ITEM 9 Alcohol & Drugs (ADP) March25
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 IJB Reporting Template REPORT Item No: 9 SUBJECT: Alcohol & Drugs TO: Integration Joint Board, Performance, Finance and Audit Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 25 February 2025 1. PURPOSE OF REPORT This report sets out the progress of the Alcohol and Drug Partnership for 2024. This report reflects a sample of the ongoing work being undertaken across North Lanarkshire to deliver on the National Drugs mission to reduce harms from substances and improve access to support. This report also sets out the range and scope of investments through the ADP to target support across our communities in 2024/25. The supports commissioned, delivered and monitored via the ADP is in addition to statutory drug and alcohol treatment and care requirements. This paper is coming to the IJB PFA for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been:
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2 Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ 3. RECOMMENDATIONS (1) Note the content of the report; (2) Acknowledge the progress made towards delivering the ADP strategic objectives and National Drug Mission priorities. (3) Recognise the broad range of supports in place and the programme of work being delivered to reduce harms and prevent deaths from alcohol and other drugs (4) Note the key developments in targeting resources in line with budgets for each priority area; (5) The MAT Standards is not covered in this report as a separate paper has been drafted and submitted for consideration. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. 5.2 The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. 5.3 The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). NLADP Structure Yes ☐ No ☐ N/A ☐ ADP Board Prevention & Early Intervention Treatment Care & Recovery Whole Family Approach Public Health Approach to justice Reducing Alcohol Harms Finance Group
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3 5.4 All sub-groups above meet quarterly and report to the ADP Partnership Board. Each sub-group held a planning session in the first quarter of 2024 to map out areas of focus and further development for the next 12 months. 5.5 ADP Priorities o Priority area 1 - Fewer people develop problem alcohol & drug use. o Priority area 2 - People access and benefit from effective, integrated person-centred support to achieve their recovery. o Priority area 3 - Children and families affected by alcohol and drug use will be safe, healthy, included and supported. o Priority area 4 - Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. o Priority area 5 – Less harm is caused by alcohol North Lanarkshire. 5.6 All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. It will do this by: providing fast and appropriate access to treatment and support through all services improving frontline drugs services (including the third sector) ensuring services are in place and working together to react immediately for people who need support and maintain that support for as long as is needed increasing capacity in and use of residential rehabilitation implementing a more joined-up approach across policy and practice to address underlying issues. 5.7 Funding letters from the Scottish Government set out that ADPs are primary partner in the delivery of the National Mission and the Alcohol framework and key to their success. Therefore, a clear commitment to monitoring and evaluation at the local level is vital. 5.8 National Missions Approach (2021 – 2026) – Reduce deaths and improve lives. • Fewer people develop problem drug use1 • Risk is reduced for people who take harmful drugs • People at most risk have access to treatment and recovery • People receive high quality recovery and treatment services • Quality of life is improved for people who experience multiple disadvantage 1 Drug Deaths Taskforce response: cross government approach - gov.scot (www.gov.scot)
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4 • Children, families and communities affected by substance use are supported 5.9 National Policy Focus, Harm Reduction, Improving Treatment, Workforce Culture, Holistic Support. 2 5.10 Commissioning and perfomance reviews - Performance monitoring reviews have been carried out in the third quarter of 2024 with all services and programmes commissioned via NLAPD reviewed. 5.11 All commisioned initiatives are required to report to the ADP on a quarterly basis to evidence impact, highlight challenges, risks and mitigation measures, whilst offering assurances that the right supports are in place and operating effectively. 5.12 A number of test of change and evaluation projects were funded via NLADP in 2024 Including; • Arrest referral pathways via Police custody centres, • Contextual safeguarding for children and young people in conflict with the law, • Alcohol and Drug Solutions Courts, and; • Extended Youth Work Provision and Diversionary Activities via Community Learning and Development (CL&D) • Residential Rehab independent review. Drug Death Prevention 5.13 The Drug Death Prevention Group (DDPG) structures are now in place with operational and strategic action plans reviewed and updated in 2024. 5.14 The plans set out all operational and strategic improvement priorities and key measures required to support all drug death prevention efforts. This includes drug trend monitoring activities and links to local/national alerts systems. 2 Changing-Lives-updated-1.pdf (knowthescore.info)
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5 5.15 A Naloxone delivery plan is now in place to target training and widen Naloxone distribution throughout 2025. 5.16 All suspected and confirmed drug deaths are reviewed. Learn is used to ensure all drug death prevention measures are in place to improve service responses and reduce harms. 5.17 More work is required in 2025 to better understand the links between determinants of health and key drivers of problem drug and alcohol use to inform preventative approaches and mitigate future harms from alcohol and other drugs. 5.18 Crisis Outreach Team (COT). A combined overdose response, assertive outreach, crisis services was formally launched in 2024. This service is vital in our efforts to reduce harms and prevent drug-related deaths in addition to statutory treatment and care services. 5.19 This COT works to connect people experiencing high risk events including Non-Fatal Overdoses (NFO) to support. In total, 293 people have been reached across all 3 elements of the combined service operated by Turning Point Scotland (TPS). 5.20 The service offers intensive wrap around support including harm reduction interventions, Naloxone provision and support with housing and social welfare needs. TPS connects people who use substances to the right treatment, care and support services based on their needs. 5.21 The COT links with Scottish Ambulance Service and the Harm Reduction Team to follow up with people after an NFO, normally within 24-48 hours (MAT Standard 3), the average response time for follow up after a NFO in 2023 was 36 hours. 5.22 The service operates 365 days a year from 10am – 10pm. The service was fully operational and available over Christmas and New Year period offering drop in support. 5.23 Nitazine testing strips have been in circulation in NL from April 2024 through this service. These are required to help detect more potent drugs in circulation and to support harm reduction efforts. Data is now being shared with the ADP on a monthly basis. 5.24 TPS will launch two new harm reduction cafes for those still using alcohol and drugs from 22nd January 2025. This will support more collective efforts to engage with those furthest from treatment and care services. 5.25 Reducing Alcohol Harms - The Reducing Alcohol Harms group has been meeting for the last 18 months and is a multi-agency group with broad representation from the ADP partners, Health Improvement and Public Health.
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6 5.26 Work has been undertaken to engage and consult with those living in North Lanarkshire to develop an alcohol health needs assessment, this has been finalised and will be used as a baseline for improvement’s moving forward. 5.27 There is a detailed work-plan linked to the RAHG that cuts across whole population measures and targeted local interventions from Licensing, Alcohol Brief Interventions, Health Needs Assessment, education and training and work to target higher risk groups. 5.28 NLAPD will hold an alcohol summit in April 2025 to share the most up to date evidence, local need and determine key priorities to reduce deaths and harms from alcohol moving forward. Residential Rehab 5.29 Residential rehab is now available to anyone wishing to access this as part of their treatment and care, with timely access to rehab following referral and assessment (within 4-6 weeks). 5.30 A residential rehab pathway has been in place in North Lanarkshire since 2022, reviewed in 2024. The ADP monitors data on assessments and placements. These are submitted to the Scottish Government via ADPs on a quarterly basis. 5.31 NLADP commissioned an independent review of the pathway with key findings and recommendations due to be published January 2025. There is now evidence to offer assurances that the North pathway is effective, efficient and focussed around individuals needs with good processes in pre/during and post placement to minimise harms and support positive transitions. 5.32 NLADP spent £119,277 in 2024, (up to 18th Jan, 2025) on residential rehab in this financial year. The residential rehab budget is set by the Scottish Government for each ADP based on the NRAC formula and drug prevalence data. There is funding available from this financial year allocation (end of March 2025) to support any further referrals between now and the year-end. 5.33 Nationally, there there’s limited residential rehab capacity (beds) across due to high demand that could impact on local waiting times, post-assessment. There is currently no local stabilisation or detox provision available in North Lanarkshire. A Short Life Working Group is being established via the ADP in 2025 to explore options required to mitigate future risks.
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7 Whole Family support 5.34 NLADP continues to invest in family support via the Whole Family Approach sub-group priorities, linked with the national holistic framework, local evidence of need and linked to wider strategic objectives. 5.35 There is now an offer for universal, additional and intensive family support for the whole family. 5.36 Funding allocated to whole family support is now fully committed to a stand- alone adult family support service (delivered by Phoenix Futures). 5.37 Additional family support is funded via the ADP to Barnardos and North Lanarkshire Council family programmes with Test of Change match funding for early learning centres provision in place between 2023 – 2026. 5.38 In 2024, the full budget allocation was £223,109 with £278,480 being spent to date, this was extended due to previous year underspend and test of change initiatives agreed with match funding from other sources. Justice pathways Arrest referral 5.39 The ADP funded an arrest referral approach for those who presented at police custody where alcohol, drugs or mental health issues were a factor. 5.40 The Arrest Referral Test of Change was initiated in April 2023 and has seen over 400 people engaged over the past 18 months and supported into treatment or community based alcohol, drug or recovery services. 5.41 This is currently being evaluated with findings, recommendations and key action to be presented at the next ADP Board in January 2025. Drug and Alcohol Solution Courts 5.42 The ADP funded a solutions court pilot through Criminal Justice social work and the courts system to divert people into treatment. This has been limited due to decisions taken by the Sherriff Principal and eligibility criteria which was reviewed and extended in May 2024. Contextual Safeguarding 5.43 Three development posts were created in 2023 working within NLC children and families social work services, to better understand Contextual Safeguarding needs across the whole system. 5.44 This Test of Change was extended in 2024 in order to identify and evidence the most appropriate early intervention, prevention and harm reduction measures for children and young people at risk of extra-familial harms, exploitation and includes those in conflict with the law.
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8 5.45 NL is the first local authority to take this step with other areas following on from our learning. 5.46 Workforce Development and learning events - The ADP support team continues to support local services to improve their offer through targeted training and learning opportunities. 5.47 In 2024, 163 people attended training over 12 different courses and learning events. This is being extended in 2025, following extensive workforce engagements, to offer a workforce development programme. 5.48 There are 22 new opportunities being made available throughout 2025, offering a total of 374 training places. 5.49 Alcohol (and other the drugs) support fund - A new fund was made available through North Lanarkshire ADP in 2024. Organisations could apply for up to £10,000. 5.50 Nine awards were made through the fund totalling £70,050. This aims to build capacity and support to people from under-represented communities with their alcohol and other drug issues. 5.51 The fund aims to improve prevention efforts, reduce crisis and promote recovery across all six localities. Grant holders will report back to the NLADP in 2025. 5.52 Lived and Living Experience (LLE) Panels – The LLE work of the ADP is progressing with a support worker in post. 5.53 The ADP carried out a broad range of engagement activities in 2024 with well- established connections across all localities and a work plan in place to support the expansion of LLE Panels. 5.54 A LLE consultation survey was co-produced with living experience groups. This was launched in August 2024 and closed after 4 weeks with 80 responses, from people with lived and living experience, including family members. 5.55 The first LLE conversation event took place on 1st October. There is a process in place to understand risks and concerns being raised during engagements. 5.56 This approach is highlighting some of the real-time challenges facing people who use alcohol and other drugs and supporting key learning to improve services. Further work is planned for 2025.
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9 North Lanarkshire ADP funded projects and initiatives for 2025. 5.57 Commitment to 3-year funding approach with quarterly reporting and annual reviews (subject to ongoing SG funding): NLC initiatives continuing NHS initiatives continuing Creative Faces Drug Testing and Treatment Order Family Plus Project Housing Life Coaching Kick start project Addiction Psychology posts Addiction Recovery Team – Integrated Gender Based Violence Service Occupational Therapy posts Substance Misuse Liaison Nurse Team Community/voluntary sector initiatives Test of Change Initiatives Barnardos Axis Equal Say Independent Advocacy Phoenix Futures Adult Family Support Phoenix Futures, Treatment Service Recovery Scotland SAMH Individual Placement Support Scottish Drugs Forum – The Traineeship Turning Point Scotland Crisis Outreach Team Youth Information and learning - Landed Alcohol Counselling and Alcohol Brief Interventions ToC (in development) Alcohol harm reduction & Housing support 50’s+ (in development) Contextual Safeguarding Drug & Alcohol Solution Courts Drug and Alcohol Harm Reduction Cafes Phoenix Futures - Prison Through-Care support extended Reach Advocacy – Charter of rights (in development) Young people in conflict with the law – extended subject to Corra bid Corra Funded initiatives Research, Development and Scoping Aruka and Freedom City Church – Prehab support Barnardos/Phoenix Futures – wider family support test of change Blue Triangle – Breakthrough Service, Extended for 2 years Circle – Families and Justice NLC - Family learning centres support Arrest Referral – Evaluation HIS/IRISS – Ethical Commissioning Non opioid and other drug use scoping study Recovery Scotland – Peer researchers Rehab Pathway Evaluation Other Community Support Fund *NLADP commission independent advocacy support thought Equals Advocacy. All NLC advocacy supports reviewed in 2024 with combined tender process carried out. Preferred supplier identified. Nine awards were made through the fund totalling £70,050. This aims to build capacity in North Lanarkshire to support local people from under-represented community’s; to improve prevention efforts, reduce crisis and promoting recovery across all six localities.
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10 Key Challenges Information Governance 5.58 The ADP Chair is working with senior leaders and governance structures to ensure the balance of risk between data protection and public protection is proportionate and relevant. Harm reduction, whole systems culture shift 5.59 Further work is being undertaken across Lanarkshire to ensure harm reduction is embedded and widely practised at each point of contact across our health and care system to ensure all efforts are made to prevent deaths and harm from alcohol and drugs. 5.60 This is an action being taken forward by the Drugs Death Prevention Group (Pan-Lanarkshire). The DDPG strategic group is Chaired by NHSL Director of Public Health. Seeking approval for NLADP to lead a review of HR. Emerging Drug Trends and Harms 5.61 Traditionally, drug treatment services are set up to support those with problem alcohol or opioid use specifically, our current response is adapting to include new synthetic opioid (such a nitazines) with measures in place to support wider harm reduction interventions more routinely for such drugs – including more targeted Naloxone distribution. • Whilst Opiates/Opioids are the most common drug implicated in Drug Related Deaths (DRDs) in Lanarkshire in 2023, the proportion is considerably less than that reported nationally (80% Scotland, 68% North Lanarkshire). • Over eighty percent (81%) of DRD in North Lanarkshire in 2023 were for individuals in the two most deprived areas (SIMD 1 and 2). • A similar relationship can be seen for benzodiazepines and Gabapentin and/or Pregabalin (Benzodiazepines 58% Scotland, 52% North Lanarkshire, Gabapentin and/or Pregabalin 38% Scotland, 29% North Lanarkshire). • Cocaine was implicated in a considerably larger proportion of DRD in 2023 in North Lanarkshire compared to Scotland (50% Lanarkshire, 41% Scotland). • Nearly three quarters (74%) of DRD in North Lanarkshire in 2023 had two or more substances implicated in the cause of death. • ‘Any street Benzodiazepine’ (52%) and Bromazolam (43%) were slightly higher than that recorded for Scotland with forty-nine percent and thirty-six recorded respectively 5.62 Drug-deaths, poverty and health inequality - those dying from drug use are using multiple substances which are often exacerbated by a number of other health-related issues and poverty/inequality.
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11 5.63 People in the most deprived areas 15.3 times as likely to die from drug misuse as those in the least deprived areas. With the shift in trends, we need to review our treatment and care services which are currently designed for alcohol and/or Opioid dependence/treatment in most areas. Shifting the response 5.64 People in Lanarkshire presenting at ART – drug treatment settings, are not fully supported when presenting with non-opioid based drug problems. This includes illicit stimulant, depressant and dissociative drugs (or a combination of many). 5.65 People are currently presenting at a range of settings including Primary Care/Acute – ED/SMLN and justice settings – Arrest referral/courts system/CJSW having consumed such substances. 5.66 Significant concerns remain about the readiness of T3 treatment services, and wider support services, to respond to emerging drug use trends including stimulants/new synthetic opioids and poly substance use. 5.67 There is limited alcohol detox and no managed alcohol programme (MAP) provision offered routinely at all T3 treatment sites, additionally there is no stabilization offer in place to address poly substance use and co-occurring mental health and substance used needs. 5.68 There is a need to build a better understanding of the extent and impact of non-opioid drug use in Lanarkshire in order to develop the right responses and supports. This includes the longer term (physical and mental) health impacts of such drug use patterns and trends. 6. CONCLUSIONS NLADP continues to deliver on the National Drugs Mission objectives and ADP strategic priorities targeting resources appropriately and measuring impact. The ADP has appropriate structures and governance arrangements in place to support decision making around spend and offering best value The right mechanisms in place to offer assurances that as much as possible is being done to tackle harms from substances and reduce deaths. Each sub-group is accountable to the ADP finance group and Partnership Board and each have clear priorities to take forward in 2025. There’s a wide variety of supports in place for individuals and families who are impacted by substance use. The current commissioning approach will support efforts to improve the quality and availability of support across statutory and community/voluntary services. There’s a strong focus on learning and development across the ADP linked to listening to stakeholder views and involving those with lived and living experience across each area of work and sub-groups.
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12 More improvement work is required within statutory services via a full service redesign and skills mix review to ensure we are meet the needs of those with co-occurring substance and mental health issues and able to respond to changing drug consumption patterns and trends as set out here and in the MAT standards paper. This will ensure we are taking a whole systems approach to reducing harms and deaths from alcohol and other drugs and future proofing our holistic. 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 The total spend for NLADP in year 2023/24 was £3,594,141. There is currently an underspend of £3,596,675. The in-year allocation from the Scottish Government to NLADP for 2024 was £2,089,737. This budget was allocated to ADPs on an 80/20% split basis, subject to a bi-annual financial return (October 24) demonstrating allocations are being utilised or allocated. Tranche 2 funding for the full amount allocated was confirmed in November 2024 and has since been received. NLADP is currently utilising last year’s allocations, by agreement with the Scottish Government. This has allowed a 3 year commissioning plan to be set out which aims to fully utilise all allocations.
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13 NLADP has a 3 year spend forecast which sets out how all budgets will be aligned with the delivery of the National Missions priorities between 2024 – 2027. All underspend and reserves are fully costed and allocated for future commissioning activities and service planning. Annual spend plans 2024 – 2025 Stabilisation Fund 188,320 188,320 188,320 Res Rehab 318,728 318,728 119,277 318,728 0 WFA 223,109 377,421 278,480 371,307 (148,198) Lived & Living 31,873 35,026 - - 31,873 PfG 1,139,315 650,000 810,255 1,080,340 58,975 Mat Standards 570,866 188,556 142,446 189,928 380,938 National Mission 701,201 530,172 209,900 279,867 421,334 DDTF 55,573 55,573 (55,573) Outreach 8,022 8,022 (8,022) SG Funding 3,173,412 2,288,223 1,623,953 2,303,764 869,648 - ADP Support Team 328,223 369,172 492,229 (164,006) Commissoned Services 855,452 989,588 603,629 989,588 (134,136) Reserve Spend 819,832 530,369 530,639 530,639 289,193 - Total 5,176,919 3,808,180 3,127,393 4,316,221 860,698 YTD Spend Forecasted Spend Variance Annual Budget Spend Plan 24/25 Current position Annual Budget YTD Budget YTD Spend Pays 1,175,828 652,925 652,925 Non Pays 4,001,095 2,474,455 2,474,467 Total 5,176,923 3,127,380 3,127,192 The table below shows the annual reserve budget and what would be required to meet forecast spend commitments for year 2025- 2028, based on SG allocations remaining at current levels. 23/24 2,576,000 860,698 24/25 3,436,698 (565,465) 25/26 2,871,233 (556,719) 26/27 2,314,515 (2,314,515) 27/28 0- Reserve Budget Spend Plan 24/25 Spend Plan 25/26 Spend Plan 26/27 Spend Plan 27/28 • The above financial plan is a forecast and the position may change. • Any underspend that is generated will be protected and carried forward into the new financial year. This paper has been reviewed by Finance: Yes ☒ No ☐ N/A ☐
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14 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Regular stakeholder engagement takes place through the ADP subgroup structures with people with lived and living experience (including families) involved in shaping the decisions around tackling alcohol and drug related harms. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ADP sub-groups/Stakeholder event and ongoing engagement in communities across North Lanarkshire. ☐ 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 ADP sub-groups/Stakeholder event and ongoing engagement in
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15 other engagement activity and local plans across the Community Planning Partnership communities across North Lanarkshire. 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 9. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Yes ☐ No ☒ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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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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