Agenda Pack
North Lanarkshire Council · 23 October 2024
Back to IJB Performance, Finance and Audit Committee — 23 October 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st August 9.30am-12pm 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 11.05am) NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Anne McCrory North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Siobhan White (Left 11am) 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: Elizabeth Seaton (Left 9.55am) Carers Together John Watson (Joined 9.40am) Unison Rep In Attendance: Andrea Breen (Observer) Senior Manager Adult Social Work Stacey Connor (Minutes) Governance Support Manager Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Sharon Murray Interim Nurse Director North HSCP Sharon Simpson (Observer) General Manager NE Sector Maggs Thomson Head of Health NHSCP Karen Workman (Observer) Senior Manger Adult Social Work Apologies: Stacey Anderson Support Services, Project Manager Paul Carey Audit Scotland Diane Fraser Head of Adult Social Work Services Margaret Gibb Interim Chief Exec, VANL Third Sector Rep Cathy McGinty NHSL Partnership/Staff Side Rep
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2 Dr Lucy Munro Medical Director North HSCP Harry Robertson Carer Representative 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 (22nd May 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: Future Meeting-Working with Chryston to identify a space big enough for December meeting to be hosted here. Also considering using meeting room 10 (new meeting room at Kirklands) for face to face meetings in 2025. 5. Community Alarms Service 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. 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. 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. 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
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3 remaining developments (which were upgraded a few years ago) to have a Digital connection available in readiness for the move to Digital. During the course of the financial year 23/24 £325,000 had been spent purchasing 1500 hybrid alarms. It is anticipated that £1,275,000 will be available to continue with the purchase of hybrid digital alarms in this financial year. There is a projected increase in cost therefore a funding gap for future years that requires to be sourced. 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. This report gave an update on the Community Alarm Service. It highlighted the work undertaken for the transition of analogue to digital; both the challenges and progress were noted. Additionally, the positive Community Alarm Service gradings from the Care Inspectorate were recognised. From engagement and consultation, it is agreed that the service staffing resource requires review. Finally, it noted the service charging position. Phillip Couser queried is the scale of uptake where we would want it to be. Ross McGuffie advised there is a stable position, throughout all the changes we have not seen a change in use pattern. Cllr Barclay questioned for those on the new system has it been a smooth transition or has there been any issues. Ross advised that the early stage of the transition was where the challenges were, as not sure where the changes were taking place now have been linking with telephone providers directly. Moving the hybrid alarms is allowing us to be ahead of the moves. Karen Workman added we are receiving roughly 130 alarm requests a month. The service has worked closely with the technology and housing teams to reduce any disruptions. Cllr Burgess asked do we have figures on loss of units over time. Ross McGuffie replied numbers are roughly static for active users- reduction is due to patients going into care or deaths in the community. Brian Moore queried will the fire alarm compatible issue be resolved in the future. It was advised that this would be resolved naturally though the digital programme. The IJB PFA agreed the following recommendations: (1) Acknowledged 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) Acknowledged 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) Acknowledged the positive Care Inspectorate grading that the service received from the Care Inspectorate.
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4 (5) Acknowledged the position with current and future charging for the service. 6. Home Support Service The report informed on the progress on the implementation of the redesign of the Home Support Service which was approved in 2018. It outlined 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 demonstrates that the model approved in 2018 remains fit for purpose and aligns with the current aims and objectives of the Strategic Commissioning Plan. 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) 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). The impact of change detailed showed improvement of the quality and consistency of care and support, improved recruitment and retention, addressed impaired staff morale, improved 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. This 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 to the committee. Key areas of focus for the work include: • Assessment and Planning • Living Well Service • Dynamic scheduling system • Engagement particularly with other boards
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5 • Quality Assurance Demonstrator sites are operational in Airdrie and Wishaw which will be rolled out further and updates will be brought back to the committee as the work progresses. John Watson noted concerns around the volume of care commission inspections and the impact this has on the staff. Ross McGuffie advised Diane Fraser and Alison Gordon are picking up discussions and raising these concerns formally with the lead inspector. In North have had 19 inspections comparted to 1 in South so looking to seek more of a balance. Some of the members asked were there particular reasons for North receiving this amount of inspections. Ross McGuffie advised there are different lead inspectors so it can be down to individual approach. Some areas have been received grades 2 inspections with areas for improvement identified which are being addressed; care inspectorate are aware of improvement processed taking place. This has been raised at the national whole system group as a concern and will be raised again. Cllr Kelly asked will the new dynamic scheduling be included as part of staff training plans. It was confirmed a training team has been identified to support staff and linking with the provider of the new system directly to offer ongoing support. Have also identified champions for the system. Phillip Couser queried are trends determined by demographics for those with complex needs. The response advised that there is an increased complexity in some cases and clear that we are currently over providing packages so should see a reducing number as reviews take place but increased complexity of cases. Looking at up skilling workforce to ensure staff are as skilled as they can be to be able to provide more complex care for patients. Cllr Burgess asked regarding more complex patients and is there more care time being allocated to staff to undertake tasks. Karen Workman advised new dynamic scheduling will assist in allocating the required time in real time and taking into account feedback from staff around this. Cllr Barclay enquired are we comparable to other Health authorities for the amount of inspections undertaken. Ross McGuffie replied we have not looked at this data yet until we try to manage this locally but will consider this in future. Brian Moore commented that despite the number of inspections there will be opportunities for learning from the findings and further reports from the Care Inspectorate on this service area should be brought back to the committee. The IJB PFA acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model.
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6 7. Home Assessment Team/ Discharge without Delay Programme Update 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. 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. The report presented provided an update on the establishment of HAT in North Lanarkshire, which includes background, progress to date, plans, recruitment update, successes, risks and next steps. 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. HAT provide 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. Cllr Kelly requested some feedback around links for HAT with health services. Morag Dendy advised working on a video to capture the enthusiasm of the staff and promote the service. This work is being done as it’s what’s right for people and want staff to feel they have done a good day’s work. Have no direct control with Acute colleagues but lots of platforms to link in for a whole system approach. Also working with South colleagues to develop on a Lanarkshire process. The IJB PFA Committee: 1. Acknowledged the report. 2. Endorsed the strategic direction of HAT and the implementation of HAT across North Lanarkshire. 3. Acknowledged the significant development in HAT practice across North Lanarkshire 8. Self-Directed Support Update The report provided an update on the progressive implementation of Self- Directed Support SDS) nationally and the position locally with reference to
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7 the Self-Directed Support Framework of Standards updated by Social Work Scotland in May 2024. The report reinforced the whole system approach to continuing to promote maximum choice and control for people living in North Lanarkshire. Self-directed support is the approach threading through all of the work 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. 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 Cllr Barclay noted some concerns –between discharge from hospital and funding allocations being sorted is the patient linked in with. Morag Dendy noted assessment of someone in crisis is the not the best time to establish long term need to trying to balance short term support and longer term capacity so constantly link with patients during the process to ensure needs are met. Brian Moore referred to a Care Solutions annual report from September 2021 which contained a section on the Self Directed Support Network which has negative comments on the experience of SDS and he requested that the self-evaluation capture the views of individual users. The IJB PFA: 1. Acknowledged the progress made in North Lanarkshire to promote choice and control through Self-Directed Support 2. Noted that a future report will be brought to detail the findings of a Self-Evaluation and associated Action Plan 9. Improving The Cancer Journey 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, the paper offered an update of progress since the launch of the service in March 2024.
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8 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. 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. The committee appreciated the presentation of the data and the use of graphics. Comments were made on the referrals gender split and the percentage of referrals by SIMD area. The IJB PFA noted 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. 10. Our Health Together A report was shared with the committee to present the new NHS Lanarkshire healthcare strategy ‘Our Health Together Living Our Best Lives in Lanarkshire’ 2024-2031. 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. 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. There was a long engagement exercise to pull this work together. There are key themes within the document around: Primary Care, Mental Health, Urgent Care and Planned Care. This will be considered for future discussion at an IJB liaison session. Can also consider linking to updates around the SCP.
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9 The IJB PFA endorse the ‘Our Health Together’ strategy. 11. North Lanarkshire ADP Annual Reporting Survey 2023/24 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. 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. Once the data is analysed and findings are published at an aggregate level as Official Statistics on the Scottish Government website 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. National drug death figures have increased in 2023- there has been 1072 deaths reported. There were 103 deaths in 2023 for North Lanarkshire compared to 65 in 2022 which is an increase of 38 from the previous year. Each death is reviewed and considered to identify any learning going forward. The committee expressed concern about the increase in NLC and requested that further information be brought back to the IJB PFA. Work has been done with HIS across Scotland to look at learning from the differences in drug related deaths in partnerships. There is a refresh of ADP leads and strategic leads in September which should lead to different information sharing across Scotland. The IJB PFA approve the following recommendations: (1) Noted the content of the report (2) Approved the Alcohol and Drug Partnership (ADP) Annual Reporting Survey 2023/24 for submission 12. Internal Audit Annual Report 2023 24 The Internal Audit Annual Audit Report for 2023/2024 provided a high-level overview of the activity undertaken by the Internal Audit teams during the year, as reflected in the annual opinion.
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10 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. 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. It was noted the overall opinion is ‘reasonable assurance’ but when you look at the definitions at the end of the paper, there is no ‘reasonable assurance’ instead the definitions are: substantial, adequate or limited. The committee would like clarity of which one ‘reasonable assurance’ would fall into. The committee also noted comments on the timing of this report as the committee would have preferred to have received it prior to the 2023/24 unaudited annual accounts being published in June so the governance statement could include the internal audit opinion for the year. A request to internal audit for 24/25 and future years would be to have this information before the statutory publication of the unaudited accounts in June. Amanda Kilburn will feed both points noted above to the internal audit on behalf of the committee. The IJB PFA 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. AK 13. Q4 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. Areas identified as red and require improvement this quarter are: • Cervical screening • Childhood Immunisations
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11 • 6-8 week reviews • Reablement and rehabilitation • Adult mental health • SLT • Dietetics • Complaints • Smoking cessation • Adult social work Brian Moore asked is there any work planned to review health visitors similar to district nursing reviews. Sharon Murray advised considering a review as there is significant different in caseloads across areas need to look at boundaries. Testing a HV app to improvement communication between staff and patients. There was also discussion regarding the over reliance on paper based systems. The current performance regarding SLT was also noted. The IJB PFA noted the contents of the report and the appendix. 14. Supporting Unpaid Carers- Carers Support Allocation Previous reporting to the IJB outlined the 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. The report shared provides an update on the current financial position and the budget allocated to carers support. 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. 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. 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. 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. The IJB PFA: (1) Endorsed the approach to supporting Carers in North Lanarkshire
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12 (2) Noted the current financial position and budget allocation in relation to carers support. 15. A Shared British Sign Language Plan for Lanarkshire 2024- 2030 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. 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. The plan for Lanarkshire sets out actions around ten priority areas which will be monitored through equalities forums, these are: • 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 The IJB PFA note the contents of the report. 16. 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 19 risks identified on its IJB risk register with 11 risks rated as high or very high. Very High Risks • IJB 06/21 – Prescribing Activity and Costs- Sitting at 38% of target achieved, this is for polypharmacy reviews rather than prescription switches which means the target will continue to rise over the year. • IJB 01/21 – Financial Challenges High Risks • IJB 04/21 - Notional Set Aside Budget • IJB 12/21 - Staff Health & wellbeing • IJB 15/22 – Cost of Living • IJB 16/22 – National Care Service • IJB 19/23 – Service Sustainability • IJB 20/23 – Workforce Sustainability
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13 • IJB 12/22 – Unscheduled Care Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. The Pharmacy Pressures within the Prison Service is a new risk that has been added to the IJB Risk Register as per IJB approval in June 2024. Costs associated with this has risen substantially meaning it is an area of concern. 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. The group were in agreement that this should be added as a risk to offer some assurance/oversight. Brian Moore noted previously got a list of Health and Council risk which may impact on the committee; to consider potentially including going forward. Recommendations agreed: 3.1 The IJB PFA noted the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 The IJB PFA noted 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. 17. Risk There were no new risks identified. 18. Date of Next Meeting 23rd October 2024 2pm-4.30pm
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 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 25. Future Meeting R McGuffie Host a future meeting face to face in Chryston hub Looking at Dec IJB –confirming arrangements. Unfortunately, there is not a meeting room large enough for committee, however in process of arranging a walk around and meet and greet. 26 25.09.24 Item 9 Integration Joint Boards Finance C Rae Ensure that their Medium-Term Financial Plans are up to date
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2 and Performance Report 2024 and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: -Service redesign focused on early intervention and prevention. -Approaches focused on improving the recruitment and retention of the workforce. 29 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve
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3 outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. 30. 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people.
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4 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 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. Update on Exit strategies to be presented to PF& A in November 2021 June 2021 November 2021 – deferred to IJB Complete Reserve strategy
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5 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 December 2021 deferred to March 2023. presented to IJB PFA on 16th 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 September/December 2020 Deferred to March 2021 – deferred to September 2021 – Original Action complete with further update on hosting arrangements presented to
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6 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 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 deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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7 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. 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 February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete
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8 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 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 June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Complete Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IJB PFA Further update on October PFA agenda
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9 5. 19/6/24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19/6/24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 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
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10 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 business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete.
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11 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 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete 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 provided after year-end figures. Combined report linked to community alarms on
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12 August PFA agenda Complete 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 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
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13 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 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
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14 Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT paediatrics and speech and language On April 2023 agenda 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 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 November 2023 Liaison Session Complete 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report Tabled @ May PFA Complete
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1 REPORT Item No: 5 SUBJECT: Getting It Right for Everyone (GIRFE) TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) Author(s) of Report Margaret Flavell, Senior Manager DATE: 23 October 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: Margaret Flavell Manager Adult Social Work ☒ Reviewed By: Diane Fraser Chief Officer Adult Social Work ☒ Endorsed By: CORE ☒
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2 3. RECOMMENDATIONS 3.1 It is recommended that IJB PFA: 3.1.1 Endorse the GIRFE Pathfinder journey and approve the next steps. 3.1.2 Endorse the testing of prototypes in multidisciplinary operational practice, through: • The provision of and deployment of existing resources to ensure capacity, providing support and challenge via the Back-to-Basics governance structure to measure the learning • Embedding the GIRFE principles and subsequent practice and ways of working underpins the Back to Basics/enabling approach. 3.1.3 Receive future reports with the national pathfinder learning 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 Getting it right for everyone (GIRFE) is a proposed multi-agency approach to support and services from young adulthood to end of life care which the Scottish Government is co-designing with place-based pathfinders. Health and Social Care North Lanarkshire North Lanarkshire is a place-based pathfinder for older people and frailty. 5.2 From the inception of Getting it right for everyone (GIRFE) in 2022/23 and recruitment of pathfinders, the aim was to publish the ‘team around the person’ toolkit by Autumn 2024. 5.3 The Scottish Government also sought to work with pathfinders and partners to develop the digital requirements to support the work and the culture and leadership requirements to support implementation. 5.4 North Lanarkshire’s commitment to getting it right first time, supporting a well- equipped and confident workforce and promoting engagement and participation made the opportunity to contribute nationally to shaping the model to deliver very welcome. 5.5 Given the range of financial and demographic challenges faced locally as well as nationally, involvement in the work as a pathfinder was also welcome in shaping improved population health and wellbeing, reducing health inequalities and creating sustainable health and care services. Yes ☐ No ☐ N/A ☒
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3 . 5.6 The following section of the report details specifically the work of the North Lanarkshire pathfinder that has been ongoing since January 2023, a set of proposed options to operationalise getting it right for everyone within the Back to Basics programme and subsequent next steps and recommendations for approval by CORE and IJB. Current position 5.7 The Pathfinder programme began in January 2023 and is underpinned by a co-design approach including: • GIRFE Design School - a support model which can help teams to come together, get ready for co-design work, and engage people with lived experience on a specific policy area, problem exploration or redesign challenge. • GIRFE Learning Networks to support a national practice model. 5.8 There are eleven place-based pathfinders across Scotland aligned to five thematic areas: 1. People in prisons. 2. People in addiction services. 3. People registered at Deep end GP Practices. 4. Families with multiple and/or complex needs and young people in transition from GIRFEC to GIRFE. 5. Older people and frailty. 5.9 The North Lanarkshire pathfinder was geared towards a focus on frailty given the population projections of North Lanarkshire and a need to reduce demand and pressure on health and social care services. The vision set out in the Strategy for Preventing and Managing Frailty 2023-2028 describes a clear commitment to working together across health, public health, social care, housing, community and voluntary organisations, and with older people and those who are important to them, to help them age well and live longer in good health. The strategy embraces the getting it right for everyone principles and the vision and commitment to new ways of working underpinned the work of the pathfinder from the outset. 5.10 The North Lanarkshire pathfinder work sought to achieve three main things. 1. To understand people’s experiences of accessing health and social care services in a range of different settings, across thematic areas and focused geographically on Wishaw (although wider engagement took place). 2. To embed their expertise and knowledge into the final version of the principles and elements of a national toolkit that would support the approach at a local level.
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4 3. To ensure, through the governance structure adopted, continued alignment with the Strategic Commissioning Plan programme of work and delivery plan for Back to Basics, that adopts the Human Learning Systems (HLS) approach. 5.11 The pathfinder team worked to a national timeline of activity as shown in Appendix 1, concurrently the partnership has been developing the ‘Back to Basics’ transformation programme within the Strategic Commissioning Plan Programme of Work. The governance structure put in place to support the GIRFE pathfinder is shown in Appendix 2. 5.12 The co-design process with people from North Lanarkshire communities, including those with lived experience and expertise in delivering services, has allowed deep and rich collaboration to consider the principles and how they should be both expressed and the thematic areas, and how they should be implemented. 5.13 Appendix 3 provides a high-level view of the reach of engagement and co- design on getting it right for everyone, and Appendix 4 illustrates the high-level themes captured during the early co-design work. Image 1.0 below outlines the initial themes the pathfinder was asked to focus on to the specific prototypes that were tested. All feedback on prototypes was captured and submitted to the national policy team and design school on 3rd June 2024. Appendix 5A and Appendix 5B illustrate the prototypes on a page. Image 1.0 Initial themes to prototypes for testing. 5.14 Members of the NL pathfinder team presented to the GIRFE steering group on 23rd May 2024 and attended a series of collaborative sense making workshops, with all pathfinders, to refine the prototypes further with final feedback submitted on 19th June to the National policy team and design school. 5.15 Consequently, the GIRFE pathfinder facilitation team recognise the need to take forward the learning from the pathfinder work and agree the next steps in line with back-to-basics programme and operationalising of the enabling approach. 5.16 Specifically, the enabling approach incorporates elements of prototype 2 relative to ageing well, assessment and planning mechanisms, how the multi- disciplined team across health, public health, social care, housing, community
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5 and voluntary organisations work together and the role of the ‘sticky person’ and the community connectors (my plan, my team, personal network discussion, care co-ordinator). Furthermore, community hubs and their underpinning principles as prototype 1 provide a delivery vehicle to strengthen the delivery of more integrated supports and services within our communities augmenting our locality model. Community Hubs are a key priority for the NLP Strategic Leadership Board. The options for taking this forward are detailed in the next section of the report. Current situation including options and implications. 5.17 The GIRFE Pathfinder in the partnership is now at the stage to work with identified staff in localities to take forward the learning from GIRFE pathfinders co-design process and agree the next operational steps. That is, progress the prototypes and making them real through working with designated staff and families in our communities. There would be limited impact on normal services as it would be business as usual and not additionality as it is more about the approach. Adhering to the principles would strengthen practice and subsequent service delivery. The approach that the Scottish Government initiative working with the pathfinders is in keeping with the North Lanarkshire partnership existing practice and approach, that is, person centred, strength based, meaningful engagement and intervening early in the right way at the right time with the right person. Explanation of prototypes: 5.18 The North Lanarkshire Pathfinder has been asked to undertake further ‘testing’ of these prototypes. In this instance, ‘prototype’ refers to practice solutions and principles in response to the difficulties people with lived experience have identified through the getting it right for everyone engagement process. Testing at this stage will involve continuing to develop these prototypes through an ongoing process of co-design and co-production with people who have lived experience, including seldom heard voices, with staff across the Health and Social Care Partnership and with colleagues in the 3rd Sector. Next steps will include developing a plan to further test the prototypes in practice. A toolkit to support operational testing developed by the Scottish Government is to be released in September 2024. 5.19 The North Lanarkshire Pathfinder will focus on the following prototypes during the next phase of testing: 5.19.1 My plan – a document for anyone who wants to record details of their plan with the aim of removing the perceived need for people to ‘retell their stories’ multiple times. This includes living well, ageing well and dying well. Areas for further development of this prototype include determining governance arrangements and ensuring GDPR compliance. A demonstrator will be undertaken in Airdrie and Wishaw to embed the getting it right for everyone
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6 principles across a variety of services and supports that deliver preventative and early intervention (Access Social Work, Home Assessment Team, Home Support Reablement, Community Nursing, Integrated Rehab Teams). It is envisaged this will improve access and change/adjust first point of contact including robust screening and allocation through multidisciplinary team conversations/activity through the enabling approach. It is hoped by this way of working that this will reduce waiting times for people, embed the team approach around the person and their plan and eradicate unnecessary referrals. 5.19.2 My team – people having a network of friends, family and professionals as an integral component to ensuring health and well-being, with people getting the right support at the right time. The further development of this prototype includes consideration of how this will be recorded and shared, including the format this may take. This will be further tested as outlined above in the Airdrie and Wishaw demonstrator. 5.19.3 Co-ordinator – the ‘sticky person’, a trusted point of contact who will support people with the coordination of their plan and appointments as an integrated member of a multi-disciplinary team, including when someone receives support from a variety of teams. Areas for further development and design include determining how the coordinator for each person is allocated and how the role might be undertaken by a family member or other non-professional. 5.19.4 Community Hub Principles – clarity of vision for a community hub that underpins delivery of a facility and what it hopes to achieve for a community. The primary focus here involves principles which will support the development of Hubs which reflect local needs and where people can connect with public services and with local people involved in both service delivery and decision making. It should be noted that the Council has an approved set of hub guiding principles so the intention here would be to build upon active work being undertaken in Newmains and St Brigid’s Community Hub, Riverbank and Chryston. Further development of this prototype includes identifying what community supports and services can be delivered through the hub, in reach and outreach, as well as the development of performance indicators to determine the impact of support on the health and well-being of the communities they serve. 5.19.5 Dementia practice - Additionally, we have agreed to consider staff competencies in supporting people with dementia post diagnosis. We understand that families can sometimes have extended wait on supports and this can be a challenging time so can we consider ‘waiting well’. We will work with staff across Home Support and Integrated Day Services in gathering data re training/development and competencies and whether this meets expectations as required in the Dementia Strategy.
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7 5.19.6 GIRFEC to GIRFE (Moving On) - Working with our Education and Families colleagues to consider this important transition stage in a young person’s life. In what way can this transition be seamless with the right support at the right time. 5.20 GIRFE, rightly has a focus on a person-centred, integrated and multi-agency approach to support individuals. Within the overarching commitment to self- direction this will improve access and embed practice in shared decision- making and promoting self-determination, encouraging those with lived experience, including unpaid carers and families to be equal partners in their care and support. 5.21 Our local approach within North Lanarkshire also has a focus on preventative and anticipatory approaches, seeking to ensure that people can remain independent and living at home, without a need for the involvement of statutory services, for as long as possible. 5.22 In line with core principles of independence, empowerment, enablement and self-help, our approach considers as a start point: • What the person can do for themselves. • What might family, neighbours and friends be able to support. • What role local community resources could play including A Local Information System for Scotland (ALISS). • What might technology be able to help with, whether personal technology, equipment through Assistive Tec team, MLE, Community Alarm Service. • What role might there be for targeted support, such as carer organisations, condition specific, or age-related support groups or Community Voluntary Sector (CVS) organisations. This also encompasses our wide-ranging Community Solutions programme. • What role might- CVS funding available through things like Time to Live, Carer Short Breaks Bureau, Carer Outcome Grants and so on play. 5.23 The wider reach of our getting it right for everyone approach requires to have an intention to ensure that there is an opportunity to “getting it right” for people not currently known to services. This could have a balanced focus on not “clientising” anyone or moving people towards ‘service land’, by drawing them into services unnecessarily, by promoting preventative and anticipatory planning and approaches with a view to reducing the likelihood of crisis arising in the first place. The working relationship with Community Connectors will assist in this area. We believe that such an approach encompasses: increased awareness about what is important to people – gleaned and gathered through day-to-day work, as well as focused engagement and participation activity; increased opportunity for preventative approaches, anticipatory planning and only where necessary, early intervention; increased connections and communication with people and communities that we need to work harder to engage with.
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8 5.24 Our Pathfinder recognises the need for a renewed focus on the outcomes that people identify as being important to them. Many people are reluctant to ask for information, advice, or support, meaning that very often, their first presentation to services is at a point when they are already in crisis. Crisis is costly in terms of time, energy, and resources, but more importantly, costly in terms of the human impact. 5.25 A GIRFE informed approach seeking to move from “eligibility to conversation around “what might help?” would assist with all the above and should start before the point where people need services. As such a getting it right for everyone informed approach becomes a much wider responsibility than solely that of Health and Social Care. If this approach was implemented, it would also help inform community planning, local outcome improvement plans, community agreements and become embedded in the much wider community and voluntary sector. 5.26 As outlined earlier we require to consider what the prototypes mean in real time. There has been extensive engagement and communication across the HSCP regarding the need for the workforce to get back to basics, have meaningful conversations with people about what is important to them. This requires the GIRFE principles to be fully understood and embedded in everyday operational practice therefore being aligned to Back-to-Basics and enabling approach across localities with a direct impact on day-to-day practice. 5.27 The challenge is how we implement the GIRFE principles and practice in a multidisciplinary way and ensure links to locality planning structures and operational practice. We require an emphasis on people with lived experience having a strong voice and influence therefore all decision-making being central to the person including working with our third sector community connectors on the preventative/early interventions. Community Hubs are ideally placed to progress this development. Governance 5.28 Presently the Governance structure has been a getting it right for everyone Steering Group, getting it right for everyone Operations Group being supported by the GIRFE Pathfinder and Facilitation group reporting to the Strategic Commissioning Plan Programme Board. With the Back-to-Basics development this has afforded an opportunity to reconsider existing Governance structures, and this was presented to Core on Monday 1st July 2024 and the GIRFE steering, operations and pathfinder facilitation governance was agreed through the partnership refreshed governance structure. 5.29 Next steps 1. Getting it right for everyone Principles understood and embedded within the operating model, in practice across UHSCNL. 2. Getting it right for everyone principles aligned with the Back- to- Basics programme i.e. they become the golden thread to connect all the strands
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9 of work and connect people with the overall vision regardless of organisation or role. 3. The testing of prototypes in a multidisciplinary way in localities through the demonstrator sites. 4. Leadership commitment to support getting it right for everyone development and embed principles in everyday practice. 5. Agree a measurement method/outcome for evaluation. 6. Shared and continuous learning to enable any refinement or recourse as required through the regular back to basics/enabling approach learning sessions. 7. Work to a whole system approach across the multidisciplinary team within and across localities. 6. IMPLICATIONS 6.1 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 ☒ 6.2 ASSOCIATED MEASURE(S) 6.2.1 In moving from prototypes to practice, it is essential to determine and agree performance measures. How do we know we are making a difference and how might we measure this through performance outcomes. Given prototype development has reached the stage in UHSCNL to be tested operationally, it requires further discussion with people in their communities and operational staff to further agree the detail (other Pathfinders across the country are at a different stage). 6.2.2 This operational testing will determine how we will know that the GIRFE overarching principles and the practice solutions identified through prototyping
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10 will make a difference. Performance measures require to identify whether the issues people have raised through the GIRFE co-design process are resolved and that people experience improved outcomes. 6.3 FINANCIAL This paper has been reviewed by Finance: 6.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 6.4.1 A preliminary risk assessment (PRA) has been carried out for GIRFE, a summary of the key risks and mitigation measures are detailed below: Risk RAG Mitigation Impact of GIRFE across all stakeholders assessed EQIA has been completed for the pathfinder project overall. An EQIA would be required for any prototype projects taken forward to implementation. This phase of the project relies heavily on lived experience co- design and this has and will allow us to assess the impact of plans on the wider community to ensure person centred approaches are the heart of our effort to design services that meet people's needs, at the same time build community capacity over the longer term through the framework for Community Wealth Building. Effective delivery of GIRFE pathfinder and embedding of principles into practice at every level. Work to align with BRB/enabling approach by having the GIRFE principles as the golden thread to connect all strands of work. Engagement across all stakeholder groups. Outcomes and measurement framework/logic model. Approvals through CORE and governance structure review. Resource capacity and effective deployment of resources Governance structure is under review at present. Resources to deliver are currently allocated and any wider resources will be identified through BACK TO BASICS/enabling approach. Finance and budget As budget is required to implement any prototypes the aspiration would be to tie this into current budget arrangements. Presently in terms of incentives for participation in co-design there is tension as Yes ☐ No ☐ N/A ☒
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11 budgets are restricted to non-essential spend. Approvals would be sought as needed through existing mechanisms. Cost estimation Costs can't be estimated accurately until the level of unknowns are reduced such as integrated service delivery models. Financial costs can be controlled within the POW whereby programmes have their own associated financial model or funding stream. Benefits, both financial and non- financial, set out now against outcomes Anticipated strategic benefits are known and outlined in the project brief (such as integrated services; easier access for community; etc.). However, the detail of these for this next phase needs to be worked through as prototypes are developed to capture aspirations of stakeholders and benefits realisation matrix is developed for any individual projects within phases and tied back to BACK TO BASICS/enabling approach. Initial work has been done on outcomes frameworks for some of the prototypes, this will be built on following approvals and agreed methodology. 6.5 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 Focus groups have taken place with people who use services, carers, those who do not currently use services and the Health and Social Care workforce. ☒ Provide stakeholders with information on how to get involved Internal and external networks have been used to invite a broad range of citizens across North Lanarkshire. ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs The EqIA has guided practice in seeking opportunities to engage with people whose voices are seldom heard. ☐ 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 Feedback is shared with people who have taken part in GIRFE engagement sessions, within the Health and Social Care Partnership and with the Scottish Government. ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of
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12 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 Existing engagement activities within Localities have been utilised in seeking participation in GIRFE co-design and to feedback on progress. 6.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 7. BACKGROUND PAPERS None. Yes ☒ No ☐ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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13 9. APPENDICES Appendix 1 The National activity timeline for the NL pathfinder Appendix 2 GIRFE pathfinder governance structure
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14 Appendix 3Engagement and co-design on GIRFE with communities Appendix 4High level themes identified through initial engagement and co-design Appendix 5AExample prototype template(s) Appendix 5BExample prototype template CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following. Diane Fraser – FraserDi@northlan.go.uk Margaret Flavell – FlavellM@northlan.gov.uk
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15 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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16 Appendix 1 The National activity timeline for the NL pathfinder
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17 Appendix 2 GIRFE pathfinder governance structure
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18 Appendix 3 Engagement and co-design on GIRFE with communities
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19 Appendix 4 High level themes identified through initial engagement and co-design (includes engagement on Early and Inclusive family support).
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20 Appendix 5A Example prototype template(s)
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21 Appendix 5B Example prototype template
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1 REPORT Item No: 6 SUBJECT: Community Nursing Review TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Sharon Murray, Interim Nurse Director, Health & Social Care North Lanarkshire Author(s) of Report Caroline Martin, Interim Associate Nurse Director DATE: 23rd October 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA to update members on progress of Community Nursing Review For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Caroline Martin, Interim Associate Director of Nursing who ☐ Reviewed By: Community Nursing Review Programme Board and Strategic Commissioni ☒ Endorsed By: ☐
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2 ng Plan Board. 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: 3.1 Consider progress of the Community Nursing review. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Community Nursing is a planned service that is delivered in all six localities and provides nursing care to people who cannot attend other care facilities or where being cared for in their home is considered the most suitable environment. 5.1.2 This service was last reviewed in 2006 therefore a review of community nursing within North Lanarkshire HSCP was commissioned by the Nurse Director, Health & Social Care North Lanarkshire on 20th August 2023 with the aim to develop a model which meets the needs of our changing demographics and also to support improved workforce planning with clear career progression pathways. 5.1.3 The Community Nursing review has now been completed and the implementation stage is ongoing. 5.1.4 Demand for our health and social care services is ever increasing as people live longer but are often now living with multiple long term conditions and increasingly complex needs for health care and social support. 5.1.5 The COVID-19 pandemic came at a time when there had already been a stalling in life expectancy and a widening of inequalities. The pandemic has compounded pre-existing health inequalities with evidence showing that COVID-19 has had greater direct and indirect effects on people living in more deprived localities and those who are most vulnerable. The impact of the Covid-19 pandemic has been a strong reminder that health and wellbeing outcomes are influenced by wider determinants in terms of the life circumstances and opportunities and fundamentally the control people have over their lives. Yes ☐ No ☒ N/A ☐
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3 5.1.6 The community nursing review will ensure the following: • Getting it right for everyone (GIRFE) principles supported. • Service develops to meet the needs of the local population, demography and economy. • Be appropriate and responsive to the changing needs of patients, be proactive (not reactive), anticipate need and prevent illness. • Be at the centre of the delivery of coordinated joint service. 5.2 Objectives and Process • Develop a Vision for Community Nursing in Lanarkshire. • Map demography, local need and current service provision. • Develop a stakeholder engagement to ensure that we engage the community, staff and service users. • Develop a revised clinical model. • To develop a workforce plan – utilising the 6-step methodology of workforce planning. • To develop a training and development plan to support the new staffing model. • Review Governance for Community Nursing. • Implement recommendations of review and monitor impact on patient outcomes. 5.2.1 To achieve the objectives a Project Plan was developed and agreed with key stakeholders. Short Life Working Groups (SLWGs) were established covering o Vision & Model o Caseload Complexity o Care Management & Referral Criteria, o Roles, Responsibilities and Training o Boundaries The SLWGs are currently being reviewed by the Community Nursing Review Working Group, who meet monthly as part of a move to an implementation stage. 5.2.2 Overall governance Is provided by the CNR Project Board which meets 12- weekly. 5.3 Current Progress 5.3.1 Vision & Model. 5.3.1.1 A stakeholder event has been arranged for 29th October 2024 to showcase the progress made on areas highlighted through feedback from stakeholder engagement and to launch the new vision and model.
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4 5.3.1.2 5.3.1.3 Our population is changing, it’s growing in diversity and people are living longer. Our services therefore need to be equipped to care for the increasingly complex health and social care needs which are a result of poorer health in older age. Our vision is to transform Community Nursing to ensure it is appropriate and responsive to meet patient’s future care needs. (Appendix 1) This includes a shift from what is often a reactive to a more proactive, preventative approach. It involves working with patients, unpaid carers, families and other agencies, as necessary, with a focus on; direct nursing care, health promotion and education, future care planning and supporting self-care for patients or for those who look after them.’ 5.3.1.4 A staff stakeholder session identified staff recruitment and shift pattern was a recurring theme raised. A review of the service needs which included evening and overnight nursing demand, against current staffing was therefore completed. The review highlighted patient visits took place mainly between 8am and 12midday, see Table 1 below, this was consistent throughout the teams and showed visits were not spread evenly throughout the day. Table 1
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5 While some visits for example, the management of patients who require insulin to be administered more than once daily, need to be completed in the morning many others could be spread more evenly throughout the day. The current way of working does not lend itself well to a change in shift pattern, a change of practice would be required to support this. Due to a stabilising of recruitment and the Once for Scotland Flexible Working Policy update, it was not felt necessary to peruse a team wide change in shift pattern. Improvements to support a more even spread of workload throughout the day via agile working/use of technology is being developed instead. 5.3.2 Caseload Complexity 5.3.2.1 New complexity descriptors have been developed using a collaborative approach with the community nursing teams. The descriptors are in line with the National Workload Tool, and all staff have received training to ensure a consistent approach to measuring complexity of patients within caseloads. These are now used on a daily basis to describe workload demand and support safe staffing. An audit tool was created to review the overall complexity of caseloads, see table 2 below. Level 1 being the least and level 4 being the most complex patients. This will be used to aid the fair distribution caseloads and support a review of skill mix within the community nursing teams. Table 2 5.3.2.2 Poor caseload management and recording of care was highlighted by the review. MORSE data showed patients on caseloads with no assessments and care plans and reviews not being completed within the minimal 12-month standard. A high 72 9 6 12 78 9 3 10 66 12 5 16 61 15 4 20 67 9 2 19 70 9 6 14 8AM-12MD 12PM-2PM 2PM-4PM 4PM-6PM PROPORTION OF CONTACTS PER LOCALITY (AVERAGE IN %) Bellshill Motherwell Wishaw Airdrie Coatbridge North 0 100 200 300 400 500 Airdrie Bellshill Coatbridge Motherwell North T1 North T2 WishawPatient numbers Locality Teams Caseload Complexity Data May 2024 Complexity Level 1 Complexity Level 2 Complexity Level 3 Complexity Level 4 Total Caseload
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6 number of visits not being entered correctly was also identifies with large numbers showing visits lasting over 24 and clinical records not being completed and saved known as unoutcomed. Practice Assessors have been allocated to each locality to support the teams. They are working with District Nurses and trainee District Nurses to support improvements in caseload management. The business information and MORSE teams are developing reports via MILAN to aid quality improvement. Table 3 below however highlights the number of unoutcomed appointments increasing again in 5 out of 6 teams, this supports the need for regular review by Team Leaders and Senior Nurses to ensure sustained improvements. Table 3 5.3.2.3 The community nursing review recognised that there is a requirement for a transformational review of care being delivered by both health and social care. The Getting it Right for everyone (GIRFE) principles have been adopted with the patient and their loved ones in the centre. The current model was task allocated and involved duplication of visits from a health and social care perspective. An initial test of change has commenced in one locality using a quality improvement approach, to transfer a care intervention from unregistered community nurses to home care staff. While education and training is required, once trained it will have no impact on the workload of home cares but will significantly reduce nursing visits of at least 240 per week, and potentially reduce the other associated resources i.e. staff savings of circa £175,000 as well as travel costs. Further roll out across all localities will require facilitation of education sessions, relationship building and robust communication across the Health and Social Care partnership. 5.3.2.4 Safe staffing levels in nursing is currently monitored daily via real time risk assessment tool known as PRAG (Purple, Red, Amber, Green). This tool records the professional judgement of staff in relation to the complexity and volume of care to be delivered against staff available to provide this care however, this can be subjective at times and has historically not applied consistently across all teams. The new complexity tool, staff training on completing PRAG and escalation guidance has resulted in more objective reporting.
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7 5.3.3 Care Management & Referral criteria. 5.3.3.1 Care Management has been used for a number of years in community nursing to categorise patients with highly complex needs. With care managed patients requiring a more senior nurse to be allocated to coordinate the care and take the role of lead professional. The staff stakeholder feedback however, highlighted that this model was not being used consistently and there was a lack of understanding regarding the remit of staff for care managed patients. A short life working group set up to review care management found a lack of literature in recent years and concluded that it was now an outdated model. collaborative approach to managing patients with complex care needs is being currently taken with nurses working as part of a wider multidisciplinary team in localities. This approach ensures that everyone works together and can quickly respond to complex often unscheduled demand for services. 5.3.3.2 In line with our strategy for preventing and managing frailty, frailty scoring is being introduced to community nursing assessments. Identifying frailty at an early stage will enable staff to plan and coordinate care, support wellbeing and optimise independence. We are also reviewing future care planning and will work in conjunction with GP’s to ensure we proactively plan and coordinate care using realistic medicine principals to achieve the aims of Healthy Ageing and Living Our Best Lives in Lanarkshire. 5.3.3.4 Until this year we were unable to provide data on preferred place of death being achieved, a key performance indicator for Excellence in Care. Data is now being collected from discharges via the electronic record system MORSE. Table 3 below shows an average of 87.5% of patients on the caseloads are receiving the care they wish at the end of their life to enable them to die at home. Table 4 In supporting; Transforming Urgent and Unscheduled care, Discharge without Delay and the Target Operating Model, a review of the current Enhanced Care model delivered by community nursing teams in North Lanarkshire has been completed. This has resulted in a change of terminology and new care pathway for patients identified as in the last 3 weeks of life. Pathway 4, as it is called is in line with South Lanarkshire Community teams, and is being adopted by all acute and community hospital sites. The community nursing teams are in the process of reinvigorating regular weekly meetings with the Social Work, locality Intensive teams which had stopped during the COVID pandemic. This will aid collaborative working, sharing of
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8 information and most importantly support person centred end of life care to ensure patients are supported to die at home if that is their preference. The new approach will commence on 16th September. 5.3.3.5 The introduction of a single point of access for patients, carers and professionals would ensure that patients are assessed and signposted to the most appropriate service to meet their individual needs in a timeous manner, allowing for prioritising of care and reducing waste visits. Right care, at the right time, by the right people, in the right place. 5.3.3.6 Having a single point of access for all, which is consistent and efficient to support early access will allow for prioritisation and appropriateness of referrals which will free up clinical staff to see more face to face patients. This will allow patients and carers easier access to Community Nursing teams and improve the patient journey 5.3.3.7. A Community Nursing Referral Centre (CNRC) was established in Feb 2024 and now takes calls for Wishaw, Motherwell, Airdrie and Bellshill. The other two localities are currently recruiting call handling staff to join the CNRC and hope to be in all localities by November. Table 4 below details the volume of calls received, with an average of around 3000 calls per month. It also shows a steady increase in calls that are able to be resolved at point of contact highlighting the development of the call handling staff. Table 5 5.3.3.8 Table 5 also details the commencement of email referrals now being received by the CNRC. This is currently for 3 localities with plans in place to roll out
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9 email referrals being received by the CNRC for all localities also by November this year. 5.3.3.9 Referrals from acute and community hospital sites are also under review with a new document being developed collaboratively with all stakeholders. The aim is to ensure improved communication and reduce discharge related clinical incidents. A change in terminology to from discharge to transfer is also being adopted to highlight the importance of receiving patient information to enable care to be continued in the community and ensure a safe patient “transfer”. 5.3.3.10 Referral criteria has been reviewed and new guidance is being issued to ensure a consistent approach to the process of referring to the teams. 5.3.4 Roles, Responsibilities and Training 5.3.4.1 Within community nursing teams there is a specific role related to District Nurses (DN) that required staff to leave their role and undertake a 1 year course at university that would allow a separate registration onto the nursing and midwifery register. 5.3.4.2 A number of years ago it was identified that this was creating a bottle neck in staff development with significant unfilled DN post. An internal DN trainee pathway was developed and has been successfully supporting the training and registration of staff. A review of this training pathway took place to ensure it reflects the new NES Nursing Midwifery Allied Health Professional (NMAHP) Competency Framework and Queens Nurse Institute Scotland (QNIS) standards. 5.3.4.3 Over recent years the number of Newly Qualified Nurses (NQN) joining the teams has gradually increased. Previously the induction for NQN was inconsistent and there was not a robust process therefor a Welcome Induction pack for all staff and an induction programme for newly qualified nurses has been developed to ensure all newly qualified nursing staff receive a robust induction. This is being evaluated on an ongoing basis. 5.3.4.4 Concerns around a gap in leadership is being addressed by encouraging Team Leaders to attend Leadership and QI courses. So far 3 of the 9 Team Leaders have completed the Essentials of Leadership and Management NHSL course with 1 currently attending and another booked onto the next intake. One Team leader has completed aEQUIP, a quality improvement NHSL course with another currently on the programme. As part of this course the participates conduct a quality improvement project within their area of practice. It is recognised however that supporting the development of leadership in all levels of registered nurses is important therefore the trainee District Nurses framework has several leadership components. Leadership training will also be added to band 5 registered nurse development to support them in their role. 5.3.4.5 Two localities; Bellshill and Wishaw, have begun supporting retention of staff by having meaning conversations with staff through Stay Conversations supported by Operational Development (OD). This highlights why staff stay in their post, what they would like to change and what would make them want to leave. OD recommend
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10 stay conversations as they “show staff that they are valued in their role” Feedback from these conversations is being analysed and themes identified will be used to form improvement plans to support staff in their workplace. This is done in conjunction with Service Managers. 5.3.4.6 Advanced Practitioners (AP) are being introduced to community nursing teams, currently there is 1 trainee in Wishaw locality and 1 who has just recently qualified in North. The AP’s have been supporting complex patients with acute care needs in their own homes. This is a developing role and pathways are being reviewed. 5.3.4.7 The Community Nursing Overnight Team is a stand-alone service which sits outside of the locality teams in the Adult Health Service Unit, this service is also being reviewed with options to align it into localities being explored as it forms an integral part of the 24 hour nursing care. 5.3.5 Boundary Work 5.3.5.1 It is recognised that we have seen demographic shifts and profile changes within our localities over recent years, this means workforce numbers and skill mix originally allocated to localities may no longer be equitable. Projected changes as highlighted below in table 6. Table 6 North Lanarkshire population projections (2018-based) by age group, comparing 2024 and 2034 Data Source: National Records of Scotland population projections North Lanarkshire population projections (2018-based) for 65+ age group Data Source: National Records of Scotland population projections 5.3.5.2 Work with a Lanarkshire Principal Information Analyst on boundaries is now in its final stages. This aims to review allocation of workforce and resources and ensure a more equitable distribution and reduce travel for staff. Table 7 below highlights the current staff resource allocation Table 7
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11 District Nursing funded establishment (WTE) by locality and band, as at August 2024 Data Source: data provided by North Lanarkshire HSCP District Nursing funded establishment (WTE) by locality and band, as at August 2024 Data Source: data provided by North Lanarkshire HSCP 5.3.5.3 The PHS Local Intelligence Support Team have developed tools which allows the resources available for localities to be calculated in a fair and transparent way. There are 2 tools currently available: 1. NRAC based Resource Allocation Tool – using the NRAC methodology Resource Allocation Formula (publichealthscotland.scot). The four components of the formula are: population, age/sex adjustment, morbidity and life circumstances adjustment and unavoidable excess costs of supply adjustment for unavoidable additional costs of delivering services due to remoteness and rurality. 2. Custom Resource Allocation Tool – contains a range of demographic and health indicators, user can assign their own desired weightings based on the importance they wish to assign to each indicator. This tool is flexible; indicators can be added/removed as requested by the user. The team are highlighting the outcomes of resource allocation when using these tools for the three different boundaries currently in use throughout University Health and Social Care North Lanarkshire to inform the group. 6. IMPLEMENTATION The final report for the Community Nurse Review will be completed in October this will detail progress so far and highlight a strategic improvement plan to enable the implementation of its recommendations and key measurements to monitor impact on both patient outcomes and the community nursing workforce. 7. CONCLUSIONS This report provides an update to IJB PFA committee members on work underway as part of the community nursing review in North Lanarkshire . It highlights some of the complexities to the review and also some of the innovative approached being taken.
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12 8. IMPLICATIONS 8.1 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 ☒ 8.2 ASSOCIATED MEASURE(S) Associated measures include: • A&E attendances • Unscheduled bed days • Delayed discharges • Emergency admissions • Re-admissions • Improved assessment/planning outcomes • Co design evidence • People dying in place of choice 8.3 FINANCIAL The financial implications of the proposed skill mix review described in 5.3.2 is currently being agreed and costed. Incremental savings due to the introduction of the Band 4 Assistant Practitioner role are likely to be realised over time. The roll out of transfer of care from Health to Social Care however as described in to 5.3.2.3 is likely to achieve instant savings. Potential saving projections reviewed so far are detailed below in table 8. Table 8 Potential Savings in £
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13 Transfer of task from Health to Social Care • Weekly catheter bag change • Stoma care 175,130 52,539 Professional Lead Review • 1 WTE Professional Lead allocated to each locality 53,765 Review of Team Leader • 1 WTE Team Leader per locality** 174,738 Band 4 Assistant Practitioner Development 255,949 Total Savings £712,121 ** Exception of North Locality due to large number of staff, patients and geographical spread. This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Project Risk Register There is a risk that due to current service demands staff are unable to participate fully in the review Medium Sharon Murray IJB 19.2023 Service Sustainability High Claire Rae 8.5 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 Questionnaires to stakeholders – GPs/Service users – June- August 2023 ☒ Provide stakeholders with information on how to get involved As above
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14 ☐ 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 Report from Stakeholder Event 30.8.23 Feedback event arranged for February 2024 ☐ 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 8.6 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 9. BACKGROUND PAPERS None. 10. APPENDICES
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15 None. CHIEF ACCOUNTABLE OFFICER (or Depute) Claire Rae Chief Officer Members seeking further information about any aspect of this report, please contact the following; Sharon Murray, Interim Nurse Director Sharon.Murray@lanarkshire.scot.nhs.uk
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16 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 Item No: 7 SUBJECT: CAMHS and NDS Recovery and Renewal Programme Board TO: Integrated Joint Board, Performance Finance, and Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NLHSCP Author(s) of Report Pauline Izat, General Manager, Specialist Children’s Health Services Unit, NLHSCP Contact details for Author(s) of Report Email:- pauline.izat@lanarkshire.scot.nhs.uk Tel:-07896415225 DATE: 23rd October 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: Pauline Izat, General Manager ☒ Reviewed By: Dr Adam Daly ( Associate Medical Director) in absence of ☒ Endorsed By: ☒
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2 Dr Lucy Munro ( Medical Director and Chair of Programme Board) 3. EXECUTIVE SUMMARY The report will give detail of scope and scale of modernisation that has been delivered by the CAMHS and NDS Recovery and Renewal Programme Board to facilitate delivery of a CAMHS and an NDS model aligned to the individual national specifications. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note contents of report and progress made to date. 4.1.1 Robust reporting is now available as an electronic patient management system with aligned electronic patient record is now in place. Performance is monitored and managed within the unit and formally reported via IQPR 4.1.2 All work streams have completed work initially advised with exception of capital planning. However, this work is in progress and can be managed locally with support from planning colleagues. Additionally, the information available to us, due to improvements in robustness of data capture is capable of informing redesign in a way that was not possible in first phase of capital investment. 4.1.3 Ongoing work of the Board will focus on NDS and the interface of NDS with CAMHS. 4.1.4 Remit of Programme Board will expand to include financial planning for workforce resilience 5. VARIATIONS TO DIRECTIONS? Yes Health Board ☒ No ☐ N/A ☐
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3 6. BACKGROUND 6.1 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0- up to 18th birthday. 6.2 The Lanarkshire CAMHS and NDS Programme Board has been in place since 2021. The Programme Plan articulates how the National CAMHS Service Specification – as well as associated Scottish Government directives – will be locally implemented. The purpose of this programme was to assess, evaluate and where appropriate redesign Child & Adolescent Mental Health services ensuring a whole systems approach based on children and young people’s rights and relationships. 6.3 The board remains committed to delivery of safe, effective and child centred mental health care for children and young people across Lanarkshire who require support and intervention to manage their complex mental health challenge. 6.4 The strategic commissioning of CAMHS and NDS for the NHS Lanarkshire area is hosted by the North Lanarkshire IJB and managed by the North Lanarkshire Health and Social Care Partnership (HSCP). In April 2021, North Lanarkshire HSCP received confirmation from Scottish Government of recurring funding via the Recovery and Renewal Fund (RFF) specific to CAMHS of £3.3 million. 6.5 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by complex mental health problems, moving early intervention support to the Schools Counselling Model, School Nursing and the Community Wellbeing Framework. It also separated the request for assistance pathway for children and young people who primarily required assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Foetal Alcohol Spectrum Disorder (FASD), Developmental Coordination Disorder (DCD) and Tourette’s and tic disorders. 6.6 In order to co-ordinate and monitor the delivery of the programme plan, North Lanarkshire HSCP established the CAMHS & NDS Recovery and Renewal Programme Board, which his is chaired by the North Lanarkshire HSCP Medical Director and has support from a Professional Adviser from the Scottish Government. 6.7 There have been 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery: - • Neurodevelopmental Service – all work completed. All neurodevelopmental requests for assistance are now channelled via established Neurodevelopmental Service. This combined 3 previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. This is a highly
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4 skilled workforce and maximum efficiencies within resource are assured. Time limited commission of an external provider has provided additional capacity that facilitated assessments of young people before they graduated to adult service referral routes. Demand for assessment continues to exceed capacity. This has been highlighted nationally and is common across all health board areas. It is advised that national work will influence next steps with neurodevelopmental services. • Choices & Partnership Approach (CAPA) Implementation within CAMHS- all work completed. This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. • HR & Workforce – all work completed. A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. • Communication and Engagement- all work completed. An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. • eHealth- all work completed. Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. • Capital/Strategic Planning- ongoing. Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same. 6.7.1 The main objectives of the Programme were: - • Review CAMHS referral and assessment pathways with a view to implementing the Choices and Partnership Approach (CAPA) model. • Full implementation of the Child and Adolescent Mental Health Service (CAMHS) Specification – Community CAMHS. • Clearance of any backlogs on waiting lists for CAMHS. • Clearance of any backlogs on waiting lists for Psychological Therapies. • Agree a workforce model to utilise the funding provided by the Mental Health Recovery Fund to enable the effective implementation of CAPA • Engage all key stakeholders to achieve consensus and clarity and enhance communication of new ways of working across all CAMHS teams and Neurodevelopmental Pathway. 6.8 The IJB should be assured that the objectives initially set by Programme Board have been realised and have now progressed to a stage of sustainability of performance and quality assurance that is aligned with national specification. 6.9 The performance trajectory is positive. 73.91% against an RTT of 90% was delivered in July 2024. Objective analysis by Public Health Scotland colleagues has assured that full delivery of 90% RTT should be realised by October 2024. This is reliant on continuance of funding aligned to a workforce that is responsible for delivery of trajectory. Additional modelling is taking place to provide assurance of patient review list care provision. Whilst not a government recorded or formally reported
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5 target, it is a good indicator of patient experience and shifts balance of care from responsive crisis management to planned intervention. 6.10 Additionally, we continue to work with West of Scotland colleagues to deliver a standard of care provision capable of managing care locally and consistently to facilitate equity with other health board areas. This has included expansion of our unscheduled CAMHS (UCAMHS) model. It has combined the expertise of CAMHS Duty Team, Intensive Treatment Team and Nurse Team. Hours of service delivery will be further expanded in October. This additional capacity and expertise will support avoidance of admission care planning, support safe hospital discharge and manage risk appropriate to environment. The UCAMHS response model is available to all children and young people on both CAMHS and NDS lists who experience deterioration in mental health whilst waiting to be seen or awaiting specific treatment. This service is also open, by referral, to any child or young person previously unknown who has presented with an acute deterioration in mental health with aligned escalation of risk. 6.11The Board will continue to build sustainability of treatment time, psychological therapy input performance within CAMHS and NDS and ensure a robust interface and response where a CYP who requires support from either or both services. 7. SUMMARY OF KEY ISSUES 7.1 Financial instability continues to challenge workforce stability. Much of funding being used to deliver scale of change needed was provided via Recovery and Renewal funding route. Projected reductions in this level of funding would have a significant negative impact on performance trajectories and implementation of full CAMHS specification due to instability of workforce. 7.2 The Neuro Developmental service works independently of CAMHS. Demand continues to significantly out strip capacity of service. The trajectory will continue to widen if resource not made available to address directly. Referrals and demand are in line with other HB areas. 7.3 Increasing complexity is both anecdotally and formally reported. Care assurance work is being undertaken in response to learning from significant adverse events. This includes assurance of consistent process in relation to mental health assessment; risk assessment; care planning and risk management. Care assurance reporting framework planning is in process and will be reported via CAMHS and NDS Quality Governance Group and onwards for assurance via HSCP Support Care and Clinical Governance meeting and via MHLD and Addictions for information. 7.4 Continuance of trajectory and ongoing performance is reported via CAMHS Performance Meeting and reported via the Specialist Children’s Unit Management meeting. 8. CONCLUSIONS
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6 8.1 The initial aims of CAMHS and NDS Recovery and Renewal Programme Board have been delivered. It is acknowledged that performance against target remains fragile due to instability of finance. However, there is now clear evidence available that can assure efficiency of service delivery aligned with monies available. 8.2 Assurance of performance and quality of service delivery have become embedded within reporting structures aligned to operational and clinical governance structures. 8.3 Financial stability will be a focus of ongoing work within CAMHS and NDS Programme Board to ensure models that have been built remain sustainable within current funding envelope. Our total funding for CAMHS and NDS is £9,464M. This excludes medical workforce budget which is held within Mental Health Unit of NL HSCP. We are currently progressing 10% saving proposals in line with ask of all health services across the HSCP and wider NHS Lanarkshire. A deliverable 10% reduction will see a loss of posts across the services. However, we are being considerate of where we can mitigate risk by focussing a higher percentage of deliverable savings on posts that do not indirectly or directly contribute to RTT. The IJB should be aware that the funding of CAMHS and NDS remains fragile and savings ask is likely to increase due to a higher than expected reduction in mental health recovery and renewal monies which account for £3,124M of overall budget. A confirmed position is awaited. 9. IMPLICATIONS The implications of additional work stream will be minimal as initial objectives have been delivered. Planning will be required to ensure changes made are sustainable despite financial pressures. 9.1 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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7 Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL 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 Level 3 High Pauline Izat IJB.14.2022 CAMHS Medium Claire Rae 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 outcomes Wide range of professional stakeholders attend Programme Board meeting. ☐ Provide stakeholders with information on how to get involved This is provided to CYP and families via our engagement officer and encouragement to use Care Opinion ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Our Engagement Officer has provided a range of opportunities for CYP and their families to provide feedback on service delivery and service planning. This can take form of focus groups or 1:1 ☐ Measure how well we involve community stakeholders in the planning, design A CYP questionnaire that rates service delivery is undertaken annually
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8 and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Our Engagement Officer provides update to our CYP and families of what changes have been made due to their input. ☐ 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 Contribute to wider organisational stakeholder engagement processes( UNCRC etc.) 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A Requires review and update to reflect UNCRC EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included.
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9 CHIEF ACCOUNTABLE OFFICER (or Depute) Claire Rae, Chief Officer. Members seeking further information about any aspect of this report, please contact the following; pauline.izat@lanarkshire.scot.nhs.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements
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11 11 Date direction will be reviewed
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1 Item No: 8 SUBJECT: Paediatric Modernisation Board TO: Integration Joint Board, Performance Finance and Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NLHSCP Author(s) of Report Pauline Izat, General Manager, Specialist Children’s Health Services Unit Contact details for Author(s) of Report Email:-pauline.izat@lanarkshire.scot.nhs.uk Tel-07896 415 225 DATE: 23rd October 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: Pauline Izat, General Manager ☒ Reviewed By: Maggs Thomson, Head of Health NLHSCP ☒ Endorsed By: Dr Adam Daly – Paediatric Modernisation Board, Chair ☒
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2 3. EXECUTIVE SUMMARY The report will provide detail of the Paediatric Modernisation Board Structure, objectives and progress of work to date. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report and progress of work achieved to date. 4.2 It is recommended that the IJB note the scale of challenge to delivery of sustainable transformational change. The success of programme delivery will require clinical modelling and clinician support. This has to be balanced proportionately with safe delivery of care whilst transformational work progresses. 4.3 It is recommended that the IJB note that elements of this work are impacted by current service level agreements with tertiary partners. This requires sensitive discussion via regional planning process. 5. 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 6. BACKGROUND 6.1 The Paediatric Modernisation Board was established in current form, formally, in February 2023. The Board is Chaired by Dr Adam, Daly, Associate Medical Director for the Health and Social Care Partnership in North Lanarkshire. Membership is inclusive of professional leadership, operational management colleague and corporate support colleagues (Communication, Digital and HR Teams). Each member was made clear of expectation of their representation and role in delivering this programme of work. 6.2 The Paediatric Board is focussed on modernisation of service delivery and clinical activity generated via acute hospital and aligned community based paediatric services. The delivery of the services within scope of board, inclusive of in-patient care are the responsibility of the Specialist Children’s Health Services Unit, and hosted on behalf of NHS Lanarkshire within North Lanarkshire Health and Social Care Partnership. The Board forms part of NLHSCP Strategic Commissioning Plan and reports to North Yes Health Board ☒ No ☐ N/A ☐
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3 Lanarkshire CORE, North Lanarkshire Integration Joint Board, South Lanarkshire Integration Joint Board and NHS Lanarkshire. 6.3 The services in scope of the Paediatric Modernisation Board include: - • Acute Paediatric Assessment Unit and In-Patient Ward (Ward 19 and 20 UHW) • Community Paediatric Service- this includes General Paediatric Out Patient clinics, Medical Child Protection Team, Adoption Panel Medical Assessment and Looked After and Accommodated Medical Reviews. • Specialist Paediatric Medical Clinics including but not exclusively, Rheumatology, Gastroenterology, Renal, Continence, Allergy, Complex Respiratory, Diabetes and Cystic Fibrosis etc. • Integrated Children’s Community Nurse Service which supports range of specialist services provided by specialist consultants as well as community and educational based health intervention support for children with a range of complex physical health needs which may or may not have a comorbid intellectual disability. 6.4 The agreed remit of Board is: - • Ensure a collaborative, inclusive approach to the design and delivery of a programme of work to implement the Paediatrics Modernisation Programme Plan • Monitoring the financial position across the Programme, including the use of Scottish Government funding for specific areas of work; • Encourage and strengthen links between the Programme, North and South Lanarkshire Paediatrics Services Plans and other relevant strategies of all key partners; • Approve Programme documents and deliverables; • Monitor the progress of Programme and delivery plans; • Approve significant changes to the Programme scope, objectives, deliverables, funding and timescales; • Provide assurance that outputs are operationally fit for purpose and implemented satisfactorily; • Identify and manage risks and issues ensuring mitigating actions • Agree and track benefits realisation and achievement of outcomes • Approve Programme closure following implementation and ensure that any end project reports, issues, lessons learned and risks are documented and passed on to the appropriate body. 6.4.1 Five working groups were planned to be established to progress this work: • Comms and Engagement • Accommodation • Transition and Interfaces • eHealth (now Digital) • HR and Workforce • Regional and National Links.
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4 6.4.2 All are at various stages of progress and have been prioritised according to acuity of clinical challenges that have arisen. Additionally, a 6th group has been established to ensure the modernisation plan is aligned with current financial challenge and potential for saving realisation as well as transformational change. 6.5 A 3 Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: - 6.5.1 Horizon 1- covers current issues that require quick response. • Nursing Care Assurance • Review of Continence Services 6.5.1.1 The Paediatric Modernisation Board are happy to advise that Horizon 1 work is progressing well. The nursing care assurance work has been led by the Associate Director of Nursing and been supported by NHS Lanarkshire Quality Improvement Team. The standards agreed have been inclusive of contributions made by nurse colleagues who work within paediatric in patient environment and of community based nurses who support specialist care for children within a clinic, their home and/or school environment(s). The first set of resultant care assurance reports are expected for presentation to NLHSCP’s Support Care and Clinical Governance Group in October. 6.5.1.2 The Review of Continence Service has been led by Clinical Lead for Community Paediatrics. This has been more challenging to progress due to clinical demands on colleagues involved, changes within continence aligned workforce and assurance work identified that required address prior to full commencement of work. Despite these challenges, a literature review has been undertaken and review of current service model undertaken with a plan to test new model soon. 6.5.1.3 We expect further projects to be undertaken subject to availability of clinical staff. Further examples of work already being considered is the development of a supported palliative care pathway and review of current acute pharmacy colleague support and its interface with primary care. Prioritisation of work to be undertaken in future will be informed by release of capacity of colleagues who are completing initial Horizon 1 work and colleagues who can be released from clinical activity. 6.5.2 Horizon 2 -covers emerging issues that are likely to be faced in the next one to three years. • Sustainability of medical rota 6.5.2.1 This Horizon 2 focus of work emerged quickly as a clinical risk due to unsustainability of Tier 1 and 2 medical rotas that require to be in place to ensure safe function of in-patient care. Tier 1 is junior trainee doctors who provide the foundation of medical intervention within ward. Tier 2 trainees are higher trainee doctors who are working towards becoming a consultant within paediatrics. This is an important trainee rota to fill as it provides a pathway for interested trainees to return in the future as consultants. If numbers are not coming through and/or they do
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5 not have a good trainee experience whilst with us, it will have a negative impact on long term recruitment of these specialist colleagues to Lanarkshire. Tier 3 is our consultant level rota. All rotas are inextricably linked and cannot be separated without negative impact on wider system, and at times on individuals. 6.5.2.2 This fragility of rota is due to a culmination of factors which include less availability of trainees being provided by deanery and increasing numbers of trainees who want to work less than full time. This has resulted at times, in increased pressures resulting in use of locums and of requests generated to consultants to act down into senior trainee roles. This negatively impacts on planned community care assessment and review and places an additional burden of stress on an already tired workforce. Due to level of risk identified, additional support was approved by Core management team. Additionally, our Medical Director continues to have dialogue with deanery to assure that we are receiving an equitable offer of trainees. 6.5.3 Horizon 3 - covers issues that might come into play in the future. • New clinical model 6.5.3.1 Clinical capacity will need to be realised from completion of ongoing Horizon work to facilitate taking forward this larger piece of work. Meantime, informal discussions have commenced between nursing and medical colleagues with their respective professional leads. 6.5.3.2 Health and well-being of colleagues during times of significant change have been recognised as a potential barrier and risk to further progression of work. Organisational development colleagues are supporting professional leadership and operational management to appropriately support staff throughout and beyond this programme of work by involving them in “stay conversations” which can also contribute and inform to modernisation plans. 7. SUMMARY OF KEY ISSUES 7.1 The pace of transformational change has been slowed by limited capacity of clinicians to commit time to service improvement work. This is due to clinical demand, which can be variable throughout seasons of year. This will be factored into plans for spring and summer 2025 that will aim to progress work towards delivery of new clinical model, Horizon 3. 8. CONCLUSIONS 8.1 The IJB should note the progress of work to date. 8.2 The IJB should note that timescale of progress is balanced with clinical demand and activity and is affected by a seasonal element of intensity due to clinician availability. 8.3 The IJB should note that discussions in regard to service level agreement with regional partners will be supported by NHS Lanarkshire Planning colleagues. 8.4 The IJB should note that this transformational change work is being taken forward in an environment of reduced financial stability and will be subject to same
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6 10% saving proposals as other health services within NL HSCP and wider NHS Lanarkshire. 9. IMPLICATIONS There is potential that there will be a shift in balance of care away from acute hospital to community care based sites and/or homes. This has potential further challenge demand for space within local health centres. 9.1 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 ☐ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL There are no specific financial implications of work to date. Programme of works is considerate of current financial environment. This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT
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7 Relevant Risk Register Details Current Risk Level Risk Owner IJB19.2023 Service Sustainability High Claire Rae 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 outcomes Scoping event with stakeholders took place in February 2023. This was supported by NL HSCP Project Management colleagues. This event prioritised approach and informed Horizon model. ☐ 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 This is provided via staff meetings ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Representation within Programme Boards of community and acute colleagues who interface with acute and community paediatric care. ☐ 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 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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8 EQIA is in progress and will be considerate and informed by UNCRC legislation. Yes No N/A In progress EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. Chief Officer CHIEF ACCOUNTABLE OFFICER (or Depute) Maggs Thomson- maggs.thomson@lanarkshire.scot.nhs.uk Members seeking further information about any aspect of this report, please contact the following; Pauline Izat - pauline.izat@lanarkshire.scot.nhs.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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10
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1 Item No: 9 SUBJECT: Speech and Language Therapy Service Improvement TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NLHSCP Author(s) of Report Pauline Izat, General Manager, Specialist Children’s Health Services Unit, NLHSCP Contact details for Author(s) of Report Email- pauline.izat@lanarkshire.scot.nhs.uk Tel-07896 415225 DATE: 23rd October 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 It has been reviewed by Speech and Language young people leads and AHP Director. Prepared By: Pauline Izat, General Manager of the Specialist Children’s ☒ Reviewed By: Christine Fear, SLT professional ☒ Endorsed By: ☐
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2 Health Services Unit. Pauline Downie, Professional Lead, Speech and Language Therapy Lead for CYP, NL Lucy Scott- Muir, Professional Lead for CYP, SL in absence of SLT Professional Lead Pauline Downie Peter McCrossan, AHP Director. 3. EXECUTIVE SUMMARY The report will provide update to IJB PFA, of scope and span of improvement work being delivered via Speech and Language Therapy (SLT) Service Improvement Steering Group, with a focus on recovery of waiting times for children and young people (CYP) service. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note the contents of the report and progress of work delivered to date via the service improvement group. 5. 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 6. BACKGROUND 6.1 The Speech and Language Therapy service is hosted within the Specialist Children’s Health Services Unit of North Lanarkshire HSCP and delivered pan Lanarkshire. The service is funded by NHS Lanarkshire and via service level Yes Heath Board ☒ No ☐ N/A ☐
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3 agreement arrangements with north and south education departments. The service offers support to children and young people and separately, to adults. The service improvement work is focussed on delivery of improvements required to support improved access to speech and language therapists and interventions for children and young people. 6.2 Child and young people speech and language therapy (SLT) works within a multidisciplinary model and aims to deliver an equitable, consistent, high quality specialist service to pupils who present with communication and/or Eating, Drinking and Swallowing issues which compromise their everyday quality of life and/or physical safety. • A tiered approach to care (universal, targeted and specialist level), essentially building capacity by providing multi-agency training, consultancy and support to colleagues. • Comprehensive packages of care to individual pupils, (specialist level) using the Care Aims principles to assess clinical risk, need and evaluate progress. • A commitment to the social model of disability, viewing the children as members of society who have the right to the support, they need in order to optimize their quality of life. 6.3 The SLT service is delivered based on Royal College of Speech & Language Therapists (RCSLT) professional guidelines and The Health and Care Professions Council’s Standards of Proficiency and Standards of Conduct; Performance and Ethics and NHS Lanarkshire SLT Service Policies and Procedures. 6.4 The support SLT gives depends on the difficulties each child or young person is having with their speech, language, communication and/or swallowing. Support can vary at different times, depending on how much their difficulties are affecting them. 6.5 SLT gives support in 5 different areas; the support needs to be right for the child or young person across each area. This is called The Balanced System. You can see the 5 areas of the balanced system in the picture below:
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4 6.6 SLT help children and young people by providing universal, targeted and specialist support. Children and young people can move through these different types of supports depending on their need at the time. • Universal - This is available to everyone. This includes getting general advice and information from NHS Lanarkshire’s Speech & Language Therapy website, social media (X or Facebook) or our telephone Enquiry Line. This is also speaking to a Therapist in school such as at Parents’ Evening. The aim of universal support is to provide those supporting the children and young people a better understanding of speech, language and communication needs. SLT may also suggest other services who can help. • Targeted - This includes working with families and other people who support the child or young person. SLT can look at the speech, language or communication difficulties the child or young person is having and suggest how to help them. 6.7 SLT might give advice, suggest things to try, recommend resources (e.g. videos, information leaflets or websites), make changes to the child or young person’s environment, or give training. Support at a targeted level helps the child or young person by giving help to the people they see most often. Children and young people’s cases do not require to be open to SLT in order to access targeted supports. • Specialist - SLT may offer assessment and treatment at this level with intervention provided in episodes determined by the Care Aims Framework. SLT will agree goals for each episode of intervention which will be shared with families and school staff. The episode goals will be updated regularly using the Care Aims Framework to evaluate progress, risk and need. SLT may work directly with the child or young person, or SLT might work with families or other people close to them. Each child or young person will have their own identified set of goals. The children and young people’s cases are open to SLT when accessing specialist level intervention.
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5 6.8 Access to service has been hampered by long waits. These are historic in nature (pre-COVID). They were in part attributable to challenges within workforce secondary to predominance of younger females in work force with resultant pregnancy and requests for less than full time work; aging group of staff who were due to retire and skills gap in applicant numbers. The waiting time worsened further post COVID. Recovery and renewal investment failed to yield sustainable workforce growth. Since then, the gap in capacity from increased demand has widened further. 6.9 The Speech and Language Service receive funding from Education Partners in both South and North Lanarkshire. The funding is negotiated annually. This year has seen a reduction in funding received via South Lanarkshire. North Lanarkshire’s funding has remained the same. However, this does not account for pay increases and reduced working week arrangements. The leadership team within Speech and Language service have worked collaboratively with colleagues in education to mitigate risks associated with decrease in funding. This will be a further focus of service improvement work that has been planned considerate of local authority commitment. 6.10 As a result, The Speech and Language Service Improvement Group was established at request of NLHSCP Chief Accountable Officer. The first scoping of service model and setting of priorities was undertaken in April 2023. As a result, areas of priority were agreed, and work streams established to progress work to date: - • Waiting List- This work is progressing well in a testing phase following ➢ review and standardisation of the processes that support patient pathway and inform digital plan. ➢ Agreeing, refining and developing core clinical offerings at Universal, Targeted and Specialist level. ➢ Ensuring workforce have the confidence, resources and knowledge to deliver the core service model • Digital- This work has progressed well. The service had no digital footprint. Trakcare has been implemented since September 8th, 2024. We are at an early stage of being able to gather evidence from the robust data it can provide. However, early indicators are that this will provide necessary evidence to better understand recording of interventions, where barriers or bottlenecks can occur in pathway. • Comms and Engagement- This work has progressed well. Colleagues within the service had already well-established social media platforms and information and education via YouTube that was used to support children and young and their parents and carers. Corporate support has been provided to extend SLT Website to include adult services. This will coordinate all SLT information to one defined space. Members of group are also contributing to development of an App that will support children and families who are supported by local health visitor colleagues.
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6 • HR and Workforce- This work has progressed well. Review of all posts across the service has been undertaken. Posts aligned with RRF monies have been removed from funded establishment and annual service level agreements with education colleagues have been agreed. Focus of future work is on continued development of relationship with higher education. This will support opportunities for students in training as well as provide development for opportunities for career development of both unregistered and registered roles. • Administration and Accommodation- This work is at an early stage and will be appropriately informed by evidence now available due to implementation of Trakcare. 7. SUMMARY OF KEY ISSUES 7.1 Ongoing impact of long waits is not keeping pace with age and stage of development of children waiting. However, it is also clear that previous recording of waits is not aligned with other HB areas. Currently we only record specialist interventions. Other HB areas are able to evidence input is making at universal and targeted points of access. Trakcare provides opportunity to understand and explore this further and use learning to inform change. 7.2 Approaches in other HB areas have delivered success by uniting local authority partners in approach and agreed funding. There focus has been on impact of supported targeting rather than counting of direct intervention sessions offered. This will require further consideration and negotiation. A Test of Change with partners to trial effect of new approach that has been successful in other areas. 7.3 Increasing demand of service in line with reduced capacity of staff available to deliver will require a different approach that can be learned from other areas and informed by evidence that is now available. 8. CONCLUSIONS 8.1 The IJB PFA should be assured that scope and span of work completed to date provides a foundation that can facilitate delivery of further service improvement work planned to address long waits with CYP service. 9. IMPLICATIONS The implications of not addressing historic long waits through a lens of service improvement is that the real barriers to access and patient experience would never be fully understood or addressed.
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7 9.1 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 ☐ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL Not applicable in this report at this time. 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 IJB23.24 SLT Service High Claire Rae 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.
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8 Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Scoping of service and areas of priority has been undertaken independently of unit. Contributors have included professional leads, aligned professional groups, colleagues within service inclusive of non-registered staff and administration colleagues ☒ Provide stakeholders with information on how to get involved Wide membership represented within Steering Group. Comms and Engagement colleagues have supported work stream leads to disseminate information. ☐ 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 Regular feedback on improvements being delivered are shared via SCCG and within locality network ☐ 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 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA is in progress and will be bench marked against delivery of work stream objectives.
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9 EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS Home - Speech and Language Therapy 11. APPENDICES CHIEF ACCOUNTABLE OFFICER (or Depute) Maggs Thomson, Head of Health, NLHSCP Members seeking further information about any aspect of this report, please contact the following; Pauline Izat- pauline.izat@lanarkshire.scot.nhs.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 Item No: 10 SUBJECT: An update on Care Academy TO: Integrated Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Chief Officer – Performance, Planning & Quality Assurance Author(s) of Report Maria Williamson, Senior Manager Quality Assurance DATE: 23rd October 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 Maria Williamson (Senior Manager Quality Assurance) and reviewed and endorsed by Morag Dendy, Chief Officer – Performance, Planning & Quality Assurance. Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA acknowledge the progress with Implementation of the Care Academy Pan Lanarkshire. 3.2 It is recommended that the IJB seek a further update on progress with the workstreams in 6 months’ time.
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2 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 Lanarkshire population is ageing with many older people and a growing number of younger people living with two or more long terms conditions such as diabetes and respiratory disease. The burden of illness will continue to increase over the next ten years as the population ages. Health and social care services are already experiencing the impact of meeting the needs of an ageing population, for example, in Home Support and District Nursing services. The vulnerability of the ageing group has been demonstrated in the pandemic, which has in turn created specific pressures for the care professions. 5.2 In an employment context, in 2023, Human Health and Social Work was the largest employing industry in Lanarkshire, accounting for 45,700 people. This industry is forecast to remain in the top employing sectors in the Lanarkshire between 2026 and 2033. 5.3 Future job openings are expected to be concentrated in a small number of industries. Within the period 2023 – 2026, figure 1 highlights the forecast total requirement by industry. As is clear, Human Health and Social Work has a requirement of 4,400 people (1,200 based on predicted expansion demand and 3,200 based on replacement demand). 5.4 Employment growth in this sector is driven by Scotland’s ageing population along with the aim to protect the provision of frontline services. It is therefore crucial that the attractiveness and retention of jobs within this sector is a key focus for future activity. 5.5 Opportunities to respond to workforce challenges exist with recently formed partnership arrangements which have been agreed between Universities and the Health and Social Care Partnerships across Lanarkshire. The key objectives for the partnerships are to formalise the working relationship between the council’s and the universities such that over an agreed period, there is a process in place for identifying, defining, and progressing potential opportunities for engagement through collaboration. To achieve this, the scope of the partnership agreements covers interactions such as research collaborations, honorary appointments, Graduate Apprenticeships, student placements, jointly funded posts, secondments of staff, student recruitment, student projects, education, continuing professional development and policy and practice. Yes ☐ No ☒ N/A ☐
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3 5.6 The overall vision for the Care Academy is to: “Develop a robust, sustained, vibrant Care Academy attracting and developing a diverse workforce for health and care services in Lanarkshire and promoting the sector as a rewarding choice for careers”. 5.7 The pan-Lan membership has been reviewed with a refreshed Terms of Reference outlining the responsibilities of the Board, and areas of activity which are (and are not) within its remit. Members of the Steering Group have been selected based on their subject matter experience and expertise. 5.8 Four workstreams have been established with the remit of each clear covered in the Terms of Reference. Related task and finish groups will be enabled by workstreams as appropriate. Each workstream has authority (under the strategic direction of the Steering Group) to determine how workstream items will be resourced, progressed, monitored, and delivered. The workstreams are: 5.8.1 W1 – Attraction, recruitment, retention and wellbeing Developing recruitment strategies to attract prospective candidates to the sector. Engaging and focusing on employee safety, well-being motivation to enhance employee retention. 5.8.2 W2 – Pathways to care for young people Strengthening the reach and impact into the health and social care sector through a vocational education model, aiming to grow a future talent pipeline. 5.8.3 W3 – Adult pathways to care Improving prospects for working-age adults entering the health and social care sector, addressing poverty, and inequality, attracting passive candidates, and facilitating career change opportunities. 5.8.4 W4 – Funding and procurement Continually review and assess current and upcoming funding streams and identify potential gaps and opportunities. Explore the potential of community benefits opportunities. It was agreed at the most recent Board meeting to put this workstream on hold until the others are all well established. 5.9 The Care Academy is a collaborative initiative between NHS Lanarkshire, North Lanarkshire Council and South Lanarkshire Council. It reports through both North and South Lanarkshire Council’s committee structure. The Academy is authorised to work with partners such as local councils, education departments, colleges, universities, the independent sector and third-sector organisations to attract and recruit staff to the health and social care workforce.
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4 6. CONCLUSIONS 6.1 Each of the workstreams are now established, with specific actions within each being developed by the workstreams themselves. As work progresses the Workstream Lead will be responsible for ensuring the deliverables are met with any exceptions and delays reported to the Steering Group. 6.2 A further update on progress on each of the workstreams will be brought back to IJB in 6 months. Progress and updates are also provided through: • Brighter Futures Programme Board - North Lanarkshire • Social Work Resource and Finance and Corporate Resources (Personnel Services) – South Lanarkshire • Core management team of both HSCP’s – NHSL 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 7.3.1 This paper has been reviewed by Finance: Yes No N/A
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5 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Service Risk Register Medium Chief Officer Adult Social Work 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 Campaign to promote the sector and the work of the Care Academy will be developed through Workstream 1. ☒ 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 Contained within the ToR ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership
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6 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 None. Please include a glossary of terms if not already included. 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
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 Item No: 11 SUBJECT: Performance Update – Quarter 1 (April – June 2024) TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 23 October 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 5.1 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. 5.2 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 ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Yes ☐ No ☐ N/A ☒
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3 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 Claire Rae 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 ☐ Ensure a diverse range of engagement and participation and opportunities are in Yes ☐ No ☐ 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 ☐ 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 None. Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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5 9. APPENDICES Appendix 1 Areas for Improvement (Quarter 1, April – June 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 Appendix 1 2. Cervical Screening Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 71.2% 71.0% RED Narrative & Corrective Action 1. Alcohol Brief Interventions Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 598 539* RED Alcohol Brief Interventions (all settings) NHSL 7381 1806 1556* RED Narrative & Corrective Action Due to an unforeseen issue with access to the ABI database it is not possible to confirm the information recorded within the database. Some ABI information is recorded on Morse and it has been possible to report on this, however it is known that the figures presented here are not wholly accurate and are reported for management information only. It is most likely that the figures presented here are understated and subsequent reporting will reflect performance in-line with expected trajectories. Revised ABI trajectories for North Lanarkshire were recently subject of an approval process and those revised targets have been updated and appear on the attached scorecard. The trajectories, which have been reset according to the latest population and activity data available, are an increase on the previous target but also provide locality level targets, offering autonomy for operational managers to monitor and manage their local targets.
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7 Detailed analysis of the data for Cervical Screening uptake in Lanarkshire is presented in a Milan Dashboard. During Q1, for the North Lanarkshire localities, in: • Airdrie - no practices achieved the 80% uptake target (range from 60% - 73.2%). • Bellshill - no practices achieved the 80% uptake target (range 66.3% - 75.1%) • Coatbridge - no practices achieved the 80% uptake target (range 64.6% - 75.9%) • Motherwell - no practices achieved the 80% uptake target (range 65.8% - 79.3%) • North - 2 practices achieved above 80% uptake target (range 74.8% - 84.1%) • Wishaw - no practices achieved the 80% uptake target (range 59.6% - 70.9%) Health Improvement and Public Health Support to Practices Public Health and Health Improvement Teams continue to provide support to North Lanarkshire practitioners to maintain and increase Cervical Screening update. In the last quarter, the Public Health Quality Improvement Facilitator has commenced a new initiative to provide support to practices on how to use the Scottish Cervical Cancer Recall System (SCCRS), which allows them to identify and prioritise “defaulters” (those who have been invited and failed to engage) and generate bespoke communications for defaulters, such as customised invitation letters to encourage uptake. Public Health and Health Improvement Teams are also in the process of producing a “How-to Guide” for practitioners, with the aim of encouraging a more efficient and standardised approach to the administrative processes for Cervical Screening. Scottish Inequalities Funds (SIF) 67.8% 69.5% 74.8% 73.3% 69.6% 73.5% 71.6% 71.4% 74.9% 70.2% 60.0% 70.0% 80.0% 90.0% 100.0% Locality Cervical Screening Uptake Q1 2024
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8 Additional SIF funding has been offered to GP practices in lower SIMD areas where there is low Cervical Screening uptake. The funds were to be used to address the practice defaulters list and offer additional screening clinic appointments. The 5 North Lanarkshire practices that took up the offer are: • Bankhouse (Airdrie) • Thistle (Airdrie) • Holytown (Bellshill) • John Street (Bellshill) • Old Mill (Bellshill Evaluation reports will be available by next Performance Review detailing the impact of the funding. Communications A number of initiatives are in place, or planned to improve communication between the Health & Social Care Partnership and General Practices to address low uptake for Cervical Screening. • Cervical Screening presentations with the latest data and information are now standing and/or regular agenda items at meetings with Clinical Leads, Health and Social Care Managers, Service Managers, Social Work Managers, Senior Nurses, Practice Managers, Practice Nurses Clinical Fora and Community Boards • An agreement has been reached with the Clinical Leads for Health Improvement to provide practices with quarterly Cervical Screening uptake data and supporting narrative to inform locality discussions • Use of the results of the recent Cervical Audit with practices (the detail includes uptake for Cervical Smear, use of waiting room digital screens to promote Cervical Screening information and messages, such as appointment availability) to highlight where improvements can be made Community Consultation and Engagement • Developing Learning Resources in Consultation with Local Women - A training resource that captures the voices of women is currently being developed, this was developed in targeted engagement with women’s groups to understand why women don’t want to attend and to listen to how we can make this process easier and better. The final product will then be shared with professionals as a workforce training resource. • A video detailing a local South Asian woman’s lived experience of surviving Cervical Cancer is also being developed to be used as a resource for communities and professionals. 3. Childhood Immunisations Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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9 Immunisations – %s of 5 year olds 95% 90.1% 90.4% 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. These additional clinics were held during the “free” week in 5 week months; any additional free time that can be identified as suitable is being utilised 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. 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. 4. 6 – 8 Week Reviews Target 2024/25 2023/24 Q4 2024/25 Q1 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% 71.5% Quarterly/ 1 quarter behind RED... Narrative & Corrective Action
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10 It has recently been established that this performance metric has been incorrectly reported in the recent past (post-Covid), 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. 5. Reablement and Rehabilitation Target 2024/25 2023/24 Q4 2024/25 Q1 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% 60.8% 61.1% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 58.5% 62.6% RED Balance Of Care - % Of People (Age 65+) 45% 36.4% 37.1% RED Narrative & Corrective Action Reablement / Home Assessment Team
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11 Since the creation of HAT and at the end of Q1, there had been a total of 2119 referrals accepted by HAT, although the 110 referrals in June was a decrease from the 128 accepted in May. Over a rolling twelve months, Wishaw has accepted 25% of the total referrals, with Airdrie, Motherwell and Cumbernauld having between 18% and 22% of the total. The proportion for Bellshill and Coatbridge is increasing as the teams develop. It is of note that the number of referrals that have not been accepted has grown recently, with 60 referrals not being accepted in June. The referrals by locality in the last year were: Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw Total 254 98 103 283 238 331 1307 19% 7% 8% 22% 18% 25% 100% The hospitals where referrals originated from are shown in the table that follows. There is little difference in the proportionality from previous reporting. Those categorised as “Other” represent older cases when a prior recording system was in use. Monklands 979 46% Wishaw 1071 51% Other 69 3% As the data set develops, it is likely that a seasonal trend will emerge in the referral data, with variation during holiday periods.
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12 The majority of referrals received related to females (60%), with the largest number in the age range 75-84 years old (40%). Under 65s only accounted for 9% of referrals and no referral referring to anyone under 18 was recorded. Input Services The overwhelming majority of referrals to HAT have input services, i.e. a service is already in place at the time of the referral; 62% had 1 or 2 services and 35% had 3 or more services. This is consistent across recent reporting and the average number of input services from HAT has only shown a slight increase over time. Overall, the largest input service remains Home Support, followed by OT and this is fairly consistent.
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13 Outcomes 13% of people were re-admitted to hospital at the end of the HAT process. At the end of the HAT process, for those noted as reaching this stage, recordings show that 63% required no further service, with 37% noted as having at least 1 service. For those requiring further service, the service with the highest number was CAS., followed by Home Support Reablement and IRT (Physio). This figure will differ in the future as ongoing service is being reconfigured to not include referrals being made to other service, such as NL Leisure.
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14 Significant effort continues to be applied to reduce discharge delays and a more coordinated approach to the work of the Flow Boards and concise monthly planning should see sustained impacts on overall system performance. This work is in preparation for Firebreak ’24, which is taking place during 16-25 September. A newly implemented Optimal Discharge Planning Target Operating Model (TOM) is now in place, designed to improve patient discharge experiences across all hospitals in Lanarkshire and ensure that patients have a smooth and well-coordinated transition from hospital to home or other care settings, avoiding unnecessary delays and improving overall outcomes. The TOM introduces four Discharge Pathways to identify and address the specific discharge needs of each patient, ensuring that every step is tailored to their situation. The Multidisciplinary Team (MDT) approach to be employed emphasises the importance of early and continuous discharge planning involving the entire MDT, ensuring all patients receive the right care at the right time. Partners have agreed on the key principles for effective discharge planning, which involves early patient and family engagement, detailed assessments, and proactive arrangements to ensure a seamless discharge process. The overall goal is to make every discharge a positive experience for our patients, supporting their recovery and reducing their time in hospital in line with our commitment to Patient-Centred Care. Materials have been produced to support staff, including a video explaining the roles and responsibilities within the MDT and the activities that ensure timely and safe discharges, team briefing sessions about the new Optimal Discharge Target Operating Model and a new Turas module on Optimal Discharge. 6. CAMHS Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 58.7% 57.6% RED Narrative & Corrective Action The RTT performance saw a slight decrease again during Q1 of 2024/25. The historic data available shows that in previous years, the service has experienced higher RTT% performance, however this does not reflect the increasing number of Children and Young People (CYP) waiting for first assessment, which is a significant factor in the increase in RTT time. The reduced capacity to see new patients has resulted in more routine/return activity, which in turn results in decreased RTT performance. It is of note that in the final month of Q1, in June 2024 there appears to have been a recovery of the position more in-line with the expected trajectory. This has been achieved by reviewing seasonal variance of patient attendance and staff capacity. To support the recovery, a focussed week of choice appointment activity was undertaken in April. This was subsequently followed by a 40% increase and 60% increase in baseline choice activity in May and June, respectively. A further week of ring fenced choice activity is scheduled to occur in all teams throughout late June and July.
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15 CAMHS Projection/Trajectories It is important to highlight that at the close of 2023/24, over 200 waits had been removed from the waiting list, with 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. The Scottish Government recently wrote to selected Health Boards regarding their recent review of the support provided to NHS Boards; the review was based on recent CAMHS and PT performance, workforce, financial information and intelligence gathered from engagement with NHS professional leads. As a result of this, they are now providing an enhanced support package to work with NHS Lanarkshire and our delivery partners to improve performance around CAMHS and PT.
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16 As the service now has one full year of CAPA and Choice appointment data, updated trajectories based on this actual data have been produced; as the volume of data increases, the intelligence in this area will increase accordingly with an associated increase in the reliability and robustness of projections and trajectories. 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. Flow through the service continues to be challenging. There is anecdotal evidence that cases are increasingly complex and difficult to address with standardised approaches. It is believed that as a result, a bottleneck is created in CYP awaiting allocation to a caseload from the patient return list. Many of these CYP have co-existent neurodiversity challenges, alongside a coexistent compromised mental health presentation. A focussed piece of work is in progress during July and August 2024, as referrals to the service for new assessments usually decrease. The work will deliver a pause to facilitate an assurance review of current caseloads to ensure they still meet the needs of the service. Work is also 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 the weeks identified as a challenge. This will remain under review to ascertain if there is any improvement. A monthly performance meeting has been established to ensure that local CAPA runs do not progress without examination of job plans and approval from senior CAMHS management colleagues. Focused work is being undertaken with clinical managers to understand the balance of capacity with demand. Support is now in place from a Senior Information Analyst, providing analysis of data and developing RTT trajectories. The ongoing support from the SIA is subject to any changes in workforce funding. The approach adopted has been very successful in Psychological Therapies, and it is anticipated this will be a significant support to the service. Updated trajectories have been provided for 2024/25 and will continue to be updated and developed. Psychiatric Consultant capacity continues to be challenged, however the vacancy rate has reduced to 39% (although this is currently being negatively impacted by long term sickness). A vacant post has been appointed to and the successful candidate will take up post in October; this will reduce vacancy rate to 31%. Interviews took place for a further substantive post in July. 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 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 • Additional support from the wider CAMHS workforce (AHP groups, Pharmacy), as well as centralised to provide additional scheduled and unscheduled support to locality teams.
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17 • 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. Work to adopt and embed MORSE is ongoing, with the roll-out commencing in July 2024. MORSE will provide organisational assurance of both caseload size and the visibility of service input and care plans across the service and NHS Lanarkshire. 7. Adult Mental Health Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 78.1% 76.0% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 37.7% 40.0% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 74.7% 69.4% 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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18 A number of factors contribute to the inability to meet the RTT target, most notably the WTE establishment. 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. 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. Using existing referral data grouped by source, we can see in the chart below the impact; the purple sections are Calm Distress and the green sections are the other self-referral modules. Since April 2021, when the service starting reporting these referral types, self-referrals have made up an average of approximately 214 referrals per month, equating to an average of about 17.5% of the total referrals each month. In terms of cases starting treatment, the average number of self-referrals reported is a similar number, equating to an average of approximately 25% of all cases starting treatment each month. In 2023, Lanarkshire PT services received 15,006 referrals, 48.1% of which were
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19 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. In terms of RTT performance (% starting treatment within 18 weeks), excluding the self-referrals does cause a noticeable drop in performance, as illustrated in the table below: Time Period Self-Referrals Included Self-Referrals NOT Included Apr 2021 to Jun 2024 82.48% 76.5% Jul 2023 to Jun 2024 78.9% 73% There remains 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 until the desired reduction in the number of patients waiting longest and over 18 weeks is achieved. The Scottish Government recently wrote to selected Health Boards regarding their recent review of the support provided to NHS Boards; the review was based on recent CAMHS and PT performance, workforce, financial information and intelligence gathered from engagement with NHS professional leads. As a result of this, they are now providing an enhanced support package to work with NHS Lanarkshire and our delivery partners to improve performance around CAMHS and PT. This will take the form of a new PT Implementation team established by the Scottish Government, who will work with NHS Lanarkshire to provide advice and support regarding improving access and increasing the quality of care in line with the national specification for psychological therapies and interventions. 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 within the existing establishment 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 resulting in 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 the Consultants resume their normal practice. The service also restructured Associate Specialist sessions to accommodate the vacancy. The new Motherwell-based Consultant started in August 2024 and has taken on the Huntington’s workload; some improvement in waiting times should be seen in subsequent quarters. The service has experienced changes to practice and two of the senior medics who are not Consultants have had to change their practice and number of sessions for health and personal reasons. The service has not been successful in recruiting to the specialty doctor sessions but will look at where other junior colleagues might cover these gaps, which will in turn provide development for those in junior grades, gaining experience and competency and may contribute positively to retention in the longer-term. Locally, teams will run ad hoc clinics to manage increased waiting times, which are monitored at departmental level to achieve the best balance of demand and capacity. Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) Recruitment, retention and development of staff is the primary challenge for the service and when considering where performance improvements might be realised, it is a lack of staff, whether through an imbalance of demand/capacity, or stability within the service that impacts most on the ability to meet service standards. The vacancy
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20 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. 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.
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21 • 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 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
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22 • 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. 8. SLT Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 21.2% 15.8% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 91.5% 85.6% RED Narrative & Corrective Action SLT Adults Service As the SLT Adults team is relatively small with few establishment WTE, any absence has a significant impact on service delivery; even a small number of short and long- term absences can have a significant impact and this is particularly evident when the absence is calculated and communicated as a percentage. As it is a team with predominantly female colleagues, the impact of any maternity leave can impact disproportionately when compared with some other services. During Q1, a number of factors have been noted as impacting on the performance: - • During Q1 there was a spike in Covid infections amongst the staff and one long-term absence. • Two colleagues returned from maternity Leave during Q1, however there was no added capacity available due to use of annual leave to support their RTW. Both colleagues have returned to work with reduced contractual hours and a contraction in finances has resulted in the service being unable to advertise posts that are favourable to applicants. • A further colleague left for Maternity Leave earlier than planned. • Financial flexibility to offer additional hours to supplement capacity is no longer available (since April 2024). • Referral rates were higher than the same quarter in 2023 (Q1 2023/24). • A reduced capacity due to the decrease in the working week. Service Improvement Plan 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
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23 • 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. Some aspects of the Programme have experienced limited progress; however, this is reflective of capacity within the service to progress the work. An OSM post has been advertised for a 1 year fixed-term and it is hoped that the role once recruited to, will increase the capacity for improvement work. 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. Although the service has several challenges, the most significant is sustained vacancies within the service. 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. • 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. Additionally, there is some initial scoping of the Health Visiting mobile application and how it might provide improvements if a similar tool was adopted in SLT.
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24 9. Dietetics Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 74.1% 64.8% RED Narrative & Corrective Action There has been a reversal of the improvements seen in Q3 and Q4; although the overall long-term trend is for improving performance, further analysis would be required to understand the variation being experienced. There is a likely cause/effect relationship with wider system factors, however 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. 10. Complaints Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days(NHSL) 100% 40.0% 27.0% RED Narrative & Corrective Action Within NHS Lanarkshire, additional resource has been diverted to support the transition from Datix to InPhase. To supplement this, additional hours have been authorised for complaints staff to deal with open complaints and producing an appropriate response within acceptable timescales. With annual leave reducing the available capacity during the summer holiday period, it is likely that there will be further delays in producing management and performance information, and additionally delays in response due to the reduced capacity within patient affairs and the general body of staff who provide material for complaint responses. Due to the recognised impact on the current timescales for addressing stage 2 complaints, resource has been agreed allowing dedicated complaints staff to work additional hours to positively impact on the overall timeline and improve compliance.
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25 11. Smoking Cessation Target 2024/25 2023/24 Q2 2023/24 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 110 170 ... ... RED Narrative & Corrective Action Please note that this data is presented quarterly, two quarters in arrears. 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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26 12. Adult Social Work Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status % Of Adult Protection Investigations Going To Initial Case Conference 20% 11.9% 12.3% RED Narrative & Corrective Action The overall number of Adult Protection referrals has decreased by 13% when compared with Q1 of 2023/24. A significant part of this overall decrease is due to a decrease in the number of referrals from the Care Home sector, which fell 34% (from 367 to 204). Despite this, Police and Health Adult Protection referrals have both increased; Police referrals have increased by 30% in comparison to Q1 of 2023/24 (94 to 121) and Health referrals have increased by 15% (155 to 178). Some additional analysis may be required, as the number of Police adult concern reports have decreased significantly; a decrease of 30% when compared with 2023/24 (1184 to 812). Adult Protection Referrals Apr 2024 May 2024 Jun 2024 Total Airdrie 46 44 40 130 Bellshill 38 43 36 117 Coatbridge 43 69 40 152 Cumbernauld 55 34 28 117 Motherwell 23 30 18 71 Wishaw 35 42 35 112 SWES 27 39 26 92 Total referrals received= 791 Police Adult Protection Concern Reports Apr 2024 May 2024 Jun 2024 Total Airdrie 59 71 40 170
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27 Bellshill 35 35 19 89 Coatbridge 70 57 60 70 Cumbernauld 73 96 82 187 Motherwell 44 41 32 117 Wishaw 50 59 70 179 Total referrals received= 812 Around 20% of all Adult Protection referrals were progressed as an inquiry with investigatory activity, however only 9% of inquires with investigatory activity went on to progress to an initial case conference (13 total initial case conferences were held and 10 review case conferences). 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. 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. 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. 13. Sickness Absence Target 2024/25 2023/24 Q4 2024/25 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 6.88% 7.49% RED Narrative & Corrective Action NHS Lanarkshire remains among the poorer performing boards in Scotland for sickness absence. Based upon historic seasonal trends it is likely that there is some underlying seasonal variation. Although above the target of 4%, the level of sickness absence appears to be relatively stable within a range. Anxiety, stress and other mental health issues remain the most prevalent cause of sickness absence, however the proportion decreased slightly in the later months of 2023/24.
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28 There is a dedicated work stream as part of the Sustainability and Value Workforce Optimisation Group that focuses on reducing sickness absence within NHSL. Within the partnership, long and short-term sickness absence continues to be managed in accordance with the relevant organisational policies and monitored at service level.
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29 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 12 SUBJECT: Tackling Poverty-Cost of Living Helpline TO: Integration Joint Board Performance, Finance and Audit and Committee Lead Officer for Report: Alison Gordon Chief Social Work Officer (Education, Families, Justice & Integrated Practice) Author(s) of Report John Campbell, Business Manager Tackling Poverty DATE: 23rd October 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 Business Manager Tackling Poverty ☒ Reviewed By: Chief Social Work Officer. ☒ Endorsed By: ☐
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2 3. EXECUTIVE SUMMARY This report provides details of the income maximisation work carried out by the Cost- of-Living Helpline (Tackling Poverty Team) and Council Services during 2023/24 which generated £47,935,822 in additional benefit income for the residents of North Lanarkshire an increase of 35.1% from the previous year. Over this reporting period the continuing legacy of the pandemic and most significantly the Cost-of-Living Crisis have continued to impact disproportionately on our most disadvantaged residents and communities, bringing the importance of income maximisation and wider work to tackle poverty into sharp focus, with the impact of low paid and insecure work a particular challenge. Since establishing the ‘Cost of Living Helpline’ in early 2023, supported by additional funding provided through the Joint Integration Board, there had been an increase of 41.2% in the number of benefit checks completed for residents; rising from 18.521 benefit checks completed in 2022/23 to 26,158 benefit checks completed in 2023/24. More broadly local approaches to tackling poverty and reducing inequality in North Lanarkshire, continue to be driven by the ‘Towards a Fairer ‘North Lanarkshire Tackling Poverty Strategy with activity focused on the key drivers of poverty. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note the contents of the report. 4.2 Endorse the report and note the impact of the funding of the Cost-of-Living helpline for residents 4.3 Approve the request to extend the use the already earmarked funds (£600,000, from April 2023 to March 2025) to support the enhanced service to June 2025. 5. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐
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3 6. BACKGROUND 6.1 Despite recent positive news on wage growth, the legacy of the global pandemic, ongoing cost-of-living crisis and high levels of deprivation, continue to acutely affect inequality and poverty in North Lanarkshire, impacting the most vulnerable in North Lanarkshire’s communities. Against this landscape the refreshed ‘Towards a Fairer North Lanarkshire’ Tackling - Poverty Strategy for 2023-2026, sets out our ambition to continue to tackle poverty and child poverty, building on our previous actions and some of the positive foundations achieved through the previous strategy for 2020-2023. The new and refreshed Tackling Poverty Strategy encompasses an integrated multi service approach within the Council, alongside an increased focus on working externally with all community planning partners, communities, and people with lived experience of poverty. 6.2 In addition, the Strategy encompasses the statutory requirement to prepare and publish a Local Child Poverty Action Report for North Lanarkshire for 2022/23, reflects the ambition of the national Tackling Child Poverty Delivery Plan 2022- 26 Best Start Bright Futures published by the Scottish Government in April 2022 as the second of 3 delivery plans required by the Child Poverty (Scotland) Act 2017. 6.3 The Tackling Poverty Team, Health and Social Work Services and Housing Solutions provides service users and members of the public with advice and assistance on a wide variety of benefit-related issues. A full benefits check is offered to all new service users. Income maximisation also plays a vital role in longer term Social Work services such as Community Care, Children and Families, Kinship Care, Justice Services, Mental Health, and Addictions. 6.4 A key role of the Tackling Poverty Team is to support the income maximisation service through the First Point of Contact Team to residents, Support Services for fieldwork staff, supporting specialist Social Work Services, Education Services and Housing Services and the Resolution Team representing clients at tribunals and hearings. Successful welfare rights intervention, where individuals are awarded extra benefit, frequently means that, as a result of increased income, they are better able to manage their own affairs and may not require further health and social work services. 6.5 The cost-of-living crisis continues to exacerbate existing health inequalities through its wider impacts on physical and mental health and well-being and in line with its strong commitment to prevention, the Health and Social Care Partnership have been keen to explore options to enhance the early help and advice available to individuals and families impacted by the current crisis. 6.6 On 30th November 2022, the Integration Joint Board approved funding of £300,000 per year 2023/24 and 2024/2025 to allow the Tackling Poverty Team to recruit additional staff and for the Council to establish a ‘Cost of Living Helpline’.
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4 7. SUMMARY OF KEY ISSUES 7.1 Although inflation has dropped from over 11% down to just above 2% in the last year, the cost-of-living crisis continues, to have unprecedented pressures on people already in poverty in North Lanarkshire. With thousands of people being forced into poverty, having to make tough decisions about when and what they eat, keep their homes, what they can do in life, and when they can afford to heat their home. 7.2 The recovery from the pandemic, the cost-of-living crisis and a number of issues causing or exacerbating the effects of poverty on people in North Lanarkshire. Whilst Inflation has reduced in 2024, issues such as mortgage interest rates increases, price increases on energy, fuel and food increases, real term cuts in wages and welfare reforms continue to acutely affect inequality and poverty, together with other economic factors, impacts the most vulnerable in North Lanarkshire’s communities. 7.3 The supports coming from both the Scottish and UK governments, have been reduced significantly 2024/2025 and the next few years will be extremely challenging for a significant number of households. 7.4 The Tackling Poverty Team submitted its Activity Report for 2023/24 to the Wellbeing and Tackling Poverty Committee on 16th August 2024, which is remitted to the IJB Board for information. 7.5 This report to Performance and Finance, outlines the activity of the Cost-of- Living Helpline and the impact of the wider use of referral pathways with Council Services, IJB Services and NHS Lanarkshire. 7.6 Since establishing the ‘Cost of Living Helpline’ in 2023, with funding provided by the Joint Integration Board, there had been an increase of 41.2% in the number of benefit checks completed for residents; rising from 18.521 benefit checks completed in 2022/23 to 26,158 benefit checks completed in 2023/24. 7.7 The additional benefit income generated by the Tackling Poverty Team and other council services increased by 35.1%, with a total of £47,935,822 of additional benefit income generated via claims, mandatory reconsiderations and appeals for benefits. 7.8 There has been a considerable increase in demand for the Tackling Poverty Team welfare rights service, with the average number of referrals per month received by the team rising from 945 in 2022/23 to 1180 referrals per month in 2023/24. A 25% increase.
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5 Maximising Income of Health and Social Work Service Users – 7.9 Social Workers can refer people and families to the Tackling Poverty Team to ensure that income is fully maximised, and that people have access to budgeting/debt advice as well as financial education. 7.10 The Tackling Poverty Team have a dedicated “support services team” for referrals from social work and other council services which may be complex and require more than initial advice offered by First Point of Contact. Referrals for Kinship Carers and those people entering residential care are sent directly to Support Services. 7.11 Considerable work has been done by the Tackling Poverty Team to promote this within social work localities and referrals have almost doubled in numbers to the team, with 4888 benefit checks being carried out via referrals received from social workers the previous year to 9639 benefit checks completed in 2023/24. 7.12 In total £5,062,066 of additional benefit income was generated for people receiving social work services, £743,199 of this is attributed to kinship care families, £895,191 generated for people accessing Justice and children and families’ services, with the remaining £3,423,676 for those accessing community care services. MacMillan Advice Service 7.13 The Tackling Poverty Team host the MacMillan Advice Service which offers income maximisation to those people and their families who are affected by a cancer diagnosis. 7.14 The Tackling Poverty Team received 700 referrals from MacMillan in 2023/24, the same number of referrals as the previous year. 52% of those people referred to the service had a terminal illness diagnosis. 7.15 The work carried out by the Tackling Poverty Team generated £3,542,782 in additional benefit income for patients and their families. Food Poverty 7.16 the food poverty referral gateway aim is to mitigate the need for foodbanks or reduce the use of foodbanks by ensuring access to advice services, claims for the Scottish Welfare Fund crisis grants and provide a cash first approach. 7.17 North Lanarkshire Council has led the way since 2014 in promoting a Cash First approach to tackling food poverty, by ensuring that people do not only have access to crisis grants for the immediate need, but also access to information and advice services to ensure sustainable solutions to food crisis. 7.18 Referrals to the Tackling Poverty Team for people who are presenting in food crisis have generated £1,211,758 in additional benefit income, with people receiving assistance to claim benefits such as adult disability payment, council tax reduction, Scottish child payment, pension credits and others.
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6 7.19 Via a Scottish Government funding bid, which was lodged by the Tackling Poverty Team in conjunction with the Food Poverty Action Group. The funding will provide people referred to the tackling poverty team who have been assisted with a crisis grant, an interim payment until the crisis grant decision has been made. 7.20 The Scottish Government funding will also allow for work to be done with emergency food providers, to allow for more uniform reporting, therefore allowing us to better measure the impact this approach is having on demand for emergency food. Health Services 7.21 For the purposes of this report relates to partnership working in this area with Health Services. 7.22 General health staff referrals to the team have increased by 50% from 2022/23 with 591 referrals received in 2023/24. The additional benefit income generated via these referrals has been £872,366. 7.23 Referrals from Health Visitors and District Nurses are relatively low in comparison to other areas of health. The total income generated from the 119 2023/24 referrals is £144,251. 7.24 Discussions have already taken place between Health Improvement Leads and the Tackling Poverty Team to plan sessions to improve the work in this area. 7.25 NHS Lanarkshire employ Community Link Workers who will take referrals from GPs in respect of social prescribing. Temporary funding has been provided to both the Tackling Poverty Team and external partners to provide income maximisation and money advice services. 7.26 Referrals from the GP Link Workers have also fallen with 482 welfare rights referrals received in 2022/23 and 333 in 23/24. The 333 welfare rights referrals to the tackling poverty team generated £252,504 in additional benefit income. (debt advice referrals 146 2022/23 and 133 in 2023/24) Improvement Service Project (Wealth & Health Project) 7.25 Temporary funding has been provided by the Improvement Service to install a welfare rights officer within 4 GP practices in North Lanarkshire (Bellshill, Coatbridge x2, Wishaw). 7.28 This project has proven to be very successful, with a 70% increase in referrals from the previous year to 608 this year. The total additional income generated for patients from these four practices is £1,738,154. Overview NHS Lanarkshire Services – Tackling Poverty Team 7.29 The Partnership between NHS Lanarkshire Services and the Tackling Poverty Team has resulted in over 2350 patients receiving a benefit check in 2023/24,
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7 with £6,550,056 in additional benefit income being generated, with14% of the income generated within North Lanarkshire was generated from Health Referrals Appendix 1 provides a more detailed presentation of the income generated for 2023/24 for Health and Social Care Services 8. CONCLUSIONS 8.1 Extending the capacity of the Tackling Poverty Team has allowed the team, to support the wider capacity issues for the Third Sector, Health and Social Care Services, Education and Families Services, Housing Solutions, and other Community Planning Partners, by providing advice, support and referral pathways for these services, and the community drop-in centres, North Lanarkshire Council’s -Work Local Hubs (available to all Council, IJB and NHS Lanarkshire staff). 8.2 As recognised above it is inevitable that the pressures and reality of the Cost- of-Living Crisis means many people will also experience negative impacts on their health and wellbeing, the Tackling Poverty Team have received additional training in key areas, e.g. mental health and wellbeing to support capacity to recognise and respond to wider needs through the appropriate signposting and referrals. The Tackling Poverty Team and NHS Lanarkshire already have a well-developed approach for financial wellbeing, signposting to other services and referrals pathways, this builds on the learning from the NL Covid (Community Hubs) Helpline. 8.3 The Tackling Poverty Team monitors and records activity of the helpline, in number of people assisted, reason for referral, income generated, advice given, outcomes, number of people/referrals signposted to other services/agencies. The Tackling Poverty Team reports on the wider use of the referral pathways with, Council Services, IJB Services and NHS Lanarkshire. 8.4 There has been a fall in activity and referrals from the Community Link Workers and low numbers from Health Visitors and District Nurses in 2023/2024. The Tackling Poverty Team and NHS Lanarkshire staff are reviewing these referral pathways to look at what steps are required to encourage and increase the referrals from these heath services during 2024/25. 8.5 To date, it is predicted that the total spends by March 2025 against the funds committed by the IJB to enhance team capacity and support the helpline will be £455,000. The underspend is due to recruitment challenges, only recruiting 2 Clerical Assistants, rather than the 4 included in the original staffing levels proposed and also due to staff moving on to permanent posts. 8.6 It is requested that there is agreement to carry over the remaining funding committed by the IJB to allow the contracts of staff employed to be extended to support the Cost-of-Living Helpline and maintain enhanced capacity until
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8 30th June 2025. This will allow the service to review any adjustments which require to be made to the service to align with decisions made on future core and supplementary funding streams. 8.7 It would be the intention to report back to the IJB Performance and Finance under the same cycle of reporting back to the Council’s Wellbeing and Tackling Poverty Committee, in 2025. 9. IMPLICATIONS 9.1 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 reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 9.2 ASSOCIATED MEASURE(S) This report highlights one of a number of initiatives being progressed by NHSL and NLC to address the immediate financial challenges facing individuals, families and communities across North Lanarkshire. 9.3 FINANCIAL The funding provided to the Tackling Poverty Team was £600,000 in total over two years 2023/2025. This paper has been reviewed by Finance: Yes No ☒ N/A
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9 9.4 RISK ASSESSMENT/RISK MANAGEMENT Tackling Poverty has been identified as a Corporate Risk, with the Chief Social Work Officer as the risk lead. Towards a Fairer North Lanarkshire - Tackling Poverty Strategy sets out a planned approach which seeks to eliminate poverty or make very significant reductions in the level of poverty resulting in benefit to the residents and including improvement in the overall level of health and wellbeing of communities. Relevant Risk Register Details Current Risk Level Risk Owner NLC Corporate High Alison Gordon IJB15.2022 Cost of Living High Claire Rae 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 outcomes A range of focus groups including with young people has informed the new Tackling Poverty Strategy □ 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 Ongoing engagement opportunities are supported through the multi- agency Tackling Poverty Officer Action Group and through the LOIP Sub Groups and Community Boards which have identified this area as a priority. □ 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
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10 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 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes ☒ No N/A The initiative will reduce inequalities in the community served by North Lanarkshire Council and the IJB. The Tackling Poverty Strategy is fully aligned with the requirements of the Fairer Scotland Duty, its purpose being to reduce the inequalities caused by socio economic disadvantage. https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty- impact-assessments EQIA added to website: Yes ☒ No N/A 10. BACKGROUND PAPERS https://www.northlanarkshire.gov.uk/sites/default/files/2023- 11/Tackling%20Poverty%20Strategy%20Towards%20A%20Fairer%20North %20Lanarkshire.pdf https://www.northlanarkshire.gov.uk/sites/default/files/2023- 11/LOCAL%20CHILD%20POVERTY%20ACTION%20REPORT%202023.pdf 11. APPENDICES Appendix 1Tackling Poverty Team - Cost of Living Helpline June 2024 CHIEF ACCOUNTABLE OFFICER (or Depute)
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11 Members seeking further information about any aspect of this report, please contact Alison Gordon.
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12 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix 1 Tackling Poverty Team – (Cost of Living Helpline) June 2024
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working as per Task is now the Strategy Increase Income Via Social Security – Council Services Maximise Income For Residents Brief Description All residents are offered income maximisation and we continue to promote the “no wrong door” approach Baseline From Action Plan 2022/23 ‐ 18,521 benefit checks completed generating £35,480,020 in additional income Update There has been a 41.2% increase in the number of benefit checks completed, from the previous year, with a total of 26,158 benefit checks carried out for the residents of North Lanarkshire. The total income generated for residents via income form social security benefits is £47,935,822 an increase of 35.1% Issues/ Points to Note The Tackling Poverty Team resources have been increased via external temporary funding from NHS Lanarkshire, Improvement Service and the UK Shared Prosperity (employability), and as such have been able to meet the demand (albeit with waiting times increasing).
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working as per Task is now the Strategy Increase Income Via Social Security – Council Services Maximise Income For Residents Brief Description All residents are offered income maximisation and we continue to promote the “no wrong door” approach First Point of Contact Referrals 1377 1242 1165 1305 1294 1295 1227 1174 1151 1092 1066 1005 933 926 977 972 1031 1051 792 773 717 APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH referrals 2022/23 referrals 2023/24 Issues/ Points to Note There has been a notable increase in the demand for welfare rights services, with the average number of referrals per month received by the team rising from 945 to 1180 (a 25%increase). Due to the level of demand on the Service, the normal 3‐5 working day wait for services has at times had to increase to 5‐7 and at peak times 7‐10 working days, this is done in conjunction with the Business Manager. The managed migration for people to move from legacy benefits to Universal Credit is extremely complex and it is vitally important that our staff are on a development path around this. 29% of our staff are on temporary contracts which are due to expire in March 25, as demand increases this remains a risk for the team
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Task is now working as per the Strategy Increase Income Via Social Security Benefits – Work With Social Work Service Brief Description Social work staff refer people to the Tackling Poverty Team who will carry out all income maximisation work Baseline From Action Plan 2022/23 4888 benefit checks Update Considerable work has been done by the Support Services Team within Tackling Poverty to promote referrals for income maximisation. 9639 benefit checks have been carried out via social work referrals, generating £5,062,066 additional income. Issues / Points to Note £743,199 was generated via Kinship Care Benefit Checks – this is an area of good practice that we will highlight in the Local Child Poverty Action Report £ 709,988 was generated via referrals from Justice Services There has been considerable inroads in the work with Social Work staff, we need to build on this ensuring that Poverty Awareness Sessions are carried out for all social work staff.
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social work income generated by referring team £2,000,000.00 £1,900,000.00 £1,800,000.00 £1,700,000.00 £1,600,000.00 £1,500,000.00 £1,400,000.00 £1,300,000.00 £1,200,000.00 £1,100,000.00 £1,000,000.00 £900,000.00 £800,000.00 £700,000.00 £600,000.00 £500,000.00 £400,000.00 £300,000.00 £200,000.00 £100,000.00 £0.00 Increase Income Via Social Security Benefits – Work With Social Work Service
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Task is now working as per the Strategy Task continues to have ongoing work Income Via Social Security Benefits – MacMillan Advice Service Brief Description Maximise the income of cancer patients, their families and carers Baseline From Action Plan 700 referrals received in 2022/23 Update In 2023/24 the Tackling Poverty Team received 700 referrals. Of those referrals, 52% were for people who were terminally ill. The total income generated via MacMillan referrals for patients and their families was £3,542,782. Issues / Points to Note The MacMillan Service is embedded in the work of the Tackling Poverty Team, there is temporary funding for 2 posts, however, the referrals are dealt with by the full team
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Task is now working as per the Strategy Increase Income Via Social Security – Food Poverty (Actions 4&5) Brief Description Mitigate the need for foodbank use by ensuring access to advice services and claims to crisis Grants. Group to consider uniform recording to access all emergency food providers Baseline From Action Plan Due to the lack of uniform recording there is no baseline Update Scottish Government funded project to provide both interim payments and a Co‐ordinator to work with foodbanks looking at uniformity. The funding is also to consider all emergency payments across the council and how these are used. Using the Cash First approach which is about providing sustainable solutions for people, the Team have generated income via social security benefits for people who have presented in food crisis etc, the total income generated is £1,211,758 The co‐ordinator in conjunction with Scottish Welfare Fund have produced a uniform referral fund, work will be done with the emergency food providers to implement this. Issues / Points to Note A number of foodbanks have now resorted to no referral forms, operating drop in sessions, the Co‐ordinator will be exploring this with these organisations.
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Increase Income Via Social Security – Food Poverty (Actions 4&5)
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Brief Description Health staff will ensure money issues are addressed and referrals are made to the tackling poverty team Baseline From Action Plan 394 referrals received in 2022/23 Update There has been a 50% increase in the number of general health referrals to the team, with 591 referrals being received in 23/24 generating 236 claims for benefits resulting in additional benefit increases of £872,366 Issues / Points to Note The Tackling Poverty Team created a “Health Advice Co‐Ordinator” post, the introduction of this post has provided improved recording with procedures put in place to ensure referrals are not only recorded accurately but outcomes are pursued. Task is now working as per the Strategy Income via Social Security – Health Staff
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Brief Description Health staff will ensure money issues are addressed and referrals are made to the tackling poverty team Baseline From Action Plan 357 referrals 22/23 Update The Wealth and Health Project began with three GP practices, one in Airdrie, Bellshill and Coatbridge, a fourth practice in Wishaw came on board at the end of 2023. The project has seen a 70% increase in referrals from last year, with the welfare rights officer receiving 608 GP referrals in 23/24. The total additional income generated for patients from these four practices is £1,738,154 Issues / Points to Note The funding for the Wealth and Health Project is temporary with the council receiving reduced funding for 2024/25. The Improvement Service were able to provide 50% funding for the project due to its success, however, the council have been asked to cover the costs of the additional half post. Task is now working as per the Strategy Income via Social Security – Improvement Service Project (GP Services)
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Brief Description Poverty Awareness Training and pathway training to take place Baseline From Action Plan No baseline available Update 119 referrals were received via health visitors and district nurses in 2023/24, generating 55 claims totalling an additional benefit income of £144,251. Issues / Points to Note Discussions have taken place between the tackling poverty team and health improvement leads to plan Poverty Awareness Sessions across both disciplines. It is recognised that the sessions will be tailored to the different disciplines and patient group of health visitors and district nurses. Below is a table showing the localities referrals are generated from. Task continues to have ongoing work Income via Social Security –Relaunch Health Visitor & District Nurse Referral Pathway Locality Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw No of Referrals 31 6 38 22 21 1
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Brief Description Community Link Worker embedded within GP practices across North Lanarkshire making referrals to information and advice services Baseline From Action Plan 482 welfare rights referrals (22/23) 146 debt advice referrals (22/23) Update There has been a decrease in the number of referrals from the Financial Link Workers to advice services, this is against the trend from all other referrers. In 23/24 welfare rights referrals were 333 and debt advice 133. The income generated from the welfare rights referrals totalled £252,504 Issues / Points to Note There has been some staffing changes within the Financial Link Workers and this may be the cause of a decline in referrals, this will be addressed with all parties involved in delivering this work. The funding for this agreement for both the Tackling Poverty Team and the External Providers is due to expire in March 2025. Task continues to have ongoing work Income via Social Security –GP Community Link Worker Programme
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Team total income MacMillan £3,542,782 Health General £872,366 Health Visitor Pilot £144,251 Health and Wealth Project £1,738,154 Financial Link Workers £252,504 Integrated Addiction Services £0.00 total £6,550,056.12 Income Via Social Security Benefits – Overview of Health Referrals
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1 Item No: 13 SUBJECT: Quality Assurance Annual Report 2023/24 TO: Integrated Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Chief Officer – Performance, Planning & Quality Assurance Author(s) of Report Maria Williamson, Senior Manager Quality Assurance Elaine McIntyre, Service Manager Quality Assurance DATE: 23rd October 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☒ To Note: ☐ 2. ROUTE TO THE BOARD Prepared By: Elaine McIntyre, Service Manager Quality Assurance. ☒ Reviewed By: Maria Williamson (Senior Manager Quality Assurance) ☒ Endorsed By: Morag Dendy, Chief Officer – Performance, Planning & Quality Assurance. ☒ 3. RECOMMENDATIONS It is recommended that the IJB Performance, Finance & Audit Committee Adult Care and Social Work Committee: 3.1 Note and endorse the contents of the report. 3.2 Remit the report to Adult Care and Social Work Committee.
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2 3.3 Remit the report to Education, Children and Families Committee 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 Yes ☒ No ☐ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES This report highlights Quality Assurance activity over the period 1 April 23 to 31 March 24. It covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Market Facilitation, In House Monitoring, Safer Staffing & Communications. Full detail of these activities is included in Appendix A. Contracts 5.1 Over the past year Quality Assurance have continued to strive to ensure that purchased services have contractual arrangements in place with clearly defined terms and conditions. These arrangements range from national frameworks to Individual Placement Agreements which balance quality against cost to achieve overall best value for services purchased to support people. As of 31 March 24, 98% of all social work spend had the provision of a formal contracting arrangement. This is an increase from 95%, reported in year 2022/23. Contract Management Framework 5.2 Adherence with the contract management framework is an integral component of the processes in place to demonstrate commissioned services are adhering to terms and conditions, outcomes are being achieved and that best value services are purchased. Contract monitoring is also a framework to inform unmet need and future strategic planning and commissioning. 5.3 Last year we reported on changes to be made to our contract management framework from 1st April 2023. From the point of implementation and throughout the duration of this reporting period, the Quality Assurance team have been evaluating the impact of the modifications. This approach reflects one of a learning organisation and focuses on our overarching aims which include monitoring our commissioned services to enable effective partnership working, early intervention and the targeting of resources to improve the experience of people. From the suite of documents which form the contract management framework and were embedded in practice throughout 2023/24, we have made further refinements.
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3 5.4 The development of an Engagement and Participation Toolkit to support the inclusion of direct stakeholder feedback and engagement by Senior Officers was a key addition to the Contract Management Framework. Throughout this reporting period Senior Officers have embedded a variety of methods to engage with a host of stakeholders during monitoring activity. The feedback received has been invaluable in understanding what good care looks like to people using services and their carers. Regulatory Activity 5.5 As of 31 March 2024, there were 27 care homes within North Lanarkshire. From these 27 care homes all 27 had been assessed by the Care Inspectorate under the key question ‘How well do we support people’s wellbeing’. There were no services achieving grade Excellent, however, 3 (11.1%) of care homes achieved Very Good under this key question. Care homes assessed as Good and above totaled 18 which is an overall percentage of 66.7%. 5.6 49 commissioned Self-Directed Support (SDS)/Care at Home services were inspected under the key question ‘How well do we support people’s wellbeing’. One service received a grade of Excellent (6) for this key question. Very good grades were received by 55.1% of services and 87.8% of services received grades of Good or above. In House Monitoring Framework 5.7 Following on from the development of the In-House Monitoring Framework reported on last year, this was approved by the Senior Leadership Team. Thereafter Homecare services commenced with a test of change across all six localities. Quality Assurance plan to carry out an evaluation of the In- House Monitoring Framework which will inform any refinements or modifications that may be required prior to roll out across the organisation. Market Facilitation 5.8 The past financial year has been challenging across the sector and through market facilitation, the team aim to support the social care sector through the right investment, in the right support, so that the wider aims of citizenship, social inclusion and community capacity can be achieved. 5.9 Recruitment and retention of staff remains a challenge across the social care workforce. Following on from the awards of Building Capacity Funding Phase 1 & 2 reported in last year’s annual report, North Lanarkshire Council facilitated a large-scale recruitment and career event on 27th April 2023 in Motherwell Concert Hall. The event was arranged to support our commissioned contractors to recruit suitable staff and in turn to maximise their capacity to provide care and support to the people of North Lanarkshire.
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4 Support to Unpaid Carers 5.10 The Commitment to Carers Conference was held on 5 September 2023 at the Bellshill Cultural Centre. The event was for carers, those who work with carers, and carer providers in North Lanarkshire, with the aim of discussing what’s working well and how we can further improve our services. 5.11 We aimed to reflect and build on achievements across North Lanarkshire, finding out what matters to carers and carer providers right now and sharing examples of how NLC is listening and improving on how we work with our carers. 5.12 Carer services were there to showcase the different kinds of support available to carers and hearing what we can do to provide the support people across North Lanarkshire need and want. Engagement & Participation Strategy 2024 - 2027 5.13 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. Procurement 5.14 Quality Assurance support individual’s rights to determine the manner in which they receive support, and this includes their right to select a contractor who is not on any of our contract frameworks. On these occasions and following due diligence checks of the preferred contractor, Individual Placement Agreements (IPA’s) are created to ensure there is a legal basis between North Lanarkshire Council and the Contractor for the delivery and manner of support. In the past year, 63 citizens of North Lanarkshire chose this route for support. This approach in aligned to the principles of Self- Directed Support. Safer Staffing 5.15 Quality Assurance have been liaising with the Care Inspectorate, other local authorities, commissioned services and internal colleagues to prepare for the implementation of the Health and Care (Staffing) (Scotland) Act 2019 which will be enacted on 1st April 2024. 5.16 Between November 2023 and February 2024, Quality Assurance staff took part in a test which was arranged by the Care Inspectorate on behalf of the Scottish Government. North Lanarkshire were one of ten authorities involved in this. The purpose was to gather information around how prepared commissioned
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5 services were for the implementation of the act and any risks that could be identified due to the implementation of the act. Complaints 5.17 Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. 205 complaints were received in the reporting period, a decrease of 16 [7.5%] from 2022- 2023, 109 of these related to Adult Services. Duty of Candour 5.18 Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain open and honest when something goes wrong, that is not related to the course of the condition for which the person is receiving care. 5.19 Work has been completed over the course to ensure our staff teams are fully aware of the reporting requirements associated with Duty of Candour. Over this reporting period, there were no Duty of Candour related incidents reported by North Lanarkshire Council care and support services. 6. CONCLUSIONS 6.1 The Quality Assurance Annual Report captures activity undertaken during the period 1 April 2023 to 31 March 2024 and highlights progress made in key activities noted in the last reporting period. Several developments are in progress or are planned for the period 2024/25.
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6 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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7 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 Service Risk Register Medium Chief Officer Adult Social Work IJB10.21 Ineffective Governance Arrangements Low Claire Rae 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 x Involve stakeholders in the development work aimed at achieving the national outcomes Engagement with Carers and people who access services x Provide stakeholders with information on how to get involved Engagement & participation strategy development and commissioned service x Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs x Measure how well we involve community stakeholders in the planning, design and delivery of our services Range of engagement events x Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Through contract monitoring and service redesign. Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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8 x Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Consultation with people who access services. Opportunities to provide feedback through Care Opinion and the complaints process. x Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff In development □ 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 Appendix 1Quality Assurance Annual Report 2023/24 Appendix 2Annual Complaints Report 2023/24 Appendix 3 Duty of Candour Report 2023/24
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9 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 Elaine McIntyre, Service Manager Quality Assurance mcintyree@northlan.gov.uk
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix 1 Quality Assurance Annual Report 2023/2024
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1. Introduction Quality Assurance have a role within most integral components of Adult Health & Social Care social work. Activity focuses on procurement & commissioning, contract monitoring, engagement & participation, support to carers and internal governance & development arrangements. Evaluation of services provided to people to ensure they receive the right support at the right time underpins the philosophy within the team. This year has brought the launch of our new Strategic Commissioning Plan 2023 – 2026 and alongside the Plan for North Lan and the ambitions of the Quality Assurance team are aligned to these programmes of work. Last year we reported on new and extended work plans for which the team has expanded both in terms of numbers and skill mix. We have had additional Senior Officers and Resource Workers join the team who bring with them varied and extensive knowledge of operational management within the field of social care, within and out with North Lanarkshire Council. To recognise the breadth of changes to the team dynamics and work activities and promote cohesiveness the team participated in the Insights programme. The Operational Development Team facilitated this, and the outcomes originally identified were achieved. Throughout the past year we have created a structured succession planning pathway from Resource Worker to Senior Officer and this has been particularly effective, enabling two‐way opportunities, development and growth. The team collated the information to inform the Chief Social Work Officer Report 2022/23 and with this being the first year this new approach has been taken a learning review highlighted key changes to take forward to the report for 2023/24. We also collaborated with the Senior Leadership Team to discuss social work self‐evaluation. Feedback has influenced and will continue to shape the benchmark standards. The preparation for the transition from SWIS to Mosaic has been extensive and on‐going. Quality Assurance have had representation in every workstream. As part of the redesign of Home Support the team have been involved in various workstreams supporting activity from supervision & observational monitoring approaches to the review of the service criteria to the streamlining of personal support plans (PSP’s) Quality Assurance are also involved in risk management activity around home support as well as having membership on the Programme Board. Throughout the reporting period we have endeavoured to offer new supports to our In‐House services and locality teams with the test of change across homecare, our work on safer staffing and the oversight we have of care inspectorate activity and actions plans. We also produced some guidance for in house registered services completing annual returns to the Care Inspectorate. Senior Officers are linked to localities, and they have been attending Community Care Operational Meetings, sharing key information. We aim to continue to support operational colleagues to provide the best services they can whilst embedding the Back2basics approach which even at this early stage has the potential to enable the delivery of more appropriate interventions by the correct people. The Quality Assurance Team work collaboratively with a range of partners to embed the principles of Self‐Directed Support. The activities reported in this 2023/24 annual report reflects our commitment to learn from what’s working well and what could be better to ensure people are central to all decisions in their lives.
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2. Contracts Quality Assurance work alongside the Corporate Procurement Team to establish and work in accordance with legal processes to support the procurement journey for all purchased services and goods across social work. This journey begins with identifying the contract route which is proportionate to the risk level and value of the contract, to developing and designing tender documentation right through to contract award and implementation. The role of Quality Assurance is to co‐ordinate and facilitate all procurement activity whilst providing advice and guidance to operational colleagues to enable them to devise service specifications which clearly describes the service required and the outcomes to be achieved. Over the past year we have continued to liaise with operational colleagues in a planned and ad hoc way, to ensure contracts are clearly interpreted and applied in practice to ensure a consistency aligned to the strategic direction of UNLHSC. We have agreed modifications to be made to current frameworks which will be progressed in 2024/2025. We have strong links with our partners at Scotland Excel who are widely recognised for their expertise in public procurement. The National Care Home Contract has existed since 2006 and it provides a contractual platform offering transparency and consistency for both purchasers and providers of older people residential and nursing care home placements. Scotland Excel are the owners of this contract and North Lanarkshire have bought into this meaning that all commissioned care homes for elderly people in North Lanarkshire are subject to the terms and conditions of this contract. The National Care Home Contract contains shared terms and conditions in relation to the arrangements around placements in Scotland including the weekly charges. Weekly charges are reviewed annually by Scotland Excel, in consultation with the Scottish Government, COSLA and Scottish Care (on behalf of providers) Scotland Excel are currently redesigning the National Care Home Contract as since it’s development in 2006 there have been significant changes to the social care environment. Providers have on an annual basis signed up to a new minute of variation to reflect annual uplifts however there is a commitment to an overhaul of the contract to reflect the current social care landscape including workforce & retention challenges, cost of living impacts, changing demographics/more complex needs of the care home population and the ambition to reflect a model which champions ‘outcomes focused and responsive care’ rather than ‘adequate care’. The Quality Assurance Team are involved in discussions around this redesign, and we hope to shape and influence meaningful change which will be to the benefit of people living in a care home, their carers/families and local authorities when placing people and monitoring the achievement of outcomes and overall quality of service thereafter. Over the past year Quality Assurance have continued to strive to ensure that purchased services have contractual arrangements in place with clearly defined terms and conditions. These arrangements range from national frameworks to Individual Placement Agreements which balance quality against cost to achieve overall best value for services purchased to support people.
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Tables 2a and 2b below illustrate that as of 31 March 24, 98% of all social work spend had the provision of a formal contracting arrangement. This is an increase from 95%, reported in year 2022/23. Quality Assurance continue to progress with the necessary arrangements to ensure all spend has robust contractual and legal agreements in place; however, it should be noted that due to the fluidity of contracting and commissioning, achievement of 100% compliance may not always be possible. Table 2a No of Contracts 2023/2024 2% No of Contracts 2022 /2023 Contracts in Place In Development Contracts in Place In Development 98 % 5 % 95 %
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Table 2b Spread of Providers 2023/2024 Spread of Providers 2022/2023 Self Directed Support 61 Secure Services 4 Misc 7 Mental Health 2 F Self Directed Support 61 Secure Services 4 Residential Schools 13 Non Traditional Respite 6 Non Framework Self Directed… 1 Misc 5 Mental Health 3 Justice 2 148 Care Home (NLC) 27 Advocacy 4 3rd Sector / Voluntary 10 Care Home (NLC) 28 Advocacy 4 3rd Sector / Voluntary 7 0 50 100 150 0 20 40 60 80 100 120 140 160 There are currently 303 provider organisations that we contract with, and this is a decrease of two from the figure reported last year and as highlighted above. The number of out of authority care homes being utilised has reduced which is a positive as it can be assumed that more people are being placed closer to home. There has also been a decrease in residential schools. It can be seen from the graphs above that non framework self‐directed support and non‐traditional respite packages have increased since last year as have 3rd sector and voluntary providers. Skyview Care Home closed in June 2023, and this accounts for the reduced number of North Lanarkshire Council commissioned care homes. Residential Schools 9 Non Traditional Respite 9 Non Framework Self Directed… 4 ostering & Continuing Care 10 Fostering & Continuing Care 11 Carers Network Care Home Out of Authority Care Home Cross Border 3 12 141 Carers Network Care Home Out of Authority Care Home Cross Border 3 9
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It is envisaged that over the coming year new providers will be added to the Self‐Directed Support Framework when it opens to new tender applications. This will further build capacity across North Lanarkshire. 3. Contract Management Framework (CMF) Last year we reported on changes to be made to our contract management framework from 1st April 2023. From the point of implementation and throughout the duration of this reporting period, the Quality Assurance team have been evaluating the impact of the modifications. This approach reflects one of a learning organisation and focuses on our overarching aims which include monitoring our commissioned services to enable effective partnership working, early intervention and the targeting of resources to improve the experience of people. Adherence with the contract management framework is an integral component of the processes in place to demonstrate commissioned services are adhering to terms and conditions, outcomes are being achieved and that best value services are purchased. Contract monitoring is also a framework to inform unmet need and future strategic planning and commissioning. The development of an Engagement and Participation Toolkit to support the inclusion of direct stakeholder feedback and engagement by Senior Officers was a key addition to the Contract Management Framework. Throughout this reporting period Senior Officers have embedded a variety of methods to engage with a host of stakeholders during monitoring activity. The feedback received has been invaluable in understanding what good care looks like to people using services and their carers. It has also enabled solutions to be found when potential improvements have been raised with Senior Officers. The Quality Assurance team will continue to analyse the information collated and quarterly performance reports during 2024/25 will include statistical and impact information resulting from the direct engagement. From the suite of documents which form the contract management framework and were embedded in practice throughout 2023/24, we have made further refinements as outlined below: ‐ • Quarterly returns are now specific to the type of service being provided e.g. Care Home, Support Provider or Funded Organisation. • Monitoring Visit Report now has mandatory and optional components included within its format which enables Senior Officers to focus their monitoring activity based on other intelligence received. • Monitoring Prioritisation Assessment form care service risks more clearly highlighted meaning that tier ratings allocated to commissioned services are more aligned to live circumstances. • Contract Monitoring Compliance Tool and sampling system designed to ensure fairness, consistency and an evidence base within our application of the contract monitoring framework. • Information available or received through other means no longer requested from commissioned services. • To support our Adult Protection Committee a range of information is being gathered around the delivery of training to our commissioned services. • Additional systems for the analysis of data received have been developed to ensure that patterns and themes are established and understood. The refinements outlined above have been made because of using the documents and tools and from gathering feedback from our commissioned services and audit and risk colleagues. With this same ethos our aim for 2024/25 is to have an on‐going philosophy of co‐design of our contract management
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framework and we have had almost 25 commissioned services commit their time to a planned working group. This approach is in line with ethical commissioning which we will speak more about later in this report. The Monitoring Prioritisation Assessment (MPA) provides a tool to enable Senior Officers to assess the level of risk associated with each commissioned service. MPA’s are carried out following submission of quarterly returns by commissioned services and analysis of the data provided by Senior Officers. MPA’s will also be reviewed following monitoring visits as a matter of routine performance measurement. Other significant events highlighting deficiencies in the quality of care may also trigger a new MPA to be completed. The outcome of the MPA determines the level of monitoring activity to be applied as a way of supporting improvements and applying a level of scrutiny which is aligned to the risk. MPA’s and monitoring visit reports form the record of discussions and recommendations agreed between Senior Officers and commissioned services. Each Tier suggests a minimum monitoring frequency as set out in Table 3a below Table 3a STATUS INDICATED MONITORING LEVEL Purple Large Scale Investigation (LSI) or Service Closure Processes that are imminent within 6 months Red Significant concerns in relation to service performance, contract compliance. TIER 4 Contract monitoring visit frequency – 1 to 4 weekly. Amber Moderate concerns in relation to service performance, contract compliance TIER 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Yellow Minor concerns identified in relation to service performance and contract compliance TIER 2 Contract monitoring visit frequency – variable, at least bi‐annually but no more than quarterly. Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Contract monitoring visit frequency – annually in most cases.
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Table 3b Commissioned Providers Q4 Tier Ratings 2022/2023 & 2023/2024 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% We reported last year about the significant improvements the Quality Assurance team had made to the suite of documents which form the Contract Monitoring Framework. We have seen a more consistent approach to the monitoring of contracts across the team. Table 3b highlights Tier Levels as reported at the end of 2022/23 and for the same time in 2023/24. An improved picture can be seen in terms of Tier 4 services which have decreased to 0%. When comparing the lower Tier ratings (1 & 2) across both reporting periods there was no overall change and the same is the case with Tiers (3 & 4) Overall, the majority of providers are Tiered within the lower tier rating categories. This is positive as the intensity and frequency of Care Inspections and our monitoring activity has been enhanced. Tier 1 Tier 2 Tier3 Tier 4 Q4 2023 to 2024 68% 25% 7% 0% Q4 2022 to 2023 85% 8% 4% 3%
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4. Regulatory Activity Table 4a below details an analysis of the key question “How well do we support people’s wellbeing”. The data has been extracted from Tables 4b and 4c below. North Lanarkshire Care Homes performance measures lower than Scotland wide care homes in that 66.7% of grades of 4 and above were awarded. Scotland wider care homes achieved 74.8% of grades of 4 and above. From the figures below it would appear that North Lanarkshire care homes seem to have an overall average of grades ranging between adequate and good. An improvement area would be to start to focus on why very few care homes are achieving good or above grades. 127 Scotland wide care inspections are reported below. Please note some care homes have not been inspected or have not been inspected under this key question. Table 4a ‐ Please note North Lanarkshire care homes are not included in the overall Scotland wide figures. How well do we support people’s wellbeing Number of Care Homes Assessed Grades Awarded Percentage North Lanarkshire Care Homes (Table 4b) 27 0 x Excellent 3 x Very Good 15 x Good 5 x Adequate 4 x Weak 0 x Unsatisfactory 0% 11.1% 55.6% 18.5% 14.8% 0% Scotland Wide Care Homes (Table 4c) 127 0 ‐ Excellent 39 x Very Good 56 x Good 30 x Adequate 2 x Weak 0 x Unsatisfactory 0% 30.7% 44.1% 23.6% 1.6% 0%
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How well do we suppor t people 's wellb… How good is our leader ship? How good is our staff team? How good is our settin g? How well is care and suppor t plann… How good is our care and suppor t durin… Adequate 2022/2023 10 5 5 3 4 1 Good 2022/2023 11 15 10 6 8 4 Very Good 2022/2023 4 1 1 3 0 0 Weak 2022/2023 2 1 0 0 2 0 Table 4b Care Inspectorate Grades -North Lanarkshire based Care Home as at 31/03/2024 16 Care Inspection Grades - North Lanarkshire Based Care Homes As At 31/03/2023 16 14 12 10 8 6 4 2 0 The tables above differ slightly in that the key question ‘How good is our care and support during the COVID 19 pandemic’ continues to feature in 2022/23 however in 2023/24 this key question had been merged into key question 1 and no longer featured as a stand‐alone key question. As of 31 March 2024, there were 27 care homes within North Lanarkshire. From these 27 care homes all 27 had been assessed by the Care Inspectorate under the key question ‘How well do we support people’s wellbeing’. There were no services achieving grade Excellent, however, 3 (11.1%) of care homes achieved Very Good under this key question. Care homes assessed as Good and above totalled 18 which is an overall percentage of 66.7%. The care homes who were assessed as Very Good under the key question ‘How do we support people’s wellbeing’ were Blair House, Kirknowe, and Summerlee. How well do we suppo rt peopl e's wellb eing? How good is our leade rship ? How good is our staff team? How good is our setti ng? How well is care and suppo rt plann ed? 1 4 1 2 1 0 8 6 4
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Care Inspectorate Grades - Care Home as at 31/03/2024 (excluding NLC) 60 50 40 30 20 10 0 How well do we support people's wellbeing? 30 0 How good is our leadership ? How good is How good is our staff our team? setting? Adequate 2023/2024 Excellent 2023/2024 2 7 1 1 9 0 1 2 1 How well is care and support planned? 25 0 From 27 care homes, 13 had been assessed under the key question ‘How well is care and support planned’. From the 13 that had been assessed 9 care homes received grades of Good and above. This is an overall 69.2%. During the reporting period Centenary House continued to be subject to Large Scale Investigation (LSI) until 11 October 2023. An improvement notice was also served by the Care Inspectorate to Centenary House on 12 July 2023 following grades of unsatisfactory being awarded in two key questions. The table above highlights the grades under key questions ‘How good is our leadership’ and ‘How good is our staff team’. The improvement notice at Centenary House was subsequently removed in December 2023 following significant improvements being identified by the Care Inspectorate. Six care homes during the reporting period were closed to admissions due to agreeing to a voluntary moratorium. One care home had an enforced moratorium placed upon them. The reasons for application of moratoriums were due to concerns around the quality of care being provided and to allow care home providers the opportunity to make the necessary improvements. Table 4c Good 2023/2024 56 44 34 37 38 Very Good 2023/2024 39 40 15 9 13 Weak 2023/2024 2 2 1 2 1
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Care Inspection Grades for Care Homes in Scotland (Excluding North Lanarkshire) as at 31/03/2023 70 Care Homes in Scotland (excluding North Lanarkshire): North Lanarkshire Council currently has people placed within 141 care homes that are located elsewhere in Scotland. The total number of people placed within these care homes from North Lanarkshire is 169. Contract Monitoring activity is carried out by the host authority where the care home is geographically located although care management responsibilities remain with North Lanarkshire Council for individuals placed. Individual Placement Agreements are implemented for individuals and these agreements detail the basis for care and support. North Lanarkshire Council are notified of any Large‐Scale Investigation activity or potential scenarios which may lead to the closure of the home e.g. Care Inspection Enforcement Action, Liquidation etc. Quality Assurance are currently leading on a subgroup from the Contracts and Commissioning Practice Network in relation to Care Homes. It has been evident from this activity that commissioned services and local authorities would benefit from a level of consistency in the application of contract monitoring. We hope to take this forward in 2024/25 to further shape, develop and share best practice as a sector. How well do we support people's wellbeing ? How good is our leadershi p? How good is our staff team? How good is our setting? How well is care and support planned? How good is our care and support during the COVID-19 pandemic? Adequate 2022/2023 32 24 22 9 17 10 Excellent 2022/2023 0 1 0 0 0 0 Good 2022/2023 60 47 28 36 37 2 Unsatisfactory 2022/2023 1 1 1 0 1 0 Very Good 2022/2023 29 30 12 6 8 2 Weak 2022/2023 3 3 1 3 1 0 60 50 40 30 20 10 0
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Table 4d Care Inspection Grades- Self Directed Support including Care at Home as at 31/03/2023 20 15 10 5 0 How well do we good is good is good is care How good is our care and Managem support our our our and suppor t Care & Environ Staffin ent & people' leaders staff setting support during Support ment g Leaders s wellbei ng? hip? team? ? planned ? the COVID- 19 pandem i c? hip Adequate 2022/2023 7 7 2 0 3 0 0 0 0 0 Excellent 2022/2023 1 0 0 0 0 0 3 0 0 1 Good 2022/2023 8 9 5 1 4 0 3 0 3 8 Very Good 2022/2023 11 6 3 1 3 0 19 1 9 10 Weak 2022/2023 0 0 1 0 0 0 0 0 0 0 Care Inspectorate Grades - Self Directed Support including Care 30 25 at Home as at 31/03/2024 2 0 1 5 1 0 0 How well do we How good is support our people's How good is our staff team? How good is ou r setting ? Adequate 2023/2024 Excellent 2023/2024 Good 2023/2024 Very Good 2023/2024 Weak 2023/2024 wellbeing? 3 1 16 27 2 8 0 2 0 1 6 1 0 9 7 2 0 0 2 1 0 How well is care and support planned? 3 0 9 7 2 How How How How well is
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Self‐Directed Support (SDS) including Care at Home: The tables above highlighting the Care Inspectorate grades for Self‐Directed Support (SDS)/Care at Home Providers 2022/23 and 2023/24 vary as in 2022/23 a high volume of providers had not been inspected under the current Care Inspectorate methodology and therefore the previous methodology areas were included within the graph. 2023/24 focuses solely on care inspections which have taken place under the new methodology. Some services continue not to have been inspected under the new framework which highlights that no inspection activity has been undertaken for several years. We understand this is due to recovery from the pandemic and that inspection activity is prioritised based on risk and other intelligence being received. This includes information submitted in annual returns, notifications of accidents/incidents and complaints. There are 50 commissioned SDS/Care at Home services that have been inspected by the Care Inspectorate under the new methodology framework and these are highlighted above in table 4d. 49 commissioned services were inspected under the key question ‘How well do we support people’s wellbeing’. One service received a grade of Excellent (6) for this key question. This was Support for Ordinary Living (SOL). Very good grades were received by 55.1% of services and 87.8% of services received grades of Good or above. Lifeways Community Care were not inspected under this key question. Under the key question ‘How well do we support people’s wellbeing’, 4% of services received grades of Weak. This consisted of 2 services who were Cera Care and Care 1 Professional. Both services continue subject to moratorium at the end of this reporting period. The reasons for the moratoriums were due to the quality of care assessed by the Care Inspectorate. Application of the moratorium is to support the provider to make the necessary improvements required. One provider agreed to this arrangement on a voluntary basis and an enforced moratorium was applied for the other. From the 50 commissioned services, 21 were inspected by the Care Inspectorate under the key question ‘How well is care and support planned’. Of these 33.3% received grades of Very Good and 76.2% received grades of Good or above. 5. In House Monitoring Following on from the development of the In‐House Monitoring Framework reported on last year, this was approved by the Senior Leadership Team. Thereafter Homecare services commenced with a test of change across all six localities. Quality Assurance plan to carry out an evaluation of the In‐ House Monitoring Framework which will inform any refinements or modifications that may be required prior to roll out across the organisation The aim of the In‐House Monitoring Framework is to support implementation of best practice and a culture of continuous improvement. It includes a cycle of on‐going self‐evaluation and monitoring, with triangulation of evidence across management tiers and sections. Services will be enabled to reflect on what they are doing well, what they could do better and to plan for change and improvement. Quality Assurance plan to facilitate learning opportunities for In House Services particularly around the use of quality improvement tools and methodologies. The team are currently developing
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workshops and materials whilst liaising with key staff around ways of enhancing the support that they can provide to in house services to share knowledge of developments, opportunities and change within the social care landscape. 6. Market Facilitation The Quality Assurance team continues to promote, stimulate and support market facilitation across the social care provider framework and the community and voluntary sector (CVS) whilst remaining outside of the market. Our approach is based on strategic intervention, relationship building, light touch intervention and supporting beneficial new relationships and activities that lead to resilient and sustainable approaches, which in turn lead to continuous improvement, improved ways of working and an active learning cycle whereby planning impacts on delivery, review and learning. The past financial year has been challenging across the sector and through market facilitation, the team aim to support the social care sector through the right investment, in the right support, so that the wider aims of citizenship, social inclusion and community capacity can be achieved.
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Provider Recruitment Event ‐ Recruitment and retention of staff remains a challenge across the social care workforce. Following on from the awards of Building Capacity Funding Phase 1 & 2 reported in last year’s annual report, North Lanarkshire Council funded and facilitated a large‐scale recruitment and career event on 27th April 2023 in Motherwell Concert Hall. The event was arranged to support our commissioned contractors to recruit suitable staff and in turn maximise their capacity to provide care and support to the people of North Lanarkshire. Over 20 social care providers took part in the event and have since reported having recruited various numbers of staff, arising from attendees on the day. A survey was carried out on the day which highlighted 65% of people completing this had applied for jobs during the event. 95% intended making applications following the event. Feedback from those who attended the event included:
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Building Capacity Funding Phase 3 – Additional financial support was offered to Care at Home Providers during the reporting period. The award was made to help create capacity and in recognition of the complexity and frailty of people Care at Home Providers support and to finalise the transition from a ‘Time & Task’ model to ‘Individual Budgets’, fully supporting the principles of Self‐directed Support. This approach ensures people accessing services have better choice and control over who supports them and how the support to meet their outcomes is met. Provider Capacity Portal – Quality Assurance and the Adults Team have been working with our Self‐ Directed Support (SDS)/Care at Home Commissioned services to establish a system to report available capacity to provide a new service. We have long recognised the demands for both social work staff and services in knowing who to make contact and with when either a service needs to be secured or capacity needs to be built upon. Throughout this year we have developed a portal whereby all commissioned services initially report their available capacity and then continue to update this as and when it occurs. The portal will be monitored by Adults/QA teams and our social work teams will have access to the data. A test of change took place with 5 providers and some feedback was provided which resulted in some refinements. We are pleased to advise that early into 2024/25 reporting period the portal will become live. 7. Support to unpaid carers Since the introduction of the Joint Partnership Statement detailed in last year’s annual report, a range of further developments to support carers have taken place. These have been part of Quality Assurance’s wider approach to Market Facilitation, to help broaden choice, control and support options for carers. Initiatives have included: • An innovative Hospital Discharge Payment Scheme for Carers – to reduce the risk of delayed discharge arising from wait times for social care provision. • Expansion of Carer Breather‐ an innovative Community Solutions approach to ensuring that carers, whether known to services or not, can access regular breaks from caring. • Increased funding to PAMIS to build capacity in the PAMIS Family Support Service, offering support to families caring for someone with profound, complex multiple disabilities. • Support for Dementia Carers through Alzheimer’s Scotland Dementia Carer Link Workers. • Extended contract for HOPE for Autism, removing the uncertainties arising from year‐to‐year annual funding. • Investment in practitioners from Autism Network to ensure that we have access to specialist knowledge around neurodivergence. • Further investment in Lanarkshire Carers to enhance existing programmes of carer support. • Continued support for Action for Children Young Carers Project. • Improved education opportunities for Social Work staff around commissioned organisations, Adult Carer Support Plans, carer budget processes and Young Carer Statements • Organising carer awareness events in tandem with the Assistive Technology team, to promote the uptake of assistive technology as a means of supporting both carers and those being cared for.
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• Supporting a range of engagement and participation activity aimed at all carers, but with a focus on underrepresented individuals, groups or communities, including carers from minority ethnic communities and LGBTQ+ communities. • Where applicable, continued promotion of Carer Budgets and support around innovative use of these. • Preparation in anticipation of forthcoming legislation around the right to carer breaks, including an updated Short Breaks Statement. • Preparatory work around the next Carers Strategy for North Lanarkshire. Developments in carer support around Dementia and Autism were informed by findings from the most recent national Carer Census, where these conditions, along with age related frailty, were identified as being the three largest areas of caring responsibility. With regard to frailty, North Lanarkshire has been a pathfinder area in the national Getting it Right for Everybody (GIRFE) approach, and whilst colleagues from other parts of University Health and Social Care are leading on this, Quality Assurance have also been directly involved. In addition to the detail noted above, a wide range of age related, or condition specific community and voluntary sector organisations were in receipt of North Lanarkshire Council funding and had a role within direct, or indirect, support to carers. Work around monitoring and quality evaluation regarding carer support across these organisations took place throughout the year. The Commitment to Carers Conference was held on 5 September 2023 at the Bellshill Cultural Centre. The event was for carers, those who work with carers, and carer providers in North Lanarkshire, with the aim of discussing what’s working well and how we can further improve our services. We aimed to reflect and build on achievements across North Lanarkshire, finding out what matters to carers and carer providers right now and sharing examples of how NLC is listening and improving on how we work with our carers. Carer services were there to showcase the different kinds of support available to carers and hearing what we can do to provide the support people across North Lanarkshire need and want.
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8. Participation and Engagement 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. As part of the work to refresh the Strategy led by the Strategic Engagement and Participation Working Group (SEPWG), a visual diagram has been designed to show the three main areas of investment that supports Engagement and Participation across our communities (Community, Carers and Supported People). The diagram, highlights our ambition to ensure strong voices to: • Improve communication and increase connections. • Increase awareness of what matters. • Increase capacity for early intervention and prevention. Following on from the successful procurement exercise resulting in a contract award to North Lanarkshire Disability Forum (NLDF) as the lead partner, alongside Lanarkshire Links and Voice of Experience Forum, as reported to Committee in September 2023, work has begun again on the recommendations from an independent review of our engagement and participation structures concluded in June 2022. There is a long history of engagement and participation in North Lanarkshire and the strength of connection across our network continues to promote involvement and representation to amplify voice. There have been some key achievements over the past year as set out below. Engagement and Participation Strategy 2024 – 2027 ‐ 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. Learning from these sessions has highlighted what is considered good engagement and participation and provided confirmation that the refreshed strategy should:
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• Be short and user friendly. • Be an overarching strategy that can guide communication and action planning across all areas of services and supports. • Build from the current strategy, including what we have learned and what people have told us. It is anticipated that the Strategy will support all stakeholders across our networks as it is written in plain English to ensure it is accessible to people who do not work in the sector but have an interest or are receiving services and supports. Strategic Engagement and Participation Working Group ‐ The primary function of the Strategic Participation and Engagement Working Group (SEPWG) is to drive forward the principles aligned to our Engagement and Participation Strategy. This group was re‐established in the last year and has led on the coordination and development of the Strategy 2024‐27. The group brings together representation from across the authority and includes people who have a role to support and develop engagement and participation. The primary objective is to coordinate various activities aimed at fostering robust and effective engagement and participation across North Lanarkshire. Its purpose is to streamline and synchronise initiatives that prioritise community involvement, ensuring that the voices, needs, and perspectives of people in North Lanarkshire are not just heard but actively integrated into the design and delivery of our services. Embedding Participation ‐ There has been good progress to increase the resource and capacity across community‐based organisations to strengthen the voice of supported people, including those harder to reach e.g. BAME, LGBTQI+ and those in more rural communities. We recognise the importance in ensuring that engagement and participation is meaningful and not tokenistic, so the principles of engagement and participation are now included in the Staff Induction programme, both as written information and as a direct input to programme for new social work and social care practitioners. A wide range of stakeholders have been actively engaged in the development of the Strategy through consultation and direct involvement. Promotion to implement the Strategy will be a shared responsibility and will include awareness raising and the development of practical tools to support: • An evidence base on how people experience services and how their experience shapes and improves future development of services and supports. • The voice of supported people in our communities • Increased capacity for early intervention and prevention. • Two‐way communication and a strengthened feedback loop back to decision makers • Increased feedback and the role of lived experience in improvement of services and supports. • Increased connections with supported people and communities that are harder to engage with. • Increased awareness about what is important to supported people and their communities. The refresh of our Locality Planning Group arrangements and alignment with the Locality Planning Teams and Community Boards is underway. Once finalised, this will provide sector, locality, and thematic forums, which can be influenced and shaped through engagement and participation with our Communities, Carers and Supported People.
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Care Opinion ‐ We recognise the importance of feedback, so have actively promoted the use of Care Opinion, which is an independent, non‐profit, web‐based feedback platform where people submit stories to share their experiences of health and social care services. These can be both positive and negative. They are moderated and quickly forwarded to the relevant area of service who can respond directly to the story. Since 2020: • 310 stories have been submitted through Care Opinion by people of North Lanarkshire. • 239 of these stories have been shared in the year April 2023‐March 2024. • Most stories received a response from the service within 24 hours. 2024/2025 will see the introduction of a Care Opinion Newsletter which the Quality Assurance team will produce. This will enable feedback to be shared across networks as well as being another way of promoting the use of Care Opinion. The Care Opinion Newsletter will celebrate positive feedback and will highlight the lessons learned from less than positive comments received. 9. Communications Quality Assurance have a key function within the area of communication. This includes the following responsibilities: ‐ • Overseeing and updating North Lanarkshire Council (Social Work) and UHSCNL websites • Facilitating, compiling and distributing the Public Protection Newsletter • Governing social work resources, policies and procedures held on our SharePoint site • Are owners and administrators of Viva Engage – which includes responding to queries and sharing updates in relation to Subject Access Requests and Resources, Policies & Procedures Social Work Policies & Procedures – Quality Assurance have established a policy review group with representation from all sections of social work including headquarters and localities. The aim of this group is to keep policies and procedures up to date with the appropriate owner and review date detailed. Policy control documents will ensure that the correct versions are being utilised at all times. Quality Assurance are the owners of this site and any edits made by social work colleagues must be uploaded by Quality Assurance. Representatives of this group will be responsible for liaising with their sections to be the link person for communicating changes required due to legislative requirements or other relevant factors. Over the next few months, a key aim is to have a register of all policies and procedures required across social work and a plan for reviewing implemented. Social Work Induction & Development – Talent and Organisational Development have recently developed a robust Social Work Induction programme and have also linked some materials into the Corporate Induction which is used for all North Lanarkshire Council employees. There is a vast amount of resources and materials available within the Social Work Induction programme which allows new employees to understand their new role.
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Quality Assurance have taken ownership of the Induction Programme with the aim of further developing the material and localising the content to the “approach of North Lanarkshire”. At this time a selection of representatives has been agreed across social work departments and they will be responsible for attending meetings and communicating changes and additions required to the induction and development programme to ensure it remains current and up to date and is the standardised approach to induction and development planning across social work. This work is in the early stages with all ideas for inclusion currently being considered. Quality Assurance Newsletter – Over the reporting period the newsletter was reestablished. This reports on key activity across the department. Moving forward we are keen to have engagement from commissioned services including the sharing of good news stories such as achieving high quality. A focus for the year ahead is to refresh the newsletter utilising other available platforms to engage a wider audience. 10. Information Governance We have legal and ethical duties in relation to handling and managing information to a high standard, and to improve in a transparent, fair, consistent, and secure way, with people always at the forefront of our minds. Our Information Governance Framework allows us to deploy our responsibilities and for social work this key function sits within the portfolio of the Quality Assurance Team. Our core group of Resource Workers with oversight from a Senior Officer are responsible for coordinating requests which include: o Subject access requests (SARs) including Information Commissioner’s Office (ICO) reviews and complaints. o FOISA (Freedom of information requests) including Scottish Information Commissioner reviews and complaints. o GDPR breach notifications o Data protection impact assessments (DPIAs) o DPA or schedule 2 requests o Annual ICO Stats o Quarterly Corporate KPI’s o Quarterly SAR stats Resource Workers liaise with the Freedom of Information Team and Data Protection Team who share their expert knowledge to guide internal processes in accordance with legislation. Over the reporting period there has been a focus on coaching/mentoring/training locality admin staff in relation to SARs and SARs recording. This follows on from the review and update of SAR’s recording systems. All reporting and monitoring systems within Quality Assurance for capturing information governance data have been developed and enhanced. This work has assisted with having the most up to date and accurate records available.
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11. Procurement Quality Assurance continues to lead on procurement activity for all social work services and collaborate with colleagues within Corporate Procurement, Service Leads and Locality Social Work Teams to ensure joined up planning, clear procurement processes and subsequent contract monitoring arrangements. This ensures that all commissioned contract work delivers best value, in accordance with Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016. Quality Assurance support individual’s rights to determine the manner in which they receive support and this includes their right to select a contractor who is not on any of our contract frameworks. On these occasions and following due diligence checks of the preferred contractor, Individual Placement Agreements (IPA’s) are created to ensure there is a legal basis between North Lanarkshire Council and the Contractor for the delivery and manner of support. In the past year, 63 citizens of North Lanarkshire chose this route for support. In the last year, Quality Assurance have supported colleagues within our adult & finance teams to review the Councils’ Self‐directed Support Option 1 Direct Payments, processes and documents. This work is extensive and includes support from Legal colleagues and has included: • review of internal processes with supporting documentation • creating systems that will enable recipients of Direct Payments to send required documentation and annual financial information directly to Localities It is anticipated this work will be concluded by the end of the next financial year. 11a describes the procurement activity for Contracts over £50,000 undertaken in 2023/24. Contract Title Contract Overview Service Area / Procurement Category Total Value of Contract (Excl VAT) Contract Start Date Contract End Date Admin of Engagement & Participation (Supported People) Provision of this Contract reinforces the Council’s commitment to ensure ongoing meaningful involvement with the communities that we serve. Adult Services / Social Care Services £900,000.00 02/10/2023 01/10/2026
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Aids for daily living The service covers the North Lanarkshire area for equipment and adaptations requests from North Lanarkshire and the whole of Lanarkshire for NHS Lanarkshire requests. Adult Services / Aids & Equipment £2,500,000.00 01/12/2023 31/05/2026 Coming Home Strategy ‐ Advocacy The current brief of the service for adults needs to be extended due to the “Coming Home” report and the need for additional advocacy provision that this duty places upon the Health and Social Care Partnership. Adult Services / Social Care Services £90,895.00 01/07/2023 30/06/2025 Counselling Services for Care Experienced Young People Based within Intensive Services Hub, Cecil Street, Coatbridge and work with 16–25‐ year‐olds who have experienced trauma and adversity. Education, Families & Justices/ Social Care Services £200,000.00 10/04/2023 09/04/2024 plus 3, 1 Year Extensions available Dementia – post‐ diagnostic support for carers Specialist support to carers who frequently report great difficulty and high levels of stress whilst caring for relatives affected by Alzheimer’s. Adult Services / Social Care Services £498,000.00 01/06/2023 31/03/2025 Digital Counselling Service and Online Platform of Support Funding had been allocated from within Scottish Government’s Mental Health Services allocation to the Council to pay for the solution in year 1. Education, Families & Justices/ Social Care Services £400,000.00 29/01/2023 30/01/2024, plus 3, 1 Year Extensions available Making Life Easier North Lanarkshire Online resource offering information, professional advice and direct access to services and support for individuals in North Lanarkshire. This service allows individuals to obtain information and/or complete self‐assessments, promoting early prevention and self‐management. Adult Services / Social Care Services £291,268.92 01/08/2023 31/07/2026, plus 1 Year Extension Available Supply, Installation and Servicing of Stairlifts and Hoists ADL provides specialist equipment and housing adaptations that support people to live independently in their own homes. Service covers the North Lanarkshire area for equipment and adaptations both Adult Services / Aids & Equipment £12,000,000.00 01/10/2023 30/09/2028
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North Lanarkshire and the whole of Lanarkshire for NHS Lanarkshire requests. Signs of Safety Signs of Safety is a strengths‐based safety‐ organised approach to child safeguarding work which expands the investigation of risk to encompass strengths and signs of safety to make an overall judgement of safety using a scale. It aims to work collaboratively and in partnership with families and children to conduct risk assessments and produce action plans for increasing safety and reducing risk and danger by focusing on strengths, resources and networks that the family have. Education, Families & Justices/ Social Care Services £95,000.00 02/10/2023 01/04/2025 Table 11b describes of the procurement activity for Contracts under £50,000 undertaken in 2023/24. Contractor Contract Overview Service Area / Procurement Category Total Value of Contract (Excl VAT) Contract Start Date Contract End Date Commercial Strategy Sourcing Route Durham University Project set‐up and design: working alongside professionals to design two approaches to be tested in the schools, including reflective workshops to explore Contextual safeguarding theory and approaches within education settings. Education, Families & Justices/ Social Care Services £34,808 01/08/2023 31/12/2024 New Requirement Proposal for Funding Care Solutions The provision of Care at Home services to support the flow of hospital discharges and service user reablement. Adult Services / Social Care Services £15,700 06/03/2023 25/06/2023 New Requirement Proposal for Funding
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Invercare Services Ltd The provision of Care at Home services to support the flow of hospital discharges and service user reablement. Adult Services / Social Care Services £17,628 06/03/2023 25/06/2023 New Requirement Proposal for Funding JKL The provision of Care at Home services to support the flow of hospital discharges and service user reablement. Adult Services / Social Care Services £14,000 06/03/2023 25/06/2023 New Requirement Proposal for Funding Keane Premier The provision of Care at Home services to support the flow of hospital discharges and service user reablement. Adult Services / Social Care Services £15,784 06/03/2023 25/06/2023 New Requirement Proposal for Funding ADL Smart Platform MILE Online resource offering information, professional advice and direct access to services and support for individuals in North Lanarkshire. This service allows individuals to obtain information and/or complete self‐ assessments, promoting early prevention and self‐management. Adult Services / Social Care Services £24,664 01/03/2023 31/07/2023 New Requirement Proposal for Funding Wise Group Community Payback Order Relational Mentoring service. Education, Families & Justices/ Social Care Services £42,000 01/06/2023 31/03/2024 New Requirement Proposal for Funding Ten for Zen To help build capacity and with the assistance from other third sector partner agencies will provide a collective effort to support Social Work to deliver vital services. Education, Families & Justices/ Social Care Services £29,250 01/04/2023 31/03/2025 New Requirement Proposal for Funding Creative Change To provide a unique in person and online experience that combines anonymity and creativity in interactive 2‐hour sessions delivered twice weekly in 12 session blocks. This will include accreditation certificate from New College Lanarkshire on completion of programme for each participant. Education, Families & Justices/ Social Care Services £49,000 01/04/2023 31/03/2025 New Requirement Proposal for Funding SACRO Provision of an individual service using a mentoring approach, which is a way of helping and supporting individuals with issues they might be facing both practically and emotionally. Education, Families & Justices/ Social Care Services £38,000 01/06/2023 31/05/2024 New Requirement Proposal for Funding
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Reeltime Music Provision of the creative arts and sessions in a studio/workshop to develop skills, create and produce music. Education, Families & Justices/ Social Care Services £6,500 01/06/2023 31/05/2024 New Requirement Proposal for Funding Women’s Aid ‐ MARAC Provision of effective management, co‐ ordination and administration of Multi Agency Risk Assessment Conferences (MARAC), on behalf of North Lanarkshire Council and North Lanarkshire Health and Social Care Partnership. Adult Services / Education, Families & Justices/ Social Care Services £48,624 01/07/2023 30/06/2024 New Requirement Proposal for Funding Autism Network Provision of specific knowledge, skill, experience and expertise from a curated organisation around: preventative and \ or anticipatory approaches, capacity building, developing skills and knowledge with staff involved in assessment and planning. influencing and shaping policy and strategy supporting people and families where Autism (Autistic people), neurodivergence and \ or complex need is a feature‐ of support requirements. Influencing and shaping approaches related to supporting people with complex care needs will predominantly, although not exclusively be people identified through the “Coming Home”*agenda. Adult Services / Social Care Services £10,000 01/11/2023 31/10/2024 New Requirement Proposal for Funding Mind of my Own Ltd Mind of my own Subscriptions – All in One. Education, Families & Justices/ Social Care Services £44,088 01/11/2023 31/10/2025 New Requirement Proposal for Funding Deaf Services Lanarkshire Provision of supports to the Deaf community to reduce inequalities for people with a sensory impairment accessing supports. Adult Services / Social Care Services £10,000 01/04/2023 31/03/2024 New Requirement Proposal for Funding
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12. Ethical Commissioning Our team responded to a request from the Scottish Government for Local Authorities to participate in a self‐assessment of ethical commissioning to outline how the principles are currently embedded in commissioning and procurement practice at a local level. The assessment considered what currently works well, where there might be opportunities for improvement, what standards may be applicable, and any opportunities or barriers linked to the principles. The findings from self‐ assessments have been summarised and will inform a national implementation plan for ethical commissioning. The Quality Assurance team are part of an on‐going working group being led and facilitated by IRISS to consider and shape training for procurement and commissioning teams. This working group aims to take forward the first four objectives within the national implementation plan referenced above. Commissioning and procurement teams are being asked by the Scottish Government to start the transition towards a National Care Service. This means working in a way that is grounded by ethical commissioning principles. The Quality Assurance team over the reporting period have participated in the Ethical Commissioning on line course available at Ethical commissioning in social care | Iriss This course is for: • Commissioning and procurement staff in public bodies • Providers of social care and support: managers and business development teams • Service managers in social work and social care • Members of Integrated Joint Boards There are 8 ethical commissioning principles in total which include Fair Working Practices and Full Involvement for People with Lived Experience. The self‐assessment referenced above highlighted strengths around our procurement and commissioning approach being focused on Fair Work Practices. The Vision ‐ By 2025, people in Scotland will have a world leading working life where fair work drives success, wellbeing and prosperity for individuals, businesses, organisations and for society. The Fair Work Dimensions Fair work is work that offers all individuals an effective voice, opportunity, security, fulfilment and respect. • It balances the rights and responsibilities of employers and workers. • It generates benefits for individuals, organisations and society. Community Benefits During 2023/24 Quality Assurance continued to increase focus on the delivery of community benefits, following new contract awards and implementation. Our approach means link Senior Officers meet with contractors to review, promote and encourage new initiatives that offer employment to people
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in the local community, youth training and training for people from disadvantaged groups, traineeships, apprenticeships, and volunteering opportunities. Scottish Living Wage Last year we reported that most contractors had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This trend continues with 98% of contractors who deliver advise, direct care & support are paying the Scottish Living Wage. The remaining 4% of contractors provide non‐ care related services or are within the cross‐ border category whereby the Scottish Living Wage does not apply. Full Involvement of People with Lived Experience Over the reporting period we will work to strengthen our involvement of people with lived experience in procurement and commissioning processes. The self‐assessment we completed highlighted this as an area we must embed in all aspects of procurement and commissioning rather than pockets of activity. We will report on how this area develops next year. 13. Adult Support & Protection The Quality Assurance team have a vital role across social work in supporting commissioned services to respond in accordance with Adult Support & Protection legislation and North Lanarkshire Council policies and procedures. Quality Assurance team members also have a role in the identifying of patterns and themes arising from referral activity and for the analysis of other information sources which may suggest referrals are required. As the direct links to commissioned services Quality Assurance promote best practice in relation to Adult Support & Protection. Over the course of the reporting period the Quality Assurance team has expanded and due to this and the need for refresher training for existing team members, reflective of the revised Adult Support & Protection (Scotland) Act 2007 Code of Practice, the Adult Support & Protection Committee facilitated a training day for the team. The training content was tailored to the role of the Quality Assurance team and included a section on Large Scale investigations due to this area featuring highly within the Quality Assurance remit. The day provided an opportunity for the team to discuss Adult Support & Protection in the context of the Quality Assurance department policies and procedures to ensure linkage to localities and oversight of Adult Support & Protection activity within commissioned services. Discussions were able to centre around the role in Adult Support & Protection for Quality Assurance in terms of provider failures and establishing root causes for services which may indicate systemic failings. As a result of Providers Paying Scottish Living Wage 2% 98 % % N/a % Yes
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the training day and the discussions facilitated, there were various actions agreed to ensure consistency in approach, on‐going learning and to build upon data collated and analysed. Quality Assurance continue to contribute to on‐going monitoring, learning and development forums such as the Pan Lan ASP task force working group. This group was established with the aim of empowering care home managers to have confidence in their decision making around adult support and protection. There have been wide ranging discussions about assessing the impact of ASP training and Quality Assurance took the lead in developing a Competency Framework which will be completed following participation in training delivered by the Adult Protection Committee. This framework is for internal and external colleagues and partner organisations. A test of change will take place over the coming months and an evaluation of whether this approach meets the intended outcomes will ensue. 14. Adult Health & Social Care Risk Management Quality Assurance have responsibility for the coordinating of the Adult Health & Social Care Risk Forum, for the facilitating of Adult Health & Social Care quarterly risk forums and for the reporting of risk to Core. Risk Forums have taken place 3 monthly during the reporting period. All activity takes place as designed within the Risk Management Corporate Risk Strategy. The risk champion within Quality Assurance attends Corporate Risk Management Meetings to ensure appropriate escalation and information sharing. Over the reporting period there has been focus on maximising attendance at risk forums, having appropriate membership, building participation and in achieving timely review of risks. Since the review of risk arrangements has taken place including discussion about roles and responsibilities and the revisiting of terms of reference attendance has increased significantly as has the enthusiasm of members. A Quality Assurance Risk Management mailbox has been set up for all communications risk related and there has been an improvement in the timescales for risk assessments being carried out. Quarterly and annual reports capture this information. Quality Assurance assist with devising any new risks and for carrying out an induction for any new members to the group. Education & Families and Justice representatives sit in the Adult Health & Social Care Risk Forum with risk information being directed to SMT Meetings. Quality Assurance link with Education & Families Risk Facilitators to establish priorities and effective reporting of risks within the field. Work in 2024/25 will focus on reframing some risks, supported by the Corporate Risk Team. The Risk Compliance Audit will also be implemented with a timescale of 6 monthly attached to this. Key findings will feature in reports to Core/SMT. It is expected that more advanced risk training will also be organised for risk champions and facilitators over the next reporting period. 15. Service and Contract Review Quality Assurance have been reviewing Registered Social Landlord Provision across North Lanarkshire over the past year. This review had commenced prior to the pandemic however was paused as a result. The review includes five providers of Sheltered/Very Sheltered/Supported Housing across a total of 12 developments. The purpose of the review is due to legacy funding arrangements and contracts having expired. Other local authorities have either carried out the review or have plans to do so imminently.
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The initial part of the review has included meeting with providers and gathering a range of data to assist in understanding the outcomes being achieved for people, how the different elements of service provision are being accessed and consideration of where there appears to be duplication of services. From the data it appeared that where people were assessed as requiring care and support individual packages of care were being provided by external providers including North Lanarkshire Council homecare services. The housing support services funded by North Lanarkshire Council and paid to Registered Social Landlords appeared to be utilised for social support and for in the event of an emergency situations. With access to emergency support available through the providers in house alarm service and also North Lanarkshire Council community alarms, as well as a range of sophisticated technology a recommendation has been made to withdraw housing support funding. North Lanarkshire Council fund a wealth of community supports which are accessible to people living in specialised housing and the Quality Assurance team have been promoting this, to ensure supports are unique to people’s wants and needs. Engagement sessions have commenced across the developments to consider the views of people and their families. Advocacy representatives have also attended to ensure that those who need support for their voice to be heard are empowered to do so. The outcome of the review will be communicated over the course of 2024.25. 16. Safer Staffing Quality Assurance have been liaising with the Care Inspectorate, other local authorities, commissioned services and internal colleagues to prepare for the implementation of the Health and Care (Staffing) (Scotland) Act 2019 which will be enacted on 1st April 2024. Preparations have included attendance at Care Inspectorate webinars, keeping abreast of all safer staffing developments and arranging for the Care Inspectorate to carry out an awareness raising session for the Quality Assurance team due to the responsibilities within the act when commissioning services. A further online session was arranged and open to all within North Lanarkshire Council. Between November 2023 and February 2024, Quality Assurance staff took part in a test which was arranged by the Care Inspectorate on behalf of the Scottish Government. North Lanarkshire were one of ten authorities involved in this. The purpose was to gather information around how prepared commissioned services were for the implementation of the act and any risks that could be identified due to the implementation of the act. Several methods were implemented to enable feedback to be captured and this included the establishing of a safer staffing working group, the devising of a questionnaire and analysis of this thereafter and having as an agenda item for monitoring visits, team meetings and provider forum meetings. The working group above has enabled the sharing of best practice and discussion around fears and apprehensions. Feedback has been that the group benefited from this approach and as learning will be on‐going after enactment the group will run for the first year of implementation. This will provide a forum to measure impact of the legislation. There is a requirement for local authorities to produce an annual report for safer staffing and this will be the role of Quality Assurance. To enable the on‐going compliance of the requirements of local authorities when commissioning services, work has been carried out to modify our contract management framework and associated terms and conditions.
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17. Care Home Governance & Assurance A review of the enhanced clinical and care oversight arrangements for care homes took place during this reporting period. The purpose of this was to ensure continued support for care homes supporting adults and older people by building upon the learning from the arrangements implemented during the COVID pandemic. It has been widely recognised that although we are post pandemic significant achievements have been made in maximising opportunities for partnership working and the outcome of the review captures the ethos of collaboration, sector expertise, access to healthcare and supporting workforce development. The functions of the Care Home Assurance and Support Board are: ‐ • Ensure assurance and support to CH sector continues in context of Excellence in Care, including IPC direct Support and embedding of the National Infection Prevention and Control manual • Oversee whole system support to care homes to improve health and wellbeing of adults living in care homes through implementation of My Health, My Care, My Home – healthcare framework for adults living in care homes and Health and Social Care Standards in Scotland • Ensure collaborative improvement model is utilised in all developments with care homes • Ensure systems and processes are in place to share intelligence between agencies to identify and allow support to be provided to care homes at risk. • Ensure systems and processes are in place to provide immediate response to serious concerns to mitigate risks • Monitor overall capacity of sector – identify risks and mitigate where possible • Ensure contingency plans are in place for the sector and regularly updated. The Care Home Assurance and Support Board also has two subgroups established. These are the Care Home Governance Group and Care Home Healthcare Framework Implementation Group. It is envisaged that following an initial gap analysis of the Healthcare Framework these two subgroups will merge with implementation of the Healthcare Framework continuing to be monitored and evaluated. Collaborative Group ‐ The Care Home Governance Group and the Healthcare Framework implementation Group have been aiming for attendance and participation from care home managers/family members however to date representation has been low. To ensure two‐way feedback Quality Assurance implemented a Collaborative Group with the aims being to ensure the voice of care home representatives are heard, to discuss the recommendations‐ and actions identified in the gap analysis and to feed information to and from the wider groups. The group also offers peer support and a shared learning experience and there is representation from health colleagues and Scottish Care. Care Home Provider Forum – Quality Assurance have reestablished Care Home Provider Forums which were stood down due to the pandemic. An initial meeting took place with care home managers to consider what format would work for them. It was agreed that an informal setting which could be in person or via teams, with key speakers attending and the availability of peer support would progress. Forums take place quarterly. 18. Complaints Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures.
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The annual summary and analysis of complaints received over the period 2023/24 is attached as appendix 1. 19. Duty of Candour Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain open and honest when something goes wrong, that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is a requirement of the Council and the report for 2023/24 is attached as appendix 2. 20. Quality Assurance Planned Developments This report has covered Quality Assurance activity undertaken during the period 1 April 2023 to 31 March 2024 and highlights progress made in key activities noted in the last reporting period. Several developments outlined below are in progress or planned for the period 2024/25 and we will provide updates in future reports. • Social Work Self Evaluation • Establishment of ASW Governance Subgroup • Safer Staffing Annual Report • On‐going development of collaborative working groups – Safer Staffing, Care Home Governance & Contract Monitoring • Developments aligning with the principles of ethical commissioning • On‐going social work induction & development planning/Social Work Policies & Procedures Review Group • Duty of Candour Reporting Processes • Awareness raising sessions delivered to Localities • Conclusion of RSL Review • Reframing of risks & 6 monthly compliance audits of risk register • Care Opinion Newsletter • Evaluation of In‐House Monitoring Framework/Roll out In House Monitoring Framework • Continued evaluation of ASP practices across QA and commissioned services • Launch of the Engagement and Participation Strategy • Introduce modified contract monitoring processes • Compile and report on quarterly performance reports • Involvement in B2B Enabling Approach • Implement learning in relation to CSWO Report
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Appendix 2 Social Work Complaints Annual Report 2023 ‐ 2024 Annual Complaints Report 2023‐2024 Social Work [Adults and Education, Families & Justice]
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Introduction This report provides an overview of Social Work’s performance in terms of handling complaints received between 1 April 2023 and 31 March 2024 and covers Adults and Education, Families & Justice. This report describes how complaints have been managed by social work services, details the number and nature of complaints received during the year and demonstrates our commitment to learning and improvement. Complaint Process We always aim to provide the highest possible quality of service across our communities and are committed to ensuring accountability and transparency. We recognise there are times when we get things wrong and fail to meet the expectations of those who use our services. We welcome feedback as it provides information that helps us to learn from complaints and shape and improve the way services are delivered. Complaints are viewed as a positive communication tool and are actively encouraged. As per the Scottish Public Services Ombudsman [SPSO] definition, we regard a complaint as any expression of dissatisfaction, by one or more members of the public, about our action or lack of action, or about the standard of service provided by us or on our behalf. Anyone can make a complaint, either verbally or in writing, face to‐face, by phone, letter or email. People are directed and encouraged to use the North Lanarkshire Council online portal to make a complaint but retain the right to use any of the aforesaid options. A two‐stage statutory social work complaints process was introduced on 1 April 2017, which harmonised complaint handling processes across all council services. The process is as follows: • Stage one – ‘frontline resolution’: we will always try to resolve complaints quickly, within five working days, and in exceptional circumstances extend for a further five days. • Stage two – ‘investigation’: if people remain dissatisfied with our stage one response, they can escalate their complaint to stage two. Complaints that are complex or need detailed investigation from the outset can be looked at immediately at stage two. These complaints will be acknowledged within three working days and a written response provided within twenty working days; this can be extended in exceptional circumstances. Following completion of the complaints process, if the person remains dissatisfied, they can ask the SPSO to consider their complaint further. We always advise of this entitlement and provide contact details. Complaint activity There remained a residual effect of the Covid 19 pandemic in terms of the numbers of complaints received in 2023‐2024. However, complaint activity has been slowly returning to pre‐covid levels. Overall, 205 complaints were received in the reporting period, a decrease of 16 [7.5%] from 2022‐ 2023. A breakdown of locality complaints are noted below:
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Education & Families 96 complaints were received in relation to Education & Families services in the reporting period, 96 received last year, so no change. The chart below is a summary of locality complaint activity for Education, Families and Justice services. Adult Social Work Services 109 complaints were received for adult services for the period, 140 received last year, a decrease of 31 [25%]. The chart below is a summary of locality complaint activity for Adult Social Work Services. Performance Indicators The Complaints Standard Authority developed a suite of four mandatory performance indicators in association with the Local Authority Complaint Handlers Network on which we are represented. These indicators [undernoted] are a valuable source of information as they help to identify recurring
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or underlying issues, derive/drive learning from complaints and highlight potential areas for improvement. • Indicator One: the total number of complaints received. • Indicator Two: the number and percentage of complaints at each stage that were closed in full within the set timescales of five and 20 working days. • Indicator Three: the average time in working days for a full response to complaints at each stage. • Indicator Four: the outcome of complaints at each stage. Education and Families – Performance Information Compliance with target statutory timeframes to complete complaint. Undernoted graphic depicts the aderhance to statutory timeframes. At Stage 1, 19% failed to meet response times, 51% did meet response times, 30% required an extention and were completed within 10 working days. Stage 2, 27% failed to meet statutory timeframes, 56% Cause of Complaints The cause of complaint is not always recorded, for those complaints that have a recorded cause, the detail is noted below:
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Cause of Complaints [Stage 1] Cause of Complaints [Stage 2] Complaint Outcome
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Adult Social Work Services – Performance Information Compliance with target statutory timeframes to complete complaint Undernoted graphic depicts the aderhance to statutory timeframes. At Stage 1, 15% failed to meet response times, 51% did meet response times, 34% required an extention. Stage 2, 16% failed to meet statutory timeframes, 79% met timeframes, 5% required an extenstion. Cause of Complaints As noted with the Education & Families data, the cause of complaint is not always recorded. For those complaints that have a recorded cause, the detail is noted below: Cause of Complaints Stage 1
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Stage 2 Complaint Outcome Comments and compliments. Across social work, ten compliments were made 2023‐2024 – seven were positive, three were neutral. 5 other comments were logged – all of which were neutral in sentiment. Learning from Complaints The learning from all social work complaints this year have highlighted: • The importance of good communication. • The need to ensuring that those who use our services and their carers have appropriate information. • The need for robust forward planning.
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• The need to ensure that equipment is clean and fully maintained prior to supply. • The need to improving information and advice for those who need to contact and seek support from social work services. • That people have the right to use their Self‐directed Support (SDS) individual budgets as creatively as necessary to reach their agreed outcomes. • The need to park vehicles with courtesy. • Necessity to dispose of PPE and other personal waste responsibly. Outcomes are often specific to the complaint, but when there are organisational learning points that influence policy or procedure, we need to ensure these are acted upon. Individual learning is dealt with directly with the complainant and through supervision, and more general issues are managed through supervision with team members and reminders at team meetings. 32% of all social work complaints recorded did not record any learning outcomes, whilst 41% were attributed to communication/staff attitude as the principal cause of complaints. 27% related to other issues such as courteous parking, failure to provide services, quality of service, provision of OT equipment. We recognise the importance of learning from complaints and acknowledge that having a learning outcome recorded is an area that requires attention. We understand that complaints help organisations learn more about the experiences of people who use their services, and that complaints can be helpful to enable us to work in a better way. At present, learning from complaints is a non‐mandatory performance indicator. However, the Scottish Public Services Ombudsman are interested in the systemic changes that are made following complaints. Going forward, we will work directly with our central and locality teams to ensure better recording and learning from complaints is embedded in practice to ensure quality services are delivered. Scottish Public Services Ombudsman The SPSO considered eight complaints throughout 2023‐2024 six of which they decided not to follow up, one was withdrawn by the complainant. In another complaint, the SPSO recommended that we compensate a complainant for loss of kinship care allowance. A payment was suggested and accepted by the complainant. Learning outcomes 1 6 1 6 2 4 8 3 Communicaton No learning outcome Service improvement Improve process Miscellaneous 6 6
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Child Friendly Complaints Procedure The SPSO are introducing a new Child Friendly Complaints Procedure, which we expect will be launched in July 2024. This procedure will ensure that children’s rights under the United Nations on the Rights of the Child [UNCRC] are met through a child‐centred complaint process. Their aim is to co‐design and implement a public sector complaints service that meets children’s rights and needs. They are working in co‐operation with children, young people, public bodies and wider stakeholders. Initially, it was envisaged that the new procedure would be fully implemented by 1 April 2024. However, following feedback from engagement and testing work, a more targeted pilot was undertaken by Aberdeen Health and Social Care Partnership. The aim of the test site was to test the new approach in practical settings, both to ensure it results in the right outcomes for children, and that it is efficient, practical, and workable for the public sector bodies managing the process. Their experiences have influenced the shape and scope of the updated procedures. Full guidance on the new process should be made available by summer 2024. Care Opinion Care Opinion is a non‐profit organisation, web‐based feedback platform funded mainly through subscriptions from health and care organisations. At present, 500 health and social care organisations use Care Opinion across the UK. People submit stories to share their experiences of health and social care services. These can be both positive and negative, and are moderated by Care Opinion staff, and quickly forwarded to the relevant area of service who can respond directly to the story. We recognise the importance of feedback; it is considered integral to quality improvement. For staff, it gives an opportunity to see the system and the service provided through the person’s eyes. • 310 stories have been submitted through Care Opinion by people of North Lanarkshire. • 239 of these stories have been shared in the year April 2023‐March 2024. • Most stories received a response from the service within 24 hours. To further support the use of Care Opinion as a vehicle to promote feedback on services, our revised Contract Management Framework requires all contracted providers, through their quarterly monitoring return, to report on their use and promotion of Care Opinion as a method of seeking feedback. We are also expanding the service tree to incorporate commissioned organisations if they wish to be included within the subscription. Training Training on the Dynamics system, where complaints are recorded, is offered as required. The licence allocation system has recently been reviewed, and licence permissions granted only to management support team members and to system administrators. Rationalisation of licence holders has increased opportunities to have closer collaboration and training across all services. Colleagues in Chief Executive’s office lead on training on system issues, and Quality Assurance Senior Officers lead on complaint handling training. Quality Assurance Quality Assurance senior officers provide training and support to social work managers and teams in relation to the complaint handling process. A suite of letter templates are available, which provide guidance on model answers and best practice when engaging with complainants. Complaints are often routed directly through the Quality Assurance officer who acknowledges receipt and assigns complaints to the relevant team manager. Guidance on response times and content is provided.
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A review of how a complaint was handled was undertaken by a Quality Assurance officer whose findings were reported to the Care and Clinical Governance Group. Complaints that relate to both health and social work/social care services are routed through the relevant lead organisations complaints process, but there is an integrated approach to resolution and any joint learning outcomes are shared. Conclusion The principal cause of complaints continues to identify poor staff communication, staff attitudes and quality of service. This is further reflected within the learning outcomes, which indicate the need to improve communication, practice and approach to those using social work services. As a service we are committed to improving learning from complaints, which is also one of the key performance indicators that are reportable to the SPSO. We will, over the course of 2024‐2025 place further emphasis on identifying and applying learning from complaints, recording learning outcomes and evidencing subsequent improvements. We will also emphasise the need to ensure that all complaints are dealt with in the identified timeframes, with clear communication of outcomes. Although 100% of complaints that were sent directly to social work were acknowledged by the due dates, only 58% overall were completed within statutory timeframes. Complexity of issues, new processes, staffing, IT systems and very tight time frames for resolution were the contributory factors in failure to complete all complaints within time. Improvement in these areas is expected in 2024‐2025. Further actions – 2024‐2025 Several key actions have been identified to strength our approach when dealing with complaints including using the learning to improve the quality of experience for those who use our services. Many are continuing or legacy commitments made in former years and remain valid objectives. The actions are: 1. We will audit all complaints over the course of 2024 ‐2025 to ensure that the procedures are understood and followed. Legacy action that is on‐going. 2. We aspire to ensure that logging actions and learning from complaints is done consistently to support the improvement of services that support people across our communities. 3. We will develop a programme of reflective learning sessions across teams ‐ Complaint activity and learning remain an agenda item in team meetings and links across services and localities are maintained with Quality Assurance Senior Officer who will review complaint activity as required. Learning sessions were delivered to home support staff across all localities. 4. We will continue to promote Care Opinion as one of the key mechanisms for engaging with members of the public and to generate meaningful feedback. Further resources have been deployed to assist with this activity – a one‐page newsletter/precis of Care Opinion will be drafted and circulated to all social work staff to support further usage and promotion of Care Opinion. 5. We will provide system training to all members of the management support teams who now have responsibility for logging and tracking complaints. This action has been hampered somewhat this year by the reduction in Dynamic 365 licences across all Council services. 6. We will offer complaint handling training sessions on at least a quarterly basis as a refresher session, or for training for new staff. Training sessions are offered on an ad hoc basis, and as required by individual teams. 7. A further legacy action from 2022‐2023 is the roll out and implementation of Child Friendly Complaints Handling Procedures. The SPSO have now indicated that Child Friendly Complaint Handling will not be a separate procedure per se, but practice guidance to ensure that the rights of children and young people, conferred by the UNCRC, are protected
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Appendix 3 Duty of Candour Report: 2023‐2024
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Introduction North Lanarkshire Council (NLC) recognises that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 was implemented on 1st April 2018 placing an organisational duty (Duty of Candour) on health, care, and social work services to be open and honest with people in their care. The Duty of Candour arrangements which we have implemented reflect the Scottish Government’s commitment to place people at the heart of health and social care services in Scotland. When harm occurs the focus must be on personal contact with those affected; support, and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement. The overall purpose of this duty is to ensure organisations are open, honest, and supportive when there is an unexpected or unintended incident resulting in death or harm as defined in the Act. All health and social care services in Scotland have a Duty of Candour, a legal requirement which means that when things go wrong and mistakes happen, the people affected understand what has happened, receive an apology, and that organisations learn how to improve for the future. A part of this duty is that Health and Social Care services publish an annual report about the Duty of Candour in our services. This report describes how our services have met Duty of Candour requirements between 1 April 2023 and 31 March 2024. When must the Duty of Candour procedure be activated? Organisations must activate the Duty of Candour procedure as soon as reasonably practicable after becoming aware that: • an unintended or unexpected incident occurred in the provision of the health, care or social work service provided by the organisation as the responsible person. • in the reasonable opinion of a registered health professional not involved in the incident: (a) that incident appears to have resulted in or could result in any of the outcomes mentioned below. (b) that outcome relates directly to the incident rather than to the natural course of the person’s illness or underlying condition. It is important to note that where the Duty of Candour procedure start date is later than one month after the date on which the incident occurred, an explanation of the reason for this has to be provided to the relevant person. The relevant outcomes are as follows: (a) The death of the person. (b) Permanent lessening of bodily, sensory, motor, physiologic or intellectual functions (including removal of the wrong limb or organ or brain damage) (“severe harm”). (c) Harm which is not severe harm, but which results in one or more of the following criteria: • an increase in the person’s treatment. • changes to the structure of the person’s body. • the shortening of the life expectancy of the person. • an impairment of the sensory, motor or intellectual functions of the person which has lasted, or is likely to last, for a continuous period of at least 28 days. • the person experiencing pain or psychological harm which has been, or is likely to be, experienced by the person for a continuous period of at least 28 days.
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Or where: The person requires treatment by a registered health professional in order to prevent: • the death of the person. • any injury to the person which, if left untreated, would lead to one or more of the outcomes mentioned above Information about policies and procedures All staff who are employed in the sector should be aware that all instances that necessitate implementation of Duty of Candour must immediately be reported. In such instances, organisations must then take the appropriate action, ensuring relevant bodies [depending on the sector] such as Social Work and \ or Care Inspectorate are notified of the event. Where an incident occurs that triggers the Duty of Candour, organisations have responsibility for ensuring that the Duty of Candour procedure is followed. Training sessions on Duty of Candour were delivered to 60 home support managers and staff throughout 2023‐2034. We will continue to provide support and training when necessary to minimise the impact on the organisation and the vulnerable people that we strive to support. Information on Duty of Candour and reportable incidents is described in detail within Appendix 1. All North Lanarkshire Council Social Work In‐house services are required to adhere to Duty of Candour reporting requirements. Initial notifications are made when reporting accidents and incidents in accordance with North Lanarkshire Council internal CIRUS system. How many incidents happened to which the Duty of Candour applies? Over this reporting period, there were no Duty of Candour related incidents reported by North Lanarkshire Council care and support services. Conclusions The requirements for Duty of Candour are such that the number of relatable incidents are generally low nationally. Duty of Candour related knowledge and reporting requirements will continue to be a statutory reporting requirement if or when, they do occur. The actions described below are intended to ensure that there is an ongoing focus on Duty of Candour. Actions If in the future, should any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify any lessons learned and the result of any such review will be shared with the relevant person/persons. Awareness raising sessions regarding Duty of Candour will be undertaken with commissioned services over the year.
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Appendix 1 – Definition of Harm and appropriate level of response Grading of Harm Definition of Harm Level of Response No harm, incident prevented Any service user safety incident that had the potential to cause harm but was prevented. These incidents are outside of the scope of the Duty of Candour. Social work professionals may however feel it is appropriate to inform the person involved if it is in their best interest. No harm, incident not prevented Any service user safety incident that occurred but no harm was caused to the person involved. These incidents are outside of the scope of the Duty of Candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Low Harm Any service user safety incident that led to the extra observation or minor treatment such as first aid or additional medication for the person involved. These incidents are outside of the scope of the Duty of Candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Moderate Harm A level of harm that is not permanent but has led to a moderate increase in treatment or prolonged psychological harm of more than 28 days. For example, a return to theatre, an unplan readmission to hospital, unexpected admission to critical care, a prolon hospital stay or additional out service user visits. Duty of Candour is a statutory requirement. Notification should be given to the person affected or their representative in person including an explanation of the incident, the process for investigation and an apology. This will be followed up in writing and on conclusion of the investigation the findings and outcome will be available to the service user of their representative. Serious Harm Any service user safety incident that has resulted in permanent harm that is directly related to the incident and not the natural course of an illness or the underlying condition of the person affected. Examples of severe harm are permanent lessening of bodily functions, sensory, motor, physiological or intellectual function, removal of the wrong organ or limb or brain damage. Duty of Candour is a statutory requirement – see above. Death Any service user safety incident that directly resulted in the death of a person and is not related to their illness or underlying condition. Duty of Candour is a statutory requirement – see above.
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1 REPORT Item No: 14 SUBJECT: Community Solutions Impact and Learning Report 2023-24 TO: Integration Joint Board, Performance, Finance and Audit Lead Officer for Report: Claire Rae, Chief Officer, NL HSCP Author(s) of Report David Wood, Chief Executive Officer, Voluntary Action North Lanarkshire Contact details for Author(s) of Report David Wood David.wood@VANL.co.uk DATE: 23rd October 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: SLT ☒ Endorsed By: ☐
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2 3. EXECTUIVE SUMMARY The Community Solutions Programme is a North Lanarkshire partnership initiative involving: • University Health and Social Care North Lanarkshire’s (UHSCNL) public sector partner organisations – North Lanarkshire Council (NLC) and NHS Lanarkshire • Voluntary Action North Lanarkshire (VANL) - the programme’s host organisation • The Community and Voluntary Sector (CVS) funded organisations and projects This report provides an overview of the work and achievements of University Health and Social Care North Lanarkshire’s Community Solutions Programme and its funded projects during 2023-24, with a focus on activity, reach and, where possible, outcomes and learning. This report is formally presented to UHSCNL’s Integrated Joint Board (IJB) and is also being shared with all stakeholders to provide accountability for the programme and to support understanding, learning, and improvement within the programme and more widely across health and social care and community planning. This report is complemented by progress reports and in-depth Impact and Learning Reports for each fund at appropriate intervals. 4. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA note the contents of the report. 5. VARIATIONS TO DIRECTIONS? 6. BACKGROUND Yes ☐ No ☒ N/A ☐
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3 6.1 Community Solutions is a successful, cross-sector health and social care investment and improvement programme for North Lanarkshire. The programme – which was established in 2012 – aims to improve people’s health, wellbeing, quality of life, and equality by investing in community-led initiatives which build community, family, and individual strengths and resources, with a focus on prevention and early intervention. 6.2 The programme invests strategically in the CVS through several complementary strands of work: • Local partnership-working between the CVS and public sector through six Community Solutions Locality Consortia, to identify and respond to local needs, including development of a Local Partnership Plan and management of a Local Activity Fund which makes small funding awards to CVS organisations • Development and delivery of direct support and services by CVS organisations on prioritised thematic issues including anticipatory care; befriending; carers’ support; community transport; hospital discharge support, and more. In order to ensure best fit with current and emerging needs, a review of these themes by a cross-sector panel is currently underway and will report in early 2024 • Capacity building for carers and the CVS 6.3 The programme is an innovative, effective, and respected partnership and collaborative initiative between statutory and community and voluntary organisations and the public, including: • UHSCNL which is responsible for planning, commissioning, and overseeing the delivery of community health and social care services across North Lanarkshire. UHSCNL provides core and project funding for the Community Solutions Programme, as well as governance and delivery support for the programme • The North Lanarkshire Children’s Services Partnership (NLCSP) which is responsible for planning, commissioning, and overseeing children and young people’s services across North Lanarkshire. The partnership provides funding for the CVS to support children and young people’s mental health and wellbeing, which is managed through the Community Solutions Programme • VANL, the local Third Sector Interface (TSI), which hosts and manages the programme on behalf of UHSCNL and the Children’s Services Partnership • The diverse, large, and vibrant CVS operating in North Lanarkshire, which receives funding through the programme and other sources to provide information, support, and care to individuals, families, and groups, working with local people to strengthen community capacity, resources, and resilience • Local people who support programme planning, delivery, and evaluation as service users, carers, volunteers, and residents.
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4 6.4 The Community Solutions vision is for a North Lanarkshire where: • The CVS has greater capacity to strengthen communities, improve lives, and advance equality and human rights • Priority groups are helped to ‘live their best life’ with access to person-centred, timely, effective community-based preventative and early intervention support, provided by community and voluntary organisations, complemented by timely access to public sector services • Communities are stronger, more resilient and inclusive, with improved health, wellbeing and quality of life, with reduced inequality and protection of human rights. 7. SUMMARY OF KEY ISSUES 7.1 VANL hosts and manages the Community Solutions programme on behalf of UHSCNL and the NLCSP and receives funding to cover the costs of this work, which includes the following: • Programme governance support • Facilitating collective planning and development of the programme overall and specific funds • Programme communications and liaison with key stakeholders • Management of funding awards • Evaluation, learning and improvement support for each custodian fund and funded projects • Overall co-ordination of programme performance management, evaluation, and reporting 7.2 In addition, VANL is commissioned by UHSCNL and others to provide capacity- building support – currently on the following three, key issues: • CVS support for children, young people, and families • CVS and localities • Volunteering 7.3 VANL staff also provide wider capacity-building support for the CVS and support links between the Community Solutions Programme, health and social care, children’s services, and community planning. Much of this work is resourced by VANL’s complementary, core funding from the Scottish Government and NLC.
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5 7.4 The Community Solutions Impact and Learning Report 2023-24 (Appendix 1) provides an overview of the work and achievements of University Health and Social Care North Lanarkshire’s Community Solutions Programme and its funded projects during 2023-24, with a focus on activity, reach and, where possible, outcomes and learning. 7.5 During 2023-24, VANL staff continued to implement the Community Solutions approach to performance management, evaluation, learning and improvement for funded projects, funds, and the programme as a whole, following the Programme’s Performance Management, Evaluation, Learning and Improvement (PMELI) framework. Ongoing feedback was sought throughout the year from the CVS and statutory partners to make continuous improvements to the Programme. 7.6 The following developments began in 2023-24, and will inform the approach to evaluation in 2024-25: • A wider stakeholder learning and improvement to showcase learning from the two mental health and wellbeing funds • Shorter flash reports for each fund • A focus on sharing case studies and personal stories via the Community Solutions website, to showcase and celebrate the impact of the CVS locally 8. CONCLUSIONS The University Health and Social Care North Lanarkshire’s Community Solutions Programme and its funded projects during 2023-24, has delivered a wide range of the work across the partnership whilst achieving a focus on activity, reach and, where possible, outcomes and learning. 9. IMPLICATIONS 9.1 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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6 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) 9.3 FINANCIAL This paper has been reviewed by Finance: 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 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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7 ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒
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8 EQIA added to website: 10. BACKGROUND PAPERS 11. APPENDICES Appendix 1 – Community Solutions Impact and Learning Report 2023-24 CHIEF ACCOUNTABLE OFFICER (or Depute) Yes / Date added ☐ No ☐ N/A ☒
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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10 Appendix 1 Phase X (20XX-XX) - Impact and Learning Report Community Solutions Impact and Learning Report 2023-24
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11 Contents 1. Introduction – Page 3 2. Background to Community Solutions - Page 4 3. Community Solutions Achievements 2023-24 – Page 10 4. Community Solutions Priorities for 2024-25 – Page 44 5. Appendices – Page 51
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12 1. Introduction The Community Solutions Programme is a North Lanarkshire partnership initiative involving: • University Health and Social Care North Lanarkshire’s (UHSCNL) public sector partner organisations – North Lanarkshire Council (NLC) and NHS Lanarkshire • Voluntary Action North Lanarkshire (VANL) - the programme’s host organisation • The Community and Voluntary Sector (CVS) funded organisations and projects This report provides an overview of the work and achievements of University Health and Social Care North Lanarkshire’s Community Solutions Programme and its funded projects during 2023-24, with a focus on activity, reach and, where possible, outcomes and learning. This report is formally presented to UHSCNL’s Integrated Joint Board (IJB) and is also being shared with all stakeholders to provide accountability for the programme and to support understanding, learning, and improvement within the programme and more widely across health and social care and community planning. This report is complemented by progress reports and in-depth Impact and Learning Reports for each fund at appropriate intervals. Many thanks to the funded projects which provided information and to the VANL staff who prepared this report.
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13 2. Background Community Solutions is a successful, cross-sector health and social care investment and improvement programme for North Lanarkshire. The programme – which was established in 2012 – aims to improve people’s health, wellbeing, quality of life, and equality by investing in community-led initiatives which build community, family, and individual strengths and resources, with a focus on prevention and early intervention. The programme invests strategically in the CVS through several complementary strands of work: • Local partnership-working between the CVS and public sector through six Community Solutions Locality Consortia, to identify and respond to local needs, including development of a Local Partnership Plan and management of a Local Activity Fund which makes small funding awards to CVS organisations • Development and delivery of direct support and services by CVS organisations on prioritised thematic issues including anticipatory care; befriending; carers’ support; community transport; hospital discharge support, and more. In order to ensure best fit with current and emerging needs, a review of these themes by a cross-sector panel is currently underway and will report in early 2024 • Capacity building for carers and the CVS
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14 The programme is an innovative, effective, and respected partnership and collaborative initiative between statutory and community and voluntary organisations and the public, including: • UHSCNL which is responsible for planning, commissioning, and overseeing the delivery of community health and social care services across North Lanarkshire. UHSCNL provides core and project funding for the Community Solutions Programme, as well as governance and delivery support for the programme • The North Lanarkshire Children’s Services Partnership (NLCSP) which is responsible for planning, commissioning, and overseeing children and young people’s services across North Lanarkshire. The partnership provides funding for the CVS to support children and young people’s mental health and wellbeing, which is managed through the Community Solutions Programme • VANL, the local Third Sector Interface (TSI), which hosts and manages the programme on behalf of UHSCNL and the Children’s Services Partnership • The diverse, large, and vibrant CVS operating in North Lanarkshire, which receives funding through the programme and other sources to provide information, support, and care to individuals, families, and groups, working with local people to strengthen community capacity, resources, and resilience • Local people who support programme planning, delivery, and evaluation as service users, carers, volunteers, and residents
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15 2.1 Vision and Mission 2.1.1 Vision The Community Solutions vision is for a North Lanarkshire where: • The CVS has greater capacity to strengthen communities, improve lives, and advance equality and human rights • Priority groups are helped to ‘live their best life’ with access to person-centered, timely, effective community-based preventative and early intervention support, provided by community and voluntary organisations, complemented by timely access to public sector services • Communities are stronger, more resilient and inclusive, with improved health, wellbeing and quality of life, with reduced inequality and protection of human rights 2.1.2 Mission The Community Solutions mission is to provide strategic investment and support to the CVS, so the sector can work with local people and public sector colleagues to achieve its vision. 2.2 Approach and Values Community Solution’s values and approach underpin our mission and provide the foundation upon which the Programme is built. 2.2.1 Holistic and Integrated Approach The Community Solutions Programme takes a holistic and integrated approach to health, wellbeing, quality of life, and equality encompassing: • Mental and physical health and wellbeing and their connections • The social, economic, and environmental influences on health, wellbeing, and equality and the actions needed to tackle these
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16 2.2.2 Strategic Investment Approach Community Solutions takes a strategic investment approach which prioritises the following in line with UHSCNL’s ambitions: • Investment in health improvement, prevention, and early intervention activities, which reduce inequalities and protect human rights • Investment in crisis and ongoing support, with a focus on recovery, re-enablement, self-directed support, and self-management • Cost-effective, community-based support and services provided by CVS organisations • Capacity building within the CVS and wider community by supporting key CVS ‘anchor’ organisations and volunteering to build the community infrastructure and capacity to support provision over time of good community-based support 2.2.3 Values Community Solutions also takes a value-based approach. The Community Solutions Programme values are: • Person-centered and empowering, placing the person at the centre of the service, helping them to live their best life and supporting their human rights by: o Actively listening and understanding their needs o Supporting people to develop their personal resources and capabilities o Helping them to develop and sustain supportive relationships and social connections • Collaborative working and co-production to achieve goals and improvements where we develop equal relationships between people who use services and people who provide services, with support provided ‘with people’ rather than ‘to them’. This means involving local people – including those receiving support – and service providers in the CVS and statutory sectors to facilitate a positive and participatory cycle of planning, delivery, evaluation, learning, and continuous improvement. This approach is informed by the Ladder of Participation and National Community Engagement Standards.
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17 2.3 Programme Governance Community Solutions is governed through a ‘triple-lock’ approach and supported and managed locally and across North Lanarkshire: • Six local CVS organisations receive funding to act as ‘locality hosts’ for the Community Solutions Programme in their area, and to convene Community Solutions Locality Consortia meetings involving CVS- funded organisations; UHSCNL locality, and VANL staff. These consortia review local needs and priorities; agree a Locality Development Plan and manage a Local Activity Fund (LAF) for their area. The six locality host organisations also meet regularly with key VANL staff to share information and discuss key issues to inform locality and North Lanarkshire-wide developments • VANL convenes and supports the Community Solutions Governance Group, which meets at least quarterly with representatives from UHSCNL, VANL, NHSL, NLC, the CVS and representatives for unpaid carers and supported people, to support strategic planning, review, improvements, and reporting • UHSCNL’s senior management and its Integrated Joint Board agree the programme’s strategy and funding and review progress reports 2.4 Programme Delivery and Evaluation Support VANL hosts and manages the Community Solutions programme on behalf of UHSCNL and the NLCSP and receives funding to cover the costs of this work, which includes the following: • Programme governance support • Facilitating collective planning and development of the programme overall and specific funds • Programme communications and liaison with key stakeholders • Management of funding awards • Evaluation, learning and improvement support for each custodian fund and funded projects
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18 • Overall co-ordination of programme performance management, evaluation, and reporting In addition, VANL is commissioned by UHSCNL and others to provide capacity- building support – currently on the following three, key issues: • CVS support for children, young people, and families • CVS and localities • Volunteering VANL staff also provide wider capacity-building support for the CVS and support links between the Community Solutions Programme, health and social care, children’s services, and community planning. Much of this work is resourced by VANL’s complementary, core funding from the Scottish Government and NLC. VANL’s support for the Community Solutions Programme is monitored through the Programme’s ‘triple-lock’ governance arrangements.
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19 3. Community Solutions Achievements 2023-24 3.1 Custodian Funds and Funding Management During 2023-24, over £3.8m of funding was managed through the Community Solutions Programme by VANL on behalf of several funders including: • University Health and Social Care North Lanarkshire • Scottish Government • NLC (linked to NLCSP) Funding awards were made to a total of 226 projects, delivered by 93 CVS organisations. In addition, VANL received £128k in funding to support CVS capacity building as outlined above. The funding to support delivery and evaluation of the Community Solutions programme has been allocated as follows: Community Solutions Funding 2023-24 This table sets out all income committed and expenditure through the Community Solutions Programme in 2023-24. Money may be committed in the current financial year, for projects delivering in the next financial year. 1. Core 1.1 Programme Management Costs Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£)
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20 University Health and Social Care North Lanarkshire Programme hosting and management 34,707 138,141 147,900 24,948 Subtotal: Programme Management Costs 34,707 138,141 147,900 24,948 1.2 VANL Capacity Building Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) University Health and Social Care North Lanarkshire Children, young people and families 24,614 30,000 102,150 50,464* *This carry forward will be used in 2025-26 to finance existing temporary Capacity Building
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21 employment contracts. CVS and locality support 60,000 Volunteering 38,000 Subtotal: VANL Capacity Building 24,614 128,000 102,150 50,464 1.3 Locality Funding University Health and Social Care North Lanarkshire Locality hosts funding 240,000 240,000 Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) University Health and Social Care North Lanarkshire Locality Activity Fund 71,990 180,000 212,088* 39,902
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22 *This figure shows the number of projects who have invoiced for funding in 2023-24. It is higher than the total figure in Appendix B, which shows the amount of funding spent by project delivery. Subtotal: Locality Funding 71,990 420,000 452,088 39,902 1.3 Thematic Funding University Health and Social Care North Lanarkshire Anticipatory Care 84,7421 40,000 40,000 78,564 Carer’s Network 40,000 40,000 Community Food 40,000 61,500 1 Funding for Community Food was suspended in 2022-23, and then received new investment in 2023-24.
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23 Community Transport 72,000 72,000 Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) Home Visiting and Befriending 195,000 195,000 Hospital Discharge 77,500 77,500 Physical Activities 40,000 40,000 Contingency 7,500 Subtotal: Thematic Funding 84,742 512,000 518,178 78,564 Subtotal: Core 216,053 1,198,141 1,220,316 193,878
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24 2. Fixed-Term (Non-recurring) Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) 2.1 Carer Breather University Health and Social Care North Lanarkshire Carer Breather 8,916 300,000 296,322 12,594 Subtotal: Carer Breather 8,916 300,000 296,322 12,594 2.2 Improving Lives Initiative Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£)
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25 UHSCNL/NHS Charities Together Improving Lives Initiative, including: • Additional Locality Host • and LAF funding • Social Prescribing Programme • Community Connectors 67,541 644,328 453,309 250,806 Macmillan/Scottish Government Improving the Cancer Journey 130,744 20,267 *Carry forward is incorporated with Improving Lives Initiative Subtotal: Improving Lives Initiative 67,541 775,072 473,576 250,806 Subtotal: Fixed-Term (Non- recurring) 76,457 1,075,072 769,898 263,400
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26 3. Fixed-Term (Other) Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) Scottish Government Community Mental Health and Wellbeing Fund Phase Two 191,739 162,411 29,321 Community Mental Health and Wellbeing Fund Phase Three 1,002,634 801,363 201,278
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27 Support in the Right Direction 105,951 105,951 North Lanarkshire Council Children, Young People, and Families Fund Phase Three 4,030 4,030 Children, Young People, and Families Fund Phase Four 40,637 479,000 346,848 172,789 Funding Source Funding Item Brought forward from 2022-23 (£) Income (£) Expenditure (£) Carry Forward to 2024-25 (£) NHS Lanarkshire Cervical Screening Inequalities Fund 15,000 15,000 Subtotal: Fixed-Term (Other) 236,406 1,602,585 1,435,603 403,388
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28 TOTAL 528,916 3,875,798 3,425,817 860,666 Please see the Appendices for a full break-down of the distribution of all Community Solutions funding for 2023-24. 3.2 Localities The Community Solutions programme is rooted in our local communities to support effective partnership working between the CVS and public sector as well as the engagement of service users, carers, and the wider public. This partnership working and engagement is supported by Community Solutions via: • 6 CVS locality host organisations • 6 Local Consortia • 6 LAFs The Community Solutions Locality Hosting Impact and Learning Report 2023-24 is available on the Community Solutions website. 3.2.1 Locality Hosts The Community Solutions programme is supported at locality level by six CVS “anchor” organisations that act as “locality hosts” for the programme. The locality hosts are responsible for: • Convening and supporting the six Community Solutions Locality Consortia and facilitating links to the nine Community Boards • Supporting Consortia members to develop a Locality Development Plan (LDP), which sets out priorities for local capacity building and the Locality Activities Fund. The LDP is informed by resident, service user and carers’ views and priorities, local Need Profiles, the Community Solutions Strategy and Investment Plan, and the Locality Outcome Improvement Plans (LOIPs) • Managing, in collaboration with local consortia and Voluntary Action North Lanarkshire (VANL), the Locality Activity Fund (LAF) for their locality • Supporting capacity building of local CVS organisations, including assistance in applying to LAF and providing progress reports • Being an active member of the North Lanarkshire-wide Community Solutions Consortium and the North Lanarkshire-wide Community Solutions Locality Host Network, convened by Voluntary Action North Lanarkshire (VANL)
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29 • Supporting and monitoring all Community Solutions activity across the locality and liaising with VANL staff to support their locality role. • Supporting the delivery of the Improving Lives Initiative (ILI) The Community Solutions’ locality hosts for 2023-24 are listed below, each of which received £40k of funding to support them in delivering these activities, plus additional funding through the ILI ranging from £18,196 to £35,674. Locality Locality Host Airdrie Diamonds in the Community Bellshill Orbiston Neighbourhood Centre Coatbridge Glenboig Development Trust Motherwell The Health and Wellness Hub The North Cornerstone House Centre Wishaw Getting Better Together 3.2.2 Locality Consortia The Community Solutions Locality Consortia comprise representatives from the local CVS and health and social care staff from the council and NHS. They discuss key local issues, and support development and delivery of their Local Development Plan and LAF. In 2023-24, they met an average of 8 times. Revised and updated consortia Terms of Reference were developed in partnership with Locality Hosts in 2023, and are available on the Community Solutions website. Each Locality Consortium developed a Local Development Plan over the course of several meetings and Consortium Development days, which can be accessed through the following links:
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30 Locality Consortium Local Development Plan 2023-24 Airdrie Airdrie Development Plan Bellshill Bellshill Development Plan Coatbridge Coatbridge Development Plan The North The North Development Plan Motherwell Currently finalising Wishaw and Shotts Wishaw and Shotts Development Plan 3.2.3 Locality Activity Fund (LAF) There are six Community Solutions LAFs, providing small grants to CVS organisations in each locality to help them deliver a new or improved activity to support residents. Each consortium decides on how to allocate these Funds in line with their Locality Development Plan. LAF awards are then managed by locality hosts and VANL. During 2023-24 each of the six Community Solutions Locality Consortia had £30k LAF to allocate, complemented by ILI funding ranging from £15,486 to £30,360 depending on locality, – a total of £300k, of which £190.6k was spent. (See Appendix B)
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31 LAF Awards 2023-24 – Reach and Activities
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32 LAF Awards 2023-24 – Impact
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33 3.3 Thematic Funding Community Solutions funding is awarded to a range of CVS organisations to provide services and support to residents on selected, priority ‘thematic’ issues, which are outlined below, with details of funding, reach, and outcomes for 2023-24. 3.3.1 Anticipatory Care Background Community Solutions funds local CVS organisation Equals Advocacy to employ advocacy workers to support anticipatory care for older, frail adults in liaison with health and social care staff. This funding has been in place since 2012. Anticipatory Care in North Lanarkshire helps connect older, frail adults to services and support at an early stage, supported by a Primary Care Frailty Multidisciplinary Team (MDT) and an independent advocacy worker, employed by Equals Advocacy. GPs support this service and approach by identifying an older person with increasing frailty. The person is then referred to Equals Advocacy who help the person complete one or more assessments at home, supported by an advocacy worker. This information is shared with the MDT which then develops and agrees an Anticipatory Care Plan in liaison with the service user. During 2023-24, Equals Advocacy received a funding award of £40k through the Community Solutions Programme to support their role in this service. Achievements 2023-24
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34 3.3.2 Befriending Background Befriending provides support to people who are lonely and isolated to increase their social support and connections, thus improving their quality of life and wellbeing. Since 2012, Community Solutions has provided funding to the following nine CVS organisations to recruit, and support trained, volunteer befrienders: • Befriend Motherwell • CACE (Cumbernauld Action for Care of the Elderly) • Elim Befriending • Getting Better Together • Glenboig Development Trust • Home-Start • Orbiston Neighbourhood Centre • Volunteering Matters • YMCA Bellshill and Mossend Total amount awarded: £195k Achievements 2023-24
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35 3.3.3 Cancer Screening Inequalities Fund Background The Cancer Screening Inequalities Fund was approved by UHSCNL in early 2023 for the delivery period from summer 2023 to March 2024, to support increased take-up of cervical and breast screening in Airdrie and Bellshill localities due to their particularly low uptake rates: • Cervical screening uptake is falling in Lanarkshire and across Scotland. Evidence demonstrates that uptake is around 20% lower in those from the lowest socio-economic areas in comparison to those in living in the highest • There is also growing concern over the youngest 25-34-year-old group and their participation in screening • There is less available data on uptake in Black and Minority Ethnic (BAME) communities, those that experience physical or learning disability, and LGBT communities, but indications are that screening uptake is generally lower compared to the white UK population A total of £15k was made available (£7.5k for each locality) to CVS organisations for delivery in either or both locality areas. A cross-sector funding panel met in May 2023 and awarded funding to two projects: • Bear Necessities (Airdrie) - £7.5k • Culture Junction (Bellshill) - £7.4k Due to staffing issues, reporting on this Fund has been delayed until late 2024. Full reporting will follow in the 2024-25 report. 3.3.4 Carer Breather Phase Two (Year One) Background The Community Solutions Carer Breather Fund was established in 2020, informed by a cross-sector review of previous Community Solutions funding for unpaid carers. The purpose of the fund is as follows: • To enable CVS organisations to enhance and extend regular and locally based support for unpaid carers, including carers who do not necessarily wish to identify as a carer and/or are unknown to formal services
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36 • For carers to be supported to: o Enjoy the benefits of regular and ongoing breaks in their neighbourhood o Access support without having to formally link up with a carers’ support organisation Community Solutions provided Carer Breather funding to the following 11 CVS organisations in Phase Two: • Bazooka Arts • Getting Better Together • Glenboig Development Trust • North Lanarkshire Disability Forum • One Parent Families Scotland • PAMIS (Promoting A More Inclusive Society) • Parkinson’s Self-Help Group • PlayPeace • The Haven • The Health and Wellness Hub • Watch US Grow Total amount awarded: £271.5k Achievements 2023-24 The Impact and Learning report for Year One of Phase Two of the Carer Breather Fund is available on the Community Solutions website.
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37 3.3.5 Children, Young People and Families’ Mental Health and Wellbeing Fund Phase Four Background The purpose of this fund is to improve the mental health and wellbeing of children and young people in North Lanarkshire by increasing support provided by local CVS organisations in liaison with schools. The fund was developed in 2020 with an initial pilot (Phase One) involving schools, staff in the council’s Education and Families team, VANL staff, and CVS organisations. Decisions regarding funding awards are led by schools, and informed by local needs and learning from the previous phase. The fund is managed and supported by School Cluster Improvement and Integration Leads (CILLs) and VANL staff, who work closely together. The fund supports delivery of the Scottish Government Children and Young People’s Mental Health and Wellbeing framework and the North Lanarkshire Children’s Services Plan, and is part of a suite of mental health and wellbeing initiatives for children and young people in North Lanarkshire, managed through our Children’s Services Partnership. Funding is provided by the Scottish Government via NLC to VANL for distribution to the North Lanarkshire CVS. The Impact and Learning reports for Phases One-Four of the Children and Young People’s Mental Health and Wellbeing Fund are available on the Community Solutions website. Funding Awards 2023-2024 Total number of CVS projects funded: 85 Total amount awarded: £449.7k Achievements 2023-24 Reach and Activities
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38 Children and Young People’s - Impact The outcomes for children and young people supported by the above funded projects are assessed using ‘The SHANARRI Wellbeing indicators for children and young people’. Outcomes for 2023-24 for children and young people (CYP) are summarised below: 3.3.6 Community Mental Health and Wellbeing Fund Phase Two Background The Community Mental Health and Wellbeing Fund is a national fund established by the Scottish government in late 2021 to help local CVS groups provide increased mental health and wellbeing support. The Scottish Government asked the 32 Third Sector Interfaces (TSIs) in Scotland, including VANL as North Lanarkshire’s TSI, to manage this funding on their behalf. VANL was required to manage the fund in partnership with UHSCNL and, given the existence of the successful Community Solutions programme, it made sense to incorporate this new fund into the programme, thus supporting synergy with other programme funding. Following the success of Phase One, VANL was allocated £955k from the Scottish government for Phase Two.
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39 The Impact and Learning reports for Phase One and Two of the Community Mental Health and Wellbeing Fund are available on the Community Solutions website. Funding Awards 2023-24 Number of Projects: 33 Total amount: £955k Achievements 2023-24 Mental Health and Wellbeing - Reach and Activities
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40 Mental Health and Wellbeing - Impact 3.3.7 Community Transport Background The Community Solutions funding to support Community Transport has been provided to the North Lanarkshire CVS organisation Getting Better Together (GBT) since 2016. Community Transport supports vulnerable residents to travel to essential appointments and key activities, supporting their health, wellbeing, and inclusion. Community Transport services are demand-responsive and therefore determined by service users’ requirements.
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41 GBT received a Community Solutions funding award of £72k during 2023-24, which, combined with funding from other sources, helped GBT deliver the following community transport services: • Transport for community groups, schools, CVS, and non-profit organisations using bookable, fully wheelchair accessible minibus and multi-purpose vehicles • A volunteer driver service, where volunteers use their own car to transport people to essential NHS appointments and are reimbursed for their expenses • A Community Transport HUB pilot partnership with NHS Lanarkshire and Community Transport Glasgow providing transport support for patients, staff, samples, and supplies Achievements 2023-24
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42 3.3.8 Hospital Discharge Background The Community Solutions funding for the Hospital Discharge Support Service (HDSS) has been provided to the CVS organisation Getting Better Together (GBT) since 2013. The aim of the HDSS is to help patients and carers to access additional community-based support following hospital discharge to: • Support rehabilitation and recovery, including physical activity • Support self-management • Reduce loneliness and isolation The service is available to all North Lanarkshire residents aged over 16. The HDSS has a base in the University Hospitals in Monklands and Wishaw. HDSS staff also liaise with University Hospital Hairmyres and other rehabilitation settings throughout Lanarkshire to support the discharge of North Lanarkshire- based patients. HDSS staff provide guidance and support to patients, carers and families through the discharge process. The service uses a person-centred approach – with staff discussing personal outcomes with patients, carers, and families. Engagement can take the form of ward visits, home visits pre- and post-discharge, as well as remotely via telephone and email. Staff also signpost service users to sources of personal and community support – including support -provided by CVS organisations – that they can access following discharge from hospital. The funding award to GBT to provide the HDSS during 2023-24 was £77.5k. An extension of the HDSS was agreed in 2021 for October 2021- September 2024, to improve the availability of support for carers in the hospital discharge process. The extension aimed to address demand from increased referrals for carers, and increase support available to carers with hospital discharge planning and once the patient returns home In 2023-24, £139.9k was awarded to GBT for the extension. Achievements 2023-24
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43 3.3.9 Improving Lives Initiative Background The Improving Lives Initiative (ILI) was developed collaboratively during 2022-23 with the Community Solutions Governance Group, UHSCNL Core Management team, NHS Lanarkshire Health Improvement senior staff, and Macmillan Cancer Support. The aim is to help improve people’s physical, mental, and social wellbeing through a locally co-ordinated approach to providing community-based support for vulnerable and equality groups The ILI provides additional funding for 24 months for the six Community Solutions locality hosts, and the LAF, to complement the existing recurrent funding. Community Connectors Through the ILI, a team of 10 Community Connectors were appointed in 2023-24 to support vulnerable people with long- term conditions in North Lanarkshire. This includes people referred through the Improving Cancer Journey project, connecting them to non-clinical support provided by CVS organisations locally. The Community Connectors were deployed to North Lanarkshire Disability Forum, beginning in November 2023, with official launch in March 2024. Achievements 2023-24
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44 3.3.10 Improving the Cancer Journey The Improving the Cancer Journey service was funded by Macmillan Cancer Support and the Scottish Government, to improve outcomes for people living with or affected by cancer through the introduction of Community Connectors posts across North Lanarkshire, offering Holistic Needs Assessments at the point of diagnosis. Achievements 2023-24
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45 3.3.11 Physical Activities Background During 2023-24, Community Solutions provided the North Lanarkshire Council with £40k to support provision of physical activities for people across North Lanarkshire with a range of health conditions to enhance their physical and mental wellbeing. Referrals to the service were received from a health and social care staff. From 2024-25, funding for the Active Health project will not be allocated through Community Solutions, but rather through the North Lanarkshire Council directly. Achievements 2023-24
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46 3.3.12 Positive Smoke-Free Role Models Background In partnership with NHS Lanarkshire’s ‘Quit Your Way’ Tobacco Control Team and Community Links, VANL managed funding for the Positive Smoke-Free Role Models Project. The project provided funding for CVS organisations across the six North Lanarkshire localities to develop and deliver: • Work across the North Lanarkshire University Health and Social Care Partnership area which developed and promoted the concept of positive smoke-free role models • Engagement with individuals, communities, and organisations to understand, sign up, and pledge action to become Positive Smoke-Free Role Models NHS Lanarkshire’s Positive Smoke-Free Role Models project has a particular focus on children, and works towards: • Preventing children and young people becoming the next generation of people who smoke • Protecting children, adults, and pets from the harmful effects of second-hand smoke The Project was originally launched in 2020, but some actions were postponed due to the Covid-19 pandemic and changing priorities. The Project was re-prioritised in April 2023. NHSL allocated £36k of custodian funding for VANL to manage. (Split between the six localities, providing £6K to each.) Funding decisions are made by locality consortia, allocation of funding will follow the LAF model (see section 3.2.3). Achievements 2023-24
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47 3.3.13 Support in the Right Direction Background The Scottish Government funds a national ‘Support in the Right Direction’ (SiRD) programme which aims to empower people and carers receiving social care support and services to be equal partners in their care where they have real choice and control over their lives, including: • Decisions about where they live and the services they receive • Participation in fulfilling activities and their community • Employment, if appropriate This is usually referred to as ‘self-directed support’. The national SIRD Fund has been managed by Inspiring Scotland on behalf of the Scottish Government and VANL since 2017. VANL has distributed this funding through the Community Solutions Programme to two CVS organisations: • Equals Advocacy • North Lanarkshire Disability Forum Their Community Solutions funding helps these two organisations provide the following services: • General and focussed in-depth self-directed support including 1-to-1 case work, online and Zoom conversations, and information sessions • Community connectors, who work directly with people to find suitable supports such as groups and activities Funding Awards 2023-24 Number of Projects: 2 Total amount: £106k Achievements 2023-24
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48 3.3.14 Community Food Background Since 2012, Community Solutions has provided £40k per year to Lanarkshire Community Food and Health Partnership (LCFHP) to provide cookery classes and nutritional advice for groups within North Lanarkshire, to contribute to a positive change in eating behaviour and a healthier diet. The training is carried out by fully qualified nutritionists and primarily helps people to eat more healthily on a budget and provides support to those with identified health issues, such as those at risk of developing Type 2 Diabetes. In 2021-22, due to organisational issues, Community Solutions thematic funding to LCFHP was suspended. Following suspension of funding, VANL continued to offer support to LCFHP. At the same time, due to the Covid-19 pandemic lockdown, NLC allocated money to LCFHP until September 2023 to provide emergency food parcels to vulnerable local residents. Due to demand, this became the sole focus of the organisation, delivering up to 800 food parcels per month. The demand for emergency food parcels continued beyond the end of funding, and it was requested that LCFHP continued to provide the emergency food, averaging 220 per month. This impacted capacity and ability of the organisation to communicate with VANL effectively. LCFHP contacted VANL to seek financial support for the emergency food parcels and 4 payments of £20.5k were made as follows between August 2023 and May 2024, using underspend from the suspended thematic funding. LCFHP worked with VANL staff to agree an action plan to resolve their organisational issues, and agreed that the Community Food Thematic funding will be reinstated in 2024-25. A payment of £23,334 will be made in 2024-25, using underspend from their suspension. An additional payment of £29,260 will be made to fund emergency parcels until the end of March 2025, also using suspended funds. This equates to an average of 220 parcels per month, at £19 per food parcel over 7 months (Sept 24 – Mar 25). LCFHP will be fully responsible for securing funding to provide emergency food parcel from April 2025 onwards.
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49 3.4 Review of Community Solutions Thematic Funding Background In line with the Community Solutions Strategy and Investment Plan 2022-25, the Community Solutions Governance Sub-Group on Wednesday 16th November 2022 approved the decision to undertake a review of the NL-Wide Thematic Funded Programme in 2023- 24. The intention of the remodelling of the thematic approach is to better reflect the purpose of the Community Solutions Programme to provide funding to support new ideas for community-based supports and to inform service redesign within UHSCP-NL. A new funding model would intend to be more dynamic and responsive to changing themes and priorities on an annual basis, including the priorities of the Community Solutions Strategy and Investment Plan and the UHSCP-NL Strategic Commissioning Plan and Programme of Work. Community Solutions first set out to review the Thematic Funding approach at the end of 2022. A Thematic Review Group was established in 2023, drawn from stakeholders involved in the Community Solutions triple-lock Governance Structures, the University Health and Social Care Partnership North Lanarkshire (UHSCP-NL) Senior Leadership Team, the Community Solutions Governance sub-group and the NL-Wide Consortium Organisations. Based on learning from the initial stages from the thematic review, the Lens process, and experience managing the CMHWB Fund, a new approach to remodelling the thematic funding was proposed and presented to the Governance Group on 23rd July 2024, who agreed to continue a consultation with the previously established Thematic Review Group, the Locality Hosts, and the NL-Wide Consortium. Subject to the consultation, a final report will be presented for consideration and agreement to the Community Solutions Governance Sub-Group on Wednesday the 4th September. If agreed, any changes to the themes will be implemented over the coming financial year (2025/26) to allow for a phased transition and recommissioning in-line with the agreed changes.
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50 3.5 Capacity Building VANL receives recurrent funding through UHSCNL to support capacity building in the following areas: • Carers • CVS capacity building for the sector generally and for CVS organisations to support Children, Young People and Families (CYPF) • Volunteering 3.5.1 Carer’s Capacity Building Background Community Solutions supports capacity building for carers by funding North Lanarkshire Carers Together to support the North Lanarkshire Carer Forum and a range of other carers’ support activities. Achievements 2023-24 During 2023-24, North Lanarkshire Carers Together received a grant of £40k, allowing them to: • Support the North Lanarkshire Carer Forum, which brings carers together to share information, provide peer support, and develop collective views to inform improved policy and practice • Support development and delivery of the Carer Breather Fund (see Section 3.3.3), including supporting network organisations with general guidance around Carer Breather Fund applications for Phase Two • Influence carers’ policy and services through participation in the North Lanarkshire Carers’ Strategy Group and other forums • Support carers to contribute to North Lanarkshire council budget consultations during the week beginning 15th January 2024. During two equality group sessions facilitated by council officers, carers were able to emphasise the importance of ASN Education, alternative education, and health and social care provision, which helped inform decisions in the budget. 3.5.2 Community and Voluntary Sector Capacity-Building Background VANL receives funding through the Community Solutions programme to support our provision of capacity-building support to the CVS so the sector is able to effectively contribute to improved health and wellbeing of residents and local communities through: • Provision of support and services to improve physical and mental health • Community wealth-building to support social and economic inclusion
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51 • Protection and improvements to our natural environment, including climate action The capacity-building support and services provided by VANL includes the following: • Information provision through the Voluntary Action North Lanarkshire website, digital bulletins and social media • Organisational development guidance on issues such as: o Set up and governance o Strategic planning o Income generation o Finance o HR o Performance management and evaluation • Peer support and learning opportunities by: o Providing or facilitating access to structured training and informal learning o Convening and supporting the CVS Strategic Partnership Group and linked thematic networks on key issues such as befriending; mental health and wellbeing; employability; and Social Enterprise o Organising regular events for the CVS, including locality meetings and an annual conference • Supporting CVS to participate in our local partnerships and contribute to delivery of associated plans including: o Our North Lanarkshire Community Planning Partnership, North Lanarkshire Partnership and its Plan for North Lanarkshire, associated North Lanarkshire- wide strategies such as the Tackling Poverty Strategy and nine linked Local Outcome Improvement Plans. (See partnership section in the diagram below) o University Health and Social Care North Lanarkshire partnership and its Commissioning Plan and linked strategies on mental health and wellbeing, alcohol and drugs, and the Community Solutions Strategy and Investment Plan. o The Children’s Services Partnership and Plan – see the Children, Young People, and Families section below VANL staff also undertake organisational reviews of CVS organisations receiving funding through Community Solutions to provide appropriate due diligence checks and identify areas where they may require support on above issues.
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52 VANL’s CVS capacity-building work was supported during 2023-24 with a £60k grant provided through Community Solutions, and supplemented by core funding from the Scottish Government and North Lanarkshire Council. (Also see the Children, Young People, and Families section below.) Achievements 2023-24
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53 3.5.3 Children, Young People, and Families Background VANL staff undertake capacity-building with the CVS to strengthen the support they provide to local children, young people, and families to improve their health, wellbeing, and inclusion. VANL does this by: • Convening and supporting the North Lanarkshire CVS Children, Young People and Families Network to provide information- sharing; peer support; and to support CVS partnership working with the public sector through the North Lanarkshire Children’s Services Partnership; UHSCNL; North Lanarkshire Partnership (NLP) • Supporting the CVS to strengthen their contributions to: o Helping mothers breastfeed successfully with bespoke training from the Infant Mental Health Team and links with community midwives o Child protection, through provision of training by VANL staff o Tackling poverty, including supporting CVS organisations that support: ▪ Employment ▪ Money and welfare advice ▪ Community food support o Children and young people’s mental health, including: ▪ A key role in developing arrangements for the Children and Young People’s Community Mental Health and Wellbeing Fund (see 3.4.4) ▪ CVS support for improving infant mental health with access to Infant Mental Health Training and the Infant Mental Health toolkit • Encouraging young people to volunteer to support development of their skills and confidence, and community engagement and contribution • Supporting CVS participation in the Children’s Services Partnership (CSP) and facilitating links between the CSP, Community Solutions, UHSCNL and community planning During 2023-2024, UHSCNL provided VANL with a grant of £30k to support the CVS to strengthen their support for children, young people, and families as outlined above. This funding was complemented by VANL’s core funding from the Scottish Government and
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54 North Lanarkshire Council which also supports VANL ability to provide capacity-building support to the CVS for children, young people, and families. Achievements 2023-24
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55 3.5.4 Volunteering VANL staff support volunteering developments across North Lanarkshire, working with: • The CVS – which involves and relies on many thousands of volunteers to deliver their support and services • Public sector partners – including North Lanarkshire Council, NHS Lanarkshire, Police and Fire and Rescue – which also involve volunteers and support volunteering more widely • Employers in all sectors, including the business sector, which contributes through employer-supported volunteering VANL staff support volunteering strategically and operationally including: • Setting up and convening the North Lanarkshire Volunteering Partnership to facilitate improved cross-sector support for volunteering. The Partnership developed a new North Lanarkshire Volunteering Strategy 2023-2026 which was approved in spring 2023. • Promoting volunteering opportunities to the public and supporting matching to roles • Supporting volunteer-involving organisations to improve their recruitment and support for volunteers, including accreditation through the Volunteer-Friendly award • Supporting CVS organisations to join and use the volunteer management software Team Kinetic During 2023-2024, UHSCNL provided VANL with a grant of £38k to support the development of Volunteering in North Lanarkshire. Achievements 2023-24
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57 4. Community Solutions Priorities 2024-25 This section provides an overview of development priorities for the Community Solutions Programme during 2024-25. 4.1 Custodian Fund Developments 4.1.1 Improving Lives Initiative As we enter year two of the Improving Lives Initiative (ILI) the focus remains on working with the Locality Hosts to strengthen the overall approach to co-designing services to improve prevention, early intervention and recovery supports within the health and social care system. The priorities for the coming year are: • Ensure the core recurring and the additional Locality Activity Fund (LAF) is fully committed by the end of year 2 of the ILI. • That all consortia’s have a robust Locality Development Plan in place going forward that can be updated on an annual basis. • The Social Prescribing Network is established. • That investment priorities for LAF applications are clear and that they align with: o local needs o the priorities of the Local Outcome Improvement Plans (LOIPs) and o gaps in services identified by Community Connectors and the Social Prescribing Network. • Identify additional funding to align the existing ILI funding with the Improving Cancer Journey funding for the 10 Community Connectors (to September 2027) • Imbed the use of Care Opinion and ALISS (A Local Information System for Scotland) in all funded programmes. • Establish a strong referral pathway with the Locality Enabling Hubs. The final main priority is to work with partners to agree a new Strategy and Investment Plan for the Community Solutions as the current plan that can be found here covers the period April 2022 to March 2025. The new strategy will aim to strengthen the funding management element of the Community Solutions Programme to increase the level of funding invested in build the capacity of CVS organisations to provide support in the community. The new strategy will also aim to further imbed the Performance Management, Evaluation, Learning and Improvement (PMELI) Framework within the University Health and Social Care Partnership so that it can inform service re-design by focusing on the learning and improvement that comes from the test projects invested in with the custodian funds.
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58 4.1.2 Community Mental Health and Wellbeing Being Fund Phase Three Funding for Phase Three of the Community Mental Health and Wellbeing Fund was announced by the Scottish Government in Autumn 2023, with a total of £955k available to fund CVS organisations in North Lanarkshire. Applications were sought from CVS organisations during November/December 2023. A cross-sector panel involving staff from VANL, NHS Lanarkshire, and North Lanarkshire Council assessed all applications and made funding decisions in early March 2024. Awards were issued by the end of March 2024 for activity to be delivered from April. Funding was awarded to 32 funded projects. Learning from Phase One and Two informed phase three, strengthening the ringfenced funding to support BAME and LGBTIA+ groups. It will also inform phase four with a commitment to strengthening the scoring panel to make it more diverse, and giving applicants longer to prepare their applications for the fund. The application form and guidance will also be updated and if time permits, funding surgeries will be offered to applicants to review their applications and to consider other sources of funding to sustain their projects. 4.1.3 Children and Young People’s Community Mental Health and Wellbeing Fund Phase Five Funding for Phase Five of this fund was agreed by NLC and the Children’s Services Partnership in spring 2024, with a launch event in June 2024. As with previous phases, funding awards for Phase Four were made to local CVS organisations to provide support to children and young people to improve their mental health and wellbeing. The approach to awarding funding decisions has been revised for Phase Five, with funding decisions now being focused on two rounds, with the first scheduled for June 2024 and the second scheduled for January 2025. If required, a final mop up round will be scheduled for March 2025 to fully allocate all of the available funding. With learning from the Community Mental Health and Wellbeing funding, school clusters will be supported to establish a scoring panel to review applications, using ongoing needs assessment by Cluster Improvement Integration Leads (CIILs) and local head teachers.
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59 4.1.4 Carer Breather Fund Phase Two Year two of Phase Two of the Carer Breather Fund, which was approved by UHSCNL in December 2022 to cover the period from April 2023 to March 2025. Staff in VANL continue to work with North Lanarkshire Carers Together (NLCT) to support the 11 organisations funded for the two years of the programme Learning from Phase One and Phase Two is informing the plans for a possible Phase three, which it is hoped will be included in the next commissioning round for carers support services, which is scheduled for February 2025. 4.1.5 Review of Community Solutions Thematic Funding The focus for the coming year is to complete the Thematic Funding Review, which will now focus more on a changing the funding model to make it more dynamic and responsive to the priorities contained in the Community Solutions Strategy and Investment Plan (2022-25) and the new UHSCNL Strategic Commissioning Plan (2023-26). The aim is also to ensure that the thematic funding, which is currently £510,000 per year from the recurring funding provided by UHSCNL, is invested to build the capacity of the CVS and to inform service change to provide a more sustainable model of service as appropriate. The New Funding Model will take learning from the Community Mental Health and Wellbeing Fund, setting funding priorities on an annual basis and ringfencing some funds into specific strands to open it up to the wider Community & Voluntary Sector (CVS) to make funding applications for new innovative services to support the people of North Lanarkshire. 4.1.6 Cancer Screening Inequalities Fund The Cancer Screening Inequalities Fund was approved by UHSCNL in early 2023 for the delivery period from summer 2023 to March 2024, to support increased take-up of cervical and breast screening in Airdrie and Bellshill localities due to their particularly low uptake rates. A total of £15k was made available (£7.5k for each locality) to CVS organisations for delivery in either or both locality areas. A cross-sector funding panel met in May 2023 and awarded funding to two projects.
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60 Due to some delay’s in start-up and delivery, the projects have been extended in to 2024, with the evaluation report scheduled for Winter 2024. It is hoped that this will inform future funding for phase two. 4.2 Capacity Building Priorities 4.2.1 Children, Young People and Families During 2023-24, VANL staff will continue to develop and deliver capacity-building support to the CVS as set out above in section 3.5.3, so these organisations are more able to contribute to improve the wellbeing of our children, young people, and families. This function will be strengthened with funding from the Local Authority to further develop the management and distribution of the Children, Young People and Families Mental Health and Wellbeing Fund, that will be entering phase 3 of the programme. The funding will now be focused on two funding rounds in June and December 2024, with a final mop-up round in the spring of 2025 if required. A new scoring process will also be introduced for this round. 4.2.2 CVS Capacity Building During 2023-24, VANL staff will continue to develop and deliver capacity-building support to the CVS, as set out above in section 3.5.2, so both Community Solutions funded organisations and the wider sector are better able to contribute to improved wellbeing of residents and communities. By part funding a Community Development officer for each of the four Community Planning Partnership areas of: • The North Locality • Airdrie and Coatbridge Localities • Bellshill and Motherwell Localities • Wishaw and Shotts Locality The programme also contributes to the work of the Income Generation Officer, to support CS Funding applicants to seek other funding to complement funding from the programme and to become a more sustainable organisation.
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61 4.2.3 Volunteering Support During 2023-2024, VANL staff continued to support volunteering across North Lanarkshire, working closely with public sector partners and the CVS in the ways set out in section 3.5.4. With the publication of the North Lanarkshire (NL) Volunteering Strategy (2023 – 2026) by the NL Volunteering Partnership in 2023 and the introduction of the new “Team Kinetic” volunteer management and recruitment system, the function will be strengthened from ring-fenced reserves for volunteering to promote the new system and to support more organisations from across North Lanarkshire to develop volunteering within their organisations. 4.2.4 Carers With Funding from the Community Solutions North Lanarkshire (NL) wide thematic programme, NL Carers Together continue to support the Carers Network and work colligatively with the CS team to manage the Carer Breather Fund, which enters it second year. The CS Programme continues to support carers through all of its funding programmes and continues to work in partnership with NL Carers Together to support other developments for carers, as it approaches a recommissioning exercise in the spring of 2025. 4.2.5 Community Mental Health and Wellbeing Mental health and wellbeing capacity building has been previously supported with recurring funding from the Community Solutions Capacity Building programme. This work will now be supported from the Scottish Government funding for the Community Mental Health and Wellbeing Programme as it enters the third year of funding. The Community Mental Health and Wellbeing Network will be re-established in 2024-25, with a focus on forging stronger links with statutory services to ease pressure on clinical therapeutic supports. A major symposium is planned for autumn 2024 to agree how community and voluntary sector organisations can provide complementary mental health support to people in the community. 4.3 Programme Performance Management, Evaluation, Learning and Improvement 4.3.1 Development of Improved Approach During 2023-24, VANL staff continued to implement the Community Solutions approach to performance management, evaluation, learning and improvement for funded projects, funds, and the programme as a whole, following the Programme’s Performance
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62 Management, Evaluation, Learning and Improvement (PMELI) framework. Ongoing feedback was sought throughout the year from the CVS and statutory partners to make continuous improvements to the Programme. The following developments began in 2023-24, and will inform the approach to evaluation in 2024-25: • A wider stakeholder learning and improvement to showcase learning from the two mental health and wellbeing funds • Shorter flash reports for each fund • A focus on sharing case studies and personal stories via the Community Solutions website, to showcase and celebrate the impact of the CVS locally 4.3.2 Reporting Approach In 2022-23, the Community Solutions Programme seen a significant increase in the number of managed funds, and a subsequent increase in the evaluation returns received from funded projects. To manage this increased workload, a review of available software was conducted in June/July 2023 and the JotForm platform has been implemented throughout 2023-24. Ongoing feedback from funded projects on the new Platform has been positive. VANL will continue to use feedback to inform ongoing improvements to the evaluation and monitoring forms in 2024-25. 4.4 Programme Communications and Liaison During 2023-24 VANL staff will continue to: • Communicate and liaise with all programme stakeholders including funded projects, locality hosts and consortia, and UHSCNL colleagues • Represent the Community Solutions Programme and CVS on UHSCNL’s Strategic Leadership Team, IJB Board, and Performance, Finance and Audit Committee • Share key information about the programme online through Community Solutions e-bulletins Development of a new Community Solutions website was planned for 2022 but due to staffing capacity issues has been deferred to early 2024. 4.5 Programme Governance VANL staff will continue to convene and support the Community Solutions Governance Group during 2023-24 as outlined above in section 2.3.
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63 During 2022-23 membership of the group was reviewed to strengthen representation and engagement of key stakeholders including: • UHSCNL staff • Council staff from the Enterprise and Communities, and Education and Families departments • Locality hosts and consortia (for implementation from spring 2023)
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64 5. Appendices Appendix A Community Solutions Locality Host Funding 2023-24: Total Funding £381K CVS Organisation Locality Locality Award Fund (£) Improving Lives Initiative – supplementary funding (£) A.1 Diamonds in the Community Airdrie 40,000 23,390 A.2 Orbiston Neighbourhood Centre Bellshill 40,000 18,196 A.3 Glenboig Development Trust Coatbridge 40,000 19,757 A.4 Cornerstone House Centre The North 40,000 35,674 A.5 The Health and Wellness Hub Motherwell 40,000 22,415 A.6 Getting Better Together Wishaw and Shotts 40,000 21,568 Total across the 6 Locality Hosts 240,000 141,000
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65 Community Solutions Locality Activity Funding 2023-24: Total Distributable Funding £300K CVS Organisation Locality Locality Activity Fund (£) Improving Lives Initiative – additional LAF funding (£) A.7 Diamonds in the Community Airdrie 30,000 19,907 A.8 Orbiston Neighbourhood Centre Bellshill 30,000 15,486 A.9 Glenboig Development Trust Coatbridge 30,000 16,815 A.10 Cornerstone House Centre The North 30,000 30,360 A.11 The Health and Wellness Hub Motherwell 30,000 19,077 A.12 Getting Better Together Wishaw and Shotts 30,000 18,355 Total across the 6 Locality Hosts 180,000 120,000
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66
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67 Appendix B Locality Activity Fund Distribution Locality Activity Fund Distribution 2023-24 Total number of projects funded in the six Community Solutions localities: 79 Total funds for 2023-24: £300,000 Total spend: £190,648 of which £61,479 from ILI Airdrie Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.1 Airdrie CAB Befriending project 3,120 B.2 Airdrie Kinship Airdrie kinship carers support 2,110
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68 B.3 Longriggend Village Association Villagers Coming Together 4.500 B.4 Make and Create Arts Making Healthy Choices, Creating Happy Smiles 2,050 B.5 Monklands Women's Aid Women’s Peer Support Group – Women Empowering Women 1,000 Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.6 Parkinson's Self-Help Group Benefits of Greenspace 400 Time for Me 1,198 B.7 Whinhall Allotments Muddy Boots 'Rain or Shine' 2,050 B.8 Bear Necessities Easter school holiday fun days programme 1,000 B.9 HOPE for Autism Easter Bingo & Coffee Morning and Flip Out Trip 420 B.10 Airdrie Adult Learning Forum AALF Holiday Provision Project * 3,050 No. of projects Total 20,897.98
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69 11 * project funded in 23-24, (continuing) delivery in 24-25 of which 7,610 from ILI
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70 Bellshill Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.11 Lanarkshire Community Food & Health Partnership (LCFHP) Let’s Fix Fussy Eaters 7,230 B.12 Voice of Experience Forum (VOEF) Voice of Experience Forum Calendar 2024 3,308 Rabbie Does Strictly – Tea Dance 952 B.13 Viewpark Conservation Group Restoring Minds, Restoring Nature 8,694 B.14 Deep Fried Media Family Friendly Art & Photography 2,246 B.15 Orbiston Neighbourhood Centre Community Fridge 4,300 B.16 YMCA Bellshill & Mossend YMCA Digital Hub * 2,839 + 1,414.70 (extension) No. of projects Total 30,983.70
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71 7 of which 8,694 from ILI
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72 Coatbridge Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.17 Kirkshaws Neighbourhood Centre Art in the Community 1,500 Kirkshaws Health & Wellbeing Community Programme 5,700 B.18 Glenboig Development Trust Together We Thrive 6,100 Keep Moving, Keep Improving 2,390 B.19 Coatbridge Consortium Men Talk 8,840 No. of projects 5 Total 24,530 of which 10,340 from ILI
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73 The North Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.20 Friends of Kilsyth Community Pantry 4,500 B.21 Kilsyth Civic Week Intergenerational Tea Dance 1,200 B.22 Auchinloch Community Council Auchinloch Community Hub 1,760 B.23 CACE (Cumbernauld Action for Care of the Elderly) CACE Local Community Family Fun Day and Open Day 350 CACE Community Transport Support 3,000 B.24 Strathcarron Hospice Absent Friends Week and National Grief Awareness Week Bereavement Support 2,400 B.25 Storehouse Church Christmas Winter Wonderland 2,600 B.26 Cornerstone Christian Fellowship Livestreaming of Interactive Events 3,500
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74 B.27 Abronhill Guild of Friendship Abronhill Guild of Friendship Christmas Party Lunch 1,000 B.28 St Patrick's Church Kilsyth Kilsyth and Villages Health and Wellbeing Project 5,232 Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.29 Manipulate Arts AnimATE Croy 4,959 B.30 Cardowan Community Meadow Cardowan Outdoor Learning Project * 4,290 B.31 Cloudberry Communities CiC Community Health Building * 4,000 No. of projects 13 * project funded in 23-24, (continuing) delivery in 24-25 Total 38,791 of which 13,482 from ILI
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75 Motherwell Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.32 Voice of Experience Forum Tea Dance 952 B.33 The Economic Forum for Women Empowerment Scotland Free Family Summer Day Trip to the Beach 2,000 B.34 The Salvation Army Motherwell Let’s Introduce Anxiety Management (LIAM) 1,390 B.35 Motherwell CAB Help First 5,000 B.36 Families and Friends affected by Murder and Suicide (FAMS) FAMS Goals – Give Youth a Chance 4,950 B.37 Lanarkshire Community Food & Health Partnership Cooking on a budget – Slow Cooker * 2,875 Big Chef Little Chef * 2,863 B.38 Elim Befriending Services Oasis Summer Trip * 1,329 B.39 Bestway Community Development Community event * 3,984
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76 B.40 Clydesdale Community Initiative Airbles Road Extension Garden 3,621 Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.41 North Lanarkshire Carers Together Carers’ Health and Wellbeing * 1,000 Family Support Outcome Star * 500 B.42 PlayPeace Parents as the Experts * 1,418 B.43 The Good Deed The Good Deed 1,669 B.44 Motherwell Foodbank Motherwell Foodbank @Maranatha * 4,415 No. of projects 15 * project funded in 23-24, (continuing) delivery in 24-25 Total 37,966 of which 11,458 from ILI
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77 Wishaw and Shotts Locality Organisation Project projects outlined in green were funded through the Improving Lives Initiative Total Funding Amount (£) B.45 Elements Netball Elements NC 2,109 B.46 Getting Better Together Health and Wellbeing Day 1,000 B.47 Newmains Community Trust Newmains on Wheels 1,760 B.48 North Lanarkshire Carers Together Family Support Outcome Star * 500 B.49 Clydesdale Community Initiatives Therapeutic Garden 1,866 B.50 Getting Better Together Making a Difference to Communities Hardest to Reach - Participatory Budgeting B.51 Getting Better Together African Drumming Ensemble Set * 2,000 B.52 Bonkle Church Bonkle Church Warm Hub 1,000 B.53 Coltness Community Council Coltness Community Christmas Fun Day 625
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78 B.54 Spotlight Shotts Family Christmas Pantomime Shows 5,200 B.55 Voice of Experience Forum Rabbie Does Strictly 952 B.56 Wishaw YMCA Keep fit Challenge * 2,000 Coding Club * 2,240 She Time * 1,440 B.57 Overtown Parish Church Game Changers * 6,160 B.58 PlayPeace Parents as the Experts * 1,418 B.59 Ponies Help Children Digital Transformation * 6,300 No. of projects 17 * project funded in 23-24, (continuing) delivery in 24-25 Total 37,480 of which 9,894 from ILI
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79 Appendix C Community Solutions Thematic Funding 2023-24: Total Awards: £893.5k C.1 Anticipatory Care: Total Awards £40k CVS Organisation/Project Total Funding Amount (£) Equals Advocacy 40,000 C.2 Carer Breather: Total Awards £272k Bazooka Arts 21,848 Getting Better Together 27,212 Glenboig Development Trust 20,760
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80 North Lanarkshire Disability Forum 28,052 One Parent Families Scotland 27,322 PAMIS 24,168 Parkinson’s Self-Help Group 25,845 PlayPeace 21,918 CVS Organisation/Project Total Funding Amount (£) The Haven 27,487 The Health and Wellness Hub 26,476 Watch Us Grow 20,565 C.3 Carers’ Support Network: Total Awards £40k
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81 North Lanarkshire Carers Together 40,000 C.4 Cancer Screening Fund: Total Awards £15k Bear Necessities 7,500 Culture Junction 7,400 C.5 Community Transport: Total Awards £72k Getting Better Together 72,000 C.6 Befriending: Total Awards £195k Befriend Motherwell 8,000 CACE 20,600
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82 Elim Christian Centre 14,228 CVS Organisation/Project Total Funding Amount (£) Getting Better Together 29,000 Glenboig Development Trust 20,000 HomeStart 33,000 Orbiston Neighbourhood Centre 20,000 Volunteering Matters 29,800 YMCA Bellshill 20,000 C.7 Hospital Discharge Support Programme: Total Award £77.5k
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83 Getting Better Together 77,500 C.8 Positive Smoke-Free Role Models: Total Award £36k Airdrie 6,000 Bellshill 6,000 Coatbridge 6,000 Cumbernauld 6,000 Motherwell 6,000 CVS Organisation/Project Total Funding Amount (£) Wishaw and Shotts 6,000
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84 C.9 Physical Activities: Total Award £40K North Lanarkshire Leisure Trust 40,000 C.10 Support in the Right Direction Fund: Total Awards £106k Equals Advocacy 16,838 North Lanarkshire Disability Forum 89,113
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85 Appendix D Community Solutions Children and Young People Fund 2023-24: Total Awards: £449.7k for 73 projects across 20 CVS organisations (See main body of this report – and also the separate Learning and Impact Report – for this Fund) CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.1 Glenboig Development Trust Without Walls 8,288 Airdrie Academy D.2 HOPE for Autism Support Anxiety Related School Absence 3,166 Community Transition Group 2,657 D.3 Lanarkshire Community Food and Health Partnership Come Dine with Me 1,480
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86 D.4 Make and Create Arts Positive Creations & Positive Families 6,000 D.5 Reeltime Music Reeltime Music - Airdrie 2,400 D.6 One Parent Families Scotland Support for Lone Parents 4,000 Bellshill Academy D.7 OutLET Small Group Support 3,131 CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.8 VIP-Pass Community Project VIP Alternative Curricular Activities 14,611 D.9 Action for Children Family Support and Wellbeing 17,749 Braidhurst High
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87 D.10 VIP-Pass Community Project Creative Transitions 27,275 Brannock and Taylor High D.11 Parent Action for Safe Play (PASP) Active Play Programme 2,400 Calderhead High D.12 The Miracle Foundation Mental Health Workshops and Exam Stress Support 10,780 D.13 Circle Whole family, trauma recovery and early intervention support 21,654 Caldervale High D.14 Ponies Help Children Equine Assisted Learning 1,120 D.15 Circle Young People’s Service 9,295 Cardinal Newman High D.16 Home-Start 1-to-1 Support 10,838 D.17 LANDED Peer Education Service Harm Reduction Workshops 750
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88 CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.18 HOPE for Autism 1-to-1 Personalised Support for Parents/Carers (Chryston HS) 3,910 Chryston High D.19 The Health and Wellness Hub Stress Buster Programme 2,196 D.20 The Miracle Foundation 1-to-1 Art Therapeutic Support 6,000 D.21 Made4UInML2 Employability Group Sessions 3,200 Clyde Valley High D.22 OutLET Group Support 6,757 D.23 Ponies Help Children Equine Assisted Learning 1,540
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89 D.24 Social Track Shredability and maintenance sessions 16,000 D.25 OutLET 8 Week Outdoor Support 1,436 Coatbridge High Individual Support 1,562 D.26 The Miracle Foundation 4x Mental Health Workshops 14,400 D.27 Action for Children Family Support and Wellbeing 13,311 Coltness High CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.28 HOPE for Autism Autism Family Training 695 Cumbernauld Academy D.29 OutLET Individual and Small Group Support 14,369
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90 D.30 Parent Action for Safe Play (PASP) Play Champ Programme 6,400 D.31 Ponies Help Children Equine Assisted Learning 180 D.32 Action for Children Family Support and Wellbeing 12,471 Dalziel High D.33 The Miracle Foundation Art Therapeutic Support 1,476 Greenfaulds High Art Therapeutic Support - 10 Weeks 3,000 1-to-1 Counselling/Art Therapy 9,000 D.34 VIP-Pass Community Project Creative Transitions 460
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91 D.35 HOPE for Autism 1-to-1 Personalised Support 792 Kilsyth High D.36 The Health & Wellness Hub Stress Buster Programme 2,341 CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.37 The Miracle Foundation 1-to-1 Art Therapeutic Support 3,000 1-to-1 Art Therapeutic Support 1,267 Mental Health Workshops 3,600 D.38 HOPE for Autism 1-to-1 Parental Support (St Mary's) 271 Our Lady’s High Cumbernauld Neurobears + Personalised Support 1,105
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92 D.39 The Health & Wellness Hub Stress Buster Programme 2,261 D.40 The Holding Space Joining the Dots 3,000 D.41 The Miracle Foundation 1-to-1 Art Therapeutic Support 1,106 1-to-1 Art Therapeutic Support 1,733 Mental Health Workshops 3,600 CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.42 HOPE for Autism Autism Supports 11,000 Our Lady’s High Motherwell
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93 D.43 The Miracle Foundation 1-to-1 Art Therapeutic Support 6,000 D.44 Action for Children Family Support & Wellbeing 20,771 St Aidan’s High D.45 Bazooka Arts Therapeutic Arts Programmes 7,950 St Ambrose High D.46 Make and Create Arts Positive Creations Project 7,000 D.47 Reeltime Music Reeltime Music - Music Workshops 1,025 D.48 Bazooka Arts Therapeutic Arts Programmes 15,560 St Andrew’s High D.49 Make and Create Arts Positive Creations Project 9,000 D.50 Parent Action for Safe Play Active Play Programme 4,080
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94 D.51 Reeltime Music Reeltime Music - Music Workshops 2,215 D.52 Make and Create Arts Positive Creations Project 4,000 St Margaret’s High D.53 Reeltime Music Reeltime Music - St Margaret's 5,950 CVS Organisation Project Total Funding Amount (£) Schools’ Cluster D.54 Social Track Shredability Sessions, Cycling, Scooting, Skateboarding Fun Sessions 6,000 D.55 The Health & Wellness Hub Stress Buster Programme 4,973 D.56 VIP-Pass Community Project Horse-riding 988
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95 VIP Horse-riding & Musical Theatre programmes 4,775 D.57 OutLET Community Ranger 8,582 St Maurice’s High D.58 The Miracle Foundation Art Therapeutic Support 6,000 St Maurice’s and Greenfaulds D.59 OutLET Small Group Support 1,436 We Aspire (ASN) D.60 Reeltime Music Music and Media Workshops 660 D.61 Social Track Shredability 3,600 D.62 The Holding Space Therapeutic Art, Therapy Dog, Self-Care 4,500 CVS Organisation Project Total Funding Schools’
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96 Amount (£) Cluster D.63 The Miracle Foundation 1-to-1 Art Therapeutic Support + Workshops 4,800
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97 Appendix E Community Solutions Community Mental Health and Wellbeing Fund 2023-24: Total Awards: £955k for 33 projects across 32 organisations (See main body of this report – and also the separate Learning and Impact Report – for this Fund) CVS Organisation Project Total Funding Amount (£) E.1 Airdrie Citizens Advice Bureau Action Beyond Courage (ABC) 40,311 E.2 Bazooka Arts Create & Connect Year Two: Community 34,900 E.3 Circle Family Wellbeing Team 50,987 E.4 Cloudberry Communities Natural Connections 43,600 E.5 Cornerstone Community Care Cornerstone Connects North Lanarkshire 10,714
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98 E.6 FAMS Spring Ahead – Connection & Information 38,640 E.7 Forgewood Housing Cooperative Forgewood & Gowkthrapple: Taking steps towards a happier and healthier life 44,739 E.8 Fresh Start NL Let's Talk 12,440 E.9 Getting Better Together Bump to Birth and Beyond 27,482 CVS Organisation Project Total Funding Amount (£) E.10 Getting Better Together Healthy & Active Lifestyles Project 30,660 E.11 Glenboig Development Trust Glenboig Community Garden 45,131 E.12 Home-Start Healthy- Happy Families 35,671
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99 E.13 Lanarkshire Rape Crisis Centre Community Support Project 16,774 E.14 Lanarkshire Community Food and Health Partnership (LCFHP) Food for Mood for Families 27,862 E.15 MADE4U IN ML2 Wellbeing in ML2: Adults and Older People 49,846 E.16 Maggie’s Lanarkshire Lanarkshire psychological wellbeing sessions and courses 21,771 E.17 Make and Create Arts Positive Youth Connections 13,293 E.18 Motherwell and Wishaw Citizens Advice Bureau Community Engagement Project 41,450 E.19 Motherwell Football Club Community Trust The Well Hub 30,300
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100 E.20 New Opportunities Project New Opportunities Project 23,122 E.21 North Lanarkshire Recovery Community NLRC Recovery Therapies 18,400 CVS Organisation Project Total Funding Amount (£) E.22 OutLET Outdoors for Wellbeing 18,393 E.23 PAMIS (Promoting a more inclusive society) Lanarkshire PAMIS Well-being Project 21,139 E.24 Parkinson’s Self-Help Group Nurture, Develop and Grow 26,972 E.25 Playlist for Life Playlist for Life North Lanarkshire 21,625 E.26 Ponies Help Children Volunteer Development Officer 18,500
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101 E.27 The Economic Forum for Women’s Empowerment BAME women food festival and wellbeing project 10,000 E.28 The Health and Wellness Hub BAME Engagement Focus and Support Project 30,212 E.29 The Miracle Foundation Diverse Community Development & Engagement 43,765 E.30 The Venture Trust Outdoor Therapy 35,020 E.31 The Well Foundation The Well Foundation Community Sports Hub 33,760 E.32 Venture Scotland Challenge Yourself, Discover Yourself Phase 2 19,965 E.33 YMCA Bellshill & Mossend Y-Virtual Wellbeing 16,427
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REPORT Item No: 15 SUBJECT: Whistleblowing Report TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Archie Aitken, Chief Officer Legal and Democratic Services NLC Paul Cannon, Board Secretary NHS Lanarkshire DATE: 23 October 2024 1. PURPOSE OF REPORT The paper is to share whistleblowing reports from North Lanarkshire council and NHS Lanarkshire. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been:
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Prepared By: Archie Aitken, Chief Officer Legal and Democratic Services NLC Paul Cannon, Board Secretary NHS Lanarkshire ☒ Reviewed By: ☐ Endorsed By: ☐
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3. RECOMMENDATIONS 3.1 The Board is asked to note the update and the content of each Whistleblowing report and seek assurance that whistleblowing standards are being followed and learning shared. 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 5.1 “Whistleblowing” refers to the act of reporting concerns or wrongdoing in the public interest either within an organisation or externally, for example to a regulator. The law on whistleblowing is contained within the Employment Rights Act 1996 as amended by the Public Interest Disclosures Act 1998. 5.2 The Public Interest Disclosures Act 1998 gives protection to workers who have blown the whistle, but only if their disclosure meets statutory requirements. There are other steps an employer can take not mandated by the law to encourage effective internal whistleblowing and to protect whistle blowers; the most important of which is to develop and implement an effective and appropriate whistleblowing policy. 5.3 Both the North Lanarkshire Council and NHS Lanarkshire’ Whistleblowing Policy each provides a mechanism for employee within the Council and the NHS to report a concern about serious wrongdoing within the Council or NHS and to do so with security and in confidence.
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4 6. SUMMARY OF KEY ISSUES 6.1 The annual review of both the North Lanarkshire Council and the NHS Lanarkshire Whistleblowing Policy has been undertaken on the use of the Whistleblowing Policies and on any amendments required to the Policies. Copies of each report is attached within the Appendices. 6.2 North Lanarkshire Council’s Whistleblowing Procedure (attached as Appendix 1) has been reviewed and no amendments requiring approval are considered necessary at this time. This is on the basis that the principal objectives of the policy and procedure remain: • To convey the seriousness and importance that North Lanarkshire Council attaches to identifying and remedying wrongdoing; • To encourage workers to raise concerns internally as soon as possible and to give them the confidence to do so; • To remind workers of the standards of behavior expected of them; • To ensure workers know who to approach with a concern, and to enable them to bypass the person, management level or part of the organisation to which the concern relates; • To outline the procedures for investigating disclosures and what steps might be taken if wrongdoing is uncovered; and • To make it clear what will happen to those who victimise genuine whistleblowers or abuse the system by making malicious allegation. 6.3 In NHS Lanarkshire no new whistleblowing cases were raised during April, May and June 2024. One case raised in Q4 of 2023/24 was withdrawn, and one case initially raised in Q1 of 2023/24 continued to be assessed to determine if it met the criteria for Whistleblowing. One new potential case was raised in May 2024 and after further consideration the member of staff decided not to pursue the Policy. No new concerns were raised which were deemed appropriate for investigation under HR policies. 7. CONCLUSIONS Regular review of the Whistleblowing Procedures and Annual Reports from both North Lanarkshire Council and NHS Lanarkshire will be provided to the IJB to help provide assurance that good Whistleblowing standards are being upheld across the Health and Social Care Partnership. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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5 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 ☐ 8.2 ASSOCIATED MEASURE(S) 8.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☒ N/A ☐ 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB.10.21 Ineffective Governance Arrangements Low Claire Rae IJB.12.21 Staff Health and Wellbeing High Claire Rae 8.5 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.
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6 □ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved Information on Whistleblowing is shared across both organisations □ 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
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7 8.6 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 ☒ 9. BACKGROUND PAPERS None. 10. APPENDICES Appendix 1 North Lanarkshire Council Annual Review of Whistleblowing Procedure. Appendix 2 NHS Lanarkshire Whistleblowing Annual Report – April 2022 to March 2023. 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
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Appendix 1 North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref AA/REB Date 06/06/24 From Archie Aitken, Chief Officer (Legal and Democratic) E-mail aitkena@northlan.gov.uk Telephone 07939 280 102 Executive Summary North Lanarkshire Council’s Whistleblowing Procedure provides a mechanism for employees and other workers in the Council to report a concern about serious wrongdoing within the Council and to do so with security and in confidence. The annual review of the Whistleblowing Procedure has been undertaken on the use of the Whistleblowing Procedure and on any amendments required to the Procedure. Recommendations It is recommended that Policy and Strategy Committee: (1) Gives consideration to the contents of the report. The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (14) Ensure the highest standards of public protection Programme of Work Statutory/corporate/service requirement Annual Review of Whistleblowing Procedure Policy and Strategy Committee
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1. Background 1.1 The act of reporting concerns or wrongdoing in the public interest either within an organisation or externally, for example to a regulator or the press, is known as “whistleblowing”. The Employment Rights Act 1996 as amended by the Public Interest Disclosures Act 1998 provides the legal framework for whistleblowing. 1.2 If a disclosure meets statutory requirements, workers who have blown the whistle are protected by the Public Interest Disclosures Act 1998. This legislation provides the legal baseline, but there are other steps, not mandated by the law, that an employer can take to encourage effective internal whistleblowing and to protect whistleblowers. The most important of these is to develop and implement an effective and appropriate whistleblowing policy. Whistleblowing policies are important and should comply with best practice in regard to content and procedure. 2. Report 2.1 The whistleblowing legislation imposes no positive obligation on an employer to encourage whistleblowing, implement a whistleblowing policy or in relation to what an employer is required to do if a disclosure is received. The law does, however, provide that an employer should refrain from dismissing workers or subjecting them to any other detriment because they have made a protected disclosure. 2.2 North Lanarkshire Council, as a public body, is expected to have a whistleblowing policy as our whistleblowing arrangements are considered as part of our annual audit process. Whistleblowing plays an important role in safeguarding effective delivery of public services and ensuring best value. North Lanarkshire Council is committed to a culture which views raising concerns of malpractice as a valuable contribution towards its efficiency and effectiveness and assuring workers that they will be treated fairly and that their concerns will be properly addressed. Annual Review of the Whistleblowing Procedure 2.3 North Lanarkshire Council’s Whistleblowing Procedure (attached as Appendix 1) has been reviewed and no amendments requiring approval are considered necessary at this time. This is on the basis that the principal objectives of the policy and procedure remain: 2.3.1 to convey the seriousness and importance that North Lanarkshire Council attaches to identifying and remedying wrongdoing; 2.3.2 to encourage workers to raise concerns internally as soon as possible and to give them the confidence to do so; 2.3.3 to remind workers of the standards of behaviour expected of them; 2.3.4 to ensure workers know who to approach with a concern, and to enable them to bypass the person, management level or part of the organisation to which the concern relates; 2.3.5 to outline the procedures for investigating disclosures and what steps might be taken if wrongdoing is uncovered; and 2.3.6. to make it clear what will happen to those who victimise genuine whistleblowers or abuse the system by making malicious allegations.
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2.4 North Lanarkshire Council’s Whistleblowing procedure sets out the legal protections available to whistleblowers. There are further sources of help and guidance; 2.4.1 Chief Officers are designated as advisers to whistleblowers in identifying whether the concern falls under one or more of the categories or should be better dealt with under a different procedure; 2.4.2 There is access to an external counselling hotline in terms of the Employee Assistance Programme; and 2.4.3 Protect, the whistleblowing charity who provide a confidential independent helpline for whistleblowers is referred to in the procedure. Annual Review of the use of the Whistleblowing Procedure 2.5 Since the last review in 2023, Education and Families received one whistleblowing report. 2.6 A thorough and comprehensive investigation into the matters raised concluded that there was no substance to the allegations made. 3. Measures of success 3.1 Further review of the application of the Whistleblowing Procedure will ensure that the Council’s resources and reputation are being safeguarded and that the Council’s good governance standards are being maintained. 4. Supporting documentation Appendix 1 - Whistleblowing Procedure. Archie Aitken Chief Officer (Legal and Democratic)
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality- and-fairer-scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Finance? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People Resources? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐
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5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☐ No ☒ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services.
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Public Interest Disclosure Whistleblowing Appendix 1
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Whistleblowing 2 Document control Title Whistleblowing Owner Archie Aitken Contact aitkena@northlan.gov.uk Governance Group Policy Strategy Author Archie Aitken Contact aitkena@northlan.gov.uk Revision History Number Originator Date Review Commenced Revision description/record of change 1 May 2024 Updated to reflect staffing changes Document Approvals Number Governance Date approval granted Date approval to be requested Group (if document still draft) 1 Policy and Strategy Committee 6 June 2024 Consultation Record (for most recent update) Status of document consulted upon Consultation with Stakeholders carried out February 2022 Stakeholders consulted/date Joint Trade Unions JNC for Teaching Staff Next review date Review Date May 2025 Strategic Alignment Improving the Council’s Resource Base – Ensure the highest standards of public protection.
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Whistleblowing 3 Preamble The purpose of this procedure is to provide a mechanism for employees, officers, consultants contractors and workers to report to the Council a concern which they have that there is serious wrongdoing within the Council – and to do so with both security and confidence. It draws on the rights and obligations contained within the Employment Rights Act 1996, the Public Interest Disclosure Act 1998, and the Enterprise and Regulatory Reform Act 2013. This procedure for reporting concerns at work is based on the following principles: • fair and reasonable treatment at work; • the right to report concerns reasonably believed to be in the public interest; • confidentiality; • openness and accountability, and • honesty and integrity.
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Whistleblowing 4 1. Introduction 1.1 In the course of your employment you may become aware of serious wrongdoing in the Council or you may have information regarding malpractice. This procedure outlines the steps you should take to bring serious situations to the attention of the Council, and has been designed to provide guidance to employees on reporting incidents of malpractice or wrongdoing. It indicates how matters can be expedited thoroughly, discreetly and, so far as possible, in a confidential way if that is necessary. This procedure outlines:- • what sort of concerns may be reported; • the employees covered by this procedure; • the nominated individuals in the Council who can be contacted regarding your concerns; • the appropriate steps to be taken to report serious wrongdoing or malpractice; • how a matter may be raised in confidence when that is appropriate; • the rights of employees who are the subject of disclosures; • any obligations placed on an employee in terms of bearing witness; • the interest of the Council; • the right to raise matters of concern and not be subject to any detriment; and • the protection which is available to an employee. 1.2 The disclosure of information in the public interest involves the reporting of serious concerns about illegal or unethical conduct or behaviour which could be described as serious malpractice in the workplace. The kinds of concerns are those set out at paragraph 2.2 of this procedure. 1.3 The principles and guidance outlined in this procedure have been developed against the background of the Council’s wish to be open and honest, to encourage high standards of conduct in the workplace and to develop the statutory protections available to employees. 1.4 Any employee who has a concern over what they consider is serious wrongdoing within the Council may wish to seek support and advice from their trade union which may be in a position to assist the employee in preparing and making a disclosure report under this procedure. 1.5 The title given to this procedure is Public Interest Disclosures. It may also be referred to as the “Whistleblowing” Procedure.
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Whistleblowing 5 2. Reporting Concerns 2.1 Most personal concerns at work can be adequately dealt with using other procedures or mechanisms. For instance, if there is an issue about your working conditions which you cannot resolve through other means, you may wish to use the Council’s Grievance Procedure. The procedure outlined in this document is designed to deal with issues of illegality or serious malpractice. 2.2 The public has a right to expect high standards of service. However, there may be occasions when, due to individual acts, omissions or failings, it may be necessary to bring certain matters which give cause for serious concern to the attention of your employer. If you are concerned about an aspect of individual behaviour or Council practice it may fall under one (or more) of the following categories: • a criminal offence; • a failure to comply with a legal obligation; • a miscarriage of justice; • danger to the health and safety of an individual; • damage to the environment, and • the deliberate concealment of information tending to show any of the matters above is being deliberately concealed. 2.3 Under the terms of this procedure an employee can report a matter which they reasonably believe to be in the public interest, on a confidential basis to their employer regarding any of these six categories. The categories are by no means mutually exclusive. For instance, you may be aware of a health and safety failure that is also a criminal offence. If you are not sure whether the concern you wish to raise falls into one of the above categories then you may contact one of several Council Officers who will try to assist you in identifying whether the concern which you have falls under one or more of these categories or whether your concern should be better dealt with under a different procedure or route. The officers available to advise on this are the Council’s Chief Officer (Legal and Democratic), Chief Officer (Finance) and Chief Officer (People Resources). 2.4 An employee may also be a resident in the Council’s area or have other good reason to approach a local councillor. Such an employee is free to raise an issue with their councillor. However, advising a local councillor of a concern over serious wrongdoing is not a substitute for advising the Council formally by following the Disclosure Report Procedure set out in Section 4. The onus rests on the employee to make the Public Interest Disclosure by following the defined reporting procedure. This will ensure that the Council deals with the matter formally, and in terms of both the legislation and this Procedure. 3. Confidentiality and Anonymity 3.1 One of the principles of this procedure is that an employee has the right to report a matter they consider to be in the public interest and the report will be treated on a confidential basis. For the reporting process to have credibility, employees must have confidence that any matter they draw to the attention of their employer will be handled with discretion and tact.
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Whistleblowing 6 3.2 The Council hopes that all staff will be able to voice whistleblowing concerns openly under this policy. If an employee wishes to raise their concern confidentially, the Council will make every effort to ensure the employee’s identity is kept a secret. If it is necessary for anyone investigating the employee’s concern to know their identity, this will be discussed with the employee. 3.3 The Council does not encourage staff to make disclosures anonymously. Proper investigations may be more difficult or impossible if the Council cannot obtain further information. It is also more difficult to establish whether any allegations are credible. Whistleblowers who are concerned about possible reprisals if their identity is revealed should come forward to the officers identified at 2.3 and appropriate measures can then be taken to preserve confidentiality. If an employee is any doubt, they can seek advice from Protect (https://protect-advice.org.uk/), the independent whistleblowing charity, who offer a confidential helpline. 3.4 It has to be recognised, however, that in some cases it may not always be possible to preserve total confidentiality, for instance, if the matter reported has to involve agencies such as the police or the Health and Safety Executive. If, in such a situation, the Council can no longer preserve total confidentiality, the employee will be advised of that fact. 4. Reporting Procedure 4.1 An employee wishing to report a matter that is covered by the categories covered in this procedure should contact the appropriate designated officer in the employing Service in the Council. The designated officers are those identified in Annex 1 to this document. This report should, preferably, be in writing and in order to avoid any doubt, should be described as a “Public Interest Disclosure”. 4.2 This procedure requires that disclosure reports should be made to the designated officers. Those designated offers are required to be alert to such disclosures and ensure that, as far as it is possible, the confidentiality of such reports is maintained. This will normally involve the report having the personal attention of the designated officer. 4.3 If a disclosure report is made which alleges wrongdoing by the Depute Chief Executive or Chief Officer that report should be made directly to the Chief Executive. 4.4 Once a report has been submitted the appropriate officer will advise you of the next steps and any expected timescale. This will be done within five working days. 4.5 At this stage of the process it is important that confidentiality is maintained by both parties where that is required to ensure that the matter can be dealt with in the appropriate way, avoid prejudice and protect individual rights. 4.6 The report will then be considered and a decision taken as to whether, and in what way, the matter should proceed. 4.7 Should the appropriate officer decide not to take any action you will be notified and given the reason(s) for this decision.
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Whistleblowing 7 4.8 If the appropriate officer decides that further action is required on the basis of your report, then you will be notified of the decision, subject to the appropriate investigation and the likely timescale, if possible, to do so. 4.9 Once the matter has been concluded and the appropriate action taken in response to your report, you will be notified of the outcome. However, sometimes the need for confidentiality may prevent the Council from giving you specific details or any disciplinary action taken as a result. You should treat any information about the investigation as confidential. 4.10 Under the terms of this procedure, you may seek a progress update from the appropriate officer regarding the status of your report, although it has to be understood that the response may have to be qualified in order to protect other interests. 4.11 While the Council cannot guarantee the outcome you are seeking, the Council will try to deal with your concern fairly and in an appropriate way. By using this procedure, you can help the Council achieve this. 4.12 If you are not satisfied with the way your report has been dealt with, you can raise this with the Chief Executive. 5. Safeguards 5.1 Under the terms of this procedure, any employee making a Public Interest Disclosure report is safeguarded against any detriment in the course of their employment, provided that the report is made in the reasonable belief that it is in the public interest. 5.2 For the purpose of this procedure, detriment is defined as any act or omission that penalises the employee for submitting the report. For example, dismissal, harassment, victimisation or any other form of punitive sanction which would not have arisen were it not for the report having been made are prohibited under the terms of this procedure. If you believe that you have been subjected to a detriment, you should immediately report that to the officer who received your disclosure report. If the matter is not remedied, you should raise it formally through the Council’s Dignity at Work procedure. 5.3 An employee must not threaten or retaliate against another employee making a Public Interest Disclosure Report. Any employee involved in such conduct, may be subject to the Councils’ disciplinary procedure. In addition, if an employee is subjected to such detriment by another employee then that other employee could be personally liable. 6. Wrong Reports 6.1 There may be instances when a report is submitted, based on a genuine belief by the employee that something is wrong at a particular time, which is subsequently demonstrated to be false or inaccurate. In such circumstances, employees will be informed of the discrepancy between their report and the facts at hand. Provided that the Council is satisfied that the employee acted in good faith and had a genuine belief that such a situation should be reported and no personal gain was involved, no further action will be taken against the reporting employee.
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Whistleblowing 8 6.2 If an employee has deliberately submitted a report that they know to be not true or unfounded or with a view to personal gain then they may be subject to the Council’s disciplinary procedure. 7. Reporting Outwith the Council 7.1 The aim of this procedure is to provide an internal mechanism for reporting, investigating and remedying any wrongdoing in the workplace. In most cases you should not find it necessary to alert anyone externally. 7.2 The law recognises that in some circumstances it may be appropriate for you to report your concerns to an external body such as a regulator. It will very rarely if ever be appropriate to alert the media. You are strongly encouraged to seek advice before reporting a concern to anyone external. Protect’s confidential helpline is available for this. In addition, Protect has a list of prescribed regulators for reporting certain types of concern. 7.3 Whistleblowing concerns usually relate to the conduct of our staff, but they may sometimes relate to the actions of a third party, such as a supplier or service provider. In some circumstances the law will protect you if you raise the matter with the third party directly. However, you are encouraged to report such concerns internally first. You should contact one of the other key contacts set out in paragraph 2.3 for guidance. 7.4 Employees within Health and Social Care can access the National Whistleblowing Standards in relation to NHS Services. Further information can be obtained from the Chief Accountable Officer or accessed here.
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Whistleblowing 9 ANNEX 1 CHIEF OFFICERS TO WHOM PUBLIC INTEREST DISCLOSURES MAY BE REPORTED – WHISTLEBLOWING PROCEDURE 1. Chief Executive’s Service Des Murray Chief Executive 2. Enterprise and Communities Service Andrew McPherson Depute Chief Executive 3. Education and Families Service Gerard McLaughlin Chief Officer (Education – North) 4. Adult Health and Social Care Services Ross McGuffie Chief Officer (Health and Social Care)
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1 of 4 Appendix 2 NHS Lanarkshire Quarter 1 - 2024/25 Whistleblowing Report SERVICE: Corporate AUTHOR: Paul Cannon, Board Secretary DATE: August 2024 1. Definition of whistleblowing Whistleblowing is defined in the Public Services Reform (the Scottish Public Services Ombudsman) (Healthcare Whistleblowing) Order 2020 as: when a person who delivers services or used to deliver services on behalf of a health service body, family health service provider or independent provider (as defined in section 23 of the Scottish Public Services Ombudsman Act 2002) raises a concern that relates to speaking up, in the public interest, about an NHS service, where an act or omission has created, or may create, a risk of harm or wrong doing. 2. NHS Lanarkshire performance – quarter one – 2024/2025 No new whistleblowing cases were raised during April, May and June 2024. One case raised in Q4 of 2023/24 was withdrawn, and one case initially raised in Q1 of 2023/24 continued to be assessed to determine if it met the criteria for Whistleblowing. One new potential case was raised in May 2024 and after further consideration the member of staff decided not to pursue the Policy. No new concerns were raised which were deemed appropriate for investigation under HR policies. The report at Appendix 1 provides performance information on the following areas which reflect the key performance indicators included in the Standards: • Whistleblowing concerns raised • Learning, changes or improvements to service or procedures • Experience of individual raising concern/s • Level of staff perceptions, awareness and training • Whistleblowing themes, trends and patterns Procedures for raising concerns should provide good-quality outcomes through a thorough but proportionate investigation. The approach to handling whistleblowing concerns ensures that learning and improvement is progressed for upheld whistleblowing concerns and are shared across all relevant services. 3. List of appendices • Appendix 1 - Whistleblowing Report for Quarter 1 – April to June 2024.
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2 of 4 Appendix 1 - Whistleblowing Report - Quarter 1 April to June 2024 1. Key Performance Indicators 1.1 Cumulative total – Whistleblowing Concerns Raised 2024/25 Quarter Appropriate for whistleblowing Stage 1 Stage 2 Outcome Comments 1 Under consideration 0 0 Further information sought from member of staff n/a 2 3 4 Total 1.2 Whistleblowing Concerns Received – Q1 The table below shows the total number of concerns received in Q1. Total no of concerns received Appropriate for WB Stage 1 Stage 2 Comments 1 under consideration 0 0 0 n/a 1.3 Concerns Closed – Q1 The table below provides the number of concerns closed at Stage 1 and Stage 2 of the procedure as a percentage of all concerns closed. WB concerns Q3 Nos closed Nos ongoing % closed against all received Stage 1 0 0 n/a Stage 2 1 0 n/a NB Stage 1 concerns are expected to achieve an early resolution within 5 days, stage 2 concerns are more complex and will require investigation. These should normally be completed within 20 working days. One case raised in February 2024 was withdrawn before any formal investigation was undertaken. 3. Learning, Changes or Improvements to Service or Procedures As no concerns were raised during this period there is nothing to report.
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3 of 4 4. Experience of Individuals Raising Concern/s As no new concerns were raised during this period there is nothing to report. 5. Level of Staff Perception, Awareness and Training - Quarter 1 Weekly reminders regarding whistleblowing continued to appear in the staff briefing during this period and the bi-annual network for confidential contacts met in May. Training on the Standards is available through TURAS via three modules (overview, line managers and senior managers) and NES provides monitoring information on the uptake of the training. We will be seeking to raise further awareness of the modules during Speak Up week (see below). Speak Up Week will be held from 30 September to 4 October, and details of the activities planned are under discussion with the Executive Lead and the Non Executive Whistleblowing Champion. This year’s theme is ‘Enabling Speaking Up’. As part of Speak Up week, we are planning, as a minimum, the following activities • A video of Eddie Docherty promoting the importance of whistleblowing • Engagement on a daily basis throughout the week on social media, including updating our social media banners to promote the week • Screensaver and FirstPort banners to raise awareness with staff • Promote the week’s work through a Pulse article • A National Toolkit will also be available to support local activities We are also planning to add to the video we have of one of the confidential contacts, with a second video and a willing volunteer is being sought. Nationally the Independent National Whistleblowing Officer (INWO) is offering live events and registration is open for these on their website. Monday 30 September, 3.30pm – 4.15pm Rosemary Agnew, Independent National Whistleblowing Officer, in conversation with Professor Caroline Hiscox, NHS Lothian Chief Executive Wednesday 2 October, 11am – 12 midday Psychological Safety and Speaking Up Liz Humphreys, Non-Executive Director and Whistleblowing Champion for the Scottish Ambulance Service and Public Health Scotland, in conversation with Paul Johnston, Public Health Scotland Chief Executive Thursday 3 October, 10.30am – 11.30am Understanding the experiences of those involved in the whistleblowing procedure Elaine Cameron, Head of Investigations INWO, hosts a panel discussion with: • Louise Ballantyne, Head of Engagement NHS Grampian • Caroline McDowall, Work Well Specialist Lead & Speak UP Ambassador NHS Lothian • Hannah Monaghan, Consultant Pathologist and Head of Pathology, Speak Up Ambassador and Confidential Contact NHS Lothian
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4 of 4 5. Reporting from Primary Care, Integrated Joint Boards (IJBs) and other Contracted Services – Quarter 1 NHS boards are responsible for ensuring all primary care, IJBs and other contracted service providers supply the appropriate KPI information to their board as soon as possible after the end of the quarter. In instances where no concerns have been raised within either primary care or other contracted services there is no need to provide a quarterly return to the board and no concerns from primary care, IJBs or other contracted services were received during Quarter 1. 6. Whistleblowing Themes, Trends and Patterns This section provides information on themes from whistleblowing concerns and will aid identification of any shared causes and progress learning and improvement in a targeted manner. The categories/classification for whistleblowing concerns are listed in Part 2 of the Standards and are outlined below for information: • Patient Safety • Patient Care • Poor Practice • Unsafe Working Conditions • Fraud • Changing or Falsifying information on performance • Breach/Breaking any legal obligation • Abusing authority • Concealment of any of the above As no concerns were raised during the quarter in question there is nothing to report in this section. 7. Independent National Whistleblowing Officer Referrals and Investigations An indicator of the satisfaction of those who raise concerns can be derived from the number of concerns that are escalated to the Independent National Whistleblowing Officer (INWO). There have been no referrals to the INWO during this quarter as a result of concerns raised in NHS Lanarkshire. 8. Summary This report provides assurance to the Staff Governance Committee that concerns raised through the Whistleblowing Standards are being recorded, investigated and reported in accordance with the requirements outlined in the Standards. PC Aug 2024
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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: Claire Rae, NL HSCP Chief Officer Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 23rd October 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: The Support Services, Project Manager ☒ Reviewed By: Chief Officer North HSCP. ☐ Endorsed By: ☐
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4 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 an overview of the corporate risk registers across parent organisations within North Lanarkshire. 3.3 The IJB may wish to consider the inclusion of climate change and public protection risks to the IJB risk register to align risk sharing across parent organisations. 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. 5.1.1 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.1.2 The following risk are currently rated as Very High on the IJB risk register. • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges • IJB 21/24- Pharmacy Pressures within Prison Services 5.1.3 The 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 • IJB 16/22 – National Care Service • IJB 19/23 – Service Sustainability • IJB 20/23 – Workforce Sustainability • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy
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5 5.1.4 The 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 are highlighted within the Risk Overview Dashboard (Appendix 1) and Risk Register (Appendix 2). 5.2 In response to a request from IJB members in August 2024, a comparative review was conducted of the corporate risk registers for North Lanarkshire Council and NHS Lanarkshire. This review also encompassed the Adult Health and Social Care Risk Register as well as the NL H&SCP Core Risk Register. 5.2.1 The review highlighted that all four risk registers had the following risk themes detailed: • Financial Risks/ Financial Sustainability • Prevention and Detection of Fraud, Bribery and/or Corruption 5.2.2 The current IJB risk themes are shared across partner organisations as detailed below; IJB Risk NHS Lanarkshire Corporate Risk Register North Lanarkshire Council Corporate Risk Register Adult Health and Social Care Risk Register North Lanarkshire H&SCP Risk Register Ineffective Governance Arrangement x Service Sustainability x x x Care Homes x Unscheduled Care Staff health and Wellbeing x x Service Sustainability / Safe workforce x x Third Sector x Cost of Living / Poverty x National Care Service x x Community Alarms x 5.2.3 Building on the findings of this review, the IJB may wish to consider the inclusion of the following risk themes in the IJB Risk Register: • Climate Change • Public Protection
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6 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 There are several risk themes currently detailed within the IJB Risk Register that are also listed across both parent organisations corporate risk registers. 6.4 The IJB may wish to consider the inclusion of climate change and public protection risks to the IJB risk register to align risk sharing across parent organisations. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centered on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.1 ASSOCIATED MEASURE(S) 7.2 FINANCIAL This paper has been reviewed by Finance:
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7 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 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
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8 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 Appendix 2 – Risk Register Appendix 3 – Risk Register Comparison Review CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 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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20 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 Assurance Source Next Review 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
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21 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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. Reviewed and no changes Sept 2024 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. 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 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches.
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22 Report Prepared by Stacey Anderson on behalf of the Chief Officer performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. 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 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 Reputati onal 01/04/2 021 Prevention and Detection of Fraud, Bribery and/or Corruption CONTROLS LOW LOW Claire Rae Amanda Kilburn SLT, IJB PFA, IJB 31.08.24 Previously IJB6. Reviewed
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23 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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. and updated on March 2023. 2. National Fraud initiative. Reviewed and Updated Oct 2023, 3. Locality/SW Enablement Groups. (previously title ineffective governanc e arrangeme nts). 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. Reviewed and No changes Sept 2024 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website
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24 Report Prepared by Stacey Anderson on behalf of the Chief Officer ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget CONTROLS HIGH MEDIUM Claire Rae 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 Reviewed May 2024 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. Reviewed July 2024. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 Reviewed Sept 2024 01/0 Hosted Services CONTROLS MED MED Claire Ama SLT, 28. 08.
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25 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB05. 21 Financial Strategic 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. Reviewed Jan 2024 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. Reviewed Sept 2024 IJB06. 21 Financial Operatio nal 01/04/2021 Prescribing Activity and Costs CONTROLS VERY HIGH LOW Claire Rae 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 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 Reviewed June 2024.
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26 Report Prepared by Stacey Anderson on behalf of the Chief Officer Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. Reviewed July 2024. 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. Reviewed Sept 2024 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 Claire Rae 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 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.
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27 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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. 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 Reviewed and no changes Sept 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. 2. Updated SLA with VANL nearing completion IJB.10 . 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements CONTROLS LOW LOW Claire Rae 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.
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28 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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, 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. Reviewed and no changes Sept 2024 9. IJB Governance reporting reviewed and associated documents updated. IJB.11 21 Performa nce 30/07/2021 Oversight of Performance Activity CONTROLS LOW LOW Claire Rae 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 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.
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29 Report Prepared by Stacey Anderson on behalf of the Chief Officer oversight role; make informed decisions and recommend remedial actions to address any performance concerns. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. Reviewed and no changes Sept 2024 IJB.12 . 21 Performa nce 30/08/2021 Staff Health & Wellbeing MEDIUM CONTROLS HIGH low Claire Rae Claire Rae 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 Reviewed Sept 2024 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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30 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.13 . 2021 Performa nce 30.08.21 Care Homes HIGH CONTROLS medium medium Claire Rae 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. Reviewed Sept 2024 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 & Performa nce 30.04.22 CAMHS VERY HIGH CONTROLS Medium Medium Claire Rae 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 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
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31 Report Prepared by Stacey Anderson on behalf of the Chief Officer potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 level lowered May 2024. Continuous review and validation of the waiting list Reviewed and no changes Sept 2024 Waiting list validation exercise completed in April 2022 with reduction in list by 16% 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 & Performa nce 05.09.22 Cost of Living HIGH CONTROLS High Medium Claire Rae Claire Rae 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 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.
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32 Report Prepared by Stacey Anderson on behalf of the Chief Officer individuals and families having insufficient funds to support basic requirements such as food and heating. ACTIONS Reviewed Sept 2024 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. IJB.16 . 2022 Strategic 05.09.22 National Care Service HIGH CONTROLS High Low Diane Fraser Claire Rae 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 Reviewed Sept 2024 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 Strategic & 05.09. 22 Unscheduled Care Very High CONTROLS High Mediu m Claire Rae Claire Rae SLT, IJB 28.08. 24 Reviewed and
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33 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.17 . 2022 Performa nce 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. Updated in June 2023. 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 Reviewed Sept 2024 Roll out of Home Assessment Teams across all 6 Localities New CSW roles in District Nursing teams to proactively support Care Managed patients 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)
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34 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.18 . 2022 Strategic and Performa nce 05.09.22 Community Alarms HIGH CONTROLS Medium Low Diane Fraser Claire Rae 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 Reviewed Sept 2024 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 centre 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 Performa nce 27/02/2023 Service Sustainability High CONTROLS Claire Rae Claire Rae 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 the IJB poses a risk on operational service delivery and IJB PFA Committee. High Low IJB Chief Officer is a member of each partner's key decision‐making forums. Reviewed and Updated Oct 2023. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Reviewed and updated Jan 2024.
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35 Report Prepared by Stacey Anderson on behalf of the Chief Officer the achievement of financial balance and patient safety 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. Reviewed Sept 2024 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 analysing service challenges and implementing phased changes to support winter pressures and beyond. Workforce Sustainability HIGH CONTROLS Claire Rae Claire Rae SLT, IJB 28.07. 24
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36 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB.20 . 2023 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 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 Reviewed Sept 2024
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37 Report Prepared by Stacey Anderson on behalf of the Chief Officer there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. IJB21. 24 Financial Jun- 24 Pharmacy Pressures within Prison Service High CONTROLS Very High Low Claire Rae Claire Rae 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) for the actual drugs bought and £246K associated with the management fees for the contract. Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS 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. 24 Performa nce Jul- 24 Speech and Language Therapy (SLT) Service High CONTROLS High Low Claire Rae Claire Rae 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. Added to the register August 2024. 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
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38 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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39 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 3 – Risk Overview Theme NHS Lanarkshire Board NLC Corporate Risk Adult Health & Social Care IJB NL HSCP Risk Register (Core)
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40 Report Prepared by Stacey Anderson on behalf of the Chief Officer Financial Related risks Ability of NHS Lanarkshire to deliver a balanced budget within periods 23/24- 25/26 Financial Sustainability Budget & Financial Financial challenges impact on delivery of Strategic Commissioning Plan - There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Meeting Financial Targets
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41 Report Prepared by Stacey Anderson on behalf of the Chief Officer Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan
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42 Report Prepared by Stacey Anderson on behalf of the Chief Officer and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges.
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43 Report Prepared by Stacey Anderson on behalf of the Chief Officer The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community-based alternatives as expected in terms of the notional set‐ aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the
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44 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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. NHS Sustainability Policy Failure to comply with NHS Sustainability Policy - Climate change Climate Change (Mitigation, Adaptation & Sustainability) (high) Change management and demographic change NA NA
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45 Report Prepared by Stacey Anderson on behalf of the Chief Officer Service Provision Ability to maintain General Medical Service provision. NA Social Care Provider Stability Service sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Workforce Sustainability It is becoming increasingly difficult to recruit to roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload Medical Vacancies across North HSCP hosted services. GP Sustainability Recruitment & Retention
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46 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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47 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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48 Report Prepared by Stacey Anderson on behalf of the Chief Officer Ability to respond to climate change Ability to respond to climate change NA NA NA NA Development of strategy Development of the new healthcare strategy, Our Health Together NA NA NA NA
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49 Report Prepared by Stacey Anderson on behalf of the Chief Officer Public Health Outbreaks Impact of Unpredictable Public Health Outbreaks on Current Services NA NA Ineffective Governance Arrangements (Medium) 1. There is a risk that the intensity of the required response to Covid‐ 19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐ making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and NA
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50 Report Prepared by Stacey Anderson on behalf of the Chief Officer PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users.
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51 Report Prepared by Stacey Anderson on behalf of the Chief Officer 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. Non-compliance with off framework Non-compliance with off framework NA NA NA NA Nurse Agency Use Nurse Agency Use NA NA NA NA
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52 Report Prepared by Stacey Anderson on behalf of the Chief Officer Nursing Home Beds Nursing Home Beds NA NA Care Homes Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home NA
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53 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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54 Report Prepared by Stacey Anderson on behalf of the Chief Officer Planned Care Planned Care NA NA CAMHS There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐ clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Service sustainability Due to competing service priorities Meeting performance targets
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55 Report Prepared by Stacey Anderson on behalf of the Chief Officer and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Prevention & Detection of Fraud, Bribery and/or Corruption Prevention & Detection of Fraud, Bribery and/or Corruption Serious Organised Crime, Fraud and Corruption Failure to prevent and detect fraud and corruption Prevention and Detection of Fraud, Bribery and/or Corruption (Low) There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance NA
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56 Report Prepared by Stacey Anderson on behalf of the Chief Officer arrangements and inadequate internal control systems which could lead to financial and reputational damage. Procurement of a new NHS Lanarkshire Labs Managed Service Contract Procurement of a new NHS Lanarkshire Labs Managed Service Contract (Very High) There is a risk of disruption to the NHS Lanarkshire Labs Managed Service Contract, because the Laboratories Managed Service Contract (Labs MSC) is one of the most significant contracts that the Health Board has both in terms of annual value and clinical criticality and it has recently came to the end. This may result in providing an inadequate NA NA NA NA
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57 Report Prepared by Stacey Anderson on behalf of the Chief Officer laboratory service, impact patient care and present reputational damage to the Board. Public Protection Public Protection Public Protection Risk Public Protection NA Care Transition- Safe and Effective Decontamination of Casualties Exposed to Chemical, Biological or Radiological Substances Safe and Effective Decontamination of Casualties Exposed to Chemical, Biological or Radiological Substances NA NA NA NA Staff Absence and Wellbeing Staff Absence and Wellbeing NA NA Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures Recruitment and retention Staff Absence
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58 Report Prepared by Stacey Anderson on behalf of the Chief Officer associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements.
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59 Report Prepared by Stacey Anderson on behalf of the Chief Officer Sustaining a Safe Workforce Sustaining a Safe Workforce. Na NA Service sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Workforce Sustainability (high)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, Medical Vacancies across North HSCP hosted services Recruitment and retention Staff Absence
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60 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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
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61 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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62 Report Prepared by Stacey Anderson on behalf of the Chief Officer Sustaining Primary Care Out of Hours Service Sustaining Primary Care Out of Hours Service. NA NA Service sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety Workforce Sustainability (high)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, Medical Vacancies across North HSCP hosted services Recruitment and retention Staff Absence -
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63 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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
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64 Report Prepared by Stacey Anderson on behalf of the Chief Officer 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.
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65 Report Prepared by Stacey Anderson on behalf of the Chief Officer Sustaining Whole System Patient Flow Sustaining Whole System Patient Flow NA Community Bed Provision Delayed Discharge The Impact from Heightened Cyber Threat The Impact from Heightened Cyber Threat Information Security & Information Governance (High) NA Ineffective Governance Arrangements (Medium) 1. There is a risk that the intensity of the required response to Covid‐ 19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐ making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not Information Governance
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66 Report Prepared by Stacey Anderson on behalf of the Chief Officer be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a
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67 Report Prepared by Stacey Anderson on behalf of the Chief Officer reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. Urgent & Unscheduled Care Urgent & Unscheduled Care. NA NA As above As above
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68 Report Prepared by Stacey Anderson on behalf of the Chief Officer Prescribing Activity and Costs NA NA NA Prescribing Activity and Costs- Very High 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 Prescribing
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69 Report Prepared by Stacey Anderson on behalf of the Chief Officer Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK.
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70 Report Prepared by Stacey Anderson on behalf of the Chief Officer Third sector NA Engagement and consultation with communities, partners and stakeholders on the shaping and delivery of services NA Third and Voluntary Sector - High 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. NA Performance Activity NA NA Performance & Planning Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and Compliance with Training Requirements: Statutory; Mandatory; Clinical and Related to Corporate Objectives
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71 Report Prepared by Stacey Anderson on behalf of the Chief Officer oversight role; make informed decisions and recommend remedial actions to address any performance concerns. Cost of Living NA Tackling Poverty (High) NA Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such NA
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72 Report Prepared by Stacey Anderson on behalf of the Chief Officer as food and heating. National Care Service NA Proposals to create a National Care Service (Very High) National Care Home Contract - Provider Requests for Enhanced Payments National Care Service There is a risk that the ongoing work around a National Care Service could destabilize 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 NA
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73 Report Prepared by Stacey Anderson on behalf of the Chief Officer the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. Community Alarms NA Na Community Alarms Analogue to Digital Transition (Telecare/Community Alarm) Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. NA Record Storage NA NA NA NA Record Storage Changes to Class of Drug NA NA NA NA NA
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74 Report Prepared by Stacey Anderson on behalf of the Chief Officer Dementia Post Diagnostic Support NA NA NA NA NA Ligature Risk NA NA NA NA NA Suspension of Occupational Therapy Provision to NW ART Teams patient population NA NA NA NA NA Unplanned Patient Absence from Wards NA NA NA NA NA Ventilation Risk NA NA NA NA NA Home Support NA Home Support NA NA NA Business Continuity Planning NA Business Continuity Planning NA NA NA Power Outage NA Power Resilience Strategy NA NA NA
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75 Report Prepared by Stacey Anderson on behalf of the Chief Officer Target Operating Model NA Target Operating Model NA NA NA Digital Adoption NA Digital Adoption NA NA NA Human Resources NA Human Resources NA NA NA ICT Operational Capability NA ICT Operational Capability NA NA NA Governance Leadership & Decision Making NA Governance Leadership & Decision Making NA NA NA Supply Chain NA Supply Chain Supplier Failure or services not provided as outlined in the Social Care (SDS) (Scotland) Act 2013 NA NA Health & Safety NA Health & Safety Health and Safety for staff in SW and partnership/agencies/supplier companies Failure to comply with fire legislation, policies and procedures across AHSC NA NA
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76 Report Prepared by Stacey Anderson on behalf of the Chief Officer Terrorism NA Terrorism NA NA NA Procurement Risk NA Procurement Risk NA NA NA Managing Strategic Change NA Managing Strategic Change NA NA NA Enterprise Project NA Enterprise Project NA NA NA Home to School Transport Disruption NA Home to School Transport Disruption NA NA NA IT NA Digital & IT Strategy IT systems No longer fit for purpose NA NA Resilience Planning NA Resilience Planning Na NA NA Scottish Child Abuse Inquiry NA Scottish Child Abuse Inquiry Na NA NA Improving Educational Outcomes NA Improving Educational Outcomes Na NA NA
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77 Report Prepared by Stacey Anderson on behalf of the Chief Officer Scottish Fire & Rescue Service Change to Operating Procedures - Unwanted Fire Alarm Signals NA Scottish Fire & Rescue Service Change to Operating Procedures - Unwanted Fire Alarm Signals Na NA NA Information and Data Protection - noncompliance with policy and legislation NA Information and Data Protection - noncompliance with policy and legislation Data Migration and Information Governance Service delivery or business operations are interrupted. NA NA Staff Skills and numbers NA Na Staff skills and numbers NA NA Governance and Supervision NA Na Governance and supervision NA NA Supplier failure due to social care challenges NA Na Supplier failure due to social care challenges NA NA
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78 Report Prepared by Stacey Anderson on behalf of the Chief Officer Mental Health Officer duties NA Na Mental Health Officer duties NA NA Assistive Technology NA Na Assistive Technology NA NA Failure to comply with legislation or regulatory procedures including SSSC regulations NA Na Failure to comply with legislation or regulatory procedures including SSSC regulations NA NA Communication NA Na Flawed Communications strategies and engagement plans NA NA Transition Team NA Na Transition Team NA NA