Board for MHLD&A services have a programme of work, which includes actions relating to medical staffing issues, along with other issues for development. The service is considering the changes needed to current “traditional” psychiatry working practices and where appropriate, developing new practice; this is secondary to the medical staffing situation, however it is acknowledged that work of this nature, such as the proposal to consider ANP community working to improve and support CMHT working more generally, can also support medical staffing gaps and such new ways of working may attract new candidates. Multiple actions are being progressed in relation to the current staffing position, characterised in the most recent medical staffing report, which is available on request. The actions being progressed include: ‐ Continued efforts to recruit via Partnership with HR and wider advertising of vacant posts. Collaboration with the Centre for Workforce Supply in Scotland, looking at partnerships with recruitment agencies, pathway for IMG, novel marketing, service model change and internal and external portfolio pathways (CESR). Exploratory work with Medical Education with regard to funding additional higher trainee placements. Use of Extra Planned Activities for current staff to cover gaps in service and vacancy. It should be noted that given the local and national situation, there are very few actions that will be likely to lead to a short‐term improvement with medical staffing and the consequent impact on waiting times; most measures being developed are medium to long‐term solutions, however it is believed that this work will best serve for the future development of the service. The vacancy level for General Adult Psychiatry remains at approximately 66% in North Lanarkshire and the staffing position for General Adult Psychiatry in North Lanarkshire is mostly unchanged since autumn 2024, with the exception of the loss of one further locum consultant from the service at the end of last month. In South Lanarkshire, there has been a substantive appointment to one consultant position in General Adult Psychiatry during that time, allowing the release of the locum doctor who was covering that post. The Programme Board for MHLD&A services have a programme of work, which includes actions relating to medical staffing issues, along with other issues for development. The service is considering the changes needed to current “traditional” psychiatry working practices and where appropriate, developing new practice; this is secondary to the medical staffing situation, however it is acknowledged that work of this nature, such as the proposal to consider ANP community working to improve and support CMHT working more generally, can also support medical staffing gaps and such new ways of working may attract new candidates. Multiple actions are being progressed in relation to the current staffing position, characterised in the most recent medical staffing report, which is available on request. The actions being progressed include: ‐ Continued efforts to recruit via Partnership with HR and wider advertising of vacant posts. Collaboration with the Centre for Workforce Supply in Scotland, looking at partnerships with recruitment agencies, pathway for IMG, novel marketing, service model change and internal and external portfolio pathways (CESR). Exploratory work with Medical Education with regard to funding additional higher trainee placements. Use of Extra Planned Activities for current staff to cover gaps in service and vacancy.
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23 It should be noted that given the local and national situation, there are very few actions that will be likely to lead to a short‐term improvement with medical staffing and the consequent impact on waiting times; most measures being developed are medium to long‐term solutions, however it is believed that this work will best serve for the future development of the service. An Options Appraisal has been developed detailing options for a Programme for Change for General Adult Psychiatry Services. The Options Appraisal, which is yet to finalised offers solutions that can be adapted given that the preferred option require integrated, cross‐disciplinary, tests of change. Six recommendations are made in the paper: Formation of a Programme Board to review the model of GAP Services and developing a sustainable, cross‐discipline workforce in alignment with the Scottish Government Adult Secondary Mental Health Services – Quality Standards consultation document. Maximise retention and recruitment of general adult psychiatrists by supporting the existing workforce to address the most acute challenges in the service, with longer‐term plans to absorb loyal ‘high cost locums’ into the NHS family in line with Scottish Government directive. A workforce review for all disciplines providing input within GAP Services, including expansion of the ANP pilot into CMHT and consideration of other non‐medical prescribers, in addition to a review of Psychological Therapy Teams. Engagement with referrers, patients and carers to ensure patients are able to access the right help at the right place at the right time. Creation of clearly defined guidance for transition between primary care and secondary care GAP Services, in addition to transitions between different sub‐ specialities within Mental Health & Learning Disability Services. Reliable and valid statistical modelling to support longer‐term workforce planning to ensure that our services meet the demand of the population. The options outlined in the paper are characterised by changes to the structural model of service, the scope of practice and the Duty AMP role, with further options around improving the attractiveness of working in NHS Lanarkshire and the principle of substantive employments only. The preferred option has been identified with due regard to the current composition and views of the existing GAP workforce. This is in addition to the views of our partners in primary care, third sector and patients / carers. Significant research and development has gone into the identification and development of all options, with due regard to both local and national workforce data, population data, including prevalence of deprivation, mental disorders and referral rates across the localities. The financial implications associated with these options has also been considered. The preferred options for the development of GAP Services in NHSL is for a change to a functional inpatient / outpatient split model of care, with one inpatient consultant per ward, this option appears to be the preferred option of GAP Services in Scotland, in addition to being favoured across the stakeholder forums held during this process. This model of functional split will allow for psychiatrists to have protected and dedicated time to embed within teams and deliver high quality care to either the inpatient service or CMHT, providing accessibility, consistency, responsivity and stability to the MDT working within these services. This option offers scope to simplify job plan, mitigate anticipated challenges regarding transitions and offers natural and pragmatic cross‐cover arrangements between inpatient psychiatrists and community psychiatrists, reducing the necessity for a Duty AMP role. As the OA is yet to be finalised, the above is still subject to change, however any developments and progression from OA to implementation of a preferred option will be communicated widely with stakeholders. Adult Community Mental Health Teams Model Review
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24 To support the implementation of the future Medical model and mitigate the staffing pressures across other key disciplines within the MDT, it has been agreed that a full Adult CMHT model review is required to develop a sustainable workforce and maintain service delivery. To support the reform and transformation methodology, this work will align itself to both the National and Local Delivery Plan for the Refreshed Mental Health & Wellbeing Strategy. The AMD and GM for MH, LD & Addictions has established an Adult Community Mental Health Team Model Review, Programme Board with multidisciplinary representation to support a whole system review. The key work streams have been identified, with each work stream having multidisciplinary, multiagency, HR and Trade Union membership. Work streams: Implementation of the GAP Medical Model Advance Nurse Practitioner Test of Change ‐ to support medical caseloads where there have been no formal reviews due to recurring vacancies. Measure the ANP four pillar clinical and professional remit within the wider CMHT. CMHT & Addiction Interface & Complex case management Review of PTT in line with the CMHT review Development of an Adult ADHD Stepped Matched Pathway Support CAMHs Transition Pathway to Adult CMHT The governance and reporting structures are currently under review to reflect the Refreshed Mental Health & Wellbeing Strategy and Delivery Plan. Consultant Outpatient WT ‐ Older Adult Psychiatry ‐ 12wks (NHSL) (NORTH HOSTED) The service has been managing a lack of Consultant capacity in Older Adults liaison since August 2023 due to maternity leave, which has been further intensified by a vacancy in the Consultant establishment, a post vacant since February 2024. As the service were not able to secure a locum for both, the maternity vacancy has been covered internally since August 2023. This requires a rota and the management of this rota requires that when on rota, the Community Consultants reduce their routine outpatient work and there is a subsequent impact on clinic waiting times. The Consultant will be returning from maternity leave in September, which will limit disruption to clinics after this time and an improvement in wait times should be realised as Consultants resume their normal practice. The service also restructured Associate Specialist sessions to accommodate the vacancy. The service has now recruited successfully to the Motherwell consultant post, vacant since February 2024 and the new post holder will take up their position in August 2024. The service has experienced changes to practice and s for two of the senior medics who are not Consultants have had to change their practice and number of sessions for health and personal reasons and we've not been successful in recruiting to the specialty doctor sessions, however I'm keen to look at more junior grades to cover these gaps and then nurturing these junior grades to gain more experience and competencies and hopefully retain the workforce in the long run. Locally, teams will run ad hoc clinics as waiting times increase to manage this. We also look at waiting times as a department on a monthly basis to keep at the forefront of people's minds.
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25 7. SLT Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT ‐ Paediatrics ‐ 12wks (NORTH HOSTED) 90%* 23.2% 21.2% RED Narrative & Corrective Action Work on the Service Improvement Plan is in progress and ongoing. There are several independent work streams reporting to the well‐established Speech and Language Therapy Service Improvement Steering Group. These include: ‐ Waiting List improvement work HR and Workforce Administration and Digital Communication and Engagement Accommodation All of the work streams are at different stages of progress, although it should be noted that not all need to proceed in a linear way. However, it is recognised that service improvement activity is the highest priority and first and foremost of that is a focus on improving the waiting time position. Through our scoping of service capacity and activity we have been able to evidence: ‐ The lack of a robust TrakCare model makes it difficult to provide reliable data across all areas of service delivery. This has been addressed by undertaking a service model review to ensure that future TrakCare builds on local learning and builds on organisational learning from other builds. Forward planning for inclusion in the AHP Hub model will proceed in parallel to these TrakCare developments. The SLT service in Forth Valley is considered an exemplar patient journey and provides an initial conversation (initial contact), which can be measured and then a specialist assessment can be provided, if it is required. Working in this way will allow a better measure of time to first assessment and the SLT CYP Trakcare build will mirror this best practice approach, embed these measurements meaning that patient journey and waiting times will be tracked more accurately. The planned go live date is 2nd September 2024. Variance in waiting list length by area, which is being addressed through revised workforce planning, incorporating the best‐practice and learning from other areas who have specialist children’s health services units. Our future focus will be to transition from restrictive locality models for managing the waiting list. Continued challenges around the recruitment and retention of newer colleagues. As a result of this, we are working with university colleagues to identify new practitioners who have expressed their desire to work in Lanarkshire on registration. This allows us to maximise and enhance opportunities for placement, improvement projects and induction planning, ensuring that we present ourselves as an area that is not only welcoming but committed to the ongoing development of individuals and the service. In addition to this, we are actively determining whether there are any skill mix solutions available when remodelling our service delivery.
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26 The funding stream from Local Authority has been reduced, which will reduce staff WTE. However, this provides an opportunity to work with professional colleagues to ensure that all activity is aligned to direct and/or indirect pursuit of meeting the SLT waiting time target. With the ongoing vacancy challenges, the SCHSU has agreed that the 10% savings targeted can be deferred towards the end of 2025/26, which will allow for some recruitment to increase capacity. Our links with further education can be further enhanced. The professional relationships between service and university have already been improved and we have academic representation that actively contributes to both our Workforce Planning and Service Improvement Steering Group. Good communication processes, and the sharing of information and practical learning online have been established and will be further developed as service improvement work progresses. Scoping of accommodation options is ongoing to ensure we have the appropriate capacity and environment to support the delivery of our future service model. 8. Dietetics Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics ‐ 12wks (NORTH HOSTED) 90%* 74.8% 74.1% RED Narrative & Corrective Action Following the significant reduction in the level of performance in Q2, the improvement in Q3 has sustained in Q4. The overall long‐term trend is for improving performance, however further analysis would be required to understand any cause/effect relationship with wider system factors, as the service continues to be restricted by the (approximately) 20% reduction in available workforce, which is due to both long term sickness and sustained vacancies. Although recruitment activity continues, as with many services Dietetics has difficulty in attracting suitably skilled and experienced staff due to lack of available workforce nationwide. The General Manager for Adult Services has commissioned modelling and process mapping for the service with the aim of modernising the approach and service model for Dietetics. However, it should be noted that some additional project management support will likely be required to progress the work, given the capacity and vacancies both within the service and the wider directorate. 9. Complaints Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days(NHSL) 90%* 33% 40% RED
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27 Narrative & Corrective Action Work is underway to develop the new Inphase system to replace Datix for the management of complaints. Significant resource has been assigned to work on the implementation of InPhase (Oversight), which will replace Datix in July 2024. It will offer improved reporting, including focus on learning. Over 2023/24, the number of contacts to Patient Affairs for North HSCP increased over time: In order to improve performance, additional communication has been disseminated to encourage resolution of complaints at Stage 1, promoting the Stage 1 guidance and for Stage 2 complaints, the Person Centred Complaint Handling procedure. A short animation on writing complaint comments has been developed, which should assist in the response to Stage 2 investigations. The Stage 2 Escalation Procedure provides examples of when it is appropriate to apply extensions to timescales, which should assist colleagues in managing the 20‐working day response target, whilst balancing the need for a quality investigation. The North HSCP Governance Team have been working closely with Patient Affairs to improve performance, implementing a new process and with the team now having direct access to the complaints on Datix, they are now able to have greater influence the management of those complaints and compliance with the performance standards. Additional admin support has been recruited in MH services and their close links to the central Governance Team further enhances complaints tracking and updates from those services. Analysis of the data and information held in the new dynamic tracker shows that although a higher volume of complaints is generally received by MH services, as well as assisting with compliance with the performance standard, the new method of tracking and sharing information between disciplines and teams is improving the response by ensuring that any necessary clinical information required for the complaint response can be collated in a timely manner. It is believed from analysis of the tracker that some improvement in response times should be realised in Q1 of 2024 as the new process is embedded in practice; in relation to MH complaints, the average total number of days that complaints are open appears to be reducing, with delays in excess of 28 days also likely to reduce.
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28 The SPSO are due to publish amended Child Friendly Complaints Procedure; the expectation is that from 16 July 2024, when handling complaints involving children Boards will be asked to be mindful of the principles but that there will be no expectation to implement the full procedure. The date for full implementation is yet to be announced and the NHSL response will be scoped when the procedure is received from the SPSO. There were 87 stories posted on Care Opinion regarding North Lanarkshire Health and Social Care services throughout Q4; all related to Health services and none were related to services provided by Social Work. A renewed campaign has commenced to promote use of Care Opinion across the North Lanarkshire Localities and Home Support services. 10. Smoking Cessation Target 2023/24 2023/24 Q1 2023/24 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 28.7 5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 Average Total Number of Days of Complaints Open & Delays Past 28 Days 01/03/2024 to 05/06/2024 Average Total Duration of Number of Days Complaints Open Delays Past 28 days (Total Duration of Days Open)
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29 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 53 110 ... ... RED Narrative & Corrective Action The indicator remains RAG Red against the targeted levels of performance; although the data is presented in two quarters in arrears, at the current level of performance it is unlikely to meet the annualised target, which was also not met in the previous year. To address this, a number of key actions have been approved and agreed by both North Health Ops and Professional Group and the South Lanarkshire HSCP SMT to improve the performance for smoking cessation in Lanarkshire. These actions were characterised in an SBAR that was developed and then presented to those groups. The initial task will be in response to the national review of smoking cessation services, with a local action plan developed to address the recommendations and adopt the best practice documented in the review. This will require a redesign of smoking cessation services aligned to the National Institute for Health and Care Excellence (NICE) guidelines, national specifications and reflect a “Once for Scotland” approach. To support this, a standard operating procedure aligned with the recent guidance from the Medicines & Health Care Products Regulatory Agency (MHRA) will facilitate the provision of Nicotine Replacement Therapies from non‐clinical staff to people who are motivated to stop smoking. In addition, the use of a patient group directive for the supply of NRT will be stood down. (Patient group directions (PGD) are written instructions to supply or administer medicines to patients, usually in planned circumstances. A qualified healthcare professional can supply or administer under a PGD) All change and improvement actions required will employ recognised improvement methodology, with a specific focus on understanding and addressing unwarranted variation in the overall system. A number of the actions focus on communication and engagement, emphasising the need for colleagues at all levels to actively raise the issue of smoking and refer, when appropriate, individuals to our smoking cessation services at every health and social care point of contact. In order to develop the necessary knowledge, skills, and awareness, colleagues working in priority areas will be encouraged to complete the Public Health Scotland Very Brief Advice module and familiarise themselves with the services referrers briefing paper. Beyond high‐level messaging around smoking cessation, our actions aim to increase direct referrals to the Lanarkshire Quit Your Way (QYW) service from maternity, mental health, secondary care services, as well as our voluntary and third sector partners. Direct communication and engagement with these services will be supplemented by a broader social media campaign to share information and details about the national QYW advice and support service, ensuring anyone trying to stop smoking in Scotland knows where to turn for help. The service provides support, advice and can help design an individualised programme to help people stop smoking, at any stage of the cessation journey and provide links and referrals to local NHS services. Further detail is available at the national website and Quit Your Way Scotland | NHS inform, helpline telephone number ‐ 0800 84 84 84. A local website provides additional detail for Lanarkshire residents, Quit Your Way | NHS Lanarkshire (scot.nhs.uk) and there is a local helpline ‐ 01698 754 888. Some preparatory work is required to facilitate information sharing between services, particularly with secondary care and our voluntary and third sector partners, however this work can be delivered in parallel with the development of the QYW service locally.
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30 11. Adult Social Work Target 2023/24 2023/24 Q3 2023/24 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of Notifications Received by LAC Team Within 3 days of LAC Date 95% 36% 26% RED % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 12.7% 20.1% RED % Of Adult Protection Investigations Going To Initial Case Conference 20% 19.2% 11.9% RED Narrative & Corrective Action LAC TEAM The impact of delays experienced following the Christmas period are seen in the Q4 performance data and the North School Nursing Team are creating an improvement plan based on analysis of the delays. Analysis of the CEL16 data has identified a lag in the reporting of cases following seasonal holidays; this is particularly evident following both the Christmas and Summer school holiday periods. The analysis also identified that there is a tendency for a greater volume of referrals to be made prior to the end of term and then an increased volume of delayed referrals following the end of term holiday; similar trends are evident in other services. More in‐depth analysis identified specific cases where the CEL16 was not received for several weeks following a holiday period. Given the circumstances being experienced, whereby the volume of CEL16 decrease over holiday period and then a significant increase of delayed referrals when staff return, this will require focussed work to improve process and practice in order to see improved performance for this metric. In the short‐term, where such instances have been identified, the specific teams have been contacted and both future communications and improvement work will be informed by those discussions. Additional analysis looking at whether particular SW team(s) are more likely to provide delayed referrals after LAC date, i.e. beyond the targeted performance of 3 days, is underway and will also inform targeted improvement actions. ADULT SUPPORT AND PROTECTION North Lanarkshire Social Work Services received 798 ASP referrals during Quarter 4 203/24. This represents a decrease of around 10% in comparison with Quarter 4 of the previous year (from 891 to 798). Despite the overall decrease, we have seen an increase in ASP referrals from Police Scotland and NHSL; Police referrals have increased by approximately 12% and Health referrals by around 13%. However, we have seen slight decreases in referrals from Scottish Fire and Rescue and NLC Housing when compared with the previous year. Over the last 12 months, the Care Home sector have generated the greatest number of AP1 referrals, however in Quarter 4 the number of referrals from Care Homes fell by around 40%, leaving Health as the highest referrer for the period. Despite this reduction, the Care Home sector remain a priority for our ongoing ASP work to support improvements in both the quality of referrals and defensible decision making.
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31 Analysis of the referrals has highlighted that Community based referrals are more likely to progress to ASP investigation when compared to referrals from Care Homes. Referrals generated by Social Work and community partners often relate to multiple types of harm but our analysis has identified that self‐neglect and hoarding continue to rise; these cases are often complex and require a long‐term, inter‐agency response. It is important to highlight that the NLC Social Work Adult Support and Protection procedures have been updated. There are significant changes to the language used in the procedures and describe how we now view ASP “Inquiries and investigations”. The service now refers to initial inquires as ‘inquiries without investigatory activity’ and ASP investigations and ASP ‘Inquiry with investigatory activity’. Importantly, investigatory activity involves any direct contact with the adult or their legal proxy and as such, it is anticipated there will be a rise in investigatory activity, which will be reflected in future reports. There were 151 ASP inquires with investigatory activity carried out during this quarter, which is a significant increase of 68% when compared to the same quarter last year (increasing from 90 to 151). The data shows that the conversion rate from initial inquiry without investigatory activity to inquiry with investigatory activity is 19% for Quarter 4. The reasons recorded for inquiry with investigation activity were Psychological/Emotional harm (47), Physical (38), Self‐neglect (31), Financial (20), Institutional harm (4) Self‐harm (1), Sexual (2), and not recorded (8). From the total of 151 inquiries with investigatory activity, 18 progressed to case conference for further action during Quarter 4, which represents 12% of all investigatory activity cases. This is a 20% increase from the same quarter in the previous year (15 to 18). In Quarter 4, 2% of the total ASP referrals progressed to an AP Case Conference; this rate is consistent with Q4 in the previous year. Internal audits of ASP records have identified discrepancies between the Social Work Information System and the Locality trackers submitted by senior social workers on a weekly basis. For example, SWIS holds records for 18 Case Conferences held for Q4 but Locality trackers indicate that there were 35 Case Conferences held during the period. Ongoing work will be completed with colleagues in localities to ensure that required information is recorded on SWIS, accurate records of Case Conferences are stored in SWIS, and performance and management information is produced.
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32 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-12 2 Report Title Q4 Performance Report 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 14 SUBJECT: Supporting Unpaid Carers – Carers Support Allocation TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Chief Officer of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager, Quality Assurance DATE: 21 August 2024 1. PURPOSE OF REPORT Previous reporting to the IJB outlined our planned approach to strengthen supports to unpaid carers. The report identified a number of carers led and carers informed initiatives introduced over the past year, highlighting our wider approach to engagement with, and the participation of, carers and carer organisations. This report provides an update on the current financial position and the budget allocated to carers support. This paper is coming to the Integration Joint Board Performance, Finance and Audit Committee for: For approval ☒ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Maria Williamson, Senior Manager, Quality Assurance ☒ Reviewed By: Morag Dendy, Head of Planning, Performance and Quality Assurance ☒ Endorsed By: Ross McGuffie, Chief Officer ☒
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA: (1) Endorse the approach to supporting Carers in North Lanarkshire (2) Note the current financial position and budget allocation in relation to carers support. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 A previous report to the IJB in May 2024 provided details of support arrangements in place for unpaid Carers and progress with the implementation of the Carers Act. 5.2 In addition, the response to a Freedom of Information request (released March 2024) on the Analysis of Carers (Scotland) Act 2016 funding 2022-2023 was included and noted the unallocated spend in North Lanarkshire stood at £1,032,017. This figure was based on caring related spend reported to Committee in 2022. Since then, there has been further investment in the carer support aligned to approaches and developments outlined in our Carers Strategy 2024-2027. 5.3 The report also included details of the position with Ear Marked Reserves related to the implementation of the Carers Act Support Act. The financial position reported as of 28 February 24 was £2.596m. 5.4 An update on the current financial position was requested and is provided in this report. Report 5.5 North Lanarkshire continues to have strong and long-standing relationships with supported people, carers, and community organisations. This approach ensures that local people and stakeholders can influence, inform, and shape local policy, strategy, and services. 5.6 Our approach has helped carers, supported people and carer focused organisations influence and shape the range of carer services in North Yes ☐ No ☐ N/A ☒
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3 Lanarkshire, with a number of successful initiatives expanded including Carer Breather, PAMIS Family Support Service, Hospital Discharge Service and Hope for Autism. 5.7 The current commissioned Carer contracts are due to end in February 2025. In line with statutory procurement rules, we have begun the process of engaging with these organisations as we progress to retendering for carer services In North Lanarkshire. Through this process, our intention is to further enhance and align carer support, as set out in the Carers Strategy 2024-2027. 5.8 The Carer Support Budget Allocation for 2024-25 is as follows: Carer Support Allocation 2024‐2025 Provision of Adult Carer Support Plans ‐ commissioned service, which also includes adult carer support £ 968,976 Provision of Young Carer Statements ‐ commissioned service, which also includes young carer support £ 461,375 Information and Advice – commissioned service, which also includes Carers Advocacy £ 315,825 Post Diagnostic Support for Carers £ 271,636 Duty to support adult carers – includes Carer Breather; Community Solutions; SDS including Carer Budgets £ 2,100,000 Duty to support young carers – includes PAMIS (provides support to families); SDS including Carer Budgets £ 186,000 Additional short breaks support £ 200,000 Local Carer strategies & Infrastructure £ 138,955 Other ‐ Hospital Support £ 146,844 Waiving of Charges £ 241,192 Developments ‐ Supporting Carers with POA £ 200,000 Unallocated Budget £ 32,506 TOTAL £ 5,263,309 5.9 The position as of Feb 24 on Ear Marked Reserves related to the implementation of the Carers Support Act has changed slightly with £188,000 utilised, leaving a balance of £2.408m. As this value is non-recurring, this will be used to support shorter term initiatives that improve outcomes for Carers.
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4 5.10 Through the process of engaging with carers, supported people and carer focused organisations we will seek to further augment carer led initiatives and solutions to meet caring related needs and outcomes. Utilising any unallocated funding and the available Ear Marked Reserves will further support the development of a preventative and anticipatory approach, where people can live independently as they wish and have support available within their own networks and communities. Measures of Success 5.11 Carers are engaged, included, and represented to the extent they wish to be. 5.12 Improved opportunities for carers to influence, shape, co-produce and \ or co- design policy, strategy, and services. 5.13 Clear focus on the nine priority areas for action that carers have identified as a priority for them, as set out in the Carer Strategy 2024-2027. Improving preventative approaches, anticipatory and future planning (and preventing crisis). Improving communication with carers and their access to information and advice. Ensuring carers know their rights. Supporting carers health and wellbeing Ensuring carers get a break from caring. Ensuring carers, and people being cared for, have their income maximised. Improving carer experience around hospital discharge. Improving awareness of and access to Assistive Technology. Influencing and shaping policy and strategy. 5.14 Reduction in the number of carers and \ or supported people first presenting whilst already in crisis. 6. CONCLUSIONS 6.1 We will work with carers, carer organisations and key stakeholders to develop initiatives that offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them. 6.2 Our aspiration is that through these initiatives, carers can lead full and meaningful lives.
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5 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are 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: Directed funding allocated for Carers support will be used to retender and deliver services that continue to support carers across our communities. Non-recurring Ear Marked reserves will be used to support shorter term initiatives that improve outcomes for carers. We will engage with carers, carer organisations and key stakeholders throughout. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner n/a Choose an item. Yes ☒ No ☐ N/A ☐
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6 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national Outcomes Through commissioned carer support organisations locally. ☒ Provide stakeholders with information on how to get involved Through commissioned carer support organisations locally. ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Through commissioned carer support organisations locally. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Through commissioned carer support organisations locally. Through participatory self-appraisal. Through monitoring and assurance. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Through engagement and participation processes with commissioned carer support organisations locally, framework support provider organisations, governance groups. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Through commissioned carer support organisations locally. Through Advocacy Through individual support. Through carer development programmes, such as Recognition to Rights. ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Through the Engagement and Participation Strategy, NLDF, and through co-production with stakeholders. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Through the Engagement and Participation Strategy, NLDF, and through co-production with stakeholders. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report:
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7 EQIA added to website: 8. BACKGROUND PAPERS 8.1 IJB report - Supporting Unpaid Carers and North Lanarkshire Carers Strategy 2024 -2027 (May 24) 9. APPENDICES N/A Morag Dendy Chief Officer (Performance, Planning & Quality Assurance) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Maria Williamson, Senior Manager, Quality Assurance WilliamsonM@northlan.gov.uk Yes ☐ No ☒ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-13 2 Report Title Supporting Unpaid Carers 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 15 SUBJECT: A Shared British Sign Language Plan for Lanarkshire 2024-2030 TO: Integrated Joint Board, Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Stacey Anderson Support Services Project Manager DATE: 21 August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Stacey Anderson, Service Support Project Manager ☒ Reviewed By: SLT ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA note the contents of the report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The British Sign Language (Scotland) Act 2015, required certain public bodies including Health Board and Local Authorities to develop a BSL plan every six years. 5.2 A Shared BSL Plan for Lanarkshire 2024-2030, is the second shared BSL local plan for Lanarkshire covering the work of NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. 5.3 The shared Plan was co-produced in partnership with Deaf and Deafblind BSL communities of Lanarkshire – Deaf Services Lanarkshire, Deafblind Scotland, D.E.A.F. South Lanarkshire and Lanarkshire Deaf Club. 5.4 The Plan mirrors the National BSL Plan which aims to make Scotland the best place in the world for BSL signers to live, learn, work and visit. 5.5 The plan for Lanarkshire sets out actions around ten priority areas: Delivery the Lanarkshire BSL Local Plan 2024-2030 BSL Accessibility Children, Young People and their Families Access to Employment Health and Wellbeing Celebrating BSL Culture BSL Data Transport Access to Justice Democratic Participation 5.6 As the Shared BSL Plan for Lanarkshire is a high level plan, a first step for the public body partners is to produce its own working action plan, ensuring accountability and compliance with the requirements of the Act. Yes ☐ No ☒ N/A ☐
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3 5.7 The implementation of the Plan will be the subject of regular reporting to Council Elected and NHS Board Members, with updates also being presented to the IJB. 6. CONCLUSIONS 6.1 The BSL Plan for Lanarkshire will continue to build on work already achieved through strong partnership and outlines the actions that will be taken while maintaining the individual accountability of each organisation. 6.2 The focus on the Plan will be to deliver actions that will lead to improved equality, opportunities and outcomes for BSL users. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner N/A Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Further engagement and participation information is detailed within the plan. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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5 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 8.1 A Shared British Sign Language Plan (BSL) Plan for Lanarkshire 2024-2030 A Shared British Sign Language Plan for Lanarkshire 2024 -2030 | NHS Lanarkshire (scot.nhs.uk) 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-14 2 Report Title Shared BSL Plan for North Lanarkshire 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 16 SUBJECT: Risk Management Report TO: Integration Joint Board Performance Finance and Audit Committee Lead Officer for Report: Ross McGuffie, NL HSCP Chief Officer Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 21st August 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ The purpose of this report is to provide a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP.
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3. RECOMMENDATIONS 3.1 The IJB PFA is asked to note the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 The IJB PFA should note the inclusion of one new risk to the IJB Risk Register regarding Pharmacy Pressures within the Prison System. 3.3 The IJB PFA is asked to consider the addition of a risk relating to the Speech and Language Therapy Service to the IJB Risk Register following recent performance reports. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 At the IJB PFA meeting on 22nd May 2024, the following risk changes were approved: Delivery of CAMHs service, risk rating reduced from High to Medium Ineffective Governance arrangements, risk rating reduced from Medium to Low. Unscheduled Care, risk rating reduced from Very High to High. Introduction of a new risk relating to Pharmacy Pressures within prison service rated Very High. 5.4 Following these changes there are currently two other risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 01/21 – Financial Challenges 5.5 There following risks are rated high on the IJB risk register. IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 15/22 – Cost of Living
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4 IJB 16/22 – National Care Service IJB 19/23 – Service Sustainability IJB 20/23 – Workforce Sustainability IJB 12/22 – Unscheduled Care 5.6 There are several High/Very High rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services and these are highlighted within the Risk OVerview Dashboard (Appendix 1) and Risk Register (Appendix 2). 5.7 Following recent performance reporting that has been presented to the IJB focused around Speech and Language Therapy, it is recommended that a risk relating to the performance of the Speech and Language Therapy Service is added to the IJB risk register as detailed in the IJB Risk Overview Dashboard. 6. CONCLUSIONS 6.1 The IJB currently has 19 risks identified on its IJB risk register with 11 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 6.3 The Pharmacy Pressures within the Prison Service is a new risks that have been added to the IJB Risk Register as per IJB approval in June 2024. 6.4 It is recommended that the IJB PFA approve the inclusion of the Speech and Language Therapy Service Risk to the IJB risk register. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centered on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐
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5 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 ☒ 7.1 ASSOCIATED MEASURE(S) 7.2 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☒ N/A ☐ 7.3 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Risk Register Choose an item. Multi 7.4 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details Involve stakeholders in the development work aimed at achieving the national outcomes 1. 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 1. Measure how well we involve community stakeholders in the planning, design and delivery of our services Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery
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6 Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.5 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☒ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Overview Dashboard
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7 Appendix 2 – Risk Register CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-15 2 Report Title Risk Management 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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15 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1
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16 Report Prepared by Stacey Anderson on behalf of the Chief Officer
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17 Report Prepared by Stacey Anderson on behalf of the Chief Officer
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18 Report Prepared by Stacey Anderson on behalf of the Chief Officer
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19 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 2 - North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (Initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges CONTROLS VERY HIGH Medium Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.06.2024 Previously IJB2, IJB7, IJB10 and IJB12. There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: HIGH 1. IJB PFA Committee. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. 2. IJB Chief Officer is a member of each partner's key decision‐ making forums. 1. The absence of a unique IJB financial settlement from the Scottish Government. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. Reviewed and updated Jan 2024. 2. The IJB is dependent on funding from both partners. 4. Regular budget meetings with Chief Executives and Directors of Finance. 3. Late Scottish Government financial settlement. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. Reviewed and updated March 2024. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 7. IJB medium term financial plan 2023‐26 and reserves strategy 2023‐24 approved at March 23 IJB Review and risk increased June 2024. 6. Demographic growth. 8. Capacity plans in place to maximise efficiency. 7. Competing service priorities. 9. IJB Integration Scheme setting out the budget recovery processes. 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 10. IJB Financial Regulations and financial procedures. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 11. Consultation and involvement with key stakeholders including service users and carers. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place.
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20 Report Prepared by Stacey Anderson on behalf of the Chief Officer 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 14. The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. ACTIONS 1. Annual budget setting processes within each of the partners. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget IJB02. 21 Financial Reputation al 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption CONTROLS LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.08.24 Previously IJB6. Reviewed and updated on March 2023. There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW 1. Fraud awareness e‐learning. 2. National Fraud initiative. Reviewed and Updated Oct 2023, 3. Locality/SW Enablement Groups. (previously title ineffective governance
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21 Report Prepared by Stacey Anderson on behalf of the Chief Officer arrangements ). 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. Reviewed May 2024 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partnerbodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website ACTIONS 1. Continue to raise fraud awareness through teambriefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget CONTROLS HIGH MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed and Updated May 2023. There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH 2.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 3. Bed modelling and capacity planning arrangements are in place. Reviewed Oct 2023. 4. Effective working relationships between both partners and the IJB have been established. 5. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2022/23 Reviewed Jan 2024 ACTIONS
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22 Report Prepared by Stacey Anderson on behalf of the Chief Officer 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. Reviewed May 2024 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 Reviewed July 2024. IJB05. 21 Financial Strategic 01/04/2021 Hosted Services CONTROLS MEDIUM MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed Jan 2024 There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH 1. North and South IJBs aim to co‐operate to ensure a pan‐ Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. Reviewed May 2024 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. Reviewed July 2024. IJB06. 21 Financial Operationa l 01/04/2021 Prescribing Activity and Costs CONTROLS VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.24 Previously IJB11. Reviewed and updated June 2023. The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical Medium 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. Reviewed and Updated (risk increased) October 2023. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. Reviewed Jan 2024 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring.In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. Reviewed June 2024. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. Reviewed July 2024.
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23 Report Prepared by Stacey Anderson on behalf of the Chief Officer products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector CONTROLS LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.06.24 Previously IJB16. There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. Reviewed April 2024. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. Reviewed July 2024 ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years.
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24 Report Prepared by Stacey Anderson on behalf of the Chief Officer 2. Updated SLA with VANL nearing completion IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements CONTROLS LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.10.24 Reviewed and updated June 2023. 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. MEDIUM 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 2. Public Health advice and support is in place. Reviewed and updated Oct 2023. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. Reviewed and updated Jan 2024. 5. Communications with employees, patients and service users may be ineffective. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. There will require to be changes to the working environment including remote working and working from home. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. Reviewed and Risk level lowered June 2024. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. 8. Staff health and wellbeing is a key priority for both partners and all key stakeholders. The commitment to staff health and wellbeing is being actively promoted through all available forums. 9. IJB Governance reporting reviewed and associated documents updated.
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25 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.11 21 Performanc e 30/07/2021 Oversight of Performance Activity CONTROLS LOW LOW Ross McGuffie Morag Dendy SLT, IJB PFA, IJB 31..10.24 Reviewed May 2024. There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. Reviewed June 2024. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. IJB.12. 21 Performanc e 30/08/2021 Staff Health & Wellbeing MEDIUM CONTROLS HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.08.24 Reviewed and Updated May 2023. There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. Reviewed and updated Dec 2023. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). Reviewed May 2024. Rest & Recuperation areas identified. Peer Support Networks established Well established Occupational Health supports available to support staff sickness. ACTIONS Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. Managers supporting & encouraging staff to take planned leave/use full leave allocation
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26 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.13. 2021 Performanc e 30.08.21 Care Homes HIGH CONTROLS medium medium Ross McGuffie Sharon Murphy IJB, PF&A, SLT, SC&SC, A H &SC 28.08.24 Reviewed and updated Oct 2023 Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. Establishment of Care Home Assurance Team. Escalation Process in place. Reviewed May 2024. . National protocol to support discharge of Covid 19 patients in place. ACTIONS Public Health teams providing guidance on infection control. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. All care homes advised to use PPE in line with national addendum. Development day on 12th May 23 to agree structures and approach for year ahead IJB.14. 2022 Strategic & Performanc e 30.04.22 CAMHS VERY HIGH CONTROLS Medium Medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments Reviewed and updated Dec 2023. Secured significant national investment to fully implement new service model Active review of skill mix to utilise medical staff only when required for highly complex patients Reviewed and risk level lowered May 2024. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 Continuous review and validation of the waiting list Waiting list validation exercise completed in April 2022 with reduction in list by 16%
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27 Report Prepared by Stacey Anderson on behalf of the Chief Officer CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion Monthly monitoring at board Incremental implementation of the new service model Performance monitoring through the programme board CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals Waiting list initiative commenced Udston opened for patients September 2022 Upgrade to North physical infrastructure agreed. Close working with health improvement and GP reps IJB.15. 2022 Strategic & Performanc e 05.09.22 Cost of Living HIGH CONTROLS High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.08.2024 Reviewed and Updated May 2023. There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. NLC Silver command group stood up focused on cost of living NHSL commenced review through CMT Reviewed Oct 2023. Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 Reviewed May 2024. ACTIONS Survey of NLC hybrid workers to see if home working remains financially viable Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost.
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28 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.16. 2022 Strategic 05.09.22 National Care Service HIGH CONTROLS High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 31.08.24 Reviewed and Updated May 2023. There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐ 26. NLC establishing NCS working groups Reviewed and Updated Oct 2023. Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA Reviewed and Updated May 2024 ACTIONS IJB response submitted on proposed Bill Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLA working groups being established ‐ local reps nominated for each IJB.17. 2022 Strategic & Performanc e 05.09.22 Unscheduled Care Very High CONTROLS High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.08.24 Reviewed and Updated in June 2023. There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision Reviewed Oct 2023 NHS CMT and Covid response group oversight of performance Daily PDD meetings to review every planned supported discharge and delayed discharge Reviewed Jan 2024. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges Reviewed and risk level reduced May 2024. Expansion of Home Support service Roll out of Home Assessment Teams across all 6 Localities New CSW roles in District Nursing teams to proactively support Care Managed patients
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29 Report Prepared by Stacey Anderson on behalf of the Chief Officer Additional Nursing capacity in District Nursing Teams Expansion of Equipment and Adaptation Service to support rapid access in community Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand Regular Firebreaks across the system Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) IJB.18. 2022 Strategic and Performanc e 05.09.22 Community Alarms HIGH CONTROLS Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 28.07.2024 Reviewed and updated June 2023. There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. Working group established to coordinate all activity Oversight through Home Support Programme Board Reviewed Oct 2023. Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB Reviewed Jan 2024. Reviewed April 2024. ACTIONS NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Communication out to all community alarm service users Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational Engagement with telecommunication suppliers to ensure sight of roll out plans across NL IJB.19. 2023 Performanc e 27/02/2023 Service Sustainability High CONTROLS Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023 Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of IJB PFA Committee. High Low IJB Chief Officer is a member of each partner's key decision‐ making forums. Reviewed and Updated Oct 2023.
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30 Report Prepared by Stacey Anderson on behalf of the Chief Officer the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Reviewed and updated Jan 2024. Regular budget meetings with Chief Executives and Directors of Finance. Reviewed April 2024. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Capacity plans in place to maximize efficiency. Consultation and involvement with key stakeholders including service users and carers. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS Sustainability plans to be reviewed regularly Re‐introduction of scrutiny panels Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. Review of reporting process into IJB to ensure continuous review of services/ service developments. Development of the programme of work to ensure regular reporting structure in place for service review. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. IJB.20. 2023 Workforce Sustainability HIGH CONTROLS Ross McGuff Ross McGuff SLT, IJB PFA IJB 28.07.2 4
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31 Report Prepared by Stacey Anderson on behalf of the Chief Officer It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐ EEA countries are subject to the same immigration rules. The new points‐ based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. High Medium Updated May 2023 In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. Reviewed and updated Oct 2023. Development of the Care Academy Reviewed and updated Jan 24 Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Reviewed April 2024. Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. IJB21.2 4 Financial Jun‐ 24 Pharmacy Pressures within Prison Service High CONTROLS High Low Ross McGuffie Ross McGuffie IJB PFA, IJB 30.07.24 Added to register June 2024. Pharmacy costs have traditionally been the highest area of non‐pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS
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32 Report Prepared by Stacey Anderson on behalf of the Chief Officer for the actual drugs bought and £246K associated with the management fees for the contract. Prescribing Action Group re‐established to try and manage the number of items prescribed Development of pain and medicine management pathways Review of prescribing habits IJB23.2 4 Performanc e Jul‐ 24 Speech and Language Therapy (SLT) Service High CONTROLS High Low Ross McGuffie Ross McGuffie IJB PFA, IJB 30.07.25 There is a risk that the SLT service cannot meet the increasing clinical demands with variance in waiting list length by area, continued challenges around the recruitment and retention of new colleagues, funding streams from Local Authority being reduce therefore reducing staff WTE. 1. Good communication processes, and the sharing of information and practical learning online have been established and will be further developed as service improvement work progresses. 2. Service model review to ensure that future TrakCare builds on local learning and builds on organisational learning from other builds. Forward planning for inclusion in the AHP Hub model will proceed in parallel to these TrakCare developments. 3. Revised workforce planning, incorporating the best‐practice and learning from other areas who have specialist children’s health services units. 4. The professional relationships between service and university have already been improved and we have academic representation that actively contributes to both our Workforce Planning and Service Improvement Steering Group. ACTIONS 1. Working with university colleagues to identify new practitioners who have expressed their desire to work in Lanarkshire on registration. This allows us to maximise and enhance opportunities for placement, improvement projects and induction planning, ensuring that we present ourselves as an area that is not only welcoming but committed to the ongoing development of individuals and the service 2. Work with professional colleagues to ensure that all activity is aligned to direct and/or indirect pursuit of meeting the SLT waiting time target. 3. Transition from restrictive locality models for managing the waiting list.