ITEM 13 Q4 Performance Report
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.
Page 1
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
Page 2
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 ☒
Page 3
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 ☒
Page 4
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 ☒
Page 5
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
Page 6
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.
Page 7
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
Page 8
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
Page 9
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:
Page 10
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),
Page 11
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
Page 12
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.
Page 13
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.
Page 14
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
Page 15
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.
Page 16
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.
Page 17
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%
Page 18
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.
Page 19
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
Page 20
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.
Page 21
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
Page 22
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.
Page 23
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
Page 24
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.
Page 25
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.
Page 26
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
Page 27
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.
Page 28
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)
Page 29
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.
Page 30
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.
Page 31
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.
Page 32
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