06 - 2025-08-27 IJB PFA - IJB Performance Update – 01st Jan 2025 to 31st Mar 2025, Q4 202425
North Lanarkshire Council · 27 August 2025
Back to IJB Performance, Finance and Audit Committee — 27 August 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 Item No: 6 SUBJECT: Performance Update – 01st January 2025 to 31st March 2025, Quarter 4 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: 27 August 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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2 3. RECOMMENDATIONS It is recommended that the IJB/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 January 2025 to 31st March 2025, Quarter 4 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 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 583 501 RED Alcohol Brief Interventions (all settings) NHSL 7381 1751 1470 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 provide ABI training to locality staff to ensure there is capacity across all teams that contribute to the target. Health Improvement also contribute to wider work supporting the reduction of alcohol misuse in North Lanarkshire. A short life working group has been established to consider the specific needs of older adults in relation to alcohol use; what support is currently in place, to identify any gaps in provision, as well as promoting the services that are available to them. A similar short-life working group has also been established to examine multi-risk-taking behaviours among young people, focusing on the support currently available to them and identifying any gaps in existing services. Additional work is being planned with parents, including consultations through focus groups, to explore their needs and how best to support them in effectively engaging with their children and young people around issues such as alcohol and other harmful substances. 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 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 70.0% 69.6% RED Narrative & Corrective Action
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7 The overall trend is for a slow and gradual decrease in the level of performance and it has been several years since the targeted level of performance was achieved. Location Quarter 1 (Apr–Jun) Quarter 2 (Jul–Sep) Quarter 3 (Oct–Dec) Quarter 4 (Jan–Mar) Target Airdrie 67.8% 68.1% 67.2% 66.5% 80.0% Bellshill 69.5% 69.7% 68.9% 68.8% 80.0% Coatbridge 69.6% 68.9% 68.0% 67.7% 80.0% Motherwell 71.4% 71.6% 70.4% 69.8% 80.0% North 74.9% 74.6% 73.6% 73.2% 80.0% Wishaw 70.2% 70.0% 68.9% 68.8% 80.0%
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8 Wider screening work is directed and monitored by the Inequalities in Screening Steering Group, which is considering a number of contributory factors to the level of performance, with access to appointments a key issue identified as impacting on screening attendance. Training, engagement with the wider organisation and leveraging wider patient contact as a means to engage regarding screening, are other key areas of interest for the steering group to develop improvement plans. Health Improvement (HI), Place-based Activity Jan – Mar 2025 Cervical Cancer Prevention features in all HI newsletters and social media across North Lanarkshire. These communications are distributed across our statutory, third sector and healthcare partnerships. Cervical Cancer Prevention Week - January 2025 Cervical Screening Pop up in ASDA – Coatbridge Locality This awareness session was attended by in excess of 50 women aged 25-64. Outcomes: Increased awareness of and reduced barriers to cervical screening (signs and symptoms) through direct engagement and information sharing with 50 customers and staff, who were within the 25-64 age range. Undertook brief intervention with those women identified from the direct engagement that had not attended their cervical screening appointment. Cervical screening information provided to be displayed and distributed in the ASDA store staff rest areas. Offered training opportunities for staff to raise awareness of cervical screening. Whilst community engagement and awareness activity is strategic and targeted at the widest audience possible it is important for the service to see the impact of their work, which is being captured through Personal Stories, with a notable example from this exercise below: “We spoke to one lady, in her 40s, who had 10 years previously received treatment for high grade CIN changes & she then went on to have children but was now too scared to attend her screening invites. We spent time with her, listening to her fears and provided her with an information leaflet for her to take home – she said she really would read this at home in her own time and we hoped that this would ‘plant a seed’ and encourage her to make a screening appointment in the future”. A similar Pop-up event was held in the atrium of Houldsworth Centre, Wishaw with a stall in place to raise awareness of the importance of cervical cancer screening. Health Improvement staff and Practice Nurses were available and spoke with in-excess of 50 women. A physical display was available for women to see equipment such as speculums, cyto-brushes and sample pots, along with a video clip giving information on HPV, with the aim of reducing fear of cervical screening and increasing awareness and understanding of the screening process. Training Opportunities
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9 Health Improvement Teams across North Lanarkshire continue to offer Screening and Inequalities training to all Health and Social Care staff and Community Voluntary Sector partners. The training available is advertised on the Health Improvement Training Calendar, which can be accessed using the QR code, below. Scan the below QR code to access our Health Improvement Training Calendar. Cervical Screening awareness in Early Years Establishments Cervical Screening leaflets were provided to Dunbeth Family Learning Centre, with the leaflets prominently on display in both the reception and the staff room, with posters on display in the staff room for increased visibility. Staff were briefed on the content and provided with information, with the view that this information and knowledge could be cascaded to users of the centre and raise awareness of Cervical Screening. There are plans to extend this to other early years settings in the future. Similar information was shared with the Young Parents Group in Cumbernauld and Routine Enquiry will continue with this group on cervical screening, as well as other health and wellbeing topics. Routine Enquiry – Brief Interventions The Treatment Room in Wishaw Locality continue to deliver cancer screening conversations as Routine Enquiry. From January to March 2025, Treatment Room staff undertook 215 cancer screening conversations, with 69 of those specifically focussed on Cervical Screening. Cervical Screening Awareness is a Wishaw Locality Planning Group (LPG) Priority Cervical Screening Awareness will be the focus of the Wishaw LPG as part of their work to address Poverty and Inequalities. A Cervical Screening Awareness sub-group, led by Health Improvement colleagues, has been formed and an Action Plan is currently in development to provide structure for this work. Clarification of performance reporting from multiple Cervical Screening Data Recording Systems Recent scrutiny of Cervical Screening performance has highlighted a need to increase awareness and understanding of the two separate data recording systems for Cervical Screening. Possible misunderstanding, or lack of knowledge and awareness of how the data recording systems are managed may be a systemic contributor to performance levels and requires further consideration. The discrepancies between the two systems in use (Scottish Cervical Call Recall Service (SCCRS) / GP recording system and the Public Health Morse data) have been escalated to the Public Health Consultant for Screening, who has agreed to raise the issue at a national level. The Scottish Cervical Call Recall Service (SCCRS) /GP recording system rules state that, after sending three invitations and recording 3 DNA, the practice is paid (so as not to cause disadvantage to them), meaning these women are considered as ‘screened’ and so removed as defaulters from that system. However, the Public Health/Milan
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10 system does not remove defaulters from their denominator. This results in the data held by GP practices reporting a higher percentage of women screened than the reporting derived from the Public Health data, which does not discount defaulters from the calculation. It is hoped that raising this issue nationally will highlight the need for improved recording and reporting of Cervical Screening uptake and potentially influence our national partners to expedite improvements at that level. 3. Childhood Immunisations Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 89.0% 88.7% RED Narrative & Corrective Action The long-term trend for the 5-year old immunisations metric is for a sustained decline in the level of performance over several years; the last time that the targeted level of performance was achieved was in Q1 of 2021/22. Whilst the result for the 2-year old immunisations metric is below target for Q4, historically the target has been achieved and there is evidence of sustained performance at the targeted level in the recent past. It should be noted that families who actively decline their children to be vaccinated, as well as children who no longer live in Lanarkshire (or in some cases no longer reside in the UK) but remain on GP lists, are still included within the denominator, which impacts on the performance figure. 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. All efforts are made with families who actively decline their children to be vaccinated, however repeat unwanted contact with those families where the position has been clarified as declining vaccination, is minimised. Staff nurses continue to offer immunisations within the clinic and at 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. The NW Sector also utilise cross-cover arrangements, with a sector approach to manage and maximise capacity within those three localities. 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.
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11 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% 83.4% ... RED Narrative & Corrective Action Please note that this performance measure is reported two quarters in arrears. 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. 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 is introduced, as the approach to this is not standard across teams.
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12 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 Q3 2024/25 Q4 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) 1387 1788 ... RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 56.5% 63.0% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 63.6% 62.5% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 60.1% 73.4% RED Narrative & Corrective Action 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 Home Support packages that are Reablement is relatively stable in a range, 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 The most recent HAT reporting covers a period beyond Q4 2024/25 and extends to May 2025. This reporting notes that since the beginning of the service, 3,496 referrals were accepted by HAT. Since the start of the service, referrals that were not accepted grew in volume up until May 2024, however this trend then reversed, with very few
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13 referrals not accepted (21 in March 2025 and 12 in April). Over the last year, 369 referrals were not accepted; 66% of referrals that were not accepted over the past year were from UH Wishaw. May 2025 was the thirteenth consecutive month where the volume of referrals exceeded 100. The average number of total monthly referrals over the past year was 127. The monthly referral distribution across the localities has been relatively stable over the past year: • Wishaw: 350 (21%) • Cumbernauld: 327 (20%) • Airdrie: 294 (18%) • Motherwell: 261 (16%) • Coatbridge: 226 (14%) • Bellshill: 181 (11%) Referral Sources There is very little difference in percentage terms from previous reporting regarding the HAT referrals by hospital of origin. However, it is notable this is the first reporting period where UH Monklands has overtaken UH Wishaw and it has now accepted 85 more referrals than UHW since the start of HAT.
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14 • UH Monklands: 1,731 – 50% • UH Wishaw: 1,646 – 47% • Other: 119 – 3% (includes older referrals with no source recorded) HAT Inputs The average number of input services for HAT cases has increased over time. The data on input services continues to reflect the expanding scope and complexity of support provided by HAT. Of the total referrals, only 1% (41 individuals) had no input services recorded, likely representing older cases, while 53% received one or two services. Notably, the proportion of individuals receiving three or more services has risen slightly and the average number of input services per referral has gradually increased; assuming that input services is a proxy of the intensity of support needs among service users, this may be an early indication that the HAT service is dealing with more complexity over time. Home Support remains the most frequently provided input service, involved in 87% of referrals, which is consistent with previous reporting. The volume of referrals where Occupational Therapy and Physiotherapy are input services has grown. HAT Outputs Around 96% of all referrals, or 3,349 individuals have completed the HAT service since its inception. Of those who completed the process, 14% (466 people) were re- admitted to hospital and 37% (1,238 individuals) were identified as needing further services; these proportions appear to be consistent over time.
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15 At the point of completion, 63% of individuals required no further support, while 37% were recorded as needing at least one service. Of those, the majority (73%) required only one service, with the remainder needing two or more. The most frequently provided services were IRT (Physiotherapy) and Reablement, each accounting for 14% of completions, followed by IRT (Occupational Therapy) and mainstream Home Support each accounting for 10%. 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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16 The overall number of waits has decreased in-line with the decrease in referrals; the number of people waiting for IRT Reablement allocation in Q4 was the lowest level experienced in financial year 2024/25. 35 30 36 27 15 25 11 13 9 8 14 4 13 0 5 10 15 20 25 30 35 40 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 No. of referrals - May-24 to May-25
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17 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. 15 12 18 13 6 13 5 5 6 8 5 3 6 0 2 4 6 8 10 12 14 16 18 20 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 No. waiting on allocation on last day of month - May-24 to May-25
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18 HOME SUPPORT REDESIGN The Home Support Redesign Programme 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. It is supported by several products that have been produced to progress the work, including service specifications, a workforce profile and an analysis of demand/capacity data. 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. 6. Adult Mental Health Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 72.3% 75.0% RED 0 10 20 30 40 50 60 aaNew Visit aaTelephone Assessment aClosing Summary Duty Repeat Visit Screening Telephone Calls zDiscussed with OT/PT zDiscussed with Senior/Team Leader zEmails Contact activity by contact type - Mar 2025 Airdrie Bellshill Coatbridge Cumbernauld Motherwell
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19 Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 23.5% 21.8% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 61.9% 66.2% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) Although the targeted level of performance has not been met for some time, there were improvements in the monthly and quarterly results for this indicator. The current performance is consistent with the DCAQ modelling produced by the PHS Analyst; the current modelling suggests that the RTT position will be within a range of between 70% and 80%, based on the overall position for the service. The total number of patients waiting over 18 weeks has decreased significantly; over the last 12 months the number of patients waiting over 18 weeks has decreased by 29.8%. The total queue is less that the anticipated trajectory, indicating that there has been sustained progress in reducing the waiting list, which is at the lowest level experienced since October 2022; there is a 22.9% reduction at end of March 2025 when compared with March 2024.
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20 The referral criteria for Neuropsychology changed in November 2023. Our analysis shows that referrals have increased by 64.3% since this change. Modelling conducted within the service indicates that, if current trends continue, the volume of referrals will result in the waiting list reaching 175.1% of its current size by November 2026. To meet the RTT (Referral to Treatment Time) target under these conditions, an additional 4.25 WTE (Whole Time Equivalent) clinician capacity would be required. An SBAR detailing potential options and the management of risk in this area has been escalated through governance structures. The waiting list reduction initiative, led by Psychological Services to reduce the longest waits within the Lanarkshire Weight Management Service (LWMS), is now complete. During the three-month period of this initiative, the waiting list for LWMS has reduced from 68 to 7. With the exception of one outlier, at the end of March 2024 all patients waiting were within the 18 week RTT. Close monitoring of waiting times within this service will continue beyond the initiative to ensure that there is a sustained improvement. As part of ongoing work relating to the Implementation of the National Specification of Delivery of Psychological Therapies and Interventions, Psychological Services have now completed a Self-Assessment against the PT Specification. Actions resulting from this will be incorporated within service work plans. The Addiction Psychology Service (APS) continues to take a lead role in supporting the implementation of Medication Assisted Treatment (MAT) standards 6 & 10. The 2024/2025 reporting for MAT standards has recently been submitted, including an overarching plan for the delivery of ‘Psychologically and Trauma Informed Care’ across addiction services. The Addiction Psychology Service lead on workforce development in relation to psychologically and trauma informed care for all staff, including those who working within both statutory and third sector addiction services in Lanarkshire. As requested by Scottish Government (SG), whole-service aggregate level trajectories against the PT waiting times standards were produced up to the end of March 2026 and recently submitted to the SG. The embedded PHS analyst is now analysing those updated trajectories using the most recent data, starting from January 2025 and as more data is available, these trajectories will be updated accordingly. In the longer-term, to support staff development, recruitment and retention, a second MDT Research conference in collaboration with University partners, which is to be held at Strathclyde University with the theme of: Research and Innovation really matters: The next generation is currently being developed, to be held on 3rd October 2025. In addition, a Psychological Services 3-year Training Plan 2025-2028 is in development. 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.
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21 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. • 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.
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22 • 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. Medical Paediatrics Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 87.9% 80.3% RED Narrative & Corrective Action Due to significant levels of acuity within the acute wards, there was a redirection of clinical capacity to support acute colleagues. In addition to this, the service experienced short term sickness absence within the group of Consultants. This was experienced in quarters three and four, however the position was improved toward the end of March, with some recovery expected in subsequent quarters. These factors led to slight decreases in capacity and cumulatively are likely to be responsible for the negative impact on performance in quarter four. The majority of children and young people on the waiting list are being seen within 4 weeks and there is continued and detailed monitoring of the waiting list by the Unit Performance Meeting. Preliminary analysis indicates that the impact has been more pronounced in certain sub-specialties within Medical Paediatrics, particularly in the Allergy specialty, which has seen a notable increase in waiting list numbers. At the time of writing, there are live adverts and interviews planned for additional Consultant staff; once recruited to, these posts will provide resilience and capacity, with an associated increase in RTT performance expected. 8. SLT Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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23 SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 16.0% 17.6% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 74.4% 79.2% RED Narrative & Corrective Action SLT - Adult - 12wks (NORTH HOSTED) Performance for Q4 improved slightly from the previous quarter (rising to 79.2%) but remains below the 90% target and significantly lower than the same quarter in the previous year. As previously reported, the end of post-COVID recovery funding continues to have an impact. Although no posts were lost, due to recruitment challenges overall staffing levels in the Adult Acquired service remain reduced by 7.4% compared to the previous year. The service continues to experience long-term sickness absence, further constraining capacity. However, these cases are being managed through ongoing HR-supported absence management processes, with monthly oversight from the management team. Despite these pressures, referral demand remains elevated, with a 4% rise in monthly referrals and high levels of referral demand sustained for several quarters. Recruitment efforts are progressing, with a focus on restoring lost capacity. Opportunities for longer-term system improvement, such as the administrative skills matrix and digital system alignment (notably Trakcare), are being actively explored, in line with broader SLT transformation work. SLT - Paediatrics - 12wks (NORTH HOSTED) Performance for Q4 has shown a modest improvement from Q3 (rising to 17.6%), though it remains significantly below the 90% target and lower than the same quarter in the previous year. The long-standing performance challenges reflect ongoing capacity constraints and structural workforce issues. As a result, the service will deliver a modernisation programme to deliver sustainable change. The SLT CYP Service Improvement Programme is now well established, with multiple work streams in place to address equity, efficiency, and quality of care. A key milestone was the Trakcare system go-live in September 2024, which has enabled more robust reporting across the universal, targeted, and specialist pathways. This has allowed better tracking of activity, particularly universal contact, which was previously underrepresented in reporting. Modernisation efforts are supported by several dedicated sub-groups: • Digital – developing e-referral processes, improved clinical documentation, and text-based communication with families to reduce DNAs and improve access. • Waiting List – reviewing and amalgamating lists, standardising pathways, and ensuring that children and young people (CYP) receive universal input while waiting for targeted or specialist input. • Workforce & HR – aligning job plans and skill mix, supporting a confident, skilled workforce through structured learning plans. • Administration – this work stream has completed a skills matrix and implemented targeted training, with Admin now integrated into the other improvement groups. • Communication – supporting the production of a Communication and Engagement Strategy and Equalities Impact Assessment to underpin change. These efforts are designed to release clinical capacity, strengthen data quality, and ensure a consistent, evidence-based approach to care delivery. Importantly, the revised model reflects a broader ambition to reconfigure teams across North and South Lanarkshire, reduce variation, and improve the responsiveness of the service.
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24 Recruitment and retention remain critical to delivery, with a 13% vacancy rate recorded in December 2024, though further recruitment is underway. The service is also preparing trajectory-based forecasts for each tier of intervention to support planning and demonstrate progress toward the 90% target. 9. Dietetics Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 65.5% 62.5% RED Narrative & Corrective Action Performance remains significantly below target, with 62.5% of patients seen within 12 weeks. A structured improvement programme is now underway. This includes a recent waiting list validation exercise targeting 100 long-wait patients, achieving a 90% removal rate from the waiting list. A rolling three-monthly validation process will be put in place to ensure more effective management of the waiting list. Inaccuracies within TrakCare, where patients had been seen but not removed, are being addressed. Some waiting list co-ordination practices, which were historically in place but had lapsed, are also being reinstated. SOPs are being developed to support more consistent processes, with staff training planned to support the implementation of these changes. To increase capacity, the service introduced a Waiting List Initiative that delivers an additional 12 adult clinic appointments and 8 domiciliary telephone consultations each week, alongside an expanded paediatric provision. In parallel, the service is progressing a broader transformation agenda. This includes modernising systems and processes, streamlining referral pathways, and embedding new ways of working that support more sustainable service delivery. Digital tools are being explored to improve patient flow and support flexible consultation formats, with Near Me and other virtual options under consideration. An interim target of 70% of patients seen within 12 weeks has been set for June 2025, with gradual recovery anticipated as improvement actions take effect. Workforce resilience remains a risk, with the service’s highly specialised configuration continuing to be vulnerable to staff turnover. Work is ongoing to explore how a more generalist model of dietetic provision could support longer-term sustainability. 10. Complaints Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days (NHSL) 50% 13% 38% RED
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25 Complaints Processed Within Timescale (NLC) 85% 90.3% (Stage 1) 71.4% (Stage 2) 60.0% (Stage 1) 76.9% (Stage 2) RED Narrative & Corrective Action The performance targets for processing complaints has been changed for both Stage 1 and Stage 2 complaints. The timescales for response remain the same, however the percentage compliance target with those response times has changed for both metrics. These reset targets reflect the national position, recognising that across Scotland, NHS Boards are consistently failing to meet the targeted level of performance. NHS Scotland complaints performance data for 2023-2024 was published in January 2025. The national average for this performance metric in 2023-2024 was for 41% of Stage 2 complaints to be closed within 20 days. The target was reviewed by the Executive Director Group in April 2025. The reset targets will now be consistent across all Lanarkshire performance reporting, including the IPQR and monthly complaints reporting. Stage 1 • Retain 65% (or more) complaints to be closed as a Stage 1. Stage 2 • 50% Stage 2 complaints responded to within 20 working days • 70% Stage 2 complaints responded to within 30 working days • 85% Stage 2 complaints responded to within 40 working days The performance will be closely monitored and revised stretch targets introduced, as appropriate. For Q4 in North Lanarkshire, 38% (18/48) of Stage 2 North Lanarkshire complaints were closed within 20 days: • 33% (6/18) MH&LD • 33% (1/3) Adult Services • 22% (2/9) Specialist Children’s Services • 53% (9/17) Prison • 0% (0/1) Primary Care For Stage 2 complaints, the average response time was 38 days • 46 days – MH&LD • 45 days – Adult Services
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26 • 35 days – Specialist Children’s Services • 29 days – Prison • 47 days – Primary Care At the time of writing, ten Stage 2 complaints remain open in North Lanarkshire. The longest wait for resolution is 37 days, which is a complex case awaiting final review and signature. As performance in this area is described by a percentage compliance metric, the performance can be significantly affected by a relatively small number of non-compliant and complex cases. As a balancing measure, University Health and Social Care North Lanarkshire had a total of 49 stories published on Care Opinion during February 2025; 90% of those were positive of their experience. A number of actions are in place to improve complaints performance. Within Patient Affairs, a recruitment process is underway to recruit additional resource to support the central processing of complaints. Within the partnership, the Senior Management Team continue to promote the early resolution of complaints at Stage 1 and any Stage 2 delays are monitored, with any escalation triggered as required. All NLC complaints are collated via one centralised, customer service portal, logged centrally and monitored through the relevant NLC governance process. A detailed dashboard provides live management and performance information. As the cost of a licence for the system increased substantially from April 2023, the number of licences allocated to SW services has been reduced and consequently, only members of management support and complaint administrators have been granted a licence. The rationalisation of licence permissions ensures confidentiality for social work complaints. Within Adult SW Services, in-house monitoring by the Quality Assurance team has been introduced to support improvements in managing complaints. 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 Sustain and embed successful smoking quits, at 12- weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 55 110 ... RED Narrative & Corrective Action Please note that this performance measure is reported two quarters in arrears.
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27 The table below presents the Q1-2 data for North localities (April to September 2024/2025), for the number of successful 12-week quits and the targeted level of performance for those localities. There is a 6-month time lag for the data, per the reporting schedule. Locality Number of Quit Date Set (QDS) Number of 12 week quits 6 month target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 86 10 45.5 -35.5 22% 12% 23% Bellshill 93 14 31.5 -17.5 44% 15% 23% Coatbridge 111 12 45.5 -33.5 26% 11% 23% Motherwell 67 14 40.5 -26.5 35% 21% 23% North 82 28 37.5 -9.5 75% 34% 23% Wishaw 86 14 41.0 -27.0 34% 16% 23% Based on the most recent data, NHS Lanarkshire as a whole is projected to achieve 48% of the Local Delivery Plan (LDP) target set by Scottish Government (431 of 902 successful 12 week quits). QYW Stop Smoking Service During Q4 there has been a significant reduction in staff capacity due to high levels of both short and long-term sickness absence. Both the number of referrals into the QYW service and the number of those who then go on to set a quit date remain low. North Lanarkshire localities have seen a 35% drop in referrals for Q4; in 2023/24 the number of referrals was 164, however this has dropped to 106 in 2024/25. QYW Community Pharmacy Service Data analysis has highlighted discrepancies in both the completeness and accuracy of data entered into the Patient Care Record (PCR) community pharmacy system. Key Actions for Q1 of 2025/2026 QYW Stop Smoking Service • The Lanarkshire Tobacco and Vaping Programme Plan (2024-2026) will be implemented from 1st April 2025. Tobacco and Vaping Action Plans will be developed to support the Lanarkshire Tobacco and Vaping Programme Plan (2024-2026). Priority areas include: Pregnancy, Secondary Care, Mental Health and the 40% most deprived SIMD data zones (community). • Implementation of the QYW service redesign commenced on 13th January 2025 and is expected to be completed by 1st April 2025.
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28 • From 1st April 2025 all colleagues working in service delivery positions will adhere to 80/20 hybrid working pattern; this supports a balance between the requirements of service delivery and flexibility for staff. This approach will enable the QYW service to effectively address the volume of demand, given Lanarkshire’s significant percentage of people who smoke, with a particular focus on priority clients, as recommended in the Scottish Government Tobacco and Vaping Framework: Roadmap to 2034. • A protocol for non-clinical staff to provide behavioural support and supply Nicotine Replacement Therapy (NRT) to clients, will be implemented by QYW staff who have attended the National Centre for Smoking Cessation and Training (NCSCT) training and have also completed the mentoring programme. This will increase capacity to support people who are motivated to stop smoking. • Increased visibility of Health Improvement staff across the three secondary care sites to promote the Quit Your Way (QYW) service. This includes assessing and providing behavioral support to patients prior to and then following discharge. The team will also work in partnership with the Lung Cancer Specialist Practitioners in both University Hospital Monklands and University Hospital Wishaw, to ensure that patients who smoke and have been diagnosed with lung cancer will be offered direct support to stop smoking. • NHS Lanarkshire staff who smoke will be given the opportunity to access a Smoke-free mobile App for behavioral support and will receive a supply of NRT from the QYW service, should they wish to participate. Encouraging NHS Lanarkshire staff to stop smoking not only improves their personal health but also sets a positive example and as a result, it is believed that staff may be more likely to promote smoking cessation to their patients. • A meeting with HSCP colleagues took place on 17th April 2025 to discuss opportunities to increase referrals to the Quit Your Way service from Allied Health Professionals working in North Lanarkshire. QYW Community Pharmacy Service • In Q1, the QYW Pharmacy Support Team will carry out support visits to community pharmacies across Lanarkshire to improve data recording and service performance across the QYW Community Pharmacy Service. Visits will be prioritised for those community pharmacies where our data analysis has highlighted that performance could be improved. A procurement process will be undertaken to commission an external, independent organisation to carry out an in-depth analysis of current practice in community pharmacies delivering QYW services. 12. Sickness Absence Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 8.10% Not available RED Sickness Absence (NLC) - days lost per person 9.22 9.52 12.92 RED Narrative & Corrective Action
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29 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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30 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