ITEM 11 Q3 Performance Report
North Lanarkshire Council · 21 May 2025
Back to IJB Performance, Finance and Audit Committee — 21 May 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 11 SUBJECT: Q3 Performance Update – 01st October 2024 to 31st December 2024, 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: 21 May 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/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 01st October 2024 to 31st December 2024, Quarter 3 2024/25 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 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 705 583 RED Alcohol Brief Interventions (all settings) NHSL 7381 2449 1751 RED Narrative & Corrective Action Whilst Public Health Scotland’s (PHS) data collection for Alcohol Brief Interventions (ABI) across all settings has been temporarily suspended and the submission of screening and intervention data is no longer required during this period, NHS Lanarkshire and the HSCP remain committed to maintaining ABI delivery and internal performance reporting, hence the metrics continuing to feature in local reviews. Locality-level ABI targets, introduced earlier this year, remain in place and team-level targets are being developed by IM to further enhance performance management. The initial review of performance at the level of individual teams has highlighted variance amongst professional groups; efforts to harmonise this will require support from service managers. Despite efforts to address previous reporting challenges, the current reported performance is below expected levels, suggesting that there are 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 Health Improvement Team continue to contribute to wider work supporting the reduction of alcohol misuse in North Lanarkshire. A short life working group has been established to look at alcohol & older adults; the group will consult with older adults across Lanarkshire to understand their current awareness of local services. The team offer training in partnership with locality staff and this is available through the HI Training Calendar. Dedicated Alcohol & Employment training is also delivered, in partnership with Healthy Working Lives. 2. Cervical Screening Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 71.9% 70.0% RED Narrative & Corrective Action Whilst there has been a decrease in performance from the previous quarter (Q2 - 71.9%, Q3 - 70%), there remains a focus on communications and improvement activity in order to address inequality and other challenges to the cervical screening uptake. In Q3, none of the 6 localities achieved the 80% target and all uptake for all localities was down from the previous quarter. Only one practice, in the North locality, met the targeted level; that practice achieved 84.4%. Although North Lanarkshire has not achieved the 80% target, it is of note than no board in Scotland has met the 80% target. • Airdrie: Uptake 67.2% (range: 59.3% - 72.2%) • Bellshill: Uptake 68.9% (range: 64.0% - 71.9%) • Coatbridge: Uptake 68.0% (range: 62.8% - 73.6%)
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7 • Motherwell: Uptake 70.4% (range: 65.5% - 78.4%) • North: Uptake 73.6% (range: 68.9% - 84.4%) • Wishaw: Uptake 68.9% (range: 58.4% - 72.5%) Efforts to strengthen the communication between the Health & Social Care Partnership (HSCP) and General Practices are ongoing and include: • Regular inclusion of cervical screening data and updates as standing agenda items at relevant forums • Health Improvement teams sharing quarterly locality-level data and narratives with GP Clinical Leads and Service Managers • Co-ordinating the innovative use of waiting room digital screens to promote cervical screening • Planning work in progress to use two new resources, listed below, as part of staff training to raise awareness and promote patient-centred approach to cervical screening: - - A multilingual video focusing on the experiences of South Asian women, aimed at raising awareness and improving cultural inclusivity in cervical screening initiatives. - A training guide informed by consultations with local women, addressing barriers and promoting a patient-centred approach. • As surveys have identified appointment accessibility as a recurring issue, focussed work on improving access through telephony and digital developments is underway Feedback from these activities will inform the Inequalities in Screening Steering Group, where wider screening work is directed and monitored. The steering group are considering a number of other factors, with access to appointments a key issue identified as impacting on screening performance more generally. Training, engagement with the wider organisation and leveraging wider patient contact as a means to engage regarding screening are other key areas of interest that the steering group are developing further. 3. Childhood Immunisations Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 90.2% 89.0% RED Narrative & Corrective Action The holiday period during Q3 is an expected seasonal impact on immunisation uptake. In order to mitigate for this, additional clinics were offered and there was a continued focus on ensuring that immunisations are a point of discussion at UHVP visits and home visits were available for hard to reach children and their families. 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 with a sector wide approach to managing capacity and a revised protocol for any non-attenders. To combat the declining trend, NHS Lanarkshire has undertaken the following actions:
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8 • 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: • 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% 80.1% Quarterly/ 2 quarters behind ... RED... Narrative & Corrective Action Following extended discussion regarding the performance reporting of 6-8 week reviews, which continues to report performance below the targeted level, Pan- Lanarkshire work is now complete to improve the current processes for managing data and reporting. As the national reporting requirement has an extended timeframe when compared with the local process (12 weeks vs. 10 weeks), this allows for more time to collect the relevant data and a significant improvement is seen when compared with local reporting. It is believed that the extended timeframe results in a more accurate position being reported. Both South and North Lanarkshire HSCP have agreed that for performance reporting purposes that they will amend their reporting to the longer timeframe (i.e. 12 weeks) and report two quarters in arrears.
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9 The Q1 data has been refreshed and is now reported in the scorecard using the new method. North HSCP for Q1 was previously reported as 73.5% at 10 weeks and is now 80.1% at 12 weeks. Although this is still below the targeted level of 90%, allowing for the data to be extracted later allows more time for the paperwork to be collated and the increase in performance is most likely attributable to this change in practice. The data will be reviewed to ensure any change in reporting does not have an adverse consequence elsewhere in the system. Given the importance of this performance measure; assuring us that children are getting this crucial assessment we can only move to a 12-week reporting cycle if we are also assured that the wider system allows practitioners to manage cases effectively. 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. 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. 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. A Lanarkshire wide SLWG with representation from operational, nursing and medical colleagues is considering improvement and change within UHVP and has designed a Standard Operating Procedure. This has previously been tested and evaluated positively in a locality in South HSCP and the process is currently being tested NHS Lanarkshire wide. Although progressing, the impact of the work from the SLWG has yet to be fully understood, however there are early indications that an improvement in recording compliance has been realised, with evidence that both GP and HV records are being completed for more reviews. 5. Reablement and Rehabilitation Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 987 1387 RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 57.1% 56.5% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 58.1% 63.6% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 65.8% 60.1% RED Narrative & Corrective Action
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10 The indicators for Reablement presented in the CE Scorecard have not met the targeted levels of performance. 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 around 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. Additional data/information on Reablement is available from the HAT and IRT datasets. Home Assessment Team Since its inception, the HAT service has accepted a total of 2902 referrals. During Q3, 123 referrals were accepted in December, which was an increase from November when 110 were accepted. The highest number of referrals in Q3 was in October, when 147 were accepted. December was the eleventh consecutive month were more than 100 referrals were accepted. Referrals by Locality and Source • Wishaw: Accepted an average of 27 referrals per month in the past year, accounting for 22% of the total referrals. • Motherwell: Accepted an average of 22 referrals per month, accounting for 18% of the total referrals. • Cumbernauld: 21% of the total referrals. • Airdrie: 17% of the total referrals. • Bellshill: 9% of the total referrals and this has remained stable over time. • Coatbridge: 14% of total referrals and this has remained stable over time.
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11 Referral Sources • UH Wishaw: 1428 referrals (49%) • UH Monklands: 1379 referrals (48%) HAT Input and Output Services The average number of input services for HAT cases has increased over time. It is recorded that 14% of people completing the HAT process were re-admitted to hospital at the end of the process; this is a significant proportion of those completing HAT and further investigation is required to understand how best this cohort of people can be supported. For those people who were recorded as having completed the HAT process, 64% required no further service with 36% noted as having at least 1 service delivered.
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12 IRT Reablement 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 in the volume of referrals 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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14 The overall number of waits has decreased in-line with the decrease in referrals; the number of people waiting for IRT Reablement allocation is at the lowest level experienced in financial year 2024/25. Detailed activity information is available in the IRT dataset. The contact activity for IRT Reablement in February 2025 presented below shows that the most prevalent contact type is telephone call. Home Support Redesign Several products have been produced in support of the Home Support Redesign Programme. Service Specifications and a Workforce Profile have been produced, with Demand/Capacity data modelling also provided to support decision making and service design. The redesign is focussed on Home Support that achieves individual outcomes for people using the service and their families. The redesign is based on core principles that are aligned with B2B, SDS and developments in Hospital Flow. The proposal is for a “Living Well” service that provides Home Support to achieve individual outcomes for the people using the service and a distinct “Assessment & Planning” service, to include Rehabilitation and Reablement services, ensuring that people receive a holistic assessment of their need and are provided with the most appropriate services to meet the individual outcomes.
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15 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly Change and Improvement work within the Equipment & Adaptation Service is governed by the Equipment & Adaptation Service (EAS) Governance Board. This ensures coordinated planning and communication, particularly in relation to performance management. The “Lanarkshire Equipment Ordering Service” (ELMS2) is now live and has replaced the MICES system. Whilst the system is live and in active use, continuous improvements in the configuration and reporting are being made to facilitate improved management and performance information and easier integration of data with wider partnership systems. New performance indicators are in development that better reflect the four level priority system used in the service, however further work is required to facilitate reporting in this way. 6. Adult Mental Health Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 74.1% 72.3% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 30.5% 23.5% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 65.1% 61.9% RED Narrative & Corrective Action The RTT Performance remains below both the targeted level and the Scottish average.
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16 There is notable pressure within the Lanarkshire Weight Management Service (LWMS). A dedicated short-life working group has been commissioned to address waits for Psychological Services within the Weight Management Service. Work to target the longest waits is in progress, with additional temporary resource being provided by Psychological Services, however it should be noted that the LWMS service is not operationally managed within Psychological Services. The short-life working group ends at the end of March 2025. Adult Psychology teams are working to increase the provision of group work, which is having a positive effect on waiting lists within the service. The service continues to implement quality improvement projects focused on reducing longest waits. Recent analysis of waiting times data indicates significant progress has been made in relation to reducing the waiting list size; there has been a 18% reduction in the total numbers waiting over 18 weeks in the reporting period as compared with the previous quarter. A self-assessment of local implementation of the Scottish Government National Specification of Delivery of Psychological Therapies and Intervention has been completed and will be submitted, which crosses the delivery of Psychological Therapies across all ages. An associated improvement plan has been included, which will be completed for adult services in the first instance.
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17 The service continues to engage with the Enhanced Support provided by the Scottish Government, with detailed discussions having taken place to better understand the impact of reporting guidance in relation to the inclusion of CAMHS Psychological Therapies data. Recent discussions with SG have highlighted there are differences across Boards in relation to data included in RTT reporting. As such, comparisons against the national average should be treated with caution. The date for a second MDT Research conference in collaboration with University partners at University of Strathclyde has been set for October 3rd 2025.The conference theme is Research and Innovation, with the intention of raising the profile of such activity in NHS Lanarkshire Psychological Services and in addition, promoting employment and development opportunities within Lanarkshire. To further support recruitment and retention, the Psychological Services 3-year Training Plan 2025-2028 has been developed, with continued investment in building internal capacity for supervision and live training needs analysis. 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. The service is still actively recruiting to posts, however the current position requires staff to provide cover for the rota sessions. 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 consultants reduce community clinical activity in order to participate in a rota to cover consultant vacancy; the changing demographics of communities have also increased demand on the service, affecting the ability to reach targets. As capacity increases, it is hoped that a positive impact will be seen in the waiting times. 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 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.
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18 • 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. 7. SLT Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 15.3% 16.0% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 74.3% 74.4% RED Narrative & Corrective Action
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19 SLT - Adult - 12wks (NORTH HOSTED) For Q3, Adult SLT services have reported performance below the targeted level. This is due, in part, to the end of funding that the service was in receipt of for post-COVID recovery. No posts have been lost, as the service was unable to recruit to the number of posts matched to the additional funding that was provided. However, staffing for the Adult Acquired service has reduced by 7.4% between September 2023 and September 2024. The impact of the loss of posts has been compounded by an increase in the average number of referrals received per month, which have increased by 4%. The team has also experienced significant long-term sickness absence; the long-term absences are being managed and monitored appropriately, with additional assurance provided by monthly sickness absence meetings that are supported by colleagues from HR. All vacancies in the service are being progressed through the HSCP vacancy panel process. SLT - Paediatrics - 12wks (NORTH HOSTED) Despite a slight improvement in the performance for Q3, the long-term trend is for a decline in the level of performance, which remains significantly apart from the targeted level. The service continues with its modernisation programme; unfortunately, progress in recent months has been challenging due to the long-term absence of colleagues who had been progressing the work, which was in addition to their substantive role when the centrally provided Project Team support was removed. Capacity to progress this work is further challenged as the hours provided to support service improvement within SLT via the service improvement board are no longer available, as the colleague in question has moved on from that post. The General Manager and Professional Lead are actively working to release capacity within the budgetary envelope to provide support for the modernisation programme. The data generated by Trakcare reporting and analysis of that data will allow performance to be measured and reported in line with the national service model. The previous waiting times measure only reported waits for specialist assessments, however Trakcare will now allow a measure linked to Targeted Support (OPWL) and Specialist Assessment (PRL). This will mean that the service can evidence improvements in waiting times linked to targeted support (OPWL); the data collected manually in the service can now be validated by the reporting generated by Trakcare to ensure that the outcomes on the system reflect the clinical activity. There is also evidence to show the numbers of children and young people waiting for Specialist Assessment (PRL) is reducing and it is anticipated that in the next six months this will be reflected in a reduction in the longest waits for a specialist assessment, although this is dependent on maintaining the staffing position within the service. To deliver this, our Waiting List Team Coordinators are undertaking a cleanse of the Targeted and Specialist PRL; this will ensure that we recognise and better manage cases where universal work has been carried out with children and young people who are waiting for targeted and specialist input. The local data that is available suggests that the service is in contact with all universal referrals within 2 weeks, however at this time, this is not reflected on Trakcare and dependent on a manual count. The current planned actions are: - • Amalgamation of waiting lists – In progress • Work on the targeted and specialist lists in order that the service can be assured that all CYP waiting on have been provided with a universal contact appointment and that this is reflected in Trakcare to facilitate better reporting against the target for 90% of patients to be seen within 2 weeks of referral – In progress, however further improvement activity will follow, informed by the findings of the initial work • Work involving the North and South senior leads with locality colleagues in order to be assured that robust job plans are in place for all practitioners – This work is planned and currently being developed
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20 • Additional Hours offered to all staff for the specific purpose of addressing and appropriately recording universal waits, to assist in better management of the longest waits for CYP whilst they await specialist support; this will create additional capacity to release flow of patients through the service – In progress • Development of three trajectories for each of the waiting lists, showing them individually and providing better management information (the focus of 12 week RTT is the universal appointment pathway). This will provide additional clarity for the senior leadership team and better demonstrate how the service will achieve the targeted level of performance and how this is reflected in Job Plans and the overall capacity model for the service – In Progress. • SLT included in the monthly performance meeting within Childrens Services unit – Ongoing • Focussed work by the General Manager and Professional Lead with colleagues on delivery of the RTT, including weekly management of the longest waits on PRL that negatively impact RTT – Ongoing All SLT funding attributed to support for children and young people is not provided by NHSL. A significant contribution is made by both local authorities and each have an aligned historical SLA. This reduces the flexibility and agility of the team response as, for example, the SLA’s do not reflect the current Terms and Conditions of staff who are aligned to these posts. In effect this means that NHSL are providing the same number of sessions to schools originally agreed many years ago, however the cost to the service is greatly increased due to: - • The reduced working week • Nationally agreed pay rises • The protected learning time required for the staff in question • Carers/Special leave arrangements that were not considered at the time the SLA was agreed • NHS staff are not employed on a term time basis and there is an associated inefficiency Schools only recognise targeted and specialist work, therefore no time is formally allocated from these contracts to the universal pathway, which affects the RTT. The SLA have been reviewed by NHSL and plans are in place to meet with both educational partners to see if some other arrangements can be made. Recruitment and retention of staff remains a challenge for the service; the vacancy rate in December 2024 was 13%/16.87 WTE. At the time of writing, there are establishment vacancies currently advertised and it is hoped that a positive response will be received. Recruitment and retention will continue to be a focus of service improvement work and will include engagement with our network of higher education and academic partners. 8. Dietetics Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 62.3% 65.5% RED Narrative & Corrective Action An initial analysis of data held by the service has highlighted a significant volume of cases that have not been closed correctly. As a result, there is likely to be some level of error in the metric as reported. The management team are looking at how admin staff are deployed and whether a more efficient use of this resource could facilitate a
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21 data cleansing exercise and improve process to prevent a recurrence. Additional hours have been authorised in short-term to cleanse the data, however in the longer term, it is acknowledged that additional work is required to improve the process. A number of areas are planned for improvement activity, including a focussed project with Domiciliary teams to ensure that appropriate levels and durations of support are being provided for patients and regularly reviewed as to the level of support provided. In addition, work to understand how digital solutions, particularly the use of Near Me, might be leveraged for improvement. As with many services, recruitment and retention is challenging. As it is a small service, configured in multiple specialisms, the loss of one member of staff results in a loss of a specialism entirely. The national position is similarly challenging; some Dietetics undergraduate programmes are at risk of deletion. Initial discussions with our academic partners are planned to fully understand the wider context for Dietetics, however in the short-term, the role and concept of a generic dietician and how the service model might accommodate a more generalised approach is a focus of the improvement work. 9. Complaints Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days(NHSL) 100% 21% 15% RED Narrative & Corrective Action It is likely that current clinical pressures and the reduced availability of clinical staff to address complaints has impacted on the ability to resolve them within the targeted timescales. The transition to the InPhase system has continued to present challenges, particularly in the development and validation of its reporting function. There is ongoing work to develop the internal reporting for complaints to identify where process improvements might be found. The direction from NHS Lanarkshire is for a focus on learning, improvement and a person-centred approach to complaint handling. This supports a listening and learning culture for both complainants and staff, in order to achieve a high quality response to complaints, whilst also maximising delivery of the time-based performance indicators. NHSL continue to encourage resolution of complaints at Stage 1, promoting a resolution-based approach for the benefit of complainant, organisation and staff involved, thus avoiding a lengthy and potentially protracted Stage 2 investigation wherever possible. A specific approach to identifying whether Stage 2 delays are justified/legitimate, or system related has been developed to provide additional context for the level of performance. This aligns with the recent Scottish Public Services Ombudsman (SPSO) consultation on complaint handling principles that states the “quality and thoroughness of investigation should not be compromised by attempts to meet timescales”. To support the learning from complaints, the partnership monitors the output from Care Opinion; in December 2024, 69% of stories recorded were positive. 62% of all stories received a response.
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22 10. Care Homes Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Care Home - Average Length of Stay 865 789 966 RED Narrative & Corrective Action North Lanarkshire HSCP is committed to ensuring that people receive timely and effective care that enables them to live in a home, or homely setting. Associated with this commitment, is a clear target for the length of stay that people have in Care Homes, with the aim to keep the length of stay in such settings as short as possible and for only those people for whom other options are not appropriate. Significant work has taken place as part of the Back 2 Basics and TOM to ensure appropriate assessment for people; this has involved significant levels of engagement with both Acute and Locality colleagues to improve the quality and timeliness of information gathered and recorded to facilitate an assessment of need and make informed decisions for people who may require more intensive support. The North Lanarkshire Strategy for Preventing and Managing Frailty (2024 – 2029) outlines several initiatives aimed at addressing the wider challenge in North Lanarkshire. Frailty affects a significant portion of our elderly population, particularly those in care homes. Our vision is to support every older person in Lanarkshire with, or at risk of, frailty to be healthier, remain independent for longer, and live their best lives. We have implemented a range of measures to enhance support in care homes, including the establishment of a Care Home Assurance Team and expanding the number of Care Home Liaison nurses. The Care Home Assurance Team is intended to evolve to a wider supporting team, reflecting a shift from inspection to a model of assurance based on appreciative inquiry and clinical support. The appointment of a Practice Development Educator for care homes to deliver an initial six-month education programme for care home staff will further enhance the quality of care provided. A multi-disciplinary approach is being encouraged, with a model for Frailty MDT meetings in care homes piloted and further developed. This pilot project will inform the expansion of the Care Home MDT model, with the aim to expand to 24 care homes across North Lanarkshire. Additional AHP support, including care home pharmacist sessions to review and optimise polypharmacy, reducing the use of medicines associated with falls and harm, are being introduced with the aim of moving toward the recruitment of dedicated care home pharmacists providing a realistic medicine approach for all new residents While we have made significant strides in enhancing care home support, we acknowledge that more work is needed to meet our target for reducing the length of stay. Our ongoing and future initiatives are designed to address this challenge, ensuring that residents receive the highest quality of care and support to return to their homes or community settings as swiftly as possible. 11. Smoking Cessation Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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23 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 55 Quarterly/ 2 quarters behind ... ... RED Narrative & Corrective Action Whilst the wider Health Improvement team widely promote the Quit Your Way (QYW) services, dedicated work is planned for Smoking Cessation workers to link directly with Locality Health Improvement Team Leads to understand if better engagement and communication can be facilitated through Community Boards and alignment with existing LOIP. A number of priority groups exist and SIMD is a proxy for these in the context of this indicator, which is for all quits. The performance for the metric is below target and the current trajectory suggests that long-term targets, including the 2034 target, will not be met. Service redesign has been planned and delivered within the service, including the development of pathways; it is intended that improvements can be realised in the next financial year. However, it should be noted that the level of referrals to the service from localities is particularly low. Additional research and engagement is requirement with locality colleagues to understand historic and current referral patterns and how improvements can be made. It is acknowledged that the impact and legacy of C19, combined with system pressures has reduced the volume of referrals from GP and District Nurses, and it is likely that this is more widespread. However, information and access for the public has improved greatly, particularly digital solutions and use of social media as a communication method. A development session is planned in the North East Sector, facilitated by QYW services alongside colleagues promoting wider screening initiatives. Both this particular performance indicator and smoking cessation more generally will be an area of focus for locality/sector performance reviews following Q4. 12. Sickness Absence Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 6.63% 8.10% RED Sickness Absence (NLC) - days lost per person 9.22 6.34 9.52 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. 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. Attendance Management Reviews are taking place as required and local General Managers are complying with the requirements of the policy. 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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24 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