ITEM 6 Q2 Performance Update
North Lanarkshire Council · 25 February 2025
Back to IJB Performance, Finance and Audit Committee — 25 February 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT ITEM NO: 6 SUBJECT: Performance Update – 01st July 2024 to 30th September 2024, Quarter 2 2024/25 TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 25 February 2025 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: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Note the contents of the report and the appendix. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. 6. CONCLUSIONS The areas for improvement and corrective action are attached as Appendix 1. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ Yes ☐ No ☐ N/A ☒
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3 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low 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 Yes ☐ No ☐ N/A ☒
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4 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings The performance information, with the corresponding improvement and corrective actions will enable stakeholder representatives to participate in wider discussion about performance. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership The performance information, with the corresponding improvement and corrective actions supports locality planning. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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5 None. 9. APPENDICES Appendix One - Areas for Improvement Quarter 2 2024/25 (01st July 2024 to 30th September 2024) CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk
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6 1. Alcohol Brief Interventions Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 539 705 RED Narrative & Corrective Action As part of Public Health Scotland’s (PHS) internal prioritisation process for 2024/25 and 2025/26, data collection for Alcohol Brief Interventions (ABI) across all settings has been temporarily suspended. NHS board ABI leads and data coordinators have been advised that the submission of screening and intervention data is no longer required during this period. This decision aligns with recommendations outlined in the recently published ALCOHOL BRIEF INTERVENTIONS: A REVIEW OF STRATEGY AND RECOMMENDATIONS FOR POLICY. Key recommendations include reducing the burden of national reporting and transitioning towards validated outcome indicators to measure effectiveness. Both North and South Lanarkshire HSCPs have committed to maintaining ABI delivery and internal performance reporting, with metrics continuing to feature in local reviews. Locality-level ABI targets, introduced earlier this year, remain in place, and discussions are underway to explore whether team-level targets could further enhance performance management. Despite efforts to address previous reporting challenges, the current reported performance is below expected levels, suggesting potential ongoing issues with data accuracy or completeness. Investigations are continuing to resolve these discrepancies, including the planned monthly transfer of paper forms to Morse. The recent national review highlights several recommendations for ABI delivery in wider settings. Short-term actions include removing the 80% delivery requirement in priority settings and strengthening indicators to capture high-risk consumption patterns across demographics, including binge drinking and co-morbid health conditions. Medium-term recommendations focus on embedding alcohol conversations into national contract frameworks, such as primary care and pharmacy, and developing strategies to normalise opportunistic alcohol discussions within health and social care settings. Further consideration is required to determine how these recommendations can be adopted locally, particularly through engagement with Primary Care and wider partners. The full PHS review is available here. 2. Cervical Screening Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 71.0% 71.9% RED Narrative & Corrective Action Detailed analysis of cervical screening uptake for North Lanarkshire is available through the Milan Dashboard.
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7 During Q2: • Airdrie: No practices achieved the 80% uptake target (range: 60.2% - 73.5%). • Bellshill: No practices achieved the 80% uptake target (range: 64.6% - 73.9%). • Coatbridge: No practices achieved the 80% uptake target (range: 67.1% - 74.9%). • Motherwell: No practices achieved the 80% uptake target (range: 65.7% - 79.0%). • North: Two practices exceeded the 80% uptake target (range: 70.7% - 84.2%). • Wishaw: No practices achieved the 80% uptake target (range: 58.9% - 74.2%). While there has been no significant change from Q1, focused improvement activity and stakeholder engagement remain ongoing to address inequalities and uptake challenges.
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8 Community Projects and Engagement An evaluation of community projects has highlighted barriers, such as difficulties in contacting GP practices for smear appointments. Key findings include: • Airdrie Project: 218 people were surveyed, using both face-to-face and online methods. These surveys identified appointment accessibility as a recurring issue. • Bellshill Project: The project reached 100 individuals through arts-based workshops and focus groups, producing an online video capturing barriers to cervical screening. Insights from these projects will inform the Inequalities in Screening Steering Group, with a focus on improving access through telephony and digital developments. Additional Screening Clinics Special clinics targeted practices in low SIMD areas, achieving the following outcomes: • Smears performed represented 1%-26% of defaulters per practice. • 63 women had no prior smear history. • Overdue periods ranged from one month to 27 years. Uptake by SIMD group: SIMD 1 SIMD 2 SIMD 3 SIMD 4 SIMD 5 40.1% 22.5% 12.3% 13.5% 8.3% Communications and Initiatives Efforts to strengthen communication between the Health & Social Care Partnership (HSCP) and general practices include: • Regular inclusion of cervical screening data and updates as standing agenda items in relevant forums. • Quarterly provision of locality-level data and narratives by Health Improvement teams to inform discussion and improvement planning. • Sharing results from recent audits to encourage uptake, including innovative use of waiting room digital screens. • Targeting of Early Years workforce to encourage uptake by younger women 25-34 years. Community Training Resources Two significant resources are in development to support engagement: • A training guide informed by consultations with local women, addressing barriers and creating a patient-centred approach. • A multilingual video focusing on the experiences of South Asian women, due for a January 2025 launch, aimed at raising awareness and improving cultural inclusivity in cervical screening initiatives.
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9 3. Childhood Immunisations Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 90.4% 90.2% RED Narrative & Corrective Action The local position remains that all holds have been removed from the system, with the exception of those families that have refused all immunisations and do not wish a recall. Staff nurses continue to offer immunisations within the clinic and home to maximise accessibility and uptake. In North East sector, a pilot initiative has commenced to streamline appointment times and improve cross-cover arrangements. The pilot is characterised in a SBAR, which can be shared on request. The wider picture in North Lanarkshire is that uptake rates for immunisations in Lanarkshire remain high compared to the Scottish average, with most vaccinations exceeding the World Health Organisation’s (WHO) recommended 95% coverage rate to prevent outbreaks. However, challenges persist: • MMR (Second Dose): Uptake by age 5 remains at 91.6%, slightly below the WHO target but above the Scottish average of 90.4%. • 4-in-1 Vaccine: Uptake for this vaccine has fallen below 95%, with a 4.5% decrease for 5-year-olds and a 3.1% decrease for 6-year-olds over 2022-2023. • National trends and the decline in MMR1 and Hib/MenC vaccinations suggest that without intervention, NHS Lanarkshire’s rates may also fall below the WHO target. The WHO and Public Health Scotland have highlighted vaccine apathy, accessibility issues, and hesitancy as contributors to the decline in uptake. Lanarkshire’s immunisation teams have proactively worked to mitigate these challenges by fostering confidence and accessibility in the vaccination process, particularly through: • Engaging families using Gillick competence and Fraser guidelines. • Collaborating with Public Health to address low uptake in specific populations, such as those in areas of deprivation or larger family groups. Key Actions and Innovations To combat the declining trend, NHS Lanarkshire has undertaken the following actions: • Streamlined Process: The North East Sector pilot mentioned above to streamline appointment times and improve cross-cover arrangements. • Targeted Clinics: Additional vaccination clinics, including home visits, are being scheduled to address accessibility issues. • Enhanced Engagement: Health visitors actively discuss vaccinations during pathway visits and use targeted scripts to support consistent messaging. • Data Analysis and Oversight: The newly established Area Oversight Vaccination and Immunisation Committee (AOVIC) is conducting comprehensive data reviews and identifying systemic changes required to maintain uptake above 95%. • Support for Children with Additional Needs: Challenges in ASN schools have been noted, particularly for children with sensory difficulties or behavioural needs. A new MS Form has been developed to capture children’s voices during the flu campaign to improve approaches. Preparing for Future Risks In response to recent measles outbreaks in Europe and concerns about whooping cough, NHS Lanarkshire is strengthening its workforce readiness by:
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10 • Recording staff vaccination statuses and conducting immunity testing. • Expanding collaboration with GP, primary care, and social care partners to ensure a whole-system approach to immunisation. These efforts reflect a continued focus on improving immunisation uptake, reducing inequalities, and preventing outbreaks to safeguard the health of Lanarkshire’s population. 4. 6 – 8 Week Reviews Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6-8 week review 90% 73.5% Quarterly/ 1 quarter behind RED... Narrative & Corrective Action It has recently been identified that this performance metric has been incorrectly reported in the past (post-Covid), with reviews counted as complete if either the Health Visitor (HV) or GP return was received. The change now being implemented will require both the HV and GP parts to be complete before a review is considered finished, restoring the metric to its pre-Covid definition. It is expected that the percentage of completed reviews will decrease as a result of this change, though the full impact is still unknown. Discussion with Executive leads is underway regarding a proposal to adjust reporting for performance purposes. This will involve some adjustments to the management of the data and still require reporting a quarter in arrears. However, the changes in process are expected to have a positive effect on reported performance levels. To support the improvement, it is suggested that a mechanism for notifying teams about missing forms will be introduced, as the approach to this is not standard across teams. Should the changes be agreed, it is proposed that for Q3, the data reported in Q2 is refreshed in line with the changes. Some discrepancies have been identified between information held in MiLan and the quarterly performance reporting. The issue identified concerns “transfers” of cases between localities, as cases transferred into a locality where the last intervention was completed by their previous HV team can result in a miscount of the data, which is then carried forward in the reporting. When reported nationally, performance indicators of this nature can show higher levels of performance due to national data being submitted later (allowing more time to chase missing forms and address issues with transfers) and being reported at a 12-week time point, rather than the local 10-week reporting window. Work continues to prioritise the Universal Home Visiting Pathway (UHVP) as an area of need and risk for Morse implementation. This aligns with broader national engagement to support a digital recording solution. Additionally, scoping work continues around the Elsie App, which has been used in other healthcare settings to reduce Did Not Attend (DNA) rates by improving communication and reducing manual processes. Further updates will be provided as discussions progress with stakeholders on the SBAR proposal for introducing the Elsie App.
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11 This indicator reflects the broader Home Visit/Universal Home Visit Pathway, and previous “deep-dive” analysis identified inconsistencies in practice across GP practices and less effective communication between Health Visitors and some GP practices as contributing to the decline in performance. Efforts are ongoing with NHS Lanarkshire-wide GP practices to support the completion and return of forms, ensuring regular engagement of GP practices on the importance of reporting non-attendance. Specific work is being undertaken with Practice Managers to discuss processes and ensure timely delivery of CHSP forms. At the locality level, practical actions are being implemented to address concerns around missed reviews and incomplete or missing records. Testing improvements are underway in Airdrie, with plans to scale these across localities to provide a more consistent approach. In the wider Health Visiting workforce, performance is monitored using the PRAG recording tool, which continues to highlight challenges in some areas. The service is responding with sector-wide support and, where possible, flexing available resources to meet demand. 5. Reablement and Rehabilitation Target 2024/25 2024/25 Q1 2024/25 Q2 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% 61.1% 57.1% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 62.6% 58.1% RED Balance Of Care - % Of People (Age 65+) 45% 37.1% 37.0% RED Narrative & Corrective Action During 2023/24, the number of people completing the Reablement process increased, however in 2024/25 there has been a reversal of this trend. The percentage of new or increased HS packages that are Reablement is relatively stable but below the targeted level of 70%. However, the percentage of people with no, or reduced Home Support at the end of the Reablement process has failed to meet the targeted level of performance for some time, with no trend supporting a trajectory toward achieving the targeted level. Additional data/information on Reablement is available from the IRT dataset. Throughout 2024/25, the overall number of IRT/Reablement referrals has decreased, however it should be noted that this decrease follows a notable and significant increase at the start of the financial year. There is no target set for this metric, however it complements the Reablement information presented above and should be considered in the context of a wider system of Reablement, Rehabilitation and Home Support.
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12 As the volume of IRT/Reablement referrals decreased, there was a corresponding increase in waits, which is contrary to expectation. Additional data/information on Reablement is available from the Home Support dataset and is presented below. Throughout 2024/25, the overall number of people starting a HS/Reablement has decreased, however it should be noted that this decrease follows a notable and significant increase during the winter period. There is no target set for this metric, however again complements the other information presented above and should be considered in the context of a wider system.
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13 ANALYSIS OF HOME ASSESSMENT TEAM DATA TRENDS – POSITION AS OF HAT REPORT DATED 8TH NOVEMBER 2024
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14 Referrals Overall Referral Volume: Since its inception, HAT has accepted 2,645 referrals, with October 2024 recording a peak of 147 accepted referrals. This marks the tenth month within the past year where accepted referrals exceeded 100, and the ninth consecutive month of such volume. Geographical Distribution: Wishaw and Cumbernauld each contributed 22% of the total referrals over the past year, while Motherwell and Airdrie accounted for 18% and 17% respectively. Bellshill and Coatbridge have shown increases in recent months, now contributing 9% and 12% respectively to the total overall volume of referrals. Hospitals of Origin: University Hospital Wishaw has 50% of referrals, University Hospital Monklands in Airdrie at 47%. A small proportion (3%) falls under "Other," which is mostly older cases with unspecified sources and incomplete data. Monthly Referral Trends Seasonal Variations: The average number of referrals per month over the past year is 119, with notable declines in December and January, likely attributable to holiday periods. October 2024 saw the highest monthly total with 147 referrals. Weekly Inconsistencies: Weekly referral rates have averaged around 30, with recent weeks showing an increase, peaking at 42 during the week of 20th November 2023, likely due to the “Firebreak”. Demographics Age and Gender: The majority of referrals (60%) are female, with 40% aged 75-84 years. Only 10% of referrals are for individuals under 65, and none for those under 18. A recent data clean-up has ensured that no unknown ages are recorded.
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15 Input Services Service Allocation: 2% of referrals had no input services, which is a slight decrease; data cleansing is identifying older and those cases where there is incomplete data. The majority of referrals (59%) had 1 or 2 services, while 40% had 3 or more services, an increase from the previously reported 35%. Service Utilisation: Home Support remains the most utilised service (86%), followed by Occupational Therapy (62%). Physiotherapy services have notably increased from 20% to 27%. Outcomes Re-admission Rates: Re-admission to hospital at the end of the HAT process remains a concern, with 14% of individuals being re-admitted. This is an unfavourable outcome, indicating potential issues in initial service suitability or adequacy. Service Requirement at Completion: Upon completion of the HAT process, 64% of individuals required no further service, while 36% needed at least one additional service. Of those needing further services, 74% required one service, and 26% needed two or more. Completion Rates Completion Statistics: A total of 2,504 individuals (95% of total referrals) completed HAT services. Wishaw led with 27% of total completions, followed by Cumbernauld (23%), Motherwell (19%), and Airdrie (19%). Timescales Process Duration: The average time from referral to completion remains at 15.6 days. However, 52% of cases took over 14 days, and 5% exceeded 31 days. While shorter timescales are generally favourable, excessively short durations may indicate inappropriate referrals or premature case closures.
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16 Summary Referral Acceptance: There has been a substantial and sustained increase in accepted referrals, particularly from Wishaw, possibly reflecting the development of HAT services in these localities. Service Utilisation: An upward trend in the number of services per referral suggests increasing case complexity. Ensuring appropriate service allocation, potentially through the development and scaling of B2B/Enabling, should be considered. Outcomes and Re-admissions: The stable re-admission rate of 14% should be investigated. Reducing re-admissions by ensuring appropriate initial service allocation and addressing complex needs through B2B/enabling may be a consideration. Completion Times: While shorter completion times are generally positive, a view on whether premature case closures are a factor in re-admission, or have an effect in the wider system should also be considered. Overall, the data shows positive trends in referrals, alongside ongoing challenges in managing and fully understanding completion timescales. Alternate indicators A wide variety of indicators that complement and supplement the Reablement position are available. Consideration should be given to the indicator set presented and whether targets should be reset, particularly in the context of B2B/Enabling. The Balance of Care indicator in the Scorecard reflects the number of people aged over 65, receiving more than 10 hours of Home Support (65+), against the number of older adults in HBCCC and Care Homes. Given the focus on moving support arrangements for older adults to individual budgets, if the figure were to include the older adults who previously received home support from the independent sector and have since moved to individual budgets, the performance improves significantly. However, the current metric does not reflect this shift and consideration of alternatives may be useful for Executive Leaders.
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17 6. CAMHS Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 57.6% 81.3% RED Narrative & Corrective Action Although the reported quarterly performance for Q2 was below the targeted level, the longer-term trend is for significant and sustained improvement. It is likely that the performance in Q3 will exceed the targeted level. The improvement can be seen in the monthly data below; 91% was achieved in September, exceeding the targeted trajectory. Should this trend continue the service will deliver in excess of the targeted level for quarterly performance in Q3.
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18 Performance and Key Achievements: The CAMHS service in North Lanarkshire continues to show progress in reducing waiting times, with notable improvements in RTT performance. A key milestone was achieved in September 2024, when the service reached 91% RTT, exceeding the targeted trajectory for the first time. This improvement is largely attributed to the efforts of clinical and support staff, along with the successful implementation of the CAPA model, which has provided more robust data to manage patient flow and appointment capacity. Key Issues: 1. Sustaining High RTT Performance: The achievement of a 91% RTT performance reflects substantial progress, however the goal remains to maintain this level consistently. Continuous collaboration with clinical and Public Health Scotland colleagues is vital to ensure modelling of trajectory is reflective of current workforce and is able to inform flex of choice appointment capacity to ensure 90% or above target maintained. 2. Anticipated Referral Growth: A growth in referrals is anticipated during the latter half of Q3 and throughout Q4. This increase will be managed through intensified choice appointment activity within each CAPA round, including: • Ring-fenced intense choice appointment activity week in each CAPA round • Considered patterns of leave and matching them with patterns of attendance • Prompted Health and Wellbeing (HWB) activities and appropriate management responses to short and long-term absences. 3. Psychiatric Consultant Capacity: While there are ongoing challenges with Psychiatric Consultant capacity, the vacancy rate has been reduced. Continued efforts are being made to address this issue and ensure adequate consultant availability. Key Actions: 1. Enhanced CAPA Planning: The data from the previous year has enabled a well-informed approach to CAPA. This approach resulted in an increase in choice appointment activity within CAMHS in late October, effectively mitigating the rise in referral rates post-return to school in August and ensuring a positive trajectory. This strategy will be replicated in Q4. Service Improvement Plan: The CAMHS Modernisation Programme Board’s Service Improvement Plan remains an ongoing deliverable, ensuring continuous progress and adaptation to emerging needs and challenges. 7. Adult Mental Health Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 76.0% 74.1% RED
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19 Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 36.0% 30.5% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 69.4% 65.1% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) The latest RTT performance reflects the refreshed criteria, with self-referral digital interventions now excluded from the calculation. This adjustment has resulted in a performance reduction of approximately 5%. It is important to note that the new reporting requirements do not reflect the service stance on the value or effectiveness of these digital therapies. It should also be noted that new requirements have been placed for NHS Boards to report all age groups within the PS RTT. This will mean inclusion of CAMHS data, which may create some difficulty in reporting, given the variation in practice across services. Forward planning within the service has been impacted by uncertainty around funding and delays in finance approval processes. The Mental Health Outcomes Framework funding allocations are significantly less than anticipated, representing a 45% reduction in the total allocation. At October, the service had 184.15WTE in post,
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20 with 24.5wte vacancies. Given the funding position, additional consideration must be given to the establishment position, recruitment and the ability to meet the RTT target There is a continued focus within the service on clearing the longest waits. However, prioritising resources in this way necessitates that the percentage of completed waits over 18 weeks remains high, impacting reported RTT performance. Despite this, the waiting list is in line with the expected trajectory. Due to an imbalance of demand and capacity within the Adult Weight Management Service, it now reports the longest waits across all Adult Psychology Services. A number of Key Actions are in place to improve overall performance: - • A rolling programme of Stress Control Classes within all localities was achieved earlier than anticipated; it was expected by April 2025, however achieved in October 2024. The service is working with Healthcare Improvement Scotland to evaluate the effectiveness and impact of the classes. • Focussed activity on the longest waits has realised improvements with the waiting list, which reduced by 69 patients between July and August 2024. • The PTOP redesign of services has demonstrated significant improvement in patient flow. • A second MDT Research conference to be held in September 2025 is being planned. This will be delivered alongside our University partners and held at Strathclyde University. The theme of the conference will be, “Research and Innovation really matters: The next generation” A Programme Board has been established for the Adult CMHT Model Review, with the PTT and Joint Mental Health & Addictions work streams particularly relevant to this service. The service is also preparing to complete a self-assessment for the Implementation of National Specification of Delivery of Psychological Therapies and Interventions, which will be required to be submitted to the Scottish Government within three months of receipt. Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) The service has been dealing with limited Consultant capacity within Older Adult Psychiatry since August 2023 due to maternity leave, which is compounded by other vacancies within the service. The service faces a continued challenge in recruiting to Specialty Doctor posts. A series of internal modifications to the rota to reflect the reduced capacity of Community Consultants to attend to routine outpatient work has contributed to longer waiting times for patients. As capacity increases, particularly with the recruitment to the Motherwell Consultant post, it is hoped that a positive impact will be seen in the waiting times for subsequent quarters. To manage increased waiting times, local teams are running ad-hoc clinics, and these are being monitored closely to ensure the best possible balance between demand and capacity. Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) Staff recruitment, retention, and development continue to present the most significant challenges for the Adult Mental Health service, particularly within General Adult Psychiatry (GAP). The ongoing imbalance between demand and capacity, alongside staffing instability, severely impacts the service’s ability to meet waiting time targets. The Programme Board for Mental Health, Learning Disabilities & Addictions (MHLD&A) services is actively working on addressing medical staffing shortages while simultaneously considering changes to traditional psychiatry working practices. This includes exploring new models of practice such as the introduction of Advanced
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21 Nurse Practitioner (ANP) roles within the community to support Community Mental Health Teams (CMHTs) and reduce reliance on medical staff. While the primary focus remains on tackling staffing gaps, these innovative approaches could also help attract new talent to the service. Several initiatives are underway to address these staffing challenges, including: • Ongoing recruitment efforts in partnership with HR and wider advertising for vacant posts. • Collaborations with the Centre for Workforce Supply in Scotland, recruitment agencies, and exploration of pathways for International Medical Graduates (IMGs), alongside novel marketing strategies. • Discussions with Medical Education regarding additional higher trainee placements. • Increased use of Extra Planned Activities to enable current staff to cover service gaps. However, given the current workforce situation, most of these initiatives are expected to produce medium to long-term improvements rather than immediate results. These actions are crucial for ensuring the future stability of the service. Additionally, an Options Appraisal (OA) has been developed to guide the future direction of General Adult Psychiatry Services. The OA, which is yet to be finalised, offers various solutions that can be adapted based on integrated, cross-disciplinary tests of change. The paper outlines six key recommendations to drive service transformation: • Formation of a Programme Board to review the GAP service model and develop a sustainable, cross-discipline workforce aligned with the Scottish Government’s Adult Secondary Mental Health Services Quality Standards. • Maximisation of recruitment and retention efforts by supporting the current workforce and absorbing high-cost locums into permanent NHS roles. • A comprehensive workforce review across all disciplines within GAP services, including expansion of the ANP pilot into CMHTs and a review of Psychological Therapy Teams. • Engaging with referrers, patients, and carers to ensure appropriate access to services. • Creation of clear guidance for transitions between primary and secondary care GAP services, and between different sub-specialities within Mental Health & Learning Disability Services. • Reliable statistical modelling to support longer-term workforce planning to ensure services meet population demand. The preferred model for GAP services in North Lanarkshire involves a functional split between inpatient and outpatient care, with dedicated consultants for each ward. This model, which is favoured by stakeholders and aligns with broader trends in Scotland, aims to provide psychiatrists with protected time to focus on either inpatient or CMHT responsibilities, improving consistency, responsiveness, and stability within these services. It also simplifies job planning and reduces the need for the Duty AMP role, improving service efficiency. As the OA is still under review, these recommendations may evolve, and any developments will be communicated widely with stakeholders.
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22 8. SLT Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 15.8% 15.3% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 85.6% 74.3% RED Narrative & Corrective Action For Paediatrics SLT, the long-term trend is for a decline in the level of performance, which remains significantly apart from the targeted level. For Adults SLT, the reported performance is closer to the targeted level, however despite achieving targeted levels in 2023/24, this has not been sustained into 2024/25. It is worth noting that referral rates for adult acquired service increased by 5% from 2023 to 2024. In Q2, both Adult and Paediatric services have reported performance below their targeted levels. Nonetheless, significant advancements have been made in several key areas. Key Developments: 1. SLT Involvement in Stroke Tech Hub: The Speech and Language Therapy (SLT) team has successfully participated in the Stroke Tech hub study at University Hospital Wishaw (UHW). A YouTube video is available at https://youtu.be/vLJXyuS4XPs highlighting patients and therapists involved in trial - as they talk about the wide ranging benefits on their rehabilitation journey. 2. Innovations in Parkinson’s Disease Treatment: A successful trial was conducted using technology to reduce the capacity required to deliver Lee Silverman Voice Treatment (LSVT) for individuals with Parkinson’s disease. This trial demonstrated the potential for technological advancements to enhance treatment efficiency and patient outcomes. Child and Young People (CYP) Improvement Programme: 1. Group Consultation Model: The waiting list group is piloting a Group Consultation model to provide support for children and families with early communication needs. This initiative aims to streamline service delivery and improve access to necessary interventions. 2. Universal Waiting Time: The service has agreed a universal waiting time of two weeks with a roadmap to achieving the targeted waiting time of 12 weeks. Continued efforts to improve specialist waiting times are expected to yield significant advancements over the next 12 months. 3. TrakCare Implementation: TrakCare has been implemented across all CYP Teams, with plans to introduce e-referral and text reminders in the new year, thereby enhancing patient engagement and service efficiency. Additional Service Improvements: 1. ALD Recruitment: The service has recruited a Band 5/6 Annex 21 post aimed at strengthening staff recruitment, development, and retention efforts. This strategic appointment is intended to build a more resilient and capable workforce. A further recruitment of 0.6WTE band 5 is underway.
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23 2. Adult Service Enhancements: TrakCare was introduced in the Acute service in September and go live date was 16 December 2024 as planned. This rollout is expected to support improved data management and service delivery. 9. Dietetics Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 64.8% 62.3% RED Narrative & Corrective Action For Q2, the Dietetics service continues to face challenges that hinder its performance, primarily due to a workforce reduction of around 20%, which has been caused by both long-term sickness and ongoing vacancies. Such workforce constraints have contributed to a variation in service delivery. Recruitment efforts remain ongoing but, similar to other services, there is significant difficulty in attracting suitably skilled and experienced staff due to the nationwide shortage in the field. In response to these challenges, the General Manager for Adult Services has initiated modelling and process mapping to modernise the service approach and model. Additional project management support has been employed to progress these improvements, however this capacity is spread across the wider directorate. 10. Complaints Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days(NHSL) 100% 27% 21% RED Narrative & Corrective Action In Q2, the ongoing transition to the InPhase system has continued to present challenges, particularly in the development and validation of its reporting function. While this work progresses, there are limitations in the available data, which should improve once the validation process is complete. The enhanced reporting capability will help to inform future improvements in addressing delays and other issues in the complaints process. To address the complaints process, local NHSL targets have been set, focussing on increasing the number of complaints closed at Stage 1 (aiming for 65% or more) and ensuring that 75% of Stage 2 complaints are closed within 20 days. Key actions to support these targets include promoting early resolution of complaints at Stage 1, addressing Stage 2 delays, and reviewing patient affairs resources. Complementary data from Care Opinion highlights that a significant proportion of public feedback for University Health and Social Care North Lanarkshire is positive. In the most recent reporting, 82% of the 34 published stories were positive, with 18% critical. The response rate for these stories was 82%. While there are no specific
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24 response time targets for the North Partnership, the NHSL target for Acute services is to respond to at least 90% of Care Opinion stories within five days, including weekends and bank holidays. Positive engagement with Care Opinion indicates ongoing efforts to address patient feedback in a timely manner. 11. Smoking Cessation Target 2024/25 2023/24 Q3 2023/24 Q4 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) 902 170 245 ... ... RED Narrative & Corrective Action In Q2, the performance for smoking cessation at 12 weeks post-quit continues to be below target, with the indicator remaining RAG Red. While the data is presented two quarters in arrears, current performance suggests that the annual target will likely not be met, following a similar trend in the previous year. In response, a series of key actions have been agreed by both North Health Operations and Professional Group, as well as the South Lanarkshire HSCP Senior Management Team (SMT), to improve performance in smoking cessation services across Lanarkshire. One of the immediate actions is to respond to the national review of smoking cessation services, which has led to the development of a local action plan to address the review’s recommendations and align the services with best practice. The smoking cessation service will undergo a redesign, following National Institute for Health and Care Excellence (NICE) guidelines and incorporating the “Once for Scotland” approach. This includes a new standard operating procedure to allow non-clinical staff to provide Nicotine Replacement Therapy (NRT) to those motivated to quit smoking, while standing down the use of a Patient Group Directive (PGD) for NRT provision. Additionally, all required improvements will follow recognised improvement methodologies, with a particular focus on identifying and addressing unwarranted variation across the system. A key action is to enhance communication and engagement, ensuring that staff at all levels actively raise the issue of smoking and refer individuals to smoking cessation services at every health and social care point of contact. Colleagues in priority areas are encouraged to complete the Public Health Scotland Advice module and become familiar with the services briefing paper. Efforts to increase direct referrals to the Lanarkshire Quit Your Way (QYW) service are ongoing, focusing on maternity, mental health, and secondary care services, as well as voluntary and third sector partners. This will be complemented by a broader social media campaign to promote the national Quit Your Way service and provide information on local support for Lanarkshire residents. This campaign aims to ensure that individuals trying to quit smoking in Scotland are aware of where to seek help. Despite these efforts, referral numbers remain low. Some preparatory work is still required to facilitate information sharing between services, particularly with secondary care and voluntary sector partners. However, this work can proceed in parallel with the development of the QYW service locally. Additionally, the installation of two benches by the Quit Your Way team within the gardens at UHM provides a visible and accessible support feature for individuals seeking cessation support. This is part of a broader, settings-based approach aligned with Realistic Medicine, which focuses on prevention and health improvement in acute and community hospital settings. The aim is to reduce health inequalities by addressing the wider determinants of health that contribute to ill health, with particular focus on smoking in deprived communities.
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25 Recognising the significant disparity in smoking rates between the most and least deprived communities (with 25% of adults in SIMD 1 areas smoking compared to just 7% in the least deprived), North Lanarkshire has made efforts to tackle these inequalities. During Challenge Poverty Week, two Tobacco and Poverty training sessions were delivered to 20 members of the North Lanarkshire Tackling Poverty Officers Action Group. These sessions increased staff knowledge on both the health and financial benefits of quitting smoking, enhanced their confidence in discussing the issue with clients, and improved their ability to signpost individuals to the Quit Your Way service. Despite the ongoing efforts, the challenge remains in increasing referrals and improving the long-term quit success rates in the most deprived areas. 12. Adult Social Work Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status % Of Adult Protection Investigations Going To Initial Case Conference 20% 12.3% 6.9% RED Narrative & Corrective Action In Quarter 2 of 2024/25, North Lanarkshire Social Work Services received fewer Adult Support and Protection (ASP) referrals than during the same period last year (down 12% from 847 to 743). However, there was a notable increase in the number of Police 'Adult Concern' reports when compared with the same quarter in the previous year (up 40% from 812 to 1131). The general increase in volume of Police Adult Concern reports is indicative of the developing role of Police Scotland as a key partner to Social Work Services, however, may also represent an unmet need or changing demand within the community.
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26 Locality Police Adult Concern reports Q2 24/25 ASP Referral (all sources) Q2 24/25 Total activity to keep adults safe Airdrie 165 105 270 Bellshill 102 85 187 Coatbridge 204 114 318 Cumbernauld 295 127 422 Motherwell 139 90 229 Wishaw 226 111 337 SWES 0 111 111 Totals 1131 743 1874 There was significant variation in the monthly referral rates across the six localities. Notably, Cumbernauld saw a 9% increase in referrals from the previous year, while Coatbridge and Bellshill saw significant decreases of 44% and 31%, respectively. Care Home referrals dropped significantly, likely due to collaborative efforts with local care homes to reassess reporting thresholds and provide alternative support options.
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27 Locality Police Adult Concern reports Q2 24/25 ASP Referral (all sources) Q2 24/25 Total activity to keep adults safe Airdrie 165 105 270 Bellshill 102 85 187 Coatbridge 204 114 318 Cumbernauld 295 127 422 Motherwell 139 90 229 Wishaw 226 111 337 Totals 1131 632* 1874** 35 26 36 48 31 34 47 29 27 39 39 30 45 30 41 32 39 40 29 32 34 AIRD BELL COAT CUMB MOTH WISH HQ/SWES Referrals in Quarter by Month and Locality Jul Aug Sep
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28 Out of the 743 ASP referrals received, 10% (72) were redirected to other services, while 27% (206) progressed under ASP inquiry with investigatory activity. 50% (373) were recorded as No Further Action (NFA) under ASP procedures, although many of these cases still required interventions to promote welfare. The 206 ASP inquiries with investigatory activity represents a significant increase (up 76%) compared to 117 inquiries with investigatory activity in the same period last year. The rise in inquires with investigatory activity was anticipated following the change to ASP policy and procedures in April 2024. The actual increase demonstrates the positive reaction the workforce has had in understanding and implementing NLC’s new ASP procedures. Data shows only 7% (14) of these investigations progressed to an initial case conference, a slight decrease from last year's 10%. Internal audits continue to be completed to ensure accurate case conference data is captured, there continues to be discrepancies between locality actions and capturing this on MySwis, work continues to be completed to ensure as accurate data as possible is recorded prior to data migration to Mosaic in 2025. 13. Sickness Absence Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 7.49% 6.63% RED Narrative & Corrective Action The Partnership continues to work towards reducing sickness absence rates as part of the Adult Social Care Services Savings Delivery Plan and the Health Care Services Savings Delivery Plan. These reviews, which began in April 2024, will run through the 2024/25 and 2025/26 financial years. Despite ongoing efforts, sickness absence remains an issue, and actions are being taken to reduce the rate by 1%, aiming to bring it to 6% and closer to the 4% target by 31st March 2025. The wider NHSL Board remains above the national average for this metric. A dedicated work stream within the Sustainability and Value Workforce Optimisation Group is focusing on reducing sickness absence. 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. Managers are focussing on cases that have breached sickness absence triggers and other long-term absences, whilst there remains a wider focus on the Health and Wellbeing of staff as a key contributing factor to levels of sickness absence.
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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