2025 02 25 Combined Agenda Pack
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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A meeting of the IJB PFA will be held on Tuesday 25th February 2025 11am – 1.30pm via MS Meetings If anyone would like to join this meeting, please contact the governance team at NLHSCPGovernance@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB PFA (23rd October 2024) For Approval Attachment Chair 4. Matters Arising/ Rolling Action List For Noting Attachment Chair Strategic Planning & Development 5. Resettlement Update Annual Report Attachment Maggs Thomson Performance & Finance 6. Q2 Performance Report Routine Report Attachment Morag Dendy 7. Internal Audit Progress Report For Noting Attachment Jocelyn Lyall 8. Financial Monitoring Routine Report Attachment Nicola Scott 9. Alcohol & Drugs (ADP) For Noting Attachment Morag Dendy 10. MAT Standards For Noting Attachment Morag Dendy 11. External Audit Plan For Noting Attachment Audit Scotland Governance & Policy 12. Risk Report Attachment Morag Dendy For Noting 13. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 14. Date of Next Meeting 21 May 2025, 14:00-16:30
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 23th October 2024 14:00-16:30 Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Paul Kelly Siobhan White North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Claire Rae Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together Liz Seaton Partnership for Change User Rep John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Rose Walker (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Margaret Flavell Joanne Jenkins Nurse Director (interim) North HSCP Thomas Moan Dr Lucy Munro Medical Director North HSCP Maggs Thomson Head of Health NHSCP John Watson Maria Williamson Senior Manager, Quality Assurance David Wood Harry Robertson (Guest) Dawn Wright Management Team Secretary, North HSCP Apologies: Nauman Dar NHS Lanarkshire Nominated Non Exec Director Diane Fraser Alison Gordon Head of Adult Social Work Services
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2 ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA 21st August 2024 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Brian Moore referenced the discussion from previous Integration Joint Board (IJB) meeting around the numbers of Care Inspectorate reports that some services were subject to, and asked if there was any feedback to the frequency and numbers undertaken. Claire Rae, Chief Officer, North Health and Social Care Partnership agreed will pick this discussion up and feedback to members of the group. Noted that the Audit Scotland report was recently discussed within an IJB meeting, and suggestion made that the recommendations within report be incorporated on the IJB Action log. It was noted on review there is a number of actions remaining. To review recommendations within a liaison session in the context of medium term financial planning arrangements. Claire Rae advised update will also be provided at the IJB meeting scheduled 4 December 2024. 5. Getting It Right For Everyone (GIRFE) Morag Dendy presented the Getting it right for everyone (GIRFE) paper highlighting is a national piece of work supporting Adults in a much more person centred way. The paper outlined 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.
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3 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. 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. 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 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. 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. Morag Dendy added that a lot of the work nationally fits with priorities locally in relation to how we help people to help themselves first; to how it is influenced locally and influence on a national context. Phillip Couser asked what confidence do we have; that we have this access to the data; to properly assess the impact and performance of this? Morag Dendy advised that benefits have been realised from the collaborative work undertaken with colleagues in Airdrie and Wishaw locality which had also provided the opportunity to test, explore and identify areas of improvement. Margaret Flavell added that one of the Pathfinders is meeting with some of the operational staff involved in the Wishaw demonstrator and is speaking with people with lived experience. The team have linked closely with the performance team to analyse and interpret the data.
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4 Brian Moore referred to the following highlights within the report and sought clarity in relation to: 1. The development of digital requirements; asked has this been advanced? 2. Did we get the toolkit in September 2024? 3. The sticky person; who do we envisage in fulfilling that role? 4. In terms of the Governance framework; the IJB is not mentioned 5. Under 6.4.1 the risks that are outlined makes reference to finance; trying to get a sense of the timeline and the process for rolling this out across different localities. What are the financial implications? 6. In terms of the demonstrator sites, Airdrie and Wishaw and its reference to community nursing. How does that overlap with the next paper on the agenda where reference is made to a single point of access for community district nursing? Morag Dendy replied; in terms of the digital requirements, the Scottish Government, share the frustrations by the slowness and progress in relation to how a national digital approach would assist the work “It's an area that we continue to feed into”. The tool kit, this is a bit more of a practical document. What we aim to do, is to embed in to our operations and not to make this feel like it's something different and additional. The focus is on how does this fit with a wider approach which helps us to be able to test the content broadly, but not necessarily adhering to the format that the Scottish Government have shared. Additionally, in relation to sticky person, the enabling approach encourages a place based opportunity to think about the people resources and wider community resources within a locality is encouraging us to really identify a lead that makes sense for each person in that context. A sticky person could be anyone in relation to people employed through statutory organisations, third sector partners, and the Community connector roles. Morag Dendy added in regard to the financial implications, it is about streamlining current operations into a more whole system way of working. With robust reviewing processes in place, to ensure we are doing things right first time. This will allow us to refine the way of operating for efficiency and effectiveness from the start, with not over-supporting or dealing with the impact of under-supporting. The single point of access from community nursing is about no waits, . how do we respond quickly, considering how do we do that in a way that takes from the lessons learnt from the work that Podiatry and CAMHS have done. It's our responsibility to consider how we undertake these streams, and get the right response in place for people to join in a locality based approach. We have structures in place that will help us learn collectively. Cllr Barclay commented on looking at Lanarkshire as a whole; referring Airdrie, Wishaw, and with Cumbernauld the point was made that there can be differences between areas sometimes and statistical outliers; is the GIRFE model flexible enough to take into consideration all of this?
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5 Morag Dendy advised the focus has been on Airdrie and Wishaw. The back to basic work has included all of the localities, however we are confident that we will get to a model that will respond to the uniqueness of the different localities. Margaret Flavell commented around the question raised regarding Governance; that the IJB was not specially mentioned. To note the Programme Board Governance structure was being refreshed at the time of the report, referred to the new Getting it right for everyone (GIRFE) board, sub groups below and pointed out this work would report in to that. IJB PFA Committee note and agreed the following recommendations: I. Endorse the GIRFE Pathfinder journey and approve the next steps. II. Endorse the testing of prototypes in multidisciplinary operational practice, through: III. 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 IV. Embedding the GIRFE principles and subsequent practice and ways of working underpins the Back to Basics/enabling approach. V. Have requested to receive future reports with the national pathfinder learning. 6. Community Nursing Review Joanne Jenkins presented an update on the progress of Community Nursing Review. 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. 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. The Community Nursing review has now been completed and the implementation stage is ongoing. 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. Planned Project 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.
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6 • 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. Phillip Couser asked is there comparative data, to other areas, to see how the service is performing or is that still an area where this is general weakness. Joanne Jenkins advised that the project have found this to be a general weakness. Nationally conversations are being had as there is a drive for this; but don’t have the data at this time. Siobhan White asked around the training for newly qualified nurses coming in at different points; has there been lessons learned from new qualified staff; and shared practice to their experience? Joanne Jenkins advised this has been looked at for newly qualified nurses within development days, and try to take a consistent approach across North and South Lanarkshire. Brian Moore commented it is interesting to see the planned work with care homes and the benefits that may arise with same. Brian also referred to the social care issue and some of the tasks that might be transferred; social care as a reference to catheter bags and stoma care and asked how this is progressing? Joanne Jenkins advised is progressing well with positive feedback received. IJB PFA Committee note and agreed the following recommendations: I. The progress of the Community Nursing review. 7. CAMHS and NDS Recovery and Renewal Programme Board Dr Lucy Munro presented 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. 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.
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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. • 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. • 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. Dr Munro reported the financial instability continues to challenge workforce stability. Claire Rae added in relation to the funding; there has been a significant reduction in the mental health bundle funding allocation that would cover CAMHS. The reduction will have a significant implication on our trajectories and performance. Claire provided assurance that both herself and the Director of Finance NHSL were in discussions with Scottish Government regarding the funding and further updates will be provided to the IJB. Cllr Barclay acknowledged compared to where we were, it seems work is moving in the right direction, and asked is it having an effect on the waiting time for people getting an appointment? Dr Lucy Munro answered yes. Have seen that improvement trajectory. Had seen a recent dip to 66% to 18 weeks, but expecting with the changes that have been made and the projections that we have from a Public Health Scotland analyst to be at 90% at 18 weeks for that first appointment. Added waiting lists are still too long; workshops are being held for people on these waiting lists; to offer support.
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8 Dr Munro outlined some of the diagnostic issues and challenges in relation to NDS and increasing demand for assessments. It was confirmed that lead civil servants share the views expressed at the meeting. Dr Munro added that Stephen MacLeod the Scottish Government advisor for CAMHS and NDS; brings this to the board. Brian Moore referred to the final recommendation; the remit of Programme Board will expand to include financial planning for workforce resilience. Brian Moore requested that an update to the IJB is required following the Scottish Government meeting to see what the short term and long term impact will be if of any financial reduction. IJB PFA Committee note and approve the following recommendations: I. The contents of report and progress made to date. II. 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 III. 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. IV. Ongoing work of the Board will focus on NDS and the interface of NDS with CAMHS. V. Remit of Programme Board will expand to include financial planning for workforce resilience 8. Paediatric Modernisation Board Maggs Thomson provided an update on the Paediatric Modernisation Board which was established in current form, formally, in February 2023. 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 Lanarkshire CORE, North Lanarkshire Integration Joint Board, South Lanarkshire Integration Joint Board and NHS Lanarkshire. 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;
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9 • 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. A three Horizon approach was taken to prioritisation and phasing of work to be planned and delivered: - Horizon 1- covers current issues that require quick response. • Nursing Care Assurance • Review of Continence Services Horizon 2 -covers emerging issues that are likely to be faced in the next one to three years. • Sustainability of medical rota Horizon 3 - covers issues that might come into play in the future. • New clinical model Brian Moore asked for further clarification on the statement that elements of this work being impacted by current service level agreements with partners and sensitive discussion via regional planning. He noted there is a big emphasis on regional planning within the national system at the moment; do you know what the implications are for this service? Maggs Thomson informed that the paediatric wards provide a District General Hospital level of care; currently in negotiations with our Glasgow colleagues to provide our tertiary level care and that's afforded through the SLA with Glasgow. It was noted the progress is still at early stages and assurance offered to members that work is being undertaken in these areas. Phillip Couser commented; the paper doesn't have any sort of hard timelines against which this work is progressing to deliver on and asked is there any risk that might change? Maggs Thomson advised the primary emphasis and focus in the first year was to start the shift in thinking and to get the right stakeholders around the table to build that level of confidence and trust, and to have plans on the table to see what could be delivered.
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10 Action/ Direction to service: Brian Moore asked when report comes back with an update, that additional information be provided to get a better understanding of the staff numbers working within the service as well as the budget and number of patients, inpatient and community supports. IJB PFA Committee note and agreed the following recommendations: I. the contents of the report and progress of work achieved to date. II. 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. III. that elements of this work are impacted by current service level agreements with tertiary partners. This requires sensitive discussion via regional planning process. 9. Speech and Language Therapy Service Improvement Maggs Thomson provided an overview of the scope and span of improvement work being delivered via Speech and Language Therapy (SLT) Service. 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 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. A 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.
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11 • 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. • HR and Workforce -This work has progressed well. Review of all posts across the service has been undertaken. Brian Moore commented in terms of paediatrics and CAMHS; the benefits of making connections with district nursing review and particularly the reference in the performance report to restrictive locality working arrangements, there needs to be a fundamental rethink of how we structure and deliver the service going forward. Maggs Thomson clarified whilst delivering in localities the services are reviewed on a Lanarkshire wide basis. IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report and progress of work achieved to date. 10. An update on Care Academy Morag Dendy provided an update on the Care Academy which 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. 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”. There have been four work streams now established, with specific actions within each being developed by the work streams themselves. A further update on progress on each of the work streams 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 Cllr Paul Kelly commented, I think it's a really important piece of work around recruitment of new people into social care; one of the challenges that may be required was to identify is around the funding aspects, the different wage elements of care from your local authority, private third sector? and in terms of how we manage it.
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12 IJB PFA Committee note and agreed the following recommendations: I. The progress with Implementation of the Care Academy Pan Lanarkshire. II. a further update on progress with the work streams in 6 months’ time will be submitted to the IJB. 11. Performance Update – Quarter 1 (April – June 2024) Morag Dendy gave an overview of the Quarter 1 performance report detailing the areas for improvement identified in Appendix 1 and progress made to date. Noted 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. Phillip Couser commented on the broader societal issues that sit outside Lanarkshire that impact some of the metrics, asked whether or not a peer group review might help focus on areas where there is room for improvement. Brian Moore pointed out we have that covered in terms of the annual performance report where we are part of a cohort, and there was some benchmarking information. Claire Rae mentioned in terms benchmarking; this is something that we constantly strive to do in terms of looking and implementing learning from other boards and local authorities in terms of performance. Acknowledged in terms of annual performance report, going forward that we will include recognition of areas of success. Cllr Barclay referred to the referrals and the figures from adult protection concern reports; asked regards the dip in the number of cases, and wondered what are the reasons behind this? Morag Dendy advised very often the referral numbers can relate to good work being done, it is not so much of a lack of reporting. Note there is also a lot of work done through the Adult Protection Committee and the reporting there, which gives a lot more detail and feed through this forum. Brian Moore asked when looking at alcohol and drug services, do we know what the impact, of all the activity is and how we capture it? And suggested a more fundamental review of how we tackle smoking cessation. Cllr Barclay referred to sickness absence- In relation to COVID and asked is there stats being kept to say this relates to COVID and is that causing some sort of fluctuation within this, or is it is like the other organisations in that COVID has just been taken as part of absence reporting? Brian Moore informed the understanding is that this is now just part of absence reporting and Maggs Thomson re-iterated this is not reported separately and is just managed along with any other sickness absence.
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13 IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report and the appendix. 12. Tackling Poverty- Cost of Living Helpline Morag Dendy provided an update on the Tackling Poverty service. 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 mean 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. 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. Siobhan White asked is there some of this work being undertaken by other bodies anywhere ie. welfare officers helping people in one capacity and then the housing associations also. Morag Dendy advised that this work has a whole system focus in relation to the joint work with housing colleagues, including housing associations, and that the collaborative approach is fundamental in the tackling poverty approach. In the report there is reference to some maybe not to others, but they are actively involved in the overall approach and work with their housing colleagues in North Lanarkshire Council which gives us good routes into those wider links. Cllr Barclay added from an elected members point of view the one door approach has been phenomenal. Action / Direction to service - Brian Moore noted that post June 2025, to support the continuation of the of the helpline; an exit strategy or alternative funding will need to be identified by the service IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report. II. Endorse the report and note the impact of the funding of the Cost-of- Living helpline for residents III. 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.
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14 13. Quality Assurance Annual Report Morag Dendy gave overview, of the Quality Assurance activity over the period April 23 to 31 March 2024 detailing Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Market Facilitation, In House Monitoring, Safer Staffing & Communications; highlighting the progress made within these key activities noted in the last reporting period, and advising of the developments in progress which are planned for the period 2024/25. There's lots of progress in relation to people who have experience of a need and support being involved directly. The activity in relation to regulatory contact through the Care Inspectorate is all captured. The report is reported through the Adult Care and Social Work Committee and through the Education, Children and Families Committee. Brian Moore commented on safe staffing; noting in terms of future work going forward the Quality Assurance team is going to look at this in more detail; highlighted an annual report to be submitted by April 2025. Suggestion made that members of the IJB PFA would benefit from having an understanding of safe staffing and some of the elements of it in terms of real time reporting and escalation. Pointed out it will be useful to bring an explanatory note to the IJB as there has been ongoing work on the health side, but it's also applicable to social care. It was noted there was zero findings of duty of candour this year and Brian Moore asked for comment regarding the absence of reports. Maria Williamson added that in previous years, have reported commissioning services duty of candour; there has been activity externally, just not internally. External organisations are required to publish their own reports. Going forward the duty of candour report that we publish will refer to our own services in terms of social care. IJB PFA Committee note and agree the following recommendations: I. Note and endorse the contents of the report. II. Remit the report to Adult Care and Social Work Committee. III. Request that an explanatory note to the IJB on safe staffing is provided at an IJB Liason session. 14. Community Solutions Annual Report Community Solutions is a successful, cross-sector health and social care investment and improvement programme for North Lanarkshire 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.
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15 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. Brian Moore mentioned in relation to Community transport; this may be an area where there could be future developments and asked around mental health and well-being funding; is there any indication as to the future, allocations in in the coming year? Thomas Moan replied seems to be very positive. On phase four, which will be allocated in the last quarter of this year for projects being delivered in 2025 from April 2035 to March 2026. Mental health and well-being is still a major issue. One of the areas that we're working closely with colleagues in NHS Lanarkshire, is to see how people with more severe mental health support needs, how we can complement from the Community voluntary sector. Philip Couser raised question in relation to funding; do we feel confident that we are able to demonstrate and defend the value that we're getting from these investments? do we have that sort of evidence? Do we have a framework by which we can judge the value that we are getting from these investments? Thomas Moan answered; have a quite a robust performance, measurement, evaluation, learning and improvement framework in place named Pemeli. The focus is on how can inform service redesign. IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report. 15. Whistleblowing Report North Lanarkshire Council’s Whistleblowing Procedure (attached at Appendix 1) has been reviewed and no amendments requiring approval are considered necessary at this time. 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. Brian Moore commented in terms of where we are, is still early days and the fact that we have low numbers is something that we need to reflect upon. In
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16 terms of raising awareness and training; as an IJB will be seeking assurance that staff and managers are aware of the whistleblowing policy. Noted will continue to monitor on an annual basis. Maggs Thomson commented although we do not see a lot of whistle blowing numbers; one of the things we do see coming through is a fair number of anonymous complaints. When the party isn't known to anyone, and asked is this something we need to do to look at. Brian Moore added is a very valid point because the whistleblowing legislation doesn't cover confidential concerns, it does give guidance that it should be investigated as best you can under the circumstances. IJB PFA Committee note and agreed the following recommendations: I. note the update and the content of each Whistleblowing report and are assurance that whistleblowing standards are being followed and learning shared. 16. Risk Report 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 risk rated as high or very high. Noted no changes to risks this period. Very High Risks • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges • IJB 21/24- Pharmacy Pressures within Prison Services 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 • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy A comparative review was conducted of the corporate risk registers for North Lanarkshire Council and NHS Lanarkshire. the review also encompassed the Adult Health and Social Care Risk Register as well as the NL H&SCP Core Risk Register. Highlighted was that all four risk registers had the following risk themes detailed: • Financial Risks/ Financial Sustainability
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17 • Prevention and Detection of Fraud, Bribery and/or Corruption Cllr Barclay gave thanks to Stacey Anderson for hard work and displaying in this format for ease of reference. Brian Moore commented that the adult protection one is part of performance reporting and questioned the submission of a report from the Adult Protection Committee to the IJB in terms of understanding those processes. Noted for the next meeting, to discuss the potential inclusion of climate change in the risk register. Noted agency is currently not included in the IJB risk register, may need to be addressed. Lucy Munro added there’s a sustainability and value group which is led by looking at all of the agency staffing from a medical perspective and advised their maybe also be work being undertaken from a nursing perspective. IJB PFA Committee note and agree the following recommendations: I. 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. II. noted the inclusion of an overview of the corporate risk registers across parent organisations within North Lanarkshire. III. Have considered the inclusion of climate change and public protection risks to the IJB risk register to align risk sharing across parent organisations. With Climate Change risk being added to the register and further discussions to be held regarding the inclusion of a public protection risk at further IJB sessions. 17. Risk No other emerging risks identified to be added to the risk register. 18. Date of Next Meeting 27th March 2025, 14:00-16:30
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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 26 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that their Medium-Term Financial Plans are up to date 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.
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2 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 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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3 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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4 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 to the September/Dec ember 2020 Deferred to March 2021 – deferred to September 2021 Original Action complete with further update on hosting arrangements presented to
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5 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 Committee and Education and Families Committee. A further report will therefore be presented to the next – 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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6 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 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. June 2021 – deferred to September 2021 Complete
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7 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 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 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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8 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 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. June 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around
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9 22.3.22 – Update provided on progress on engagement and development of business case September 2022 engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided March 2022 June 2022 Complete
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10 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. 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 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
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11 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 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 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
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12 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 18. 31.8.22 Item 6 IJB Self- Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Picked up at November Liaison Session Complete 25. Future Meeting R McGuffie Host a future meeting face to face in Chryston hub Dates set up for 2025 Walkrounds Complete
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1 REPORT Item No: 5 SUBJECT: Health Care Resettlement for asylum seekers and refugees across Lanarkshire. TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Maggs Thomson, Head of Health Author(s) of Report Sharon Simpson, Health and Social Work Manager Susan Lyttle, Health Improvement Manager (Asylum Seekers & Refugees) DATE: 13 January 2025 This paper is coming to the IJB PFA for: For approval ☐ For endorsement ☐ To note ☒ The purpose of the report is to provide an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. This report will also provide an update on the work of the resettlement programme. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Sharon Simpson, Health and Social Work Manager and Susan Lyttle, Health Improvement Manager (Asylum Seekers & Refugees), NHS Lanarkshire. 3. RECOMMENDATIONS It is recommended that the IJB PFA: acknowledge the contents of report. Future reports can be provided.
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The UK Government has made a commitment to resettle refugees from various countries since 2015. From 2015 until 2019, approximately 300 Syrian refugees were settled in Lanarkshire. The Scottish Government (SG) in conjunction with COSLA has also made a commitment to support Unaccompanied Asylum seeking Children (UASC) with approximately 5-6 arrivals per month in Lanarkshire. In spring 2020, the ‘UK Resettlement Scheme’ (UKRS) was established in response to the ongoing refugee crisis across the globe and a number of refugees continue to arrive in Lanarkshire from Syria and other countries such as Sudan, Iraq, Palestine and Afghanistan. The Afghan Relocations and Assistance Policy (ARAP) was launched in 2021, reflecting the changing situation in Afghanistan with Lanarkshire continuing to see a number of arrivals via the ARAP programme. Mears Group are the company who have been awarded government contracts to provide accommodation and support to asylum seekers. In December 2021 the Home Office and Mears Group established an emergency contingency accommodation for single male asylum seekers at a hotel in East Kilbride with a capacity of 93 residents. As part of the widening Asylum Dispersal Strategy, Lanarkshire is now starting to receive small numbers of families into dispersal accommodation that have been procured and supported by Mears Group. In response to the crisis in Ukraine, the SG and COSLA agreed to support Ukrainian people coming to live with relatives and friends, via the Homes for Ukraine scheme or The Scotland Super Sponsor scheme. The number of arrivals was much higher than anticipated with a requirement for the use of 6 hotels across Lanarkshire to support the increasing numbers of arrivals. None of the hotels are used now as people have moved on to their own accommodation. Approximately 2000 Ukrainian people have resettled in Lanarkshire. The Healthcare Resettlement team was established in October 2022 to provide assistance and support to refugees and asylum seekers in accessing healthcare services upon their arrival into interim hotel accommodation across Lanarkshire. Alongside this a Health Improvement Manager post was secured to conduct a population health needs assessment and to help build capacity in the Third Sector to support the resettlement of asylum seekers and refugees. The healthcare team was an initial response to the Ukraine crisis however the team has not been functioning since December 2023. The significant decline in the numbers of Ukrainian arrivals and the closure of hotels has meant the workload Yes ☒ No ☐ N/A ☐
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3 decreased substantially and currently there is no ongoing requirement to provide clinical triage or health needs assessment to the Ukraine population. Work is ongoing to further define and refine the service model to assure that appropriate levels of assessment and response are delivered timeously and to level appropriate to need. This is in the context of a demand profile that is variable with unpredictable complexity. To date there has been little research to understand the challenges faced in accessing healthcare or how healthcare experiences affect the health and wellbeing of asylum seekers, refugees and displaced persons in Scotland or indeed in the UK. A population health needs assessment (PHNA) for these populations was undertaken to ensure that their health needs are addressed and health inequalities are reduced. This report will provide a summary of the refugee and asylum arrivals to hotel accommodation, the settled population and recommissioned properties. It will also provide a summary of work completed to support resettled populations and ongoing work of the Health Improvement Manager for Health and Wellbeing of Asylum Seekers and Refugees. 5.1 Health Care Resettlement The purpose of the Oversight Group and the Resettlement Operational Groups is to provide forums to ensure a planned and strategic approach to the delivery of healthcare and wellbeing for displaced people, refugees and asylum seekers, settling in Lanarkshire. The Oversight Group provides a platform for the planning, the financial and professional governance and accountability of the care and support being delivered, and ensures reporting of performance and key outcomes to the relevant forums and structures. The Resettlement Operational Group oversees the resettlement process for individuals requiring health care services. The group works collaboratively to ensure the efficient and effective resettlement of clients, enabling them to access health care services as and when required until they are fully integrated in to localities and can access universal services. The interim Health Care Resettlement team haven’t been in post since December 2023. Pathways have been developed for direct referrals to services including Midwifery Services, Mental Health, Sexual Health, Public Health, Mears and the wider Vaccination Service. Standard Operating Procedures have been compiled to support the administration of vaccinations to the asylum population within their current accommodation. A resettlement health care repository has been set up on a shared drive to ensure knowledge, information, processes and protocols are accessible. A resettlement email has also been developed to share and transfer information with colleagues and partners. One WTE Health Improvement Manager is currently in post until March 2025 and conducted a training needs assessment of health care staff and a population health
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4 needs assessment of asylum and refugee populations resettling in Lanarkshire to inform planning for future support. Connections have been made across all NHS services to improve their understanding of the health needs of refugees and asylum seekers and the rights and entitlements of them to access health services. Information for staff on supporting the healthcare and wellbeing of asylum seekers and refugees living in Lanarkshire has been created and is now available on a landing page on the NHSL intranet, FirstPort. The development of information for the public to access is also planned. 5.2 Recommissioned properties At present there are circa 2000 people from Ukraine now settled in Lanarkshire within recommissioned properties, private arrangements and hosting arrangements. There have been a number of properties recommissioned across Lanarkshire to support Ukrainian refugees: Birkshaw Tower in Wishaw has 53 properties occupied with 116 people in total residing there, consisting of 78 adults and 38 children. High Coats in Coatbridge has 142 properties occupied at this time with 306 residents consisting of 216 adults and 90 children. Barrack Street accommodation has 109 adult residents at this time. 5.3 Asylum population Currently the Bruce Hotel in East Kilbride is hosting 87 male residents. All new arrivals to the hotel have been offered a health needs assessment specifically developed for the asylum population. These assessments have helped identify any immediate health concerns or underlying medical conditions. Vaccination history has been sought and those with outstanding vaccinations that have consented are being immunised by the team and connections have been made with the wider vaccination service moving forward. Networks of support have been set up and the Health Protection team have offered and carried out TB screening to many of the residents. 5.4 Unaccompanied Asylum Seeking Children Lanarkshire has been supporting young people arriving under the revised National Transfer Scheme for Unaccompanied Asylum Seeking Children (UASC). Demographics of arrivals have been mainly boys aged 16-17yrs with a small number of 15 year olds. The health needs of this population are predominantly supported by the Through Care and School Nursing service. All of these young people are residing with foster placements, children’s houses or supported accommodation. 5.4.1 North Lanarkshire Within North Lanarkshire, 51 young people have been supported, 47 males and 4 females. Main countries of origin are Afghanistan, Sudan, Eritrea, Vietnam with a few others from Albania, Egypt, Iraq and Iran.
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5 5.4.2 South Lanarkshire Fifty-seven UASC have been supported in South Lanarkshire with currently 52 young people still residing and eligible for support, comprising 3 females and 49 males. Six of these young people are in residential or foster care and a further 12 are being supported in the community whilst they await the outcome of their claim for asylum. Countries of origin include Iran, Vietnam, Iraq, Syria and Afghanistan. 5.5.1 Resettlement Health Care & Wellbeing Improvement Plan 2023-2024 A Resettlement Healthcare & Wellbeing improvement plan is currently being updated. The main high level outcomes of this plan are: 1. Staff and service providers have a sound knowledge and understanding of the rights and health and wellbeing needs of New Scots settling in NHS Lanarkshire area. 2. Appropriate and timely health & social care services and wider wellbeing services, that are sensitive to the needs of New Scots settling in Lanarkshire are established. 3. All staff have access to up to date information regarding resettled populations, access to translation & interpreting services as well as to technology & equipment that supports the delivery of services for resettled populations. 4. New Scots are thriving and are integrated into their local community & able to access health & wellbeing services and supports. 5.6.1 Support - Strategic & Operational Groups & Third Sector Involvement A Lanarkshire Resettlement Healthcare and Wellbeing Oversight group and an Operational Group are fully established and the Oversight Group has ratified the current improvement Plan. A Lanarkshire New Scots Integration Network has been established to bring together community and voluntary, and statutory partners to increase the level of support available to New Scots in Lanarkshire. The network aims to mobilise and co-ordinate community assets to address their needs and to support their integration. Scottish policy guidance and standards on NHS interpretation support have been developed in a bid to help NHS Scotland staff to understand the support available for their patients who do not speak or use English and to help ensure they have equitable access to health services. Public Health Scotland have produced a Competency Framework for Interpreting (2020) and locally NHS Lanarkshire has developed their own guidance on the use of interpreters in their Communication Support for Spoken Language, British Sign Language and Interpreting Policy (2022). The national Resettled Populations Health and Wellbeing Group (Refugees, Asylum Seekers, Displaced People) is chaired by Public Health Scotland. The aim of the
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6 group is to share good practice, resources and foster joint work in relation to the health needs, access to services and to the resettlement and integration of ASRs. It also provides a forum for Scotland wide staff to work together to update on and respond to national or local policy developments in healthcare and health improvement of these target populations. An Equality Impact Assessment (EQIA) has been completed for the Resettlement Healthcare & Wellbeing Programme. Work to date has focused on addressing the immediate and longer term health needs of those ethnic minority groups who have recently resettled in Lanarkshire. 5.6.2 Training Needs Assessment A training needs assessment (TNA) has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role. The TNA aimed to identify areas where staff may require further training and knowledge to identify areas where staff may require further training and knowledge to improve the provision of good quality and equitable health care delivery to refugees and asylum seekers resettling in Lanarkshire. The results of the TNA will inform the development of any recommendations on how best to support healthcare staff to provide high quality care for these populations. 5.6.3 Population Health Needs Assessment A Population Health Needs Assessment (PHNA) was undertaken. To date there has been little research to understand the challenges faced in accessing healthcare or how health care experiences effect the health and wellbeing of asylum seekers and refugees in Scotland or indeed in the UK. The undertaking of a health needs assessment on these populations will help ensure that their health needs are addressed, reduce health inequalities but also support future planning and integration to local health care systems. The PHNA aimed to find out the following: • What do people asylum seekers and refugees (ASRs) know about health services in Lanarkshire? • What factors promote and what factors inhibit people’s access and use of health services? • What is the availability of routinely collected health data on these populations? Findings The review of the evidence base highlighted that ASRs can face multiple challenges with their basic needs and rights not always being met. The stress of travelling to seek asylum, unemployment, poor living conditions, living in fear of deportation and being subjected to racial discrimination can have a profound and detrimental effect on their mental health and wellbeing.
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7 The 2021 census was delayed and had not been published when the PHNA was completed. The PHNA highlighted that there is no single source of data that is able to provide an accurate estimate of the number of people from various countries seeking refuge in Scotland and the ever changing picture of immigration makes it difficult to anticipate the demand or need for service provision. Now that the 2021 census data is available, the results will be reviewed to assess if this has any impact on the results. The results from the PHNA, mirrors the main findings of the review of the literature. Challenges include: language and communication barriers, some lack of understanding on how to navigate our healthcare systems, different expectations of healthcare provision, a need for increased awareness of the ASR population’s rights and some difficulties accessing and using interpreters. It was highlighted that there are clear distinctions between the refugee and asylum seeker populations as well as the various sub groups within each - the refugee population is much larger but with less severe health issues and the asylum seeker population is much smaller but with more complex health issues. This study also identified a need to involve service users in health service design as well as the need for culturally-sensitive services and healthcare staff trained in culturally sensitive and trauma informed practice to provide good quality care and onward signposting for these populations. 6. Conclusions The programme of work is ever changing and necessitates partnership and multidisciplinary working to ensure connectivity to support the transition and integration into main stream services. The work has had a profound impact on improving health outcomes and overall wellbeing of asylum seekers and refugees. A partnership approach has ensured that that the settling populations can easily access healthcare services, resulting in timely diagnosis, treatment and improved health outcomes. Through the support of the Health Improvement Manager, the wider team have empowered asylum seekers and refugees with the essential knowledge and skills to maintain and improve health, prevent ill health and navigate the health care system independently. The arrival of Ukrainian refugees to Lanarkshire has greatly decreased such that there are no hotels in Lanarkshire required to provide temporary accommodation. Additionally, there is currently one hotel hosting asylum seeking males. As part of the Widening Asylum Dispersal Strategy, Lanarkshire is now seeing people seeking asylum moving in to dispersal accommodation. At this time numbers have been low however it is difficult to estimate these numbers. The Mears Housing Group procure accommodation for asylum seekers and the local authority resettlement teams will notify health of any new arrivals in to the area. The Mears Welfare Officers will support GP registrations as directed. Those male asylum seekers residing in the hotel accommodation are supported by one GP Practice as a Local Enhanced Service (LES) agreement.
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8 The numbers of people seeking asylum and refugees coming to and settling in Lanarkshire will continue to increase. By working together, we can ensure that refugees and asylum seekers in Lanarkshire have access to the health care services they require to live healthy, fulfilling lives and integrate into our community effectively. 7. Implications Workforce – A Service Manager in North and South have been identified and agreed to oversee any future programmes of work and will attend single and multiagency meetings that are currently in place. All relevant information, processes and pathways have been developed and accessible on the resettlement shared drive and regular meetings have been established to facilitate a seamless transfer of information and responsibilities. Currently there are no new arrivals of Ukrainians to interim hotel accommodation therefore no clinical triage will be required however if there were to be a large number of new refugee or asylum populations arriving in Lanarkshire this would have an impact on universal services. Standard Operating Procedures and pathways have been developed to support this until any new arrivals are fully integrated into mainstream health services. The situation is changing regularly regarding arrivals, therefore this report sets out what is known to date. There is no ongoing funding and/or an indication of a predictable volume / flow of people coming to Lanarkshire that would indicate the need for a discrete Resettlement Team. Moving forward the model being proposed is one that creates a sustainable approach and ensures that we can react At this time the model needs to be finalised and signed off and an implementation plan developed that will identify process, staff and training. The current infrastructure of the Strategic and Operational Resettlement Healthcare Groups will be the vehicle to support the change in model. 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 ☐
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9 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) Resettlement Healthcare & Wellbeing Improvement Plan 2025-2026 incorporates measures for each action. 7.3 FINANCIAL All refugees and asylum seekers have a right to health care. Funding for health can be accessed for refugees coming via the UKRS. This is funding that can be drawn down by NHSL from the Home Office to cover primary and secondary care costs, in the initial year up to £2,600 per person. Unfortunately, there is no additional funds that health can access to cover the costs of the Ukrainian refugees, asylum seekers or UASC. The Health Care Health Improvement staff and the Health Care Resettlement team was established on a temporary basis from the reserves drawn down from this funding. Funding may be required for public health screening. A refreshed LES agreement was being developed and accepted by the GPs, which has provided them with a payment for each person registered with their practice paid from this current fund. This LES agreement has been agreed until the 31st of March 2025. All refugees have access to public funds, the UASC have become the responsibility of and are cared for by the Local Authority. The asylum population residing in initial hotel accommodation are supported by Mears with accommodation and meals provided however they have no recourse to public funds and those families living and arriving in dispersal properties do not have any recourse to public funds. The details of the proposed capacity have been agreed and approved by Finance. Appendix 2. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Stakeholders have been consulted and involved through the development of the Health Care Resettlement oversight and operational groups. Multiagency groups are currently in place across both local authorities. A community and third sector Yes ☒ No ☐ N/A ☐
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10 conference took place in June 2023 and as a result a Lanarkshire New Scots Integration Network has been established to bring together community and voluntary, and statutory partners to increase the level of support available to New Scots in Lanarkshire. A training needs assessment has been carried out with NHS Lanarkshire staff most likely to come into contact with asylum seekers and refugees as part of their healthcare role aimed to identify areas where staff may require further training and knowledge. A Population Health Needs Assessment was undertaken and will inform service delivery for resettled populations. 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 place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed. Appendix 3
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11 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; Sharon Simpson Health and Social Work Manager Sharon.Simpson@lanarkshire.scot.nhs.uk Yes ☒ No ☐ N/A ☐ Yes / Date added ☒ No ☐ N/A ☐
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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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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
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Appendix 1 1 IJB Reporting Template REPORT ITEM NO: 7 SUBJECT: Internal Audit Progress Report TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Nicola Scott, Chief Finance Officer Author(s) of Report Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire Contact details for Author(s) of Report Francis Scott – ScottFr@northlan.gov.uk Jocelyn Lyall – Jocelyn.lyall2@nhs.scot DATE: 25 February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE PFA This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒
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Appendix 1 2 Chief Officer (Audit and Risk) (North Lanarkshire Council) and Chief Internal Auditor (NHS Lanarkshire) The Chief Finance Officer The Chief Officer 3. EXECUTIVE SUMMARY The progress in respect of the Internal Audit Plan 2024/2025 is summarised in Appendix 1. A workplan has been agreed to ensure the Internal Audit Plan 2024/2025 is delivered by 31 March 2025. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB Performance, Finance & Audit Committee: 1) Consider the attached Progress Report at Appendix 1, the Summary of audits completed as part of the Internal Audit Plan 2023/24 at Appendix 2, the summary of relevant partner reports at Appendix 3 and note the final report on HSCP Governance Arrangements at Appendix 4. 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 As stated in the Integrated Resources Advisory Group guidance, it is the responsibility of the Integration Joint Board (IJB) to establish an adequate and proportionate internal audit of the arrangements for risk management, governance and control of the delegated resources. The internal audit arrangements for the IJB are provided jointly by the internal audit teams of North Lanarkshire Council and NHS Lanarkshire. The IJB approved the Internal Audit Plan 2024/2025 on 22 May 2024. A total of 60 days has been committed to undertake the IJB Internal Audit Plan, which has been designed to target the priority issues which have been aligned to Yes ☐ No ☒ N/A ☐
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Appendix 1 3 strategic risks and reflect the evolving and complex challenges to service delivery. The Public Sector Internal Audit Standards (PSIAS) require that activity and performance relative to the approved annual plan is periodically reported to the Performance, Finance & Audit Committee (PF&A Committee). The Internal Audit Plan 2024/2025 will provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. The Internal Audit Plan 2024/2025 also takes account of assurances which will be provided to the IJB based on the work performed under the Internal Audit Plans of both North Lanarkshire Council and NHS Lanarkshire for 2024/2025. The audit of operational activities is being undertaken under the auspices of the partner bodies. The IJB is asked to note that the outcomes of these operational audits are reported to the partner body Audit Committees and discussed with the IJB Chief Officer and IJB Chief Financial Officer. The assurances gained will be provided to the IJB as part of the overall assurances received from the partner body Audit Committees. We include a summary of relevant completed NHS Lanarkshire and North Lanarkshire Council reports at Appendix 3. 7. SUMMARY OF KEY ISSUES Progress on the Internal Audit Plan is 2024/25 at Appendix 1. Completed audits from the IJB Internal Audit Plan 2023/24 are summarised at Appendix 2. The Summary of relevant partner body reports is at Appendix 3 and a copy of the report on HSCP Governance Arrangements is included at Appendix 4. 8. CONCLUSIONS The Internal Audit Plan 2024/2025 is designed to target the priority issues and to provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. 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. ☐
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Appendix 1 4 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 financial impacts arising directly from this report. This paper has been reviewed by Finance: Yes No X N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The internal audit planning process which produced the Annual Internal Audit Plan considers the strategic risk profile of the organisation. Individual internal audit assignments identify the key risks at the planning stage and our work is designed to evaluate whether appropriate systems are in place and operating effectively to mitigate the risks identified. Legislative requirements are a core consideration in planning all internal audit reviews. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Chief Officer
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Appendix 1 5 9.5 ENGAGEMENT & PARTICIPATION The Chief Officer and the Chief Finance Officer have both been consulted in respect of the preparation of the Internal Audit progress report. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY An EQIA & Fairer Scotland Impact Assessment Form is not required as there are no EQIA implications arising directly from this report. All internal audit reviews which involve review of policies and procedures will examine the way in which equality and diversity is incorporated within documentation. EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No X N/A EQIA added to website: Yes No X N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 – 2024/25 Internal Audit Progress Report Appendix 2 – Summary of 2023/24 IJB Internal Audit Reports Appendix 3 – Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued Appendix 4 – Final Audit Report – HSCP Governance Arrangements
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Appendix 1 6 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Chief Finance Officer
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Appendix 1 7 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2024/25 NL01- 25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2024 N/A NL02- 25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03- 25 1Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. December 2024 March 2025 NL04- 25 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2024 Reasonable
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Appendix 1 8 NL05- 25 2 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. October 2024 March 2025 NL06- 25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. March 2025 1The Audit Follow Up position will be reported to the March 2025 PF&A Committee. 2 As reported to the 21 August 2024 PF&A Committee, Internal Audit completed a review of the IJB Governance Checklist self- assessment in July / August 2024 and provided an adequate level of assurance (see Appendix 2). Therefore, this 2024/25 audit will now be completed for reporting to the March 2025 PF&A Committee. This should provide sufficient time for previous recommendations to be completed and will provide an opinion on the governance framework in place for 2024/25.
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Appendix 2 9 Summary of 2023/24 IJB Internal Audit Reports Report No. Report Description Audit Opinion Key findings 0500/2024/001 Review of NL HSCP Governance arrangements (copy of report at Appendix 4) Adequate The primary purpose of this audit review was to provide independent assurance on the adequacy and effectiveness of the processes in place to enable the North Lanarkshire Health and Social Care Partnership (HSCP) to review and assess its governance arrangements against expected good practice. The self-assessment was undertaken using a Governance Self-Assessment Checklist developed by the Chief Internal Auditor (NHS). This was based on professional judgement and relevant guidance, as well as the CIPFA Delivering Good Governance in Local Government Framework (2016). NLC Internal Audit thereafter undertook a high-level review of both the Governance Self- Assessment Checklist completed by the North Lanarkshire HSCP and the draft Annual Governance Statement for 2023-24, to identify areas where it is considered improvements could be made to strengthen the arrangements. We have concluded that the arrangements the North Lanarkshire HSCP has in place for reviewing and assessing its governance framework are largely satisfactory and that this framework is generally consistent with legislative requirements and expected good practice. The following areas for improvement were identified during the review: • A need to ensure that going forward the Annual Governance Statement (AGS) fully reflects any improvement actions arising from the annual self-assessment undertaken in respect of compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016), and that these actions are thereafter monitored, and their progress periodically reported to the Performance, Finance and Audit Committee; • Appropriate and timely action is required to progress previously agreed outstanding actions (service level agreement for those services ‘hosted’ by Education and Families and accessed by Adult Health and Social Work Services and vice versa, finalise the revised performance scorecard and determine a timeline for developing a sound understanding of the impacts for NL HSCP of the outputs of the National Care Service legislation); and • A need to review the North Lanarkshire Health and Social Care Partnership Audit Charter.
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Appendix 3 10 The following relevant reports have been issued by North Lanarkshire Council Report No. Report Description Audit Opinion Key findings 0510/2025/001 Social Work – Quality Assurance arrangements Reasonable The purpose of this audit was to provide independent assurance on the adequacy and effectiveness of the Council’s quality assurance arrangements in relation to the provision of social work and social care services. We are satisfied that the Services arrangements for monitoring external care providers is generally sound and broadly reflects good practice principles and reports have been produced for key stakeholders on the results of the Council’s quality assurance and continuous improvement activities. We are also satisfied that the key expectations set out in the contract management framework are generally being applied in practice. However, we identified several areas where we consider scope for improvement exists including: • A need for the Contract Management Framework to be reviewed and updated to fully reflect both best practice and actual current working practices; • A need to finalise, and thereafter implement, the monitoring framework for internally provided services • A need for greater consistency with, and for the Quality Assurance Team to better demonstrate compliance with, expected monitoring arrangements; and • Recently revised arrangements to record, monitor and track issues identified and actions arising from monitoring activity need to be reviewed to ensure they are adequate and effective.
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Appendix 3 11 The following relevant reports have been issued by NHS Lanarkshire Report No. Report Description Audit Opinion Key findings L05/25 Board & Operational Committees Reasonable An appropriate new governance structure has been approved for implementation it is still to be embedded. Therefore, we cannot yet comment on effectiveness of the revised governance structures, and we will report on this in our 2024/25 Internal Control Evaluation report. A programme of governance improvements, led by the Director of Human Resources, is ongoing to support the revised governance structures. A summary of areas for consideration as part of the further development of good governance was provided by internal audit and we will work with officers to support this ongoing work. Our review identified that the standard governance documentation for committees has not always been completed nor presented to the relevant committee at the stipulated time. We noted several developments, including that a standard cover paper template has been issued and the timeframe for issue of papers is included in all revised Terms of Reference. ‘Once for Scotland’ documentation was introduced in July 2024 and work on the Board Assurance Framework (BAF) will be taken forward with support from the Chief Internal Auditor, with review planned for the end of the financial year to ensure the BAF meets the requirements of the Board. L06/25 Risk Management Reasonable Assurance Our review identified that there are gaps and duplication in the extant NHS Lanarkshire Risk Management documentation. The Risk Management Strategy, Framework and Policy are currently under review and internal audit have made recommendations for inclusion in the revised documentation. Extant Risk Management documentation was not resubmitted to the Audit & Risk Committee for formal approval and therefore unapproved documents were posted on FirstPort. A Risk Appetite statement will be developed and implemented following Corporate Management Team and Board review, in November 2024. L08/25 Strategic Planning Substantial Assurance Internal Audit concluded that the process to develop Our Health Together followed robust project management methodologies, good governance was evident and there was an
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Appendix 3 12 Report No. Report Description Audit Opinion Key findings extensive stakeholder engagement process. Therefore, we did not make any recommendations for improvement. L10&26/25 Review of Delayed Discharge & Data Reasonable Assurance Internal audit reviewed implementation of improvements to minimise Delayed Discharges monitoring and reporting of outcomes. The 'Sustaining Whole System Patient Flow' strategic risk was assessed as Very High with a target of Medium and has been adequately described and scored. There is appropriate assurance in place for the identified mitigating controls. Implementation of changes to pathways, development of models of care and redesign of services to improve delayed discharge performance commenced in Summer 2024. Therefore, sufficient information is not yet available to assess the impact of these changes on improved flow and sustained performance. We will report on this area in our 2024/25 Internal Control Evaluation and Annual Report. Internal audit concluded that all elements of national initiatives to improve Delayed Discharge performance are included in Operation Flow. The Chief Executive led a comprehensive diagnostic of the current delayed discharge performance in July 2024 and a route map to an improved position was developed with agreed actions to implement the optimal Discharge Planning Target Operating Model, establish a Once for Lanarkshire system Home First Assessment approach and complete Demand, Capacity, and Queue analysis of community and social care resources. A Delayed Discharge Improvement Plan has been developed and is monitored through the Operation Flow governance and performance reporting structures. We concluded that these reporting and monitoring structures are robust. Recording of a Planned Date of Discharge (PDD) within 48 hours of admission is a key control to improve the route map through the patient journey but was not recorded for all patients in our sample. The ‘Firebreak 24’ in September 2024 focused on accelerating transformation efforts to reduce hospital occupancy, streamline admissions, and manage unscheduled care demand, as well as planning for increased demand over winter. A ‘24/72’ discharge rule setting out the notice
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Appendix 3 13 Report No. Report Description Audit Opinion Key findings period for requesting support on discharge was implemented and remains in place. We would expect to see future reporting of the impact of the 24/72 discharge rule on delayed discharges. To support the full implementation of the Optimal Discharge Target Operating Model, and further embedding of the flow foundation bundle, a training, education, communication, and engagement plan will be supported by the establishment of an Unscheduled Care Improvement Team. The team will work with Management to deliver the improvement actions and activity required to ensure that PDD setting and recording is fully implemented across the system. Work is ongoing with Health Improvement Scotland colleagues to develop a PDD decision making tool to further support frontline operational and clinical teams. L27/25 Waiting Times Limited Assurance Internal audit L31/24 Review of Waiting Times methodology was issued in June 2024 and provided Limited Assurance. While there has been some progress, implementation of actions has been delayed. This follow up report described the progress made to date. As in 2022/23 and 2023/24, Internal Audit provided a Limited Assurance opinion on this system. Two of the three recommendations made in internal audit L31/24 have not progressed and one recommendation relating to communication has been partially implemented. We do however acknowledge that progression of actions is partially dependent on development of national processes. Original recommendation Due date Revised due date RAG status, updated position, and Agreed Action Implementation of four “Next Steps” detailed within the Patient Rights (Treatment Time Guarantee) (Scotland) Directions 2022: Communication with staff and patients and August 2024 April 2025 Work is progressing to align all communications with Scottish Government Communication trigger points. Netcall reminder service is in place. Content of letters, including single point of contact being updated. TTG Letters acknowledgement and apology revised and tested.
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Appendix 3 14 Report No. Report Description Audit Opinion Key findings automation of clinical letters. Not currently possible to align all clinical letters with TrakCare due to specialty specific information - working to migrate when / where possible. Production of automated TTG letters August 2024 April 2025 A national approach to production of automated TTG letters has been agreed, to be phased across Boards from February 2025. This will require consideration of: • A Communication plan • Amendment and alignment of letters with regard to patient response time • Testing to determine any unexpected impact on other processes • Agreement of a Go live date. Completion of Waiting Times audits August 2024 April 2025 Automated Waiting List letters are not being produced to inform patients of progress on their TTG pathway and the reasons for not meeting the dates. As a result monthly TTG audits are not being completed. The original ‘NHS Waiting Times Guidance’ Short Life Working Group is progressing to become a Reference Group to support audit requirements and ensure they are aligned to both what can be done locally and the National requirement. The audits will be recommenced once the letters are ready to be sent out to patients.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 1 REVIEW OF NORTH LANARKSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP GOVERNANCE ARRANGEMENTS ITEM 7.1 Appendix 4 INTERNAL AUDIT REPORT Contents 1. Executive Summary 2. Findings and Recommendations 3. Action Plan Appendix 1: Audit grading Appendix 2: Good Governance Principles Appendix 3: Management actions assessed as ‘not yet complete’ Issued to: Chief Officer (North Lanarkshire HSCP) Copied to: Chief Financial Officer (North Lanarkshire HSCP) and Service Support Project Manager (NHS Lanarkshire) Headlines The primary purpose of this audit was to provide independent assurance on the adequacy and effectiveness of the processes in place to enable the North Lanarkshire Health and Social Care Partnership (HSCP) to review and assess its governance arrangements against expected good practice. As part of a review of the effectiveness of the governance arrangements in place, the North Lanarkshire HSCP have undertaken a self-assessment in respect of their compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016) (see Appendix 2). This Framework places a responsibility on an authority to ensure additional assurance on the overall adequacy and effectiveness of the framework of governance, risk management and control is provided by the internal auditor. The self-assessment was undertaken using a Governance Self-Assessment Checklist developed by the Chief Internal Auditor (NHS). This was based on professional judgement and relevant guidance, as well as the CIPFA Delivering Good Governance in Local Government Framework (2016). NLC Internal Audit thereafter undertook a high-level review of both the Governance Self-Assessment Checklist completed by the North Lanarkshire HSCP and the draft Annual Governance Statement for 2023-24, to identify areas where it is considered improvements could be made to strengthen these arrangements. Part of the work undertaken by NLC Internal Audit during this exercise included assessing the extent to which management have implemented those actions previously committed to in response to both recommendations contained in previous Internal and External Audit reports and improvement actions identified by management in previous years’ Annual Governance Statements (AGS). We have categorised this audit as providing ‘adequate assurance’ meaning that we have concluded that the arrangements the North Lanarkshire HSCP has in place for reviewing and assessing its governance framework are largely satisfactory and that this framework is generally consistent with legislative requirements and expected good practice. However, during our review we did identify the following areas for improvement: • improvement actions identified in the governance self-assessment undertaken by the North Lanarkshire HSCP have not been taken forward to the Annual Governance Statement (AGS); • appropriate and timely action is required to progress previously agreed outstanding actions; and • there is a need to review the North Lanarkshire Health and Social Care Partnership Audit Charter. Detail on these findings and the associated recommendations made by NLC Internal Audit are included in the action plan at section 3 of this report. Assurance Opinion (see definition at Appendix 1) Adequate assurance Report status FINAL Audit ref 0500/2024/001 Date issued 12/08/2024 Audit Team Lynn McCrum and Paula Hendry
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 2 1. Executive Summary Objectives The primary purpose of this audit was to provide independent assurance on the adequacy and effectiveness of the processes in place to enable the North Lanarkshire Health and Social Care Partnership (HSCP) to review and assess its governance arrangements against expected good practice. As part of a review of the effectiveness of the governance arrangements in place, the North Lanarkshire HSCP have undertaken a self-assessment in respect of their compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016) (see Appendix 2). This Framework places a responsibility on an authority to ensure additional assurance on the overall adequacy and effectiveness of the framework of governance, risk management and control is provided by the internal auditor. The self-assessment was undertaken using a Governance Self-Assessment Checklist developed by the Chief Internal Auditor (NHS). This was based on professional judgement and relevant guidance, as well as the CIPFA Delivering Good Governance in Local Government Framework (2016). NLC Internal Audit thereafter undertook a high-level review of both the Governance Self-Assessment Checklist completed by the North Lanarkshire HSCP and the draft Annual Governance Statement for 2023-24, to identify areas where it is considered improvements could be made to strengthen the arrangements. This engagement has been conducted in accordance with the ‘Public Sector Internal Audit Standards’. The Internal Audit section reports formally on conformance with these standards to the Performance, Finance and Audit Committee. Work undertaken: Follow-up of previously agreed actions All Internal and External Audit reports contain management responses to audit recommendations which generally include a commitment to specific actions by a stated timescale. Part of the work undertaken by NLC Internal Audit during this exercise included reviewing the extent to which management have implemented those actions previously committed to in response to recommendations contained in both previous Internal and External Audit reports and with regards to improvement actions identified by management in previous years’ Annual Governance Statements (AGS). Information is contained in respect of those Internal Audit, External Audit and Annual Governance Statement actions previously reported as outstanding in the ‘Follow-Up of Actions Previously Agreed by Management in Response to Audit Recommendations’ report issued by NL Internal Audit in June 2023. We have also included an assessment of the current position in respect of actions agreed in response to recommendations made in the 2022/23 External Audit Report. It should be noted that the improvement actions identified by management in the 2022/23 AGS all relate to actions raised in previous Internal Audit or External Audit reports or in previous AGS. An update in respect of progress to date regarding the previously agreed outstanding actions was reported to the Performance, Finance and Audit Committee in October 2023 with a further update included in the draft Annual Governance Statement 2023/24. These updates were thereafter reviewed by NLC Internal Audit in June 2024 to assess and verify progress made, with testing carried out/evidence reviewed accordingly for those actions reported as being complete. The status of the action was then updated accordingly to reflect our assessment of progress made. It should be noted that this review has focussed on whether planned actions have been completed as previously committed to and this does not include detailed testing of whether the implemented actions have been effective in addressing the previously detailed weaknesses. Detail in respect of each of these recommendations is provided in Appendix 3. The action plan at section 3 of this report includes a recommendation for management in relation to the progress of these outstanding actions.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 3 2. Findings and Recommendations Number and category of recommendations raised (see definition of priority at Appendix 1) High Medium Low 0 3 0 Key areas requiring management action (High) There were no areas requiring urgent management attention identified. Good practice identified We noted the following areas of good practice during the audit: • The North Lanarkshire HSCP includes an Annual Governance Statement (AGS) in their Annual Accounts. The AGS provides an assessment of the adequacy and effectiveness of the HSCP’s governance arrangements and system of internal control and provides an explanation as to how the HSCP complies with the Code of Corporate Governance and meets the requirements of the CIPFA Delivering Good Governance in Local Government Framework (2016). • The AGS also includes an update on how continuous improvement actions identified in previous years’ in respect of internal controls, risk management and other governance arrangements have been/are being progressed, with regular updates on progress of these agreed actions being presented to and monitored by the IJB Performance, Finance and Audit Committee. • The North Lanarkshire HSCP have undertaken a self-assessment in respect of their compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016). Other areas for improvement (Medium) A small number of other areas for improvement were identified: • Improvement actions identified in the governance self-assessment undertaken by the North Lanarkshire HSCP have not been taken forward to the Annual Governance Statement (AGS); • Appropriate and timely action is required to progress previously agreed outstanding audit actions; and • There is a need to review the North Lanarkshire Health and Social Care Partnership Audit Charter.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 4 3. Action Plan Review of North Lanarkshire HSCP Governance Arrangements 0500/2024/001 Ref Finding 1 Improvement actions identified in the governance self-assessment undertaken by the North Lanarkshire HSCP have not been taken forward to the Annual Governance Statement (AGS). As part of a review of the effectiveness of the governance arrangements in place, in April 2024 the North Lanarkshire HSCP undertook a self-assessment in respect of their compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016) using a Governance Self-Assessment Checklist developed by the Chief Internal Auditor (NHS) which is based on professional judgement and relevant guidance, as well as the aforementioned CIPFA Delivering Good Governance in Local Government Framework (2016). NLC Internal Audit has used this as a basis for independently assessing compliance with the Framework, obtaining and reviewing evidence to substantiate management’s self-assessment of governance arrangements and identifying areas where we considered improvements could be made to strengthen the arrangements. To ensure continual improvement of the North Lanarkshire HSCP’s governance arrangements, any actions identified from the self-assessment on the effectiveness of these arrangements, together with improvement areas identified by Internal and External Audit, are generally included in an action plan in the North Lanarkshire HSCP’s Annual Governance statement (AGS). Regular updates on the progress of the agreed actions are thereafter presented to the Performance, Finance and Audit Committee. While we were pleased to note that previous actions identified have been monitored and progress on these reported in the 2023/24 AGS, improvement actions identified from the self- assessments undertaken in either 2022/23 or the current assessment for 2023/24 to this year’s AGS have not been taken forward to the action plan contained in the AGS. There were a small number of areas highlighted in the self-assessment undertaken by the North Lanarkshire HSCP which we consider should have been taken forward to the improvement action plan within the AGS in the 2023/24 Annual Accounts and progress thereafter monitored. These include the following points: • development of a revised framework for North Lanarkshire which will ensure engagement and participation in the development of the Strategic Commissioning Plan across the entire health and social care system. While we understand that a refreshed performance scorecard for the partnership has been developed, with a refined set of performance indicators, this has not yet been finalised and used in practice; • reference to work requiring to be undertaken around performance output and associated data from other Health Boards and Local Authorities; • recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. Implication Recommendation Priority Management response Implementati on Month/Year The North Lanarkshire HSCP may not be being fully transparent and may not be able to fully demonstrate compliance with the Code of Corporate Governance and the requirements of the Delivering Good Governance in Local Government Framework. Improvement actions may not be adequately identified and/or acted upon. The Chief Officer (North Lanarkshire HSCP) should ensure that going forward the Annual Governance Statement (AGS) fully reflects any improvement actions arising from the annual self-assessment undertaken in respect of compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016), and that these actions are thereafter monitored, and their progress periodically reported to the Performance, Finance and Audit Committee. Medium Agree Amanda Kilburn, Chief Finance Officer This action will be taken forward for the 2024/25 and ensuing years Annual Governance Statement to further support the IJB in carrying out their strategic oversight and assurance role. April 2025
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 5 3. Action Plan (continued) Review of North Lanarkshire HSCP Governance Arrangements 0500/2024/001 Ref Finding 2 Appropriate and timely action is required to progress previously agreed outstanding audit actions. All Internal and External Audit reports contain management responses to audit recommendations which generally include a commitment to specific actions by a stated timescale. Part of the work undertaken by NLC Internal Audit during this exercise included reviewing the extent to which management have implemented those actions previously committed to in response to recommendations contained in both previous Internal and External Audit reports and with regards to improvement actions identified by management in previous years’ Annual Governance Statements (AGS). A management update in respect of progress to date regarding the previously agreed outstanding actions was reported to the Performance, Finance and Audit Committee in October 2023 with a further update included in the draft Annual Governance Statement 2023/24. These updates were thereafter reviewed by NLC Internal Audit to assess and verify progress made, with testing carried out/evidence reviewed accordingly for those actions reported as being complete. The status of the action was then updated accordingly to reflect our assessment of progress as at time of audit fieldwork which was concluded in June 2024. This is depicted in the table below. Source Report Complete Partially Not yet No longer Total implemented due relevant Internal Audit 1 4 0 0 5 External Audit 3 1 0 0 4 Actions in AGS 0 2 0 0 2 TOTAL 4 7 0 0 11 There are seven actions which we consider are not yet complete and detail in respect of these are included at Appendix 3. Four of the actions relate to similar recommendations in respect of the disaggregation of Children, Families and Justice Social Work Services and need for hosting arrangements to be finalised for cross-cutting services. While the disaggregation exercise has now been complete, work is currently underway to agree, approve and implement the new Service Level Agreement (SLA) in partnership with Children, Families and Justice Services. The delay in implementation is primarily due to slippage in the timeframe with regards to the National Care Service. We understand that as there have been further delays reported by the Scottish Government, the Service will now look to prepare their own SLA. While management consider, and have reported, the two previously agreed actions pertaining to the Performance Management audit as being complete, NLC Internal Audit do not consider this to be the case. This is primarily due to the refreshed Chief Executive’s balance scorecard not yet having been finalised and presented to the Performance, Finance and Audit Committee. The remaining outstanding point relates to an improvement action identified by management in the 2021/22 AGS and centres around developing a sound understanding of the impact for the North Lanarkshire HSCP of the outputs of the National Care Service legislation. As with the action relating to the SLA in partnership with Children, Families and Justice Services this has been delayed due to the uncertainty around the National Care Service and further updates will be presented to the IJB as they become available. We acknowledge that, for both of these actions, the delays are due to circumstances outwith the control of North Lanarkshire. (continued overleaf)
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 6 3. Action Plan (continued) Review of North Lanarkshire HSCP Governance Arrangements 0500/2024/001 Implication Recommendation Priority Management response Implementation Month/Year Risks previously identified may not be appropriately mitigated, exposing the HSCP to these risks and leaving them vulnerable. (1) The Chief Officer (NL Health and Social Care Partnership) should ensure that, to fully address previously agreed audit recommendations, appropriate and timely action is sought and thereafter undertaken to: Medium Agree Amanda Kilburn, Chief Finance Officer (1) The North Lanarkshire Health and Social Care Partnership are awaiting guidance from the Scottish Governance with regards to which services will be included in the new National Care Service and which will not. Once this guidance has been received, the issues at bullet points 1 and 3 will be addressed. Once finalised the revised performance scorecard, referenced at bullet point 2, will be reported to the Performance, Finance and Audit Committee. (2) The proposed actions for each of the recommendations will be included on an action plan and tracked, with progress on the agreed actions reported to the Performance, Finance and Audit Committee. (1) March 2025 • determine, agree and fully document in a Service Level Agreement, the proposed arrangements for those services which are ‘hosted’ by Education and Families and accessed by Adult Health and Social Work Services and vice versa. • finalise the revised performance scorecard ensuring that this clearly details the rationale for, and approval of, the targets and trajectories set for the indicators and thereafter report this to the Performance, Finance and Audit Committee; and (2) September 2024 • determine a timeline for developing a sound understanding of the impacts for the North Lanarkshire HSCP of the outputs of the National Care Service legislation. (2) The Chief Officer (NL Health and Social Care Partnership) should ensure that each of the recommendations stated at (1) above are included on an action plan which details actions proposed, together with responsible officers and expected implementation dates and that these are thereafter monitored until completion.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 7 3. Action Plan (continued) Review of North Lanarkshire HSCP Governance Arrangements 0500/2024/001 Ref Finding 3 There is a need to review the North Lanarkshire Health and Social Care Partnership Audit Charter The Public Bodies (Joint Working) (Scotland) Act 2014 requires the HSCP to comply with the accounts and audit regulations and legislation under Section 106 of the Local Government (Scotland) Act 1973 and to comply with Article 7 of the Local Authority Accounts (Scotland) Regulations 2014, the HSCP requires a professional and objective internal audit service. At its inception, it was agreed Internal Audit coverage for the North Lanarkshire HSCP would be jointly provided by the Chief Officer (Audit and Risk) for North Lanarkshire Council and the Chief Internal Auditor for NHS Lanarkshire. NHS Lanarkshire Internal Auditors are responsible for undertaking audit assignments in relation to operational matters across in-scope NHS services, with North Lanarkshire Council Internal Auditors undertaking audit assignments in relation to operational matters across social work. Joint working arrangements are in respect of ‘Board only’ audits and any cross-cutting audits. A formal document, the North Lanarkshire HSCP Audit Charter, is in place which sets out the responsibility and authority for, and approach to, North Lanarkshire HSCP’s internal audit activity. The Charter was approved in December 2016 and while it states that it will be subject to a full review at least biennially, there has been no formal review since its approval. Implication Recommendation Priority Management response Implementati on Month/Year The Chief Internal Auditors may not be in a position to conclude on the level of assurance that can be placed upon the overall adequacy and effectiveness of the HSCP’s framework of governance, risk management and internal control arrangements. The Chief Officer (North Lanarkshire HSCP) should liaise with the Chief Officer (Audit and Risk) and Chief Internal Auditor (NHS Lanarkshire) to ensure that the North Lanarkshire HSCP Audit Charter is reviewed and updated as necessary. Medium Agree Ross McGuffie, Chief Officer (North Lanarkshire HSCP) The Chief Officer (North Lanarkshire HSCP) will instruct the Chief Officer (Audit and Risk) and Chief Internal Auditor (NHS Lanarkshire) to undertake a review of the North Lanarkshire HSCP Audit Charter and update the document as necessary to reflect the current environment and working arrangements. September 2024
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 8 Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion Level of Assurance Definition Substantial Assurance Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Adequate Assurance The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited Assurance The systems for risk, control and governance have some satisfactory aspects, but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse. Recommendation priority Priority Definition High Significant weaknesses which management needs to address to achieve objectives. Medium Weaknesses which require prompt action to avoid exposure to risks in achieving objectives. Low Action advised/area for improvement to enhance control or improve efficiency. Appendix 1 - Audit Grading
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 9 Appendix 2 – Good Governance Principles The core principles and sub principles of good governance set out in the 2016 CIPFA/Solace ‘Delivering good governance in Local Government Framework (‘the framework’) are taken from the International Framework: Good Governance in the Public Sector (IFAC/CIPFA 2014) and interpreted for a local government context. It is the responsibility of each local government body to: (1) Set out its commitment to the principles of good governance included in the framework; (2) Determine its own governance structure or local code by these principles; and (3) Ensure that it operates effectively in practice. Principle A: Behaving with integrity, demonstrating strong commitment to ethical values, and respecting the rule of law Sub-principles 1. Behaving with integrity 1.1 Ensuring members and officers behave with integrity and lead a culture where acting in the public interest is visibly and consistently demonstrated thereby protecting the reputation of the organisation. 1.2 Ensuring members take the lead in establishing specific standard operating principles or values for the organisation and its staff and that they are communicated and understood. These should build on the Seven Principles of Public Life (the Nolan Principles). 1.3 Leading by example and using these standard operating principles or values as a framework for decision making and other actions. 1.4 Demonstrating, communicating and embedding the standard operating principles or values through appropriate policies and processes which are reviewed on a regular basis to ensure that they are operating effectively. 2. Demonstrating strong commitment to ethical values 2.1 Seeking to establish, monitor and maintain the organisation’s ethical standards and performance. 2.2 Underpinning personal behaviour with ethical values and ensuring they permeate all aspects of the organisation’s culture and operation. 2.3 Developing and maintaining robust policies and procedures which place emphasis on agreed ethical values. 2.4 Ensuring that external providers of services on behalf of the organisation are required to act with integrity and in compliance with high ethical standards expected by the organisation. 3. Respecting the rule of law 3.1 Ensuring members and staff demonstrate a strong commitment to the rule of the law as well as adhering to relevant laws and regulations. 3.2 Creating the conditions to ensure that the statutory officers, other key post holders and members are able to fulfil their responsibilities in accordance with legislative and regulatory requirements. 3.3 Striving to optimise the use of the full powers available for the benefit of citizens, communities and other stakeholders. 3.4 Dealing with breaches of legal and regulatory provisions effectively. 3.5 Ensuring corruption and misuse of power are dealt with effectively.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 10 Appendix 2 – Good Governance Principles (continued) Principle B: Ensuring openness and comprehensive stakeholder engagement Sub-principles 1. Openness 1.1 Ensuring an open culture through demonstrating, documenting and communicating the organisations commitment to openness. 1.2 Making decisions that are open about actions, plans, resource use, forecasts, outputs and outcomes. The presumption is for openness. If that is not the case, a justification for the reasoning for keeping a decision confidential should be provided. 1.3 Providing clear reasoning and evidence for decisions in both public records and explanations to stakeholders and being explicit about the criteria, rationale and considerations used. In due course, ensuring that the impact and consequences of those decisions are clear. 1.4 Using formal and informal consultation and engagement to determine the most appropriate and effective interventions/courses of action. 2. Engaging comprehensively with institutional stakeholders (Note: institutional stakeholders are the other organisations that local government needs to work with to improve services and outcomes (such as commercial partners and suppliers as well as other public or third sector organisations) or organisations to which they are accountable.) 2.1 Effectively engaging with institutional stakeholders to ensure that the purpose, objectives and intended outcomes for each stakeholder relationship are clear so that outcomes are achieved successfully and sustainably. 2.2 Developing formal and informal partnerships to allow for resources to be used more efficiently and outcomes achieved more effectively. 2.3 Ensuring that partnerships are based on: trust; a shared commitment to change; a culture that promotes and accepts challenge among partners and that the added value of partnership working is explicit. 3. Engaging with individual citizens and service users effectively 3.1 Establishing a clear policy on the type of issues the organisation will meaningfully consult with or involve communities, individual citizens, service users and other stakeholders to ensure that service (or other) provision is contributing towards the achievement of intended outcomes. 3.2 Ensuring that communication methods are effective and that elected members and officers are clear about their roles with regard to community engagement. 3.3 Encouraging, collecting and evaluating the views and experiences of communities, citizens, service users and organisations of different backgrounds including reference to future needs. 3.4 Implementing effective feedback mechanisms in order to demonstrate how views have to be taken into account. 3.5 Balancing feedback from more active stakeholder groups with other stakeholder groups to ensure inclusivity. 3.6 Taking account of the impact of decisions on future generations of taxpayers and service users.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 11 Appendix 2 – Good Governance Principles (continued) Principle C: Defining outcomes in terms of sustainable economic, social and environmental benefits Sub-principles 1. Defining outcomes 1.1 Having a clear vision, which is an agreed formal statement of the organisations purpose and intended outcomes containing appropriate performance indicators, which provide the basis of the organisation’s overall strategy, planning and other decisions. 1.2 Specifying the intended impact on, or changes for, stakeholders, including citizens and service users. It could be immediately or over the course of a year or longer. 1.3 Delivering defined outcomes on a sustainable basis within the resources that will be available. 1.4 Identifying and managing risks to the achievement of outcomes 1.5 Managing service users’ expectations effectively with regard to determining priorities and making the best use of the resources available. 2. Sustainable economic, social and environmental benefits 2.1 Considering and balancing the combined economic, social and environmental impact of policies and plans when taking decisions about service provision. 2.2 Taking a longer term view with regard to decision making, taking account of risk and acting transparently where there are potential conflicts between the organisation’s intended outcomes and short term factors such as the political cycle or financial constraints. 2.3 Determining the wider public interest associated with balancing conflicting interest between achieving the various economic, social and environmental benefits, through consultation where possible, in order to ensure appropriate trade-offs. 2.4 Ensuring fair access to services.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 12 Appendix 2 – Good Governance Principles (continued) Principle D: Determining the interventions necessary to optimise the achievement of the intended outcomes Sub-principles 1. Determining interventions 1.1 Ensuring decision makers receive objective and rigorous analysis of a variety of options indicating how intended outcomes would be achieved and associated risks. Therefore ensuring best value is achieved however services are provided. 1.2 Considering feedback from citizens and service users when making decisions about service improvements or where services are no longer required in order to prioritise competing demands within limited resources available including people, skills, land and assets and bearing in mind future impacts. 2. Planning interventions 2.1 Establishing and implementing robust planning and control cycles that cover strategic and operational plans, priorities and targets. 2.2 Engaging with internal and external stakeholders in determining how services and other courses of action should be planned and delivered. 2.3 Considering and monitoring risks facing each partner when working collaboratively, including shared risks. 2.4 Ensuring arrangements are flexible and agile so that the mechanisms for delivering goods and services can be adapted to changing circumstances. 2.5 Establishing key performance indicators (KPIs) as part of the planning process in order to identify how the performance of services and projects is to be measured. 2.6 Ensuring capacity exists to generate the information required to review service quality regularly. 2.7 Preparing budgets in accordance with objectives, strategies and the medium term financial plan. 2.8 Informing medium and long term resource planning by drawing up realistic estimates of revenue and capital expenditure aimed at developing a sustainable funding strategy. 3. Optimising achievement of intended outcomes 3.1 Ensuring the medium term financial strategy integrates and balances service priorities, affordability and other resource constraints. 3.2 Ensuring the budgeting process is all-inclusive, taking into account the full cost of operations over the medium and longer term. 3.3 Ensuring the medium term financial strategy sets the context for ongoing decisions on significant delivery issues or responses to changes in the external environment that may arise during the budgetary period in order for outcomes to be achieved while optimising resource usage. 3.4 Ensuring the achievement of ‘social value’ through service planning and commissioning.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 13 Appendix 2 – Good Governance Principles (continued) Principle E: Developing the entity’s capacity, including the capability of its leadership and the individuals within it Sub-principles 1. Developing the entity’s capacity 1.1 Reviewing operations, performance use of assets on a regular basis to ensure their continuing effectiveness. 1.2 Improving resource use through appropriate application of techniques such as benchmarking and other options in order to determine how the authority’s resources are allocated so that outcomes are achieved effectively and efficiently. 1.3 Recognise the benefits of partnerships and collaborative working where added value can be achieved. 1.4 Developing and maintaining an effective workforce plan to enhance the strategic allocation of resources 2. Developing the capacity of the entity’s leadership and other individuals 2.1 Developing protocols to ensure that elected and appointed leaders negotiate with each other regarding their respective roles early on in the relationship and that a shared understanding of roles and objectives is maintained. 2.2 Publishing a statement that specifies the types of decisions that are delegated and those reserved for the collective decision making of the governing body. 2.3 Ensuring the leader and the chief executive have clearly defined and distinctive leadership roles within a structure, whereby the chief executive leads the authority in implementing strategy and managing the delivery of services and other outputs set by members and each provides a check and a balance for each other’s authority. 2.4 Developing the capabilities of members and senior management to achieve effective shared leadership and to enable the organisation to respond successfully to changing legal and policy demands as well as economic political and environmental changes and risks by ensuring: (a) members and staff have access to appropriate induction tailored to their role and that ongoing training and development matching individual and organisational requirements is available and encouraged; (b) members and officers have the appropriate skills, knowledge, resources and support to fulfil their roles and responsibilities and ensuring that they are able to update their knowledge on a continuing basis; and (c) personal, organisational and system-wide development through shared learning, including lessons learnt from both internal and external governance weaknesses. 2.5 Ensuring that there are structures in place to encourage public participation 2.6 Taking steps to consider the leadership’s own effectiveness and ensuring leaders are open to constructive feedback from peer review and inspections 2.7 Holding staff to account through regular performance reviews which take into account of training development needs 2.8 Ensuring arrangements are in place to maintain the health and wellbeing of the workforce and support individuals in maintaining their own physical and mental wellbeing
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 14 Appendix 2 – Good Governance Principles (continued) Principle F: Managing risks and performance through robust internal control and strong public financial management Sub-principles 1. Managing risk 1.1 Recognising that risk management is an integral part of all activities and must to considered in all aspects of decision making 1.2 Implementing robust and integrated risk management arrangements and ensuring that they are working effectively 1.3 Ensuring that responsibilities for managing individual risks are clearly allocated 2. Managing performance 2.1 Monitoring service delivery effectively including planning specification, execution and independent post- implementation review 2.2 Making decisions based on relevant, clear objective analysis and advice pointing out the implications and risks inherent in the organisation’s financial, social and environmental position and outlook. 2.3 Ensuring an effective scrutiny or oversight function is in place which encourages constructive challenge and debate on policies and objectives before, during and after decisions are made thereby enhancing the organisation’s performance and that of any organisation for which it is responsible (OR for a committee system). Encouraging effective and constructive challenge and debate on policies and objectives to support balances and effective decision making. 2.4 Providing members and senior management with regular reports on service delivery plans and on progress towards outcome achievement 2.5 Ensuring there is consistency between specification stages (such as budgets) and post-implementation reporting (e.g. financial statements). 3. Robust internal controls 3.1 Aligning the risk management strategy and policies on internal control and achieving objectives 3.2 Evaluating and monitoring risk management and internal control on a regular basis 3.3 Ensuring effective counter fraud and anti-corruption arrangements are in place 3.4 Ensuring additional assurance on the overall adequacy and effectiveness of the framework of governance, risk management and control is provided by the internal auditor. 3.5 Ensuring an audit committee or equivalent group of function which is independent of the executive and accountable to the governing body (a) provides a further source of effective assurance regarding arrangements for managing risk and maintaining an effective control environment; and (b) that its recommendations are listened to and acted upon 4. Managing data 4.1 Ensuring effective arrangements are in place for the safe collection, storage, use and sharing of data, including process to safeguard personal data. 4.2 Ensuring effective arrangements are in place and operating effectively when sharing data with other bodies. 4.3 Reviewing and auditing regularly the quality and accuracy of data used in decision making and performance monitoring. 5. Strong public financial management 5.1 Ensuring Financial management supports both long-term achievements of outcomes and short term financial and operating performance. 5.2 Ensuring well-developed financial management is integrated at all levels of planning and control including management of financial risks and controls.
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https://nlcgov-my.sharepoint.com/personal/scottfr_northlan_gov_uk/Documents/Documents/Appendix 4 - Final Audit Report - HSCP Governance Arrangements.docx 15 Appendix 2 – Good Governance Principles (continued) Principle G – Implementing good practices in transparency, reporting, and audit, to deliver effective accountability. Sub-principles 1. Implementing good practice in transparency 1.1 Writing and communicating reports for the public and other stakeholders in an understandable style appropriate to the intended audience and ensuring that they are easy to access and interrogate. 1.2 Striking a balance between providing the right amount of information to satisfy transparency demands and enhance public scrutiny while not being too onerous to provide and for users to understand. 2. Implementing good practice in reporting 2.1 Reporting at least annually on performance, value for money and the stewardship of its resources. 2.2 Ensuring members and senior management own the results 2.3 Ensuring robust arrangements for assessing the extent to which the principles contained in the Framework have been applied and publishing the results on this assessment including an action plan for improvement and evidence to demonstrate good governance (annual governance statement). 2.4 Ensuring that the Framework is applied to jointly managed or share service organisations as appropriate 2.5 Ensuring the performance information that accompanies the financial statements is prepared on a consistent and timely basis and the statements allow for comparison with other similar organisations. 3. Assurance and effective accountability 3.1 Ensuring that recommendations for corrective action made by external audit are acted upon 3.2 Ensuring an effective internal audit service with direct access to members is in place which provides assurance with regard to governance arrangements and recommendations are acted upon. 3.3 Welcoming peer challenge, reviews and inspections from regulatory bodies and implementing recommendations 3.4 Gaining assurance on risks associated and delivering services through third parties and that this is evidenced in the annual governance statement 3.5 Ensuring that when working in partnership, arrangements for accountability are clear and that the need for wider public accountability has been recognised and met.
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Appendix 3 Management actions assessed as ‘not yet complete’ Report Details Details from original recommendation Current position per management update Original and revised timescales Internal Audit comment INTERNAL AUDIT Financial due diligence (May 2020) – 2 actions EXTERNAL AUDIT Annual Audit Report 2019/20 – 1 action ANNUAL GOVERNANCE STATEMENT Continuous improvement actions for 2019/20 – 1 action Risk: A lack of formally documented arrangements may increase the risk that the resources transferred from the IJB to the Council do not reflect the cost of the relevant services in terms of delegated and non- delegated functions. Recommendation: Each of the reports listed contained similar recommendations in respect of the disaggregation of Children, Families and Justice Social Work Services and need for hosting arrangements to be finalised for cross-cutting services. The budget disaggregation exercise has been concluded and the revised IJB direction to NLC issued in March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Management recognises that the finalisation of the Service Level Agreement (SLA) for future hosting arrangements and associated budgets is overdue. Once finalised, the SLA will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. The Scottish Government have advised that the timeframe around the National Care Service has now slipped further than intended and, as a result, the Service will now consider creating their own Service Level Agreement between Children, Families and Justice Services. Original timescale: March 2021 Revised timescales: September 2021 June 2022 Ongoing We are pleased to note that the budget disaggregation exercise has been concluded. We acknowledge that Covid has had a significant impact on the Health and Social Care Partnership which has in turn impacted on the prioritisation of resources. In addition, we welcome the Services’ intentions to now exploring the option for creating their own Service Level Agreement between Children, Families and Justice Services. INTERNAL AUDIT REPORT Performance management (August 2019) Risk: There is no formal documented record or clear rationale for the targets and trajectories set. Recommendation: Management should ensure that a formal record is retained detailing the rationale for, and approval of, the targets and trajectories set for the indicators on the performance scorecard and this information should be shared with the Performance, Finance and Audit Committee. Category: Amber The Annual Performance Report presented to the Performance, Finance and Audit Committee in October 2023 includes details of the targets and trajectories set for the indicators on the performance scorecard. There is however currently no formal record detailing the rationale for the targets and trajectories set for the indicators on the performance scorecard. The scorecard is currently being finalised and this action will now be progressed with a view to completion and reporting to the Performance, Finance & Audit Committee in August 2024. Original timescale: October 2019 Revised timescales: March 2022 September 2023 August 2024 We are pleased to note that action is being taken to progress this action, however it is imperative that the performance scorecard is finalised and that this clearly details the rationale for the targets and trajectories set for each of the indicators.
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Appendix 3 (continued) Management actions assessed as ‘not yet complete’ Report Details Details from original recommendation Current position per management update Original and revised timescales Internal Audit comment INTERNAL AUDIT REPORT Performance management (August 2019) Risk: The IJB may not provide adequate performance information to key stakeholders to enable the, to make informed decisions and recommend remedial actions to address concerns arising. The IJB Performance, Finance and Audit Committee may not be in a position to fulfil its remit which includes the requirement to ‘review quarterly performance and recommend remedial action to address concerns’ and to ‘ensure effective arrangements are in place to register all performance and operational risks’. Recommendation: Management should undertake a formal review of the current arrangements for monitoring and reporting performance to reflect on whether reports are fit for purpose and contain relevant, comprehensive information useful to stakeholders. This could include comparison with other IJB published reports. Particular consideration should be given to the areas identified in the finding, i.e.: • an overview of all indicators on the performance scorecard including a mechanism to provide an update on indicators previously reported but now considered satisfactory; • areas for improvement listed should include proposed actions with timescales, progress with these and how effective they are; • greater use of benchmarking with other IJBs and trend information; and • incorporating reporting by locality. Category: Amber In August 2022, the IJB’s Performance, Audit and Finance Committee endorsed the development of a revised whole system performance framework for the partnership, which it was expected would address all outstanding points raised in the finding. The range of associated performance measures within both the national outcome indicators and the local performance framework have been refreshed alongside the development of the Strategic Commissioning Plan 2023- 26 and the continued development of the Programme of Work. However, the revised balanced scorecard reflecting the new indicators has not yet been finalised. This will be finalised and reported to the Performance, Finance and Audit Committee in August 2024, with the scorecard populated to reflect the Quarter 1 data. Original timescale: October 2019 Revised timescales: March 2022 September 2023 August 2024 We were pleased to note that significant action has been taken in this area, to fully implement the recommendations made. However, we consider it is imperative that the performance scorecard is finalised and reported to the Performance, Finance and Audit Committee.
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Appendix 3 (continued) Management actions assessed as ‘not yet complete’ Report Details Details from original recommendation Current position per management update Original and revised timescales Internal Audit comment ANNUAL GOVERNANCE STATEMENT Continuous improvement actions for 2021/22 Risk: N/A Recommendation: To develop a sound understanding of the impact for the North Lanarkshire Health and Social Care Partnership (NLHSCP) of the outputs of the National Care Service legislation. Category: N/A There has been very little movement in this area primarily due to the uncertainty and lack of detail currently available from the Scottish Government. This will be revisited once further clarity has been obtained. A paper was presented to the IJB in January 2024 giving an update on the status of the action. Further details will be reported to the IJB as details are released. Original timescale: March 2023 Revised timescale: To be determined once further clarity obtained regarding National Care Service proposals. We acknowledge that implementation of the recommendation has been delayed as a result of the uncertainty and lack of detail available in respect of the new National Care Service.
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REPORT Item No: 8 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the period 1 April 2024 to 30 November 2024. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report; and (2) Acknowledge the projected outturn for 2024/25 is an underspend of £1.454m 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Chief Officer (Finance). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in table 1, the IJB projected outturn position, prior to removal of ring- fenced funding, is an underspend of £1.454m, assuming the current trajectory of spend continues until the end of this financial year. SUBJECT: Financial Monitoring Report 2024/25 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 25 February 2025 Yes No N/A
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Table 1 6.2 Appendices 1 to 3 show a detailed revenue budget position for each care group above. 6.3 In line with Scottish Government guidance, unspent ring-fenced funding must be transferred to relevant reserves at the end of each financial year for use in later years. Subject to IJB approval, in-year underspends will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2024/25 FINANCIAL PERFORMANCE 7.1 The current financial forecast for 2024/25 projects a yearly underspend of £1.454m relating to various under and overspends across the whole integrated budget. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – underspend of £15.920m As highlighted throughout 2024/25, there are continuing challenges in terms of recruitment and retention across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skill mix required or the competition being offered by other private and public sectors. As highlighted in the financial plan, included in this underspend is £6.961m relating to a non-recurring reduction in pension contributions within Social Care. This will be used to offset overspends in other areas of Adult Social Care during 2024/25 to allow time for savings plans to be realised. 7.1.2 Payments to Other Bodies (PTOB) – overspend of £4.341m This overspend is primarily in relation to anticipated spend in Independent Care Homes and also within ‘Care at Home’ through self-directed support (SDS) plans. These projections are demand led and are based on full year costs for both current clients and those anticipated, therefore projections will alter as the year progresses, updates will be provided in future reports. Further details are provided below: • Independent care homes have a yearly budget to fund 1,367 care plans but at present the number of care plans is 1,468 resulting in an overspend of £2.015m. • Car at Home costs are projected to overspend by £3.364m, the budget is based on funding 2,617 care plans however the actual plans in place total 2,689. These costs are partially offset by minor underspends across other areas within payments to other bodies. £m £m £m £m £m Health Care Services 545.965 12.426 558.391 558.312 0.079 Social Care Services 263.874 0.000 263.874 262.499 1.376 TOTAL 809.839 12.426 822.265 820.811 1.454 Annual Budget 2024/25Care Group Projected Year End Variance 2024/25 Projected Year End Spend 2024/25 In Year Drawdown From Reserves Revised Budget 2024/25
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7.1.3 Transport – overspend of £0.548k The overspend is attributed to an increase in running costs associated with the home support additional pool cars that were purchased during 2024/25 along with an increase in staff mileage claims. 7.1.4 Prescribing – overspend of £6.696m This projected overspend is based on actual prescribing data available to September 2024 and estimated data for October and November 2024. The forecast will be updated as further data becomes available. Based on data received to date the cost per item has increased to £10.51, and the number of items being dispensed has increased by 1.3% based on the same period in 2023-24. Therefore, the projected overspends is attributable to both the number of medicines being prescribed and dispensed in community pharmacies remaining at high levels alongside higher prices. This is exacerbated by the fact that there hasn’t been an inflationary increase added to 2024-25 annual budget. 7.1.5 North Lanarkshire Hosted Services – projected underspend of £1.934m The main areas reporting an underspend within hosted services include speech and language therapy, children and adolescent mental health services and podiatry services. The underspends in this area are partially offset by the following areas of concern: • Continence Services – overspend of £0.792m which is related to product costs within both the care home environment and within the community. • Children Services Diabetic Nursing – overspend of £1.565m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. • Prisoner Healthcare – overspend of £0.852m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. • Mental Health Eating Disorders – overspend of £0.339m relating to the day bed charges of Lanarkshire patients within the Priory. 7.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and table 2 shows the current funding allocation received from Scottish Government during 2024/25.
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Table 2 7.3 Directors should note the Mental Health funding original allocation for 2024/25 did not cover all the partnerships current Mental Health commitments. However, following numerous discussions with the Scottish Government an additional allocation has been awarded on a one-off basis bringing the total allocated for the year up to £17.329m. As shown in table 3 the projected spend against this is currently £16,231m and the reason for this underspend is the result of vacancies being held during the year when the funding commitment was uncertain. 7.4 The 2025/26 allocation from Scottish Government has been budgeted at £14.8m however the NHSL draft financial plan includes an additional allocation to the partnership of £2.5m to address the shortfall. It is anticipated that the full £17.329m will be utilised during 2025/26 as Managers will be permitted to recruit to this value. Table 3 Scottish Government Allocations as at 30 November 2024 £m Alcohol and Drug Partnership Funding 1.684 Band 7 OPAT Post 0.069 Digital Mental Health Licences 0.120 Distress Brief Intervention 2.780 Family Nurse Partnership 1.074 Hospital at Home 0.276 Long Covid Support Fund 0.224 Meningitis C 0.106 Mental Health Outcomes 0.166 Specialty and Specialist Doctors Contract 0.194 V1P & ICU Funding 0.170 Dementia Post 0.431 Enhanced Mental Health Outcomes Framework 14.829 TOTAL 22.122 Funding Forecast £m £m Scottish Government Allocation 14,829 Top Up 2,500 Action 15 3,965 Perinatal 590 Infant 433 Neonates 190 Child and Adolescent Mental Health Services 5,642 Psychologists 1,643 Historical Mental Health 2,378 Learning Disability Health checks 23 School Nursing North 729 School Nursing South 638 TOTAL 17,329 16,231
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8. GENERAL RESERVES 8.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 8.2 The current IJB reserves position for 2024/25 after adjustments for the drawdown of in-year reserves, is a revised balance of £63.098m and is summarised in table 4. Table 4 8.3 A detailed list of all reserve movement during 2024/25 is at appendix 5 including a key guidance table showing how the reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 8.4 Regular updates will be provided to the IJB throughout the year as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 9. SAVINGS 9.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. 9.2 CORE management team alongside various sustainability and value workshops have been meeting on a regular basis to discuss and monitor the management actions reported in the financial plans to progress savings and redesign of services to help support future years budget planning. This includes the following areas of work: • Review of financial planning assumptions for 2024/25. • Review of all current vacancies including length of time left vacant. • Review of discretionary spend and supplementary staffing. • Updates on saving planning in significant areas of budget pressures. • Various service reviews across the partnership. • Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 9.3 The current IJB savings position at the end of September 2024, show total savings achieved of £9.664m and is summarised in chart 1. Opening Balance As At 1 April 2024 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 £m £m £m £m NHSL Ring-Fenced Reserves 19.281 0.000 (5.630) 13.651 NLC/NHSL Earmarked Reserves 20.955 0.000 (1.693) 19.261 NLC/NHSL Risk-Based Reserves 17.045 0.000 0.000 17.045 NHSL Contingency Reserves 13.390 0.000 (0.250) 13.140 NLC/NHSL Closed Reserves 4.853 0.000 (4.852) 0.001 75.524 0.000 (12.426) 63.098Total LEAD SUMMARY
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Chart 1 9.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving plans. 10. VACANCY POSITION 2024/25 10.1 Table 5 shows the full time equivalent (FTE) vacancy numbers at 30 November 2024 within each service compared against their budgeted establishment. Table 5 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours is used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7 and summarised in Table 6. Establishment Actual Vacancies FTE FTE FTE North West Locality 393.60 366.58 27.02 North East Locality 332.01 310.68 21.33 Adult Services 294.97 282.61 12.37 Children Services 495.19 542.22 -47.03 Mental Health 1,168.67 1,177.33 -8.66 Social Care Services 987.70 838.69 149.01 Home Support 996.57 952.75 43.82 Other 219.08 235.04 -15.96 TOTAL 4,887.79 4,705.90 181.89 Position as at 30 November 2024 Service
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Table 6 11. DIGITAL FINANCE POSITION 2024/25 11.1 Below is a summary of the current North Lanarkshire IJB digital programmes of work and the agreed funding associated with each: Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.058 0.022 0.454 0.011 0.545 North East Locality 0.034 0.013 0.271 -0.002 0.316 Adult Services 0.037 0.048 0.210 0.008 0.303 Children Services 0.107 0.027 0.443 0.172 0.749 Mental Health 0.215 0.054 2.815 2.744 5.828 Social Care Services 0.516 - - 0.011 0.526 Home Support 3.016 - - - 3.016 Other 0.010 0.009 0.037 - 0.056 TOTAL 3.993 0.173 4.228 2.944 11.338 SERVICE Costs As At 30 November 2024 Home Support Scheduling System (ACCESS) COST £m FUNDING £m Year 1 (23/24) 0.521 Year 2 (24/25) 0.610 Year 3 (25/26) 0.547 Year 4 (26/27) 0.312 Year 5 (27/28) 0.326 Year 6 (28/29) 0.340 TOTAL COST OF PROGRAMME 2.656 Recurring Revenue Budget (0.224) Earmarked Reserve (2.432) TOTAL FUNDING AVAILABLE (2.656) Community Alarms Analogue to Digital COST £m FUNDING £m Year 1 (24/25) 0.399 Year 2 (25/26) 0.229 Year 3 (26/27) 0.279 TOTAL COST OF PROGRAMME 0.907 Capital Budget (0.087) Recurring Revenue Budget (0.135) Earmarked Reserve (0.465) TOTAL FUNDING AVAILABLE (0.687) Recurring Funding Gap From Year 3 (26/27) 0.220
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11.2 Currently two of the three programmes are progressing within their allocated funding however, Community Alarms envisage a gap in recurring funding from 2026/27 onwards. To ensure future financial transparency, the Medium Term Financial Plan will be updated to reflect this additional pressure. 12. IMPLICATIONS 12.1 NATIONAL 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 ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Social Work Case Management System (MOSAIC COST £m FUNDING £m Year 1 (23/24) 0.213 Year 2 (24/25) 0.174 Year 3 (25/26) 0.114 Year 4 (26/27) 0.114 Year 5 (27/28) 0.114 Year 6 (28/29) 0.114 Year 7 (29/30) 0.114 TOTAL COST OF PROGRAMME 0.957 Capital Budget (0.157) Non-Recurring Funding (0.100) Earmarked Reserve (0.700) TOTAL FUNDING AVAILABLE (0.957)
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12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 12.5 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 The Director of Finance of NHSL and the Chief Officer (Finance) within NLC both continue to be consulted on the financial position of the NL IJB. ☐ 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 Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ 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 IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny.
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12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 - North Lanarkshire IJB 2024/25 Budget Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 5 – North Lanarkshire IJB Movement on Reserves Appendix 6 – North Lanarkshire IJB 2 Year Savings Delivery Plan Appendix 7 - Analysis of Additional Employee Costs 2024/25 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07816 126362.
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North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 November 2024 Appendix 1 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2024/25 November 2024 November 2024 November 2024 2024/25 £m £m £m £m £m Health Care Services Locality and Other Services 67.305 43.401 41.600 1.801 2.702 Addiction Services 4.765 2.898 2.893 0.004 0.007 Medical and Nursing Directorate 4.734 3.232 2.949 0.283 0.424 Prescribing 74.360 50.013 54.477 (4.464) (6.696) Out of Area Services 4.318 2.879 2.606 0.273 0.409 Area Wide Services 8.468 4.923 4.702 0.220 0.331 Hosted Services 188.745 132.844 130.910 1.934 2.902 Family Health Services 131.159 91.298 91.298 0.000 0.000 Set-Aside Budget 74.537 49.691 49.691 0.000 0.000 Total Expenditure - NHSL 558.391 381.178 381.126 0.051 0.079 Social Care Services Social Care Services Gross Expenditure 269.367 186.485 185.586 0.899 1.123 Social Care Services Gross Income (7.722) (5.346) (5.400) 0.054 0.078 Social Care Services Net Expenditure 261.645 181.139 180.187 0.952 1.201 Housing Revenue Account 2.229 (1.543) (1.664) (0.121) 0.175 Social Care, Housing and Transport Services Net Expenditure 263.874 179.596 178.522 0.831 1.376 Total Expenditure - NHSL and NLC 822.265 560.774 559.649 0.883 1.454 Annual Budget 2024/25 £m NHS Lanarkshire Funding (545.965) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.965) Transfer from Reserves (Approved) (12.426) Total Funding - NHSL (612.748) NLC Funding - Social Care Services (207.288) NLC Funding - Housing Services (2.229) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (209.517) Total Funding - NHSL and NLC (822.265) Care Group Year To Date Funded By:
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Hosted Services Appendix 2 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 3.607 2.497 2.480 0.017 1.876 1.298 1.281 0.017 1.732 1.198 1.198 0.000 Continence Services 2.527 1.692 2.148 (0.456) 1.314 0.880 1.336 (0.456) 1.213 0.812 0.812 0.000 Immunisation Services 2.218 2.998 2.891 0.108 1.153 1.559 1.451 0.108 1.065 1.439 1.439 0.000 Speech and Language Therapy Services 7.495 5.009 4.366 0.643 3.897 2.605 1.962 0.643 3.598 2.405 2.405 0.000 Children and Adolescents Mental Health Services 9.910 9.331 9.040 0.290 5.153 4.852 4.562 0.290 4.757 4.479 4.479 0.000 Childrens Services 13.113 9.037 10.412 (1.375) 6.819 4.699 6.075 (1.375) 6.294 4.338 4.338 0.000 Integrated Equipment and Adaptations Store 0.817 0.628 0.619 0.009 0.425 0.327 0.317 0.009 0.392 0.302 0.302 0.000 Dietetics Services 4.566 3.107 2.909 0.198 2.375 1.616 1.418 0.198 2.192 1.492 1.492 0.000 Podiatry Services 5.151 3.444 3.105 0.338 2.678 1.791 1.452 0.338 2.472 1.653 1.653 0.000 Prisoner Healthcare Services 2.101 1.412 1.556 (0.144) 1.093 0.734 0.878 (0.144) 1.009 0.678 0.678 0.000 Blood Borne Viruses Services 1.893 1.275 1.109 0.165 0.984 0.663 0.497 0.165 0.908 0.612 0.612 0.000 Hospital at Home 3.212 2.064 2.064 0.001 1.670 1.073 1.073 0.001 1.542 0.991 0.991 0.000 Mental Health and Learning Disability Services 90.089 62.409 60.270 2.139 46.846 32.453 30.314 2.139 43.243 29.957 29.957 0.000 TOTAL 146.699 104.904 102.970 1.934 76.284 54.550 52.616 1.934 70.416 50.354 50.354 0.000 Led by the North Partnership South Lanarkshire IJB - 48% Share Year to DateAnnual Budget 2024/25 Annual Budget 2024/25 Year to Date North Lanarkshire IJB - 52% ShareYear to DateAnnual Budget 2024/25 Hosted Services Appendix 3 November 24 November 24 November 24 November 24 November 24 November 24 November 24 November 24 November 24 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 8.524 5.713 5.061 0.652 4.433 2.971 2.971 0.000 4.092 2.742 2.090 0.652 Brain Injury Unit 2.502 1.668 1.584 0.084 1.301 0.868 0.868 0.000 1.201 0.801 0.717 0.084 Out of Hours Services 10.327 6.885 6.248 0.637 5.370 3.580 3.580 0.000 4.957 3.305 2.668 0.637 Palliative Care Services 7.323 4.912 4.870 0.042 3.808 2.554 2.554 0.000 3.515 2.358 2.316 0.042 Physiotherapy Services 12.310 8.207 7.307 0.900 6.401 4.267 4.267 0.000 5.909 3.939 3.039 0.900 Primary Care Services 0.880 0.587 0.506 0.081 0.458 0.305 0.305 0.000 0.423 0.282 0.201 0.081 South Improving Cancer Journey 0.300 0.300 0.300 0.000 0.156 0.156 0.156 0.000 0.144 0.144 0.144 0.000 Occupational Therapy Services 9.039 6.050 5.699 0.351 4.700 3.146 3.146 0.000 4.339 2.904 2.553 0.351 Diabetic Services 5.096 3.037 3.840 (0.803) 2.650 1.579 1.579 0.000 2.446 1.458 2.261 (0.803) Primary Care Improvement Fund 24.556 16.371 16.366 0.005 12.769 8.513 8.513 0.000 11.787 7.858 7.853 0.005 TOTAL 80.858 53.730 51.781 1.949 42.046 27.940 27.940 0.000 38.812 25.791 23.842 1.949 Annual Budget 2024/25 Year to Date South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Year to Date North Lanarkshire IJB - 52% Share
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North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 4 2024/25 NHSL Financial Allocation to North Lanarkshire HSCP £m 2024/25 NLC Financial Allocation to North Lanarkshire HSCP £m 2024/25 North Lanarkshire HSCP Financial Allocation 338.816 2024/25 North Lanarkshire HSCP Financial Allocation 206.811 Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229 South Hosted @ 52% 39.188 NLC Financial Allocation at 11 October 2024 209.040 Family Health Service South @ 52% 124.475 Budget Adjustments Posted in Month 5 NHSL Financial Allocation at 31 May 2024 577.016 Transfer Scottish Living Wage budget to Housing -0.023 NHSL Financial Allocation at 23 August 2024 209.017 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 6 Draw Down From Reserves 1.747 Scottish Living Wage for Childrens Services 0.500 Increase in ERS Usage 1.943 NHSL Financial Allocation at 11 October 2024 209.517 Long Covid, ADP, Men C Funding 0.387 Budget Realignment 0.981 Increase in Hosted Services Led by South 1.358 Increase in Area Wide Services 0.072 Other Budget Adjustments 0.273 NHSL Financial Allocation at 30 June 2024 583.777 Budget Adjustments Posted in Month 4 Draw Down From Reserves 1.626 Non Recurring Funding Hospital at Home 0.442 Other Budget Adjustments 0.084 NHSL Financial Allocation at 31 July 2024 585.929 Budget Adjustments Posted in Month 5 Draw Down From Reserves 2.935 Increase in Hosted Services Led by South 0.087 Veterans 1st Point Funding 0.126 Other Budget Adjustments 0.886 NHSL Financial Allocation at 31 August 2024 589.963 Budget Adjustments Posted in Month 6 Draw Down From Reserves 0.846 Increased income 0.099 Increase in Hosted Services Led by South 5.734 Prescribing adjustments 1.144 Other budget adjustments 0.187 NHSL Financial Allocation at 31 September 2024 597.973 Budget Adjustments Posted in Month 7 Draw Down From Reserves 0.691 Increased income 0.554 Increase in Hosted Services Led by South 1.727 Prescribing adjustments 0.400 AW 0.354 Other budget adjustments 8.019 NHSL Financial Allocation at 31 October 2024 609.718 Budget Adjustments Posted in Month 8 Draw Down From Reserves 0.886 Increased income 0.654 Increase in Hosted Services Led by South 0.465 AW 0.163 Prescribing adjustments 0.520 Other budget adjustments 0.342 NHSL Financial Allocation at 30 November 2024 612.748
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North Lanarkshire IJB Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.597 (1.021) 2.576 (1.021) 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Dis 0.106 (0.025) 0.081 (0.025) 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.194 (0.039) 0.155 (0.039) 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 2.849 2.849 0.000 1, 2, 4, 5 NHSL Community Living Change Fund 1.164 1.164 0.000 1, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.000 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 (0.400) 0.001 (0.400) 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.962 (0.283) 0.679 (0.283) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 (0.257) (0.024) (0.257) 2, 3, 4, 5 NHSL Mental Health Covid Clinicians 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 (0.250) 0.722 (0.250) 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.111 0.000 1, 2, 3, 4, 5 NHSL Mental Health Eating Disorders 0.036 0.036 0.000 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 1, 2, 4, 5 NHSL Mental Health Wellbeing in Primary 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-D 2.719 (2.871) (0.152) (2.871) 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming 0.013 (0.012) 0.001 (0.012) 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.288) 0.334 (0.288) 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 0.194 0.194 0.000 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 3 NHSL Third Sector Initiatives To Improve 0.247 (0.172) 0.075 (0.172) 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.027 (0.013) 0.014 (0.013) 3 19.281 0.000 (5.630) 13.651 (5.630) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter Preparedness F 1.000 1.000 0.000 1, 2, 3, 4, 5 NLC Adaptations Fund 0.308 0.308 0.000 2, 4 NLC Adult Protection (share with C&F and 0.050 0.050 0.000 1, 2, 4, 5 NLC Advocacy Services 0.065 0.065 0.000 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.705 (0.196) 0.509 (0.196) 1, 2, 5 NLC Business Case - Non-Recurring NLC 1.319 1.319 0.000 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.596 2.596 0.000 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 0.268 0.268 0.000 4 NHSL Childrens Services - Paediatric Band 7, 0.107 (0.175) (0.068) (0.175) 3 NHSL Development of Chryston Community 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - Double Running 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy Technology 0.465 0.465 0.000 2, 3 NLC Digital and IT Strategy Technology 3.699 3.699 0.000 2, 3 NLC Digital and IT Strategy Technology 0.389 0.389 0.000 NLC Digital and IT Strategy Technology 0.700 0.700 0.000 2, 3 NLC Financial Strategy - Changes to LA 0.027 0.027 0.000 NHSL Health Inequalities - Screening 0.044 (0.019) 0.025 (0.019) 2 NHSL Health Visiting Students/Trainees 0.311 (0.223) 0.088 (0.223) 3 NLC Home Support Resilience (2 year 0.656 0.656 0.000 3, 4 NHSL HR Employability Team (2 year funding 50:50 split between North and 0.087 0.087 0.000 3 NLC IJB Helpline (2 years funding) 0.360 0.360 0.000 1, 4, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NLC Mental Health Social Workers 2 x NL10 0.162 0.162 0.000 3, 4 NHSL Mental Health Wards Window 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics Dieteics 0.450 (0.129) 0.321 (0.129) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and 0.569 (0.031) 0.538 (0.031) 1, 2, 3 NLC Planned Date of Discharge - Discharge 0.109 0.109 0.000 1, 5 NHSL Podiatry Services - Foot Screening 0.350 (0.004) 0.346 (0.004) 1, 2 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 3 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.025) 0.035 (0.025) 3 NHSL Sexual Health Services - Forensic 0.152 (0.127) 0.025 (0.127) 1, 2 NHSL Sexual Health Services - Long-Acting 0.404 (0.077) 0.327 (0.077) 1, 2 NLC Social Care Contracting Staff within 0.087 0.087 0.000 3 NLC/NHSL Staff Training Academy 2.042 (0.443) 1.599 (0.443) 3 NHSL Vulnerable and Complex Cases - Test 0.816 (0.236) 0.580 (0.236) 5 20.955 0.000 (1.693) 19.261 (1.693) Ambition Statement & Performance APPENDIX 5 Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ongoing TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 LEAD RING-FENCED RESERVES
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Opening Balance As At 1 April 2024 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Prescribing Fund 4.361 4.361 0.000 2, 4 NLC Social Care Demand 12.684 12.684 0.000 2, 4 17.045 0.000 0.000 17.045 0.000 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 13.390 (0.250) 13.140 (0.250) 13.390 0.000 (0.250) 13.140 (0.250) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL District Nursing 0.292 (0.292) 0.000 (0.292) 1, 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 (0.730) (0.000) (0.730) 1, 2, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 (3.396) 0.000 (3.396) 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.074) 0.000 (0.074) 1, 2, 4, 5 NHSL Pharmacy Mental Health Recovery & NE 0.341 (0.341) (0.000) (0.341) 1, 2, 3, 4, 5 NHSL Prisioner Healthcare - Transitional 0.020 (0.019) 0.001 (0.019) 3 4.853 0.000 (4.852) 0.001 (4.852) 75.524 0.000 (12.426) 63.098 (12.426) KEY 1 2 3 4 5 LEAD CONTINGENCY FUND RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing APPENDIX 5 (CONTD) Ambition Statement & Performance CLOSED RESERVES TOTAL CLOSED RESERVES TOTAL RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES Develop and support a workforce for the future. Improve mental health and wellbeing. Supporting people through a whole family approach. Ambition Statement & Performance Ambition Statement & Performance Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Ambition Statement & Performance Do the right thing first time. To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing TOTAL CONTINGENCY FUND RESERVES LEAD To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing
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APPENDIX 6 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 1 Ongoing Prescribing Savings 2.280 1.309 1.309 0.971 GREEN 2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000 GREEN 3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds 2.600 0.263 0.263 2.337 RED 4 Review of Discretionary Spend 2.188 0 0.000 2.188 RED 5 Review of Supplementary Staffing 0.982 0.959 0.959 0.023 GREEN 6 Workforce Management and Service Redesign 4.699 0.927 0.927 3.772 RED 7 Financial Management - Support Costs and Vacancy Review 1.486 0.777 0.777 0.709 GREEN 17.681 7.681 0.000 7.681 10.000 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 8 Financial Management - Overspends 4.827 0 0.000 4.827 RED 9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.293 0.293 0.307 GREEN 10 Review of Supplementary Staffing 0.750 0.75 0.750 0.000 GREEN 11 Service Redesign and Contract Review 0.400 0.485 0.485 (0.085) GREEN 12 Review of Operating Model Supporting Back to Basics 3.825 0.135 0.135 3.690 RED 13 Financial Management - Vacancy Review 1.000 0.32 0.320 0.680 RED 11.402 1.983 0.000 1.983 9.419 29.083 9.664 0.000 9.664 19.419 Reference 1 2 3 4 5 6 7 8 Reference 8 9 10 11 12 13 Adult Social Care Services Savings Delivery Plan Review of non traditional respite, advocacy and community services. Review of whole system approach to ensure that when people contact our services the response is quick and effective, with a focus on helping people to help themselves first. Review of all vacant posts. Reducing current overspends to align with allocated budgets. (IEAS, Independent Care Homes, SDS, Private Sector Housing Grants) Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities by opting to reconfigure some existing sheltered/very sheltered housing to retirement models. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. Health Care Services RAG Rating Adult Social Care Services RAG Rating North Lanarkshire IJB 2024/25 & 2025/26 - 2 Year Savings Delivery Plan Total Health Care Services Reference Reference Outstanding Target to Date Additional non-recurring funding received in year from Scottish Government. This will be used in 2024/25. Outstanding Target to Date 2 Year Savings Delivery Plan (Target = £17.681m) Plan Total Achieved 2 Year Savings Delivery Plan (Target = £11.402m) Plan The current model of HBCCC is being reviewed with a view of moving patients into a more suitable and homely environment, such as a mainstream care home which would be a less intensive setting whilst also improving the quality of life of the individual. Total Adult Social Care Services TOTAL Total Achieved Review of all unfunded posts (£4.324m). Redesign of Continence Service delivery schedule and products (£0.375m). Review of all vacant posts and realignment of support costs to all funding streams to show true cost of each service. Health Care Services Savings Delivery Plan Review all areas of discretionary spend including postage, stationery and printing, staff travel and subsistence, domestic supplies, subscriptions and licenses and hospitality. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. The prescribing efficiency programme will continue. This will include additional efficiencies around medicines of low clinical value, drug patent expiry list, product switches, complex rebates and prescribing waste. Reducing current overspends to align with allocated budgets. For 2024/25, this is being off set by non-recurring consequential funding from Scottish Government.
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Analysis of Additional Employee Costs 2024/25 Appendix 7 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 50,169 38,615 22,052 56,191 305,642 4,702 477,371 2 41,325 32,875 23,320 46,102 264,497 7,042 415,161 3 51,328 40,468 21,249 52,407 367,143 3,350 535,945 4 58,802 28,506 17,872 45,313 315,928 4,243 470,664 5 61,261 31,359 29,225 52,339 399,493 4,356 578,033 6 49,005 24,134 22,906 47,399 332,879 3,695 480,018 7 60,542 27,518 26,314 48,610 346,546 4,197 513,726 8 81,265 47,032 47,065 94,164 482,507 5,357 757,389 9 0 10 0 11 0 12 0 TOTAL 453,697 270,507 210,003 442,525 2,814,634 36,941 4,228,307 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 6,112 -1,743 -17 - 286,364 - 290,716 2 - - 606 -80 569,840 - 570,366 3 1,526 - 1,229 - 337,115 - 339,870 4 1,280 - 51,839 - 335,537 - 388,656 5 528 - -33,399 - 351,443 2,311 320,883 6 1,352 0 606 0 290,147 0 292,105 7 0 -428 -11,959 4,286 282,409 0 274,308 8 569 0 -1,096 167,781 291,259 5,732 464,245 9 2,626 2,626 10 0 11 0 12 0 13 0 TOTAL 11,367 -2,171 7,809 171,987 2,744,114 10,669 2,943,775 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 7,896 6,109 4,121 14,860 30,578 -5,031 -36,239 737 23,031 2 11,173 8,470 4,855 17,042 30,317 84,416 341,911 2,508 500,692 3 7,738 7,429 5,896 10,311 21,831 65,331 331,451 1,247 451,234 4 7,253 5,666 3,373 17,206 29,554 48,786 385,446 1,407 498,691 5 6,018 1,257 7,614 10,756 19,232 40,111 412,126 253 497,367 6 7,059 714 5,354 12,415 30,811 60,954 400,282 490 518,079 7 4,767 2,620 3,308 13,841 24,698 63,268 360,760 2,293 475,555 8 6,319 1,819 2,563 10,898 27,613 80,104 408,207 1,451 538,974 9 77,587 412,013 489,600 10 0 11 0 12 0 13 0 TOTAL 58,223 34,084 37,084 107,329 214,634 515,526 3,015,957 10,386 3,993,223 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 4,408 2,005 7,033 9,061 9,873 1,559 33,939 2 2,745 3,160 4,339 3,462 5,718 1,250 20,674 3 1,508 1,689 4,890 850 6,956 776 16,669 4 2,606 991 5,042 3,474 5,352 1,315 18,780 5 1,732 2,785 5,716 1,863 6,623 966 19,685 6 2,353 632 7,455 1,266 7,388 554 19,648 7 3,283 307 8,342 4,200 6,327 1,087 23,546 8 3,199 1,606 5,031 2,974 6,134 1,246 20,190 9 0 10 0 11 0 12 0 TOTAL 21,834 13,175 47,848 27,150 54,371 8,753 173,131 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period AGENCY COSTS YEAR TO DATE
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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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17
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1 IJB Reporting Template REPORT Item No: 10 SUBJECT: MAT Standards 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 John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 19 March 2025 1. PURPOSE OF REPORT This paper sets out the progress made towards implementing the Medication Assisted treatment (MAT) standards in North Lanarkshire for 2024. The current position for each standard is set out below with an updated status on each standard required for national reporting in April 2025. 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: ☐
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Acknowledge the significant progress made towards delivering the Medication Assisted Treatment Standards (MAT) throughout 2024. (3) Note the current status of MAT Standards implementation and the position for this year’s national benchmarking report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Scottish Government initiated the Medication Assisted Treatment (MAT) Standards in 2021 with the expectation of MAT being fully implemented by 2024. 5.2 North Lanarkshire ADP and relevant integrated authorities are required to work towards the national drug mission objectives which includes the delivery of the MAT Standards. 5.3 A national benchmarking report was published by Public Health Scotland in July 2024, showing progress made across Scotland on a RAG status basis. Lanarkshire was in a good position to implement the MAT standards with more work still required to fully embed standards 6-10 across all localities. 5.4 This paper sets out the progress made in more detail and highlights the position for North Lanarkshire, based on evidence due to be submitted to Public Health Scotland, for the 2025 benchmarking report. 5.5 North Lanarkshire RAG Benchmarking position 2024: MAT 1 = Green MAT 2 = Green MAT 3 = Green MAT 4 = Green MAT 5 = Green MAT 6 & 10 = Amber MAT 7 = Provisionally Amber Yes ☐ No ☐ N/A ☐
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3 MAT 9 = Amber 5.6 In order to meet green status there is a requirement to provide numerical data, evidence standard operating procedures (SOPs) in place, and report on experiential feedback gathered through interviews with those in services, practitioners and families. 5.7 National progress on MAT Implementation – Published July 2024
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4 5.8 A Pan-Lanarkshire oversight group met quarterly in 2024 with a north delivery group meeting monthly to monitor and progress the MAT standards delivery plan. 5.9 This group was Chaired by the Head of Health and includes representatives from the MAT delivery team from Public Health Scotland. – Throughout 2024, NLADP was required to report to the Scottish Government on MAT standards progress on a monthly basis. – A Project Lead is in place to oversee all MAT deliverables supporting a range of operational improvement measures with drug and alcohol treatment services. – Key MAT leads were identified to maintain progress on each standard. – A peer support worker was recruited to support the experiential elements of the MAT standards delivery. – North Lanarkshire received positive feedback from PHS and the Scottish Government on the significant improvements and progress made between 2023 and 2024.
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5 5.10 MAT 1. All people accessing services have the option to start MAT from the same day of presentation. Standard met – Green. ‒ The Urgent Care Response Team launched in March 2023. This was initially supported by 3 Advance Nurse Practitioner’s (ANPs) with 2 further posts in North as part of a Pan-Lanarkshire approach. ‒ In total, 515 referrals were made for MAT in North Lanarkshire via the Urgent Response Team from April 2023 – March 2024 and since April 2024 – Dec 2024 122 people have been supported. ‒ From Sept - December 2024, 86% of people referred for MAT were assessed within 24 hours, the target is to reach 75% of referrals prescribed OST within in 24 hours. ‒ A decision was reached in January 2024 to move to a North specific approach linking the local Addiction Recovery Teams (ART); to enhance capacity and improve access for those requiring same day access to MAT. ‒ 1 ANP is currently in place for the response team (from July 2024) and being supported with Community Prescribing Service (CPS) to deliver same day prescribing. ‒ The current ANP structure needs reviewed with addiction services in 2025 to ensure any risk to service continuity can be mitigated. 5.11 MAT 2. All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. Standard met - Green. – Standardised approach in place setting out a range of choices can be offered to individuals across all services - SOPs/guidelines in place. – Leaflet/promotional content improved for individuals accessing treatment, setting out all medication options available. – NHSL continues to grow the focus on choice with more people moving to longer lasting OST including Buvidal. – Updated prescribing guidelines finished in 2024. – Currently, 1207 people access OST/OAT in North Lanarkshire.
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6 5.12 MAT 3 & 5 are now linked. All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. All people will receive support to remain in treatment for as long as requested. Standards 3 –Green. – A local near-fatal overdose response system is in place. This system links with the Scottish Ambulance Service, tier 2 support services including the active recovery community. – The Crisis Outreach Team was commissioned via the North ADP to provide Overdose response, assertive outreach capacity and crisis support (linked to housing service as part of the rapid rehousing transition plan). – Since the service became operational (December 2023), 293 people have been reached across all 3 elements of the combined service operated by Turning Point Scotland (TPS). – NHSL Harm Reduction Team screened 232 Near Fatal Overdoses in 23/24 and have screened 122 so far in 24/25. – MAT 5 data sets are now complete and in place with final snap shot data collections tested. – Exit planning – supported/unsupported discharge data still required for review and improvement plan is in place. 5.13 MAT 4. All people are offered evidence-based harm reduction at the point of MAT delivery. Standard Implemented – Green. - All locations now offering core harm-reduction measures (take-home naloxone and overdose awareness, injection equipment provision and blood-borne virus testing) at follow up MAT appointments. - ART started recording Harm Reduction Interventions July 23, 2464 were recorded between July 23 and Mar 24.
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7 - Since April 24 till Dec 24, 3454 harm reduction interventions have been recorded. - This includes, BBV testing, naloxone offered/taken up, sexual & reproductive health screening. - Harm reduction kits are supplied to all ART sites with Injecting Equipment Provision/Wound care/Dry Blood Spot Testing - staff guides within to ensure consistency all across teams. - Experiential data gathered suggests people have access to harm- reduction interventions and there is widespread awareness of naloxone. 5.14 MAT 6 & 10 are now linked. The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low-intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. Standard in progress – Amber. – A multi-agency steering group is in place and a training plan is being rolled out in conjunction with the development of appropriate training resources for all frontline staff. – Some constraints exist due to release time for staff to complete training linked to this standard, this is limiting the roll out of the workforce development plan. – T1 workforce training, 83% complete with staff, T2 workforce training at 97% and by 31st March 2024 we will be at 100%. The target for MAT benchmarking for PHS is 50%. – Reflective practice sessions now available to all staff, 2 sessions have taken place and been evaluated by participants and facilitators. T2 groups are being piloted in 2 localities, with learning being shared at the North MAT 6&10 meetings. – There are now 4 Turas hosted modules available to expedite the delivery of the training plan. 5.15 MAT 7. All people have the option of MAT shared with primary care. Provisionally amber – NHS Lanarkshire took a strategic decision over 15 years ago to centralise provision of MAT in a GP-run Community Prescribing Service to ensure equity of access. – These arrangements have worked well and are funded from FHS budget (£0.55m in 2022/23). In addition, a MAT dispensing and pharmaceutical care service is funded via community pharmacy (£2.016m) alongside a needle exchange scheme (£0.05m). – Following discussions with the GP subgroup, there is a strong preference to retain a special interest GP approach as there is neither the capacity nor skillset within most practices to reverse our approach. – Prescribing within community pharmacy may be an option but will require further maturity and development – A task and finish group has been created to guide MAT 7 compliance within our existing infrastructure, focussing on a range of options to review and improve the offer to meet MAT 7
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8 – Medical Director has met with MAT Joint Chairs and locality service managers North and South to discuss the approach moving forward 5.16 MAT 8. All people have access to independent advocacy and support for housing, welfare and income needs. Standard met – Green. – Review carried out across all services with key actions, recommendations required to standardise referral pathways, baseline data and reporting arrangements to evidence MAT 8. – Commissioned advocacy services are in place in North Lanarkshire via ADP funding and clear pathways now exist across treatment and care services. – New combined service commissioned via NLC procurement with all MAT requirements included. 5.17 MAT 9 is linked to MAT1. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. Standard in progress – Amber - A steering group was established in 2024 with joint working between mental health and addiction services (including commissioned services) is in place. - Joint review board now reviewing all aspects of MAT 9 work. - Mapping exercise being carried out and linked to the Mental Health and Substance Use (MHSU) protocol published by HIS in 2024. - Work underway to identify gaps across services with a staff questionnaire being drafted and issued to all MHSU staff. - All people accessing MAT are screened for co-occurring MHSU needs – 122 in total, in 2024. - There is a delivery plan for this standard in place and more wide-spread and routine screening for Mental health concerns now takes place across all key services. - Robust experiential evidence submitted to demonstrate progress is being made in this standard. Experiential Engagement 5.18 In 2023-24 North Lanarkshire’s experiential programme was robust, coordinated and met all of MIST/SG’s criteria. The expectation for 2024-25 is to develop a sustainable model for continued service user, family /loved ones and staff’s feedback. 5.19 This system has been developed and is being piloted and the findings will be part of the 2024/25 submission of evidence. 6. CONCLUSIONS
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9 North Lanarkshire is on track to meet all MAT standards with the exception of MAT 7, which his provisional at Amber. This is due to constraints linked to delivery of MAT across Primary Care. North Lanarkshire is not unique in this. MAT 7 limitations have been acknowledged by the Scottish Government and Public Health Scotland as a national barrier with the majority of ADP areas unable to fully deliver on this standard, hybrid approaches are in place in many Board areas. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. North Lanarkshire is in a much stronger position to offer MAT as proposed with further improvement work in place to improve the quality and consistency of MAT standards delivery across all localities. The appropriate measures and plans are now in place to drive forward the additional improvements required to fully embed all standards across all localities in 2025. 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
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10 MAT standards Annual budget for 2024/25 is £570,866, of which £142,446 has been spent (as of month 9). This has been allocated to the fixed-term posts set out above and delivery of MAT standards 1-10, in keeping with the current delivery model. The majority of MAT standards funding is tied to posts with reserves in place to support further mental health and substance use protocol resourcing and stabilisation services in 2025. Additional Injecting Equipment Provision and Naloxone costs have now been linked to this budget for 2024 as well as equipment and supplies for the day to day running of the Urgent Care Response team. This paper has been reviewed by Finance: 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 ☐ 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 Yes ☒ No ☐ N/A ☐
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11 ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 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. Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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12 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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13 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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14
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North Lanarkshire Integration Joint Board Annual Audit Plan 2024/25 Prepared for North Lanarkshire Integration Joint Board February 2025
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North Lanarkshire Integration Joint Board Annual Audit Plan | 2 Contents Introduction 3 Audit scope and responsibilities 4 Audit of the annual accounts 6 Wider scope and Best Value 10 Reporting arrangements, timetable and audit fee 12 Other matters 15 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility.
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Introduction | 3 Introduction Purpose of the Annual Audit Plan 1. The purpose of this Annual Audit Plan is to provide an overview of the planned scope and timing of the 2024/25 audit of North Lanarkshire Integration Joint Board’s (North Lanarkshire IJB’s) annual accounts. It outlines the audit work planned to meet the audit requirements set out in auditing standards and the Code of Audit Practice, including supplementary guidance. Appointed auditor and independence 2. John Boyd, of Audit Scotland, has been appointed by the Accounts Commission as external auditor of North Lanarkshire IJB for the period from 2022/23 until 2026/27. The 2024/25 financial year is therefore the third of the five-year audit appointment. 3. John Boyd and the audit team are independent of North Lanarkshire IJB in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. This standard imposes stringent rules to ensure the independence and objectivity of auditors. Audit Scotland has robust arrangements in place to ensure compliance with ethical standards. The arrangements are overseen by the Executive Director of Innovation and Quality, who serves as Audit Scotland’s Ethics Partner. 4. The Ethical Standard requires auditors to communicate any relationships that may affect the independence and objectivity of the audit team. There are no such relationships pertaining to the audit of North Lanarkshire IJB to communicate.
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Audit scope and responsibilities | 4 Audit scope and responsibilities Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on other statutory information published with the financial statements in the annual accounts, including the Management Commentary, the Annual Governance Statement, and the audited part of the Remuneration Report. • Conclusions on North Lanarkshire IJB’s arrangements in relation to wider scope areas: Financial Management, Financial Sustainability, Vision, Leadership, and Governance, and Use of Resources to Improve Outcomes. • Reporting on North Lanarkshire IJB’s arrangements for securing Best Value. • A review of North Lanarkshire IJB’s arrangements for preparing and publishing statutory performance information. • Provision of an Annual Audit Report setting out significant matters identified from the audit of the annual accounts and the wider scope areas specified in the Code of Audit Practice. Responsibilities 6. The Code of Audit Practice sets out the respective responsibilities of North Lanarkshire IJB and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts and concluding on North Lanarkshire IJB’s arrangements in place for the wider scope areas.
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Audit scope and responsibilities | 5 North Lanarkshire IJB responsibilities 8. North Lanarkshire IJB has primary responsibility for ensuring proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance, propriety and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements and other information that gives a true and fair view. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function.
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Audit of the annual accounts | 6 Audit of the annual accounts Introduction 9. The audit of the annual accounts is driven by materiality and the risks of material misstatement in the financial statements, with greater attention being given to the significant risks of material misstatement. This chapter outlines materiality, the significant risks of material misstatement that have been identified, and the impact these have on the planned audit procedures. Materiality 10. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 11. Broadly, the concept of materiality is to determine whether matters identified during the audit could reasonably be expected to influence the decisions of users of the financial statements. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement. 12. The materiality levels determined for the audit of North Lanarkshire IJB are outlined in Exhibit 1. Exhibit 1 2024/25 Materiality levels for North Lanarkshire IJB Materiality Amount Materiality – based on an assessment of the needs of users of the financial statements and the nature of North Lanarkshire IJB’s operations, the benchmark used to determine materiality is gross expenditure based on the audited 2023/24 financial statements. Materiality has been set at 2% of the benchmark. £16.176 million Performance materiality – this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate that further audit procedures are required. Using professional judgement, performance materiality has been set at 75% of planning materiality. £12.132 million
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Audit of the annual accounts | 7 Materiality Amount Reporting threshold – all misstatements greater than the reporting threshold will be reported. £809 thousand Source: Audit Scotland Significant risks of material misstatement to the financial statements 13. The risk assessment process draws on the audit team’s cumulative knowledge of North Lanarkshire IJB, including the nature of its operations and its significant transaction streams, the system of internal control, governance arrangements and processes, and developments that could impact on its financial reporting. 14. Based on the risk assessment process, significant risks of material misstatement to the financial statements have been identified and these are summarised in Exhibit 2, page 8. These are the risks which have the greatest impact on the planned audit approach, and the planned audit procedures in response to the risks are outlined in Exhibit 2. 15. The risk assessment process is an iterative and dynamic process. The assessment of risks set out in this Annual Audit Plan and Exhibit 2 may change as more information and evidence is obtained over the course of the audit. Where such changes occur, these will be reported to North Lanarkshire IJB and those charged with governance, where relevant. 16. As set out in International Standard on Auditing (UK) 240: The auditor’s responsibilities relating to fraud in an audit of financial statement, there is a presumed risk of fraud over the recognition of revenue. There is a risk that revenue may be misstated resulting in a material misstatement in the financial statements. We have rebutted this presumed risk in 2024/25 as, while the possibility of fraud exists, we do not judge it to be a significant risk due to the revenue streams coming from the partner bodies of NHS Lanarkshire and North Lanarkshire Council. 17. In line with Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom, as most public- sector bodies are net spending bodies, the risk of material misstatement due to fraud related to expenditure recognition may in some cases be greater than the risk relating to revenue recognition. Due to the nature of North Lanarkshire IJB’s expenditure, being the commissioning of services from partner bodies, we have also rebutted the significant risk of material misstatement due to fraud in expenditure in 2024/25. 18. Assurances over the accuracy and completeness of IJB transactions will be obtained from the auditors of North Lanarkshire Council and NHS
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Audit of the annual accounts | 8 Lanarkshire. We have not, therefore, incorporated specific work into our audit plan in these areas over and above our standard audit procedures. Exhibit 2 Significant risks of material misstatement to the financial statements Risk of material misstatement Planned audit response Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override controls that otherwise appear to be operating effectively. The audit team will: • Agree balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports/ledger/correspondence. • Assurances will be obtained from the auditors of North Lanarkshire Council and NHS Lanarkshire over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year end where we consider there to be greatest risk of material misstatement through management override of controls. • Review of financial monitoring reports during the year. • Evaluate significant transactions outside the normal course of business. • Assess the adequacy of controls in place for identifying and disclosing related party relationships and transactions in the financial statements. Source: Audit Scotland Other areas of audit focus 19. As part of our assessment of audit risks, we have not identified any other areas of specific audit focus. Key audit matters 20. The Code of Audit Practice requires public sector auditors to communicate key audit matters. Key audit matters are those matters that, in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 21. In determining key audit matters, auditors consider:
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Audit of the annual accounts | 9 • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 22. The matters determined to be key audit matters will be communicated in the Annual Audit Report. Exhibit 2 outlines the significant risks of material misstatement to the financial statements that have been identified, including those that have greatest impact on the planned audit procedures and require most attention when performing the audit.
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Wider scope and Best Value | 10 Wider scope and Best Value Introduction 23. Reflecting the fact that public money is involved, the Code of Audit Practice requires that public audit is planned and undertaken from a wider perspective than in the private sector. The wider scope audit set out by the Code of Audit Practice broadens the audit of the annual accounts to include consideration of additional aspects or risks in four wider scope areas, which are summarised below: • Financial Management – this means having sound budgetary processes. Factors that can impact on North Lanarkshire IJB being able to secure sound financial management include the strength of the financial management culture, accountability, and arrangements to prevent and detect fraud, error and other irregularities, bribery and corruption. • Financial Sustainability – this means looking forward over the medium and longer term in planning the services to be delivered and how they will be delivered effectively. This is assessed by considering North Lanarkshire IJB’s medium- to longer-term planning for service delivery. • Vision, Leadership and Governance – this means having a clear vision and strategy, with set priorities within the vision and strategy. This is assessed by considering the clarity of plans in place to deliver the vision and strategy and the effectiveness of the governance arrangements to support delivery. • Use of Resources to Improve Outcomes – this means using resources to meet stated outcomes and improvement objectives through effective planning and working with partners and communities. This is assessed by considering North Lanarkshire IJB’s arrangements for ensuing resources are deployed to improve strategic outcomes, meet the needs of service users, and deliver continuous improvement. 24. A conclusion on the effectiveness and appropriateness of arrangements North Lanarkshire IJB has in place for each of the wider scope areas will be reported in the Annual Audit Report.
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Wider scope and Best Value | 11 Wider scope and Best Value risks 25. The risk assessment process has identified one risk in the wider scope area as outlined in Exhibit 3, and this includes the planned audit procedures in response to the risk. Exhibit 3 Wider scope and Best Value risks Description of risk Planned audit response Financial sustainability In recent years North Lanarkshire IJB has achieved short term financial balance. However, it continues to be faced with significant financial challenges and difficult decisions to ensure resources are allocated to areas of strategic priority and user need. Further work is required to ensure sustainable financial balance is maintained. The audit team will: • Review financial plans developed and assess the appropriateness of the financial plans and any assumptions made. • Assess if financial plans developed are aligned to North Lanarkshire IJB’s strategic priorities. • Review financial monitoring reports to assess the financial position, including progress of partner bodies in achieving planned savings. • Review controls in place and updates to financial plans to assess financial sustainability. Source: Audit Scotland Best Value 26. Under the Code of Audit Practice, the duty on auditors to consider the arrangements an audited body has in place to secure Best Value applies to audited bodies that fall within section 106 of the Local Government (Scotland) Act 1973. 27. Consideration of the arrangements North Lanarkshire IJB has in place to secure Best Value will be carried out alongside the wider scope audit, and a conclusion on those arrangements will be reported in the Annual Audit Report.
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Reporting arrangements, timetable and audit fee | 12 Reporting arrangements, timetable and audit fee Audit outputs 28. The outputs from the 2024/25 audit include: • This Annual Audit Plan. • An Independent Auditor’s Report to North Lanarkshire IJB and the Accounts Commission setting out opinions on the annual accounts. • An Annual Audit Report to North Lanarkshire IJB and the Accounts Commission setting out significant matters identified from the audit of the annual accounts, conclusions from the wider scope and Best Value audit, and recommendations where required. 29. The matters to be reported in the outputs will be discussed with North Lanarkshire IJB for factual accuracy before they are issued. All outputs from the audit will be published on Audit Scotland’s website, apart from the Independent Auditor’s Report, which is included in the audited annual accounts. 30. Target dates for the audit outputs are set by the Accounts Commission. In setting the target dates for the audit outputs, consideration is given to the statutory date for approving the annual accounts, which is 30 September 2025 for local government bodies. 31. The Independent Auditor’s Report and Annual Audit Report are planned to be issued by the target date of 30 September 2025. Audit timetable 32. Achieving the timetable for production of the annual accounts, supported by complete and accurate working papers, is critical to delivery of the audit to agreed target dates. Exhibit 4 includes a timetable for the audit, which has been agreed with management. Agreed target dates will be kept under review as the audit progresses, and any changes required, and their potential impact, will be discussed with North Lanarkshire IJB and reported to those charged with governance, where required.
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Reporting arrangements, timetable and audit fee | 13 Exhibit 4 2024/25 audit timetable Audit activity North Lanarkshire IJB target date Audit team target date Relevant committee date Issue of Annual Audit Plan N/A 14 February 2025 25 February 2025 Annual accounts: • Consideration of unaudited annual accounts by those charged with governance 30 June 2025 N/A 18 June 2025 • Submission of unaudited annual accounts and all working papers to audit team 30 June 2025 N/A N/A • Latest date for audit clearance meeting 21 August 2025 21 August 2025 N/A • Agreement of audited and unsigned annual accounts 22 August 2025 22 August 2025 N/A • Issue of draft Letter of Representation, proposed Independent Auditor’s Report, and proposed Annual Audit Report N/A 5 September 2025 17 September 2025 • Approval by those charged with governance and signing of audited annual accounts 17 September 2025 N/A 17 September 2025 • Signing of Independent Auditor’s Report and issue of Annual Audit Report N/A 30 September 2025 N/A Source: Audit Scotland Audit fee 33. North Lanarkshire IJB’s audit fee is determined in line with Audit Scotland’s fee setting arrangements. The proposed audit fee for the 2024/25 audit is set out in Exhibit 5. 34. In setting the audit fee, it is assumed that North Lanarkshire IJB has effective governance arrangements in place and the complete annual accounts will be provided for audit in line with the agreed timetable. The audit fee assumes there will be no significant changes to the planned scope of the audit. Where the audit cannot proceed as planned, for
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Reporting arrangements, timetable and audit fee | 14 example, due to incomplete or inadequate working papers, the audit fee may need to be increased. Exhibit 5 Audit fee (including VAT) Fee component1 Fee (£) External auditor remuneration 37,670 Pooled costs, such as travel and subsistence costs 950 Contribution to the performance audit programme [local government only] 7,230 Adjustment for average audit price increase (11,850) Total 2024/25 fee 34,000 Source: Audit Scotland 1 Information on the components that make up the total fee can be found in Audit Scotland’s Audit management and quality guidance.
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Other matters | 15 Other matters Internal audit 35. North Lanarkshire IJB’s internal audit function is provided jointly by the internal audit teams of NHS Lanarkshire and North Lanarkshire Council. 36. While we are not planning to place formal reliance on the work of internal audit in 2024/25, we may consider aspects of internal audit’s work in respect of our wider audit dimension responsibilities. Audit quality 37. Audit Scotland is committed to the consistent delivery of high-quality audit. Audit quality requires ongoing attention and improvement to keep pace with external and internal changes. Details of the arrangements in place for the delivery of high-quality audits is available from the Audit Scotland website. 38. The International Standards on Quality Management (ISQM) applicable to Audit Scotland for 2024/25 audits are: • ISQM (UK) 1, which deals with an audit organisation’s responsibilities to design, implement, and operate a system of quality management (SoQM) for audits. Audit Scotland’s SoQM consists of a variety of components, such as: governance arrangements and culture to support audit quality, compliance with ethical requirements, ensuring Audit Scotland is dedicated to high- quality audit through engagement performance and resourcing arrangements, and ensuring there are robust quality monitoring arrangements in place. Audit Scotland carries out an annual evaluation of its SoQM and has concluded it complies with this standard. • ISQM (UK) 2, which sets out arrangements for conducting engagement quality reviews, which are performed by senior management not involved in an audit, to review significant judgements and conclusions reached by the audit team, and the appropriateness of proposed audit opinions on high-risk audits. 39. To monitor quality at an individual audit level, Audit Scotland carries out internal quality reviews on a sample of audits. Additionally, the Institute of Chartered Accountants of England and Wales (ICAEW) carries out independent quality reviews on a sample of audits.
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Other matters | 16 40. Actions to address deficiencies identified by internal and external quality reviews are included in a rolling Quality Improvement Action Plan, which is used to support continuous improvement. Progress with implementing planned actions is monitored on a regular basis by Audit Scotland’s Quality and Ethics Committee. 41. Audit Scotland may periodically seek the views of North Lanarkshire IJB on the quality of audit services provided. The audit team would also welcome feedback at any time.
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North Lanarkshire Integration Joint Board Annual Audit Plan 2024/25 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot AS.5.0
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NL H&SCP Risk Overview Report Meeting Name – IJB PFA Reporting Period: IJB PFA Risk Register –Feb 2025
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NL HSCP IJB Risk – Dashboard Feb 2025 Executive Summary Risk Register Number of Risks IJB 19 NL Council 21 NHS Lanarkshire 21 Risk movement since last report No Change Increase Decrease New Closed Riskswith updated actions 0 0 19 Risk Score Trend IJB06/21 PrescribingActivityand Costs VH IJB.01/21 Financial Challenges VH IJB.21/24 Pharmacy Pressures within Prison Service VH IJB Highest Scoring Risks NL H&SCP Risks Reported to Assurance Committees Service risks- Service level Level 3- North Health Professional/ Operational Group and Support Care and Clinical Governance IJB Risk Register – IJB and IJB PFA Level 2- Core Risk Overview Process NL H&SCP
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Risk in Focus –Pharmacy Pressures within Prison Service Risk Description Risk Owner Risk Lead 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. MT CR Current Controls CONTROLS • Reviewofthedispenseprocesseswithintheprison • Implementationofguidelines • Improvedcommunicationwithpharmacyprovider Actions ACTIONS • PrescribingActionGroupre-establishedtotryandmanagethenumberofitemsprescribed • Developmentofpainandmedicinemanagementpathways • Reviewofprescribinghabits Risk Trend FollowingthePrisonerHealthcareReportpresentedto IJB PFAonthe 22nd May 2024. The IJB PFArecommendedthat a PharmacyPressurewithinPrisonServiceRisk wasadded to therisk register. Target- Low Current – Veru High
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Risk in Focus –Financial Challenges Risk Description Risk Owner Risk Lead Financial Challenges 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: AK AK Current Controls CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023-26 and reserves strategy 2023-24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget Risk Trend No Movement Increasing financial pressures have resulted in no movement of the risk rating for this risk. Further controls and actions are currently being reviewed Target- Medium Current – Very High
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Risk in Focus –Prescribing Activity and Costs Risk Description Risk Owner Risk Lead The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. CR AK Current Controls 1. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring.Inrespect of the regulation of medicines and medical devices, the 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. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new tradedeal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes Actions 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports Risk Trend No movement Consider any still ongoing, however good progress has been made regarding achievement of the prescribing target for 2024-25 Target- Low Current – Very High