Agenda Pack
North Lanarkshire Council · 31 August 2022
Back to IJB Performance, Finance and Audit Committee — 31 August 2022 and its agenda
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A meeting of the Performance Finance & Audit Committee will be held on Wednesday 31st August 2022 at 2.00pm via Microsoft Teams If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. AGENDA CHAIR: Brian Moore No Time Item Action Attachment Reporting 1. Welcome and Apologies: B Moore 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes Performance, Finance & Audit Committee 16.2.22 For Approval Attachment B Moore 4. Matters Arising - Action Log For Approval Attachment R McGuffie GOVERNANCE 5. P,F & A Risk Register For noting Attachment R McGuffie 6. IJB Self-Assessment Report For noting Attachment R McGuffie FINANCE & AUDIT 7. Financial Monitoring Report For Noting Attachment N Lynch PERFORMANCE 8. Quarter 4 Performance Report For Noting Attachment G Cowan 9. Whole System Performance Framework for North Lanarkshire For Noting/Approval Attachment G Cowan 10. Covid Update For Noting Attachment R McGuffie
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11. First Point Of Contact (Evaluation of Learning) For Noting Attachment G Cowan 12. Strategic Commissioning Plan – Progress Report on Programme Of Work For noting Attachment G Cowan 13. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls B Moore 14. Date of Next Meeting: Wednesday 16th November 2022 at 2pm
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ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 16th February 2022 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Non Exec Director Neil Findlay NHS Lanarkshire Non Exec Director Councillor Paul Kelly (Chair) North Lanarkshire Council Nominated Councillor Councillor Jorden Linden North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Dr Avril Osborne (Vice Chair) NHS Lanarkshire Nominated Non Exec Director Councillor Sandy Watson North Lanarkshire Council Nominated Councillor Non-Voting Members in Attendance Professional Advisors: Ross McGuffie Chief Officer, North Lanarkshire HSCP Marie Moy Section 95 Finance Officer Stakeholders: Maddy Halliday Chief Exec, VANL Third Sector Rep Cathy McGinty Unison Staff Side Rep (NHSL) Harry Robertson North Lanarkshire Carer Together Elizabeth Seaton Partnership for Changer User Rep In Attendance: Stacey Connor (Minutes) Minute Secretary Morag Dendy Head of Planning, Performance & Quality Mark Dell Communications Manager Brian Howarth Audit Director Christine Jack IJB Board Secretary Trudi Marshall Nurse Director Thomas Moan Partnership for Change Development Worker Apologies: Councillor Jim Logue North Lanarkshire Council Nominated Councillor ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above.
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2. Declaration of Interests There were no declarations of interest raised. 3. Minutes 9th November 2021 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Christine Jack shared an updated action log to reflect the progression of work since the last committee. Updates were as listed below: Item 5(First Point of Contact)- Deferred to August PFA as evaluation on learning not yet complete due to delayed start in October 2021. Item 6(Integration Review)- The proposal to create an additional finance officer post has been approved at the South IJB after it was approved at the North IJB; HR process is now taking place. 5. PF & A Risk Register Christine Jack shared a report to provide the committee with an update on risk management activity, noting any amendments and additions to the current risk register. There have been no new risks identified since the risk register was last approved by the IJB in December 2021. Marie Moy stated for the finance risks it is too early to make any changes as still awaiting some information being confirmed. May see some changes at the next IJB meeting in March. The IJB Performance, Finance & Audit Committee agreed the following recommendations: To note the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of PFA Committee business. 6. External Audit Annual Report 2020/21 Marie Moy advised the external audit has now been completed, Brian Howarth (Audit Scotland Director) is in attendance today to take the committee through the report. The report has been tabled today to seek approval from the committee. The audit will be signed off after the committee with relevant members and officers.
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There are not any significant issues, the main issue was the delay in getting the audit completed due to the impact of the pandemic, the audit team itself was directly affected with staff absences. The 2020/21 funding gap was not fully addressed in the initial budget, but additional Covid-19 funding and an underspend on core activities resulted in a surplus of £37 million. Unachieved savings were fully funded through the Covid-19 allocations. Total reserves are £53 million, with the majority of this either earmarked or ring-fenced for specific purposes. Dr Avril Osborne noted the committees thanks to Brian Howarth and audit colleagues in preparing this report. Maddy Halliday queried what the time frame and capacity was to get the website updated. Marie Moy advised the website will be updated within the next 3-6 months; it will be before the 21/22 external audit. Ally Boyle queried what will be the impact of the feely report as it is uncertain at the minute; Marie Moy advised when this is available she will bring back an update report to the committee for endorsement and approval. Ally Boyle also queried how hosted services are managed in the audit. Marie Moy stated for hosted services current arrangements work well, with the lead partner being responsible for under and over spends. Looking at best value options and improvement opportunities. It is unlikely there will be any radical changes to hosted services arrangements. Ross McGuffie advised there is an agreement in place on how to manage collaborative services, need to be responsive to both partners needs in creating service models required. Trying to collaborate as much as we can to ensure manage any areas of conflict. In future challenges may come when the National Care Service is introduced. There is an agreement through the NHS Corporate Management Team (CMT) on how hosted services will be managed. Marie Moy advised further that in terms of the external audit there are more formal arrangement in place for under and over spends which has been included in the financial plan but the preference would be to have a longer term service level agreement (SLA) in future; Marie Moy will review this as she brings recommendations into line. Neil Findlay noted that the report does not make reference to during the pandemic when patients were discharged from hospitals into care homes without undertaking a covid test which is now part of a public enquiry. Brain Howarth advised to include this information would require additional resources and funding which is not available currently. Neil Findlay queried is this work being undertaken nationally as part of the public enquiry. Brain Howarth was un sure but can check if any work is planned for this. Ross McGuffie advised during the pandemic in North Lanarkshire discharges were not made for short term patients only those moving to longer term placements follow the national policy. MM MM
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Trudi Marshall advised Lanarkshire health board has undertaken a review form the clinical perspective which was led by Dr Jane Burns and the findings have been to HQAIC committee. The IJB agreed the following recommendations: (1) Consider the External Auditor’s Annual Audit Report, attached at appendix 2, in advance of the approval of the IJB Annual Accounts 2020/2021; (2) Note that an unqualified audit certificate has been received in respect of the North Lanarkshire IJB Annual Accounts 2020/2021; and (3) Approve the management response to the action points which is highlighted at pages 18 to 20 of the External Auditor’s Annual Audit Report which is attached at appendix 2. 7. Audited Accounts Marie Moy shared a report which provides details of the unsigned audited IJB Annual Accounts 2020/2021 for endorsement prior to approval by the Integration Joint Board (IJB). She advised there have been no material changes since the previous presentation to the committee in June. The committee were asked to note the recommendations. Brian Moore queried timelines for completion if they are realistically or should they be revised. Marie Moy will review and revise the timelines for the future documents, this document is a retrospective look at the previous position so may not reflect current timescales. The PFA agreed the following recommendations: (1) Note that the External Auditor’s audit opinions are all unqualified in respect of the IJB Annual Accounts 2020/2021; (2) Endorse the IJB Annual Accounts 2020/2021 for approval by the IJB; and (3) Note that the signed audited IJB Annual Accounts 2020/2021 will be available to view electronically at the following website: https://www.hscnorthlan.scot/key‐documents/. MM 8. Financial Monitoring Report Marie Moy advised the report tabled provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 31 December 2021 (Health Care Services) and 7 January 2022 (Social Work and Housing Services). There is a net underspend of £4.432m on the core budgets within Health Care Services and a net underspend of £4.910m on the core budgets within Social Care and Housing Services.
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There is an assumption that the Scottish Government will fund covid costs but this has not been confirmed. Once we have this confirmation we will be able to revisit the financial risks in the risk register. It is planned to table the reserve strategy at the IJB meeting on 23rd March to approve the programme of work in respect of the business case. There are plans against the underspends also. Overall everything will be brought back to the March IJB for approval. The IJB PFA agreed the recommendations made. 9. IJB Financial Plan 2022/23 Progress Report This report provides an update on the preparation of the IJB Financial Plan for 2022/2023 including the key financial planning assumptions underpinning the budget setting process for both partners and the IJB at this stage. Marie Moy highlighted that this is an interim report in advance of the full plan being tabled at the March IJB, finance colleagues are working through the cost commitments for 22/23 related to budget announced on 9th December and national funding allocations. Both partners are supportive of Health and Social Care Integration and will continue to pass through any funding made available to partners. Brain Moore queried where are we for the 10% of frontline staffing being committed to MH services, where are we currently and what is required to get to the end position. Marie Moy will include an update in future reports to the committee to clarify this. Ross McGuffie advised there has been expansion of staff within CAMHS and psychological therapies as well a range of external funding being made available. Dr Avril Osborne endorsed the support from both partners which was also supported by the committee. The PFA Committee agreed the following recommendations: (1) That the content of the report is noted; (2) that the update in respect of the additional Scottish Government funding for 2022/2023 is noted; (3) that the progress made in respect of the IJB Financial Plan 2022/2023 in consultation with both North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) is noted; and (4) that the requirement to update the IJB Medium to Long Term Financial Plan is noted. MM 10. Progress Report on Internal Audit Agreed Actions Marie Moy advised the report provides an outline of the actions agreed with the External Auditor, the Internal Auditors and the Senior Management Team to further develop the IJB governance framework.
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An update on the progress made to date was reported to the PFA Committee on 9 November 2021. As previously reported, the position statement in respect of progress in the table below reflects the Internal Audit assessment of the work required to complete the Internal Audit actions. Progress is also being measured against revised target timescales. 8 of the deadlines have been extended to June 2022. Overall 47% of actions have been completed, there are still 17 actions which require to be brought to a conclusion. It was noted this is last year of the current audit Scotland team with a new team due to be appointed for 22/23. The PFA Committee agreed the following recommendations: (1) That the content of the report is noted; and (2) That further progress reports will be presented to future meetings of the PFA Committee in respect of the actions which are ongoing. 11. Quarter 2 Performance Report Morag Dendy advised the purpose of the report is to provide an update to the Board on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 July 2021 to 30 September 2021 (Quarter 2). It has been an improving picture for delayed discharges but there are still pressures in community services particularly around home support availability and also care home outbreaks which have impacted on discharges. There has been a whole system approach to manage this. Morag Dendy outline the other performance areas included within the report. Ally Boyle queried how do the committee and the public understand what happens after the 12 or 18 week waiting time for patients. How are they triaged at this point to ensure they received assistance from appropriate services. Ross McGuffie advised doing a governance approach overall to ensure patients are correctly triaged. At the March IJB there will be progress reports for CAMHS and psychological services which will provide the committee with more details. There has been a change in the split of Mental Health referrals with more urgent referrals being submitted who require to be been seen within 24/48 hours which may affect the data reported. The chair commended the work of the staff in managing the challenges they have faced and continue to face. Maddy Halliday queried if possible for some of the upstream investments into community schools and the voluntary sector to be reviewed to access the impact the investments have made. Morag Dendy advised they are trying to align with particular investments to show the difference they are making but it is difficult to get an exact cause and effect.
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Ross McGuffie noted trying to influence investments being made into more preventative work initially. In CAMHS have started the distress brief intervention programme in 3 schools which has already seen an impact. Brain Moore noted this is helping in trying to understand whole system services making the linkages between this report and budget monitoring. Maddy Halliday advised there are concerns for speech & language service and their lack of capacity, as any delay in access to the service can have other impacts for children. Ross McGuffie advised previously had screening services to pick up early speech delays, so should have seen a reduction of children requiring other services. Then the pandemic started which caused a delay in getting access to the service. The IJB PFA committed noted the report and its contents. 12. Covid Update Ross McGuffie advised previously seen extensive levels of community transmission in Lanarkshire, which had the highest rate in Scotland. Acute service is still under incredible pressure due to covid and winter pressures. Although it is now an improving picture 73 covid positive inpatients across the 3 acute sites and 2 patients in level 3 ITU. Care homes currently have 10 homes with outbreaks across Lanarkshire. The HSCP is supporting Hillend View around the concerns raised by the Care Inspectorate and working with social work colleague around adult support and protection concerns raised. Home Support services has seen a peak in sickness absence levels with a 25% absence rate which is impacting on discharges from Acute. There were 110 delayed discharges at the start of January now as of today there are 87. Undertaking work nationally on through put of discharges this week have discharged 30 on Monday, 24 on Tuesday and 26 on Wednesday. For the vaccination programme 1.4m overall doses have been delivered, 54000 have had their first dose and 404 have received their boosters. Currently working with councils to confirm the vaccine delivery model in future. Dr Avril Osborne raised concerns about Adults with Incapacity having to wait 13 weeks in Acute due to delays in getting assessments to allow them to move on, she asked is there an update for those in this position. Ross McGuffie advised doing work nationally through the NHS gold group to get an idea of how many people are in this position and experience longer delays. There have been further been delays due to delays in the legal service which is effecting guardianship applications.
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Trudi Marshall noted aiming to promote power of attorney through a campaign to encourage patients to have this in place before it requires to reduce delays. Ally Boyle noted there are challenges for some immunosuppressed patients receiving their 4th dose and uncertainty about the future for them. Ross McGuffie advised work is ongoing with vaccination staff, looking to put in place a more permanent structure to support further vaccination programmes. Awaiting advice from the JCVI as expecting to delivery another round of boosters in future but awaiting the data to indicate when this is required. Starts to see other treatment opportunities being made available to aid future modelling. Brain Moore suggested it may be useful when reviewing the delayed discharges pathways to have an understanding of all elements that can impact on discharges becoming delayed. Ross McGuffie advised Graeme Cowan is involved in national discussions and the discharge without delay programme. The IJB PFA committed noted the report. 13. Alcohol & Addiction Services Morag Dendy advised the report provided is an update on the work of the North Lanarkshire Alcohol and Drug Partnership to achieve the strategic aims and support development of the investment plan for additional funding allocation, Programme for Government Funding and Ministerial Priorities. In 2020 a staggering 195 people died as a result of drug or alcohol. The ADP strategy was previously presented to the committee which outlined 5 key priority areas which now has a work stream under each area to review the priorities with stakeholders including experts, frontline staff and those with lived experience to work on developing a commissioning strategy going forward. There was an event held at the start of February where 65 stakeholders attended to look at improving communication, the work streams are progressing at pace with support being offered from Health Improvement Scotland. In future a further report will be presented to the committee to supplement the content provided today. Neil Findlay queried what activity and actions are being taking on cocaine and street drugs which are 2 of the biggest issues in communities. Morag Dendy advised there is working being undertaken. She can bring back additional information on this to committee in future to offer assurance. Neil Findlay also queried if the social impact of covid may make the death figures worse next year. Soft information has indicated this is likely to be the case. MD
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Maddy Halliday noted it would be useful to look at the spread of resources for the upstream investment and also community based investment. Morag Dendy noted it should be focused across the whole services. Ally Boyle stated need to pull learning out from patient encounters to help influence lessons learned. He also queried for medication assisted treatment how confident is the Board that they have got the capacity in place to meet this. Morag Dendy advised working to target share and focus the information going forward likely implementation will be phased from 1st April. Will be in the position to roll out a robust response but not in a full state to meet the full MAT standards. Morag Dendy can provide supplementary information to add to the information within the report if required. Maddy Halliday asked what are the plans to sustain engagement as the plans are developed and delivered. Morag Dendy replied moving toward co production going forward. The IJB PFA committee noted the report. MD 14. High Resource Users Trudi Marshall advised the original project started in 2018 the report came to a previous committee based on the finding then. Funding was extended to take the project into the third phase of engagement with the community to develop services to fit patient needs. The original staff involved in the project were redeployed which caused a delay in the progress of work but they are now back in their substantive posts. Although not been able to progress the project as planned as other services are not functioning fully operationally. Doing as much work as possible and interfacing with stakeholders, have identified a 3rd cohort of individuals to work with. The plan is as services recover looking at how this in embedded back into locality teams. The report shows the progress made to date and there is still benefit to work with this cohort of individuals to reduce dependency on services. Maddy Halliday asked was there an evaluation undertaken with those who took part in each of the cohorts. Trudi Marshall advised evaluation questions were asked in 2019, there was a number of client interviews undertaken also using the Getting It Right for Every Child (GIRFEC) approach. The project did also work alongside ISD colleagues. Ally Boyle asked how do we pull this learning out to help support high resources user and how do we catch them initially before they become part of this cohort. Trudi Marshall advised in cohort 2 tried to identify downstream
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individuals but they did not engage. They were identified as could see the early triggers signs of individuals who would become high resource users. The IJB PFA committee noted the report. 15. Participation & Engagement Morag Dendy advised the work has been a core part of the development of services in North Lanarkshire to get participant and engagement maturing to move forward. The report shared today is an update on the important aspects covered with a range of stakeholders and key actions taken. A review is being undertaking currently and due to conclude at the end of March in relation to key engagement forums that support the committees. Ally Boyle asked how do we recognise the individual’s contributions to the work and ensure they receive the best benefit from the opportunity. It could be a financial reward or skills development. Morag Dendy advised in the strategy there in more information for the financial remunerations available for individual involved and support is offered to support skills. Important to take a whole system approach to have better structures in place to support this and make use of the vast knowledge and experience available. Maddy Halliday queried for those out with of the HSCP scope how do you bring involvement into them. Morag Dendy noted there is a heavy focus on HSCP structures currently but when recommendations are made should show the whole system approach. 16. Fairer Scotland Duty Ross McGuffie advised a report previously came to the committee in April 2018 on this topic. Looking at what governance process is required to complete in line with duty. Working with planning leads to get a consistency of approach across the whole system. Aim to undertake the work required and then bring back a report to set out how this will work in practice working with community planning partners. Ally Boyle stated need to consider how to engage with tactical and operational levels going forward so that at every stage everyone is thinking about the 7 questions. Need to keep a log somewhere to show the changes that are being made to give the evidence to illustrate it is not just a tick box process. The IJB PFA committee noted the report.
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17. Strategic Commissioning Plan-Progress Report on Programme of Work A paper was brought to the February 2021 PFA aligning the recovery work with the Programme of Work supporting the Strategic Commissioning Plan (SCP) 2020-23. This paper detailed the intention to renew the focus on the ambitions set out in the SCP as services were remobilised and redesigned. The initial plan had 4 cycles through the year. The cycles proposed were based on patterns of reporting over the past 2 years, accommodation reporting against nationally set timescales and spreading work over all the cycles. Review of current service, resetting objectives and other requirements will cause the programme outlined below to change but in the future the reporting cycles should be changed by agreement and by exception. The impact of responding to the pressures of the pandemic has resulted in the development of the detailed Progress of work taking longer than expected in order to focus on operational pressures. However, progress on reporting as expected is noted as: 45 Programme of Work reports were expected across the 4 Cycles 30 reports were presented 15 were not presented The report included the proposed flow of reports for this year, as the Strategic commissioning plan is in place until 2023. The IJB PFA committee agreed the following recommendations: Note the progress made in aligning the remobilisation of services to the Programme of Work which sits alongside the Strategic Commissioning Plan, 2020-23. Note that work will commence to refresh the Strategic Commissioning Plan. Approve the revised Programme of Work Note the associated measures in relation to the supporting measures 18. Risk There was no new emerging risk identified by the committee for any of the items discussed. 19. Date of Next Meeting 17th August 2022 at 2pm
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ITEM 4 Performance, Finance & Audit Committee ITEM 4 ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 28.5.19 & 27.8.19 Item 11 & Item 5 Reserves Strategy R McGuffie M Moy Detail on exit strategies for services funded from reserves to be included in report at next meeting. Update: Deferred to IJB 22nd June 2021 where the IJB Reserves Strategy 2021/2022 was approved. The report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. 9.11.21 – verbal update given and further update due at IJB in December 2021. 16.2.22 - Reference to Reserves included within the Financial Plan Progress Update item on Agenda 16.2.22 Original date - November 2020 New date – November 2021 – deferred to February 2022. Ongoing – to be reviewed by North IJB CFO for September IJB 2022 2. Feb/March 2020 Comments received from circulated papers Internal Audit Plan 19/20 Progress Report M Moy 1. Update on Actions identified within report. Agreed to remain as standing item on agenda until all actions complete. Updates on progress with completion on actions given on 25.5.21, 24.8.21, 9.11.21 & 16.2.22 Ongoing until completion of all actions Ongoing
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ITEM 4 2. Service Level Agreement to be drafted around disaggregation of Children’s & Families & Justice Social Work Budgets. Revised timescale – September 2022 Ongoing 3. 25.5.21 Item 8 Alcohol & Addiction services M Dendy 1. ADP risk register to be developed and presented to PF&A 2. NLADP Strategic Plan and Investment Plan to be presented to future PF&A meeting. 3. An update on accommodation issues to be presented. November 2021 ADP Strategy presented to IJB 21.9.21 Ongoing Complete Ongoing - report to be presented to IJB September 2022 4. 24.8.21 Item 13 First Point of Contact M Dendy Committee to receive updates on learning from the Innovation Site. 16.2.22 Deferred to August PFA as evaluation on learning not yet complete due to delayed start in October 2021 February 2022 (Deferred to next PF&A in August 2022) Agenda Item 24.8.22 5. 24.8.21 Item 6 Integration Review R McGuffie 1. Finalise last remaining action from the audit around Chief Financial Officer support Update: Discussions have commenced with colleagues in South Lanarkshire, but currently on hold due to current operational priorities 16.2.22 – Verbal update on HR recruitment process noted. October 2021 – deferred to December 2021. Update given Feb 2022 Verbal Update to be given 24.8.22 to note completion of action
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ITEM 4 6. 9.11.21 Item 6 Participation & Engagement M Dendy Arrangements for the 2 existing Partnership Boards to be reviewed. Update report to be provided to next PF&A. 16.2.22 - Review of participation & engagement underway with report with recommendations due to be presented to IJB February 2022 (complete) September 2022 Update to IJB in September 2022 7. 9.11.21 Item 9 Quarter 1 Performance Report M Dendy Agreed that a more rounded set of indicators and measures should be included within future Performance reports particularly around Referral to Treatment Targets (RTT). A new set of Measures around CAMHS was being developed and would be brought to the next meeting. February 2022 Agenda item 24.8.22 8. 9.11.21 Item 13 Staff Health & Wellbeing R McGuffie 1. Details of Sickness Absence rates within the partnership requested. 2. The Risk rating around staff health & wellbeing was to be reviewed. February 2022 1.Sickness Absence Figures included in Quarter 1 Performance Report 24.8.22 2.Complete - Risk rating reviewed & approved at IJB in December 2021 9. 16.2.22 Item 6 Finance M Moy/CFO Report on financial implications of the Feeley report to be brought back to a future meeting. 24.8.22 – note requirement for further details on NCS to be made available to allow this work to be undertaken To be discussed with new North IJB CFO to confirm date Ongoing
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ITEM 4 10. 16.2.22 Item 6 Comms M Dell Update requested on development of H&SC NL website August 2022 Ongoing 11. 16.2.22 Item 6 Finance M Moy/CFO Longer term SLA to be developed for Hosted service arrangements. February 2023 Ongoing 12. 16.2.22 Item 16 Fairer Scotland Duty M Dendy Report to be provided setting out the refreshed approach which will include performance measures to evidence effective use/implementation of FSD. 24.8.22 Collaborative approach being taken by NHSL/NLC/SLC around support for EQIA &FSD including training & updated templates etc February 2023 Ongoing 13. 16.2.22 Item 9 Financial Plan M Moy Update to be provided within Financial Plan on 10% budget being committed to frontline MH staffing February 2023 Ongoing 14. 16.2.22 Tem 13 Alcohol & Addictions service M Dendy Additional Information on Drug use & achievement of MAT standards was requested & agreed to provide information in future report Update to be provided to the IJB in September 2022 Ongoing
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1 REPORT Item No: 5 SUBJECT: Risk Management: IJB Risk Register TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Christine Jack, Operational & Business Manager Author(s) of Report Christine Jack, Operational & Business Manager DATE: 31st August 2022 1. PURPOSE OF REPORT This paper is coming to the Performance, Finance & Audit Committee; For approval For endorsement To note The purpose of this report is to provide a summary to the Performance, Finance & Audit (PFA) Committee on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Operational & Business Manager and Chief Officer for H& SC NL. 3. RECOMMENDATIONS 3.1 The PFA Committee is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of PFA Committee business. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Yes No N/A
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2 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 There are currently two risks rated as Very High on the IJB risk register. IJB 08/21 – Financial Implications of Responding to Covid IJB 09/21 – Impact on the Strategic Plan due to Covid These risks refer to the Financial planning for 2021/22 and will be reviewed by the new CFO for the IJB and either closed or updated to reflect the financial plan and attendant risks identified for 2022/23 5.4 There are four high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing 5.5 At the IJB meeting in June 2022, it was agreed that the following risks should be reviewed with potential to add to the IJB Risk Register; Impact of Cost of Living on IJB strategic objectives Unscheduled Care & patient flow Community Alarms Development of National care service & impact on Business Continuity Once these risks have been developed and reviewed, they will be presented to the next IJB in September for approval. 6. CONCLUSIONS 6.1 The IJB currently has 13 risks identified on its IJB risk register with 6 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance:
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3 Yes No N/A Financial risks are identified in the risk register. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE N/A 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and can contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPER None 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Christine Jack on telephone number 01698 752590.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB02. 21 Financial Reputational 01/04/2021 Ineffective Governance Arrangements There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Planned Procurement and Standing Financial Instructions presentations at Extended SLT by 31 March 2022. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB6. Reviewed and updated on 15 May 21. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programmes which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. 16. Additional Scottish Government funding to address Covid‐19 costs and to progress the Remobilisation and Recovery Plan in 2021/2022 is not sufficient. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2021/2022 has been agreed and is being reviewed regularly. The IJB Financial plan 2022/23 is being developed. 7. Capacity plans in place to maximise efficiency. 8. IJB Integration Scheme setting out the budget recovery processes. 9. IJB Financial Regulations and financial procedures. 10. Consultation and involvement with key stakeholders including service users and carers. 11. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 12. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. Financial sustainability payment arrangements in place to 30 June 2022 to support external social care providers. 16. A Change Fund of £6.076m has been agreed with the Scottish Government. 17. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. The Scottish Government announced on 9 December 2021 the indicative Scottish Budget 2022/2023. Work is ongoing to confirm recurring and non‐recurring funding allocations. 19. Lanarkshire Mobilisation Plan 2021/2022 Funding has been confirmed which meets the additional costs of the Covid‐19 pandemic, including the underachievement of savings. The cost of the recovery and remobilisation of health and social care services in 2022/2023 continues to be monitored. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2022/2023 is being progressed. 3. The review and update of the IJB Medium to Long Term Financial Plan is ongoing. 4. The Business Case to take forward the remobilisation and recovery of services and also transformational changes is being developed. 5. The Lanarkshire Mobilisation Plan 2021/2022 costs for quarter 3 were submitted to the Scottish Government on 31 January 2022. 6. Confirmation was received on 25 February 2022 of the additional funding for 2021/2022 to address the costs incurred in 2021/2022 in respect of the Covid‐19 pandemic and also the remobilisation and recovery of services. On conclusion of the financial year 2021/2022, any uncommitted funding will be ring‐fenced as an IJB reserve to meet Covid costs in 2022/2023. The financial implications of this are being monitored. 7. Ongoing consultation with the Scottish Government in respect of the IJB Reserves Strategy 2022/2023 and the anticipated additional costs in 2022/2023 will be progressed by the IJB Chief Financial Officer. 8. The implementation of the approved Business Case to invest the Change Fund and the 2022/2023 recurring Scottish Government funding to maximum effect over the following 2 to 3 year period. HIGH Report Prepared by Christine Jack on behalf of the Chief Officer Page 1 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2021/2022. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. ACTIONS 1. North and South IJBs will undertake a review the financial principles in respect of the hosted services to further develop the current arrangements in line with emerging good practice and guidance. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs Prescribing costs may escalate due to increases in prescribing activity and increasing price volatility, new drugs becoming available, the response to the Covid‐19 pandemic and the impact of EU withdrawal. M edium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. ACTIONS 1.. Locality Prescribing Action Groups. 2. Continuation of Scriptswitch. M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB11. Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB03. 21 Financial Strategic 01/04/2021 Impact of European Union Withdrawal There is a risk that the IJB is unable to implement the Strategic Plan because of the operational and financial challenges posed by European Union (EU) withdrawal leading to a failure to achieve the desired strategic aims and an adverse impact on both operational service delivery and the achievement of financial balance. The impact on health and social care services of leaving the EU continues to be difficult to forecast. The following significant risks continue to be monitored at a national level. (1) The UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology. (2) In respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. (3) There is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. (4) The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. (5) There continues to be a risk of disruption to the supply chains, part of the risk in respect of which was minimised with mitigating actions such as stockpiling. (6) The future of Scottish patients' healthcare in other European countries and the impact of reciprocal healthcare and the free movement of healthcare including the impact of the changes to the European Health Insurance Card (EHIC). M edium CONTROLS 1. Silver command' group formed for HSCP. 2. On 24 December 2020 a new EU‐UK trade and co‐operation deal was agreed. 3. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 4. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 5. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 6. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 7. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 3 stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. 9. Reciprocal health care is subject to the Withdrawal Agreement, the collection of guidance outlining the rules in each state, the completion of relevant visa applications and the payment of the Immigration Health Surcharge in order to access NHS services (where applicable). The rights of access for EU citizens who need work or study in the UK for less than six months was still being decided. Global Health Insurance Cards have been implemented to cover both urgent and routine medical treatment. 10. In respect of reciprocal health care, the rights of access to health care for UK citizens who move to the EEA after the transition period is being decided independently by each member state and will differ substantially between them. ACTIONS 1.HSCP fully participates in the NLC and NHSL resilience arrangements. 2.HSCP workshops undertaken. 3. Business Continuity Plans revisited and updated for all services and sites. Report Prepared by Christine Jack on behalf of the Chief Officer Page 2 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB16. IJB08. 21 Financial Strategic 01/04/2021 Financial Implications of Responding to and Recovering from the Covid‐19 Pandemic There are a range of IJB risks associated with the response to and recovery from the Covid‐19 pandemic. Additional funding was received from the Scottish Government in 2020/2021 to meet the additional costs of the Covid‐19 pandemic. Further funding for 2021/2022 has been confirmed by the Scottish Government to meet the additional costs of responding to and recovering from the Covid‐19 pandemic. The IJB projected out turn 2021/2022 is not available to meet the 2021/2022 Covid‐19 costs. The projected underspend requires to be retained to implement the Business Case and to recover and redesign health and social care services. Insufficient reimbursement of funding from the Scottish Government would impact on the implementation of the Response, Recovery and Redesign Plans in 2022/23. The 2022/2023 Savings Plans may also not be achieved in part or in full due to key resources continuing to be diverted to respond to the Covid‐19 pandemic. This risk could lead to significant operational, financial, legal and/or reputational harm to the HSCP and also adversely impact on the Strategic Plan outcomes. VERY HIGH CONTROLS 1.Governance arrangements are in place in respect of the approval and monitoring of additional Covid‐19 costs and the recovery and redesign plans. 2 Delivery of savings will continue to be tracked and monitored. 3.The financial position is being monitored on an ongoing basis by SLT, IJB PFA and IJB. 4. The IJB Chief Officer and the Chief Financial Officer are actively engaging with the Scottish Government and other Networks and providing regular updates on the mobilisation and remobilisation plans and the associated costs. ACTIONS 1. All costs associated with responding to the Covid‐19 pandemic are being tracked and reported to the Scottish Government through the completion of the Remobilisation Plan Financial Returns. 2. A financial tracker on Covid‐19 related expenditure (as part of the Local Remobilisation Plan) is updated on a 4 weekly basis. Quarterly updates are submitted to the Scottish Government. 3. The IJB Reserves Strategy 2021/2022 has been discussed with the Scottish Government Officers. 4. The IJB Reserves Strategy 2021/2022 is being implemented. The IJB Reserves Strategy 2022/2023 is being developed. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB09. 21 Financial Strategic 01/04/2021 Impact on the Strategic Plan Due to the Covid‐19 Pandemic 1. Social Care providers continue to be significantly impacted by the Covid‐19 pandemic. There are risks associated with the ongoing financial stability of providers during the Covid‐19 pandemic and some external providers may be unable to continue operating without ongoing financial and operational support. If providers are unable to safely staff services, there could be a risk of harm to service users and failure of the provider. 2. Providers are operating under unique and significantly detrimental conditions including continuity of service being disrupted due to the requirement to focus on priority services only, increased infection control measures and associated costs, increased staff absence and associated costs, reduced availability of back‐up staff and social distancing requirements. Premises may not be suitable to deliver services in these circumstances. 3. Increased reporting requirements to provide data to regulatory bodies are stretching limited resources. 4. Sufficient emergency/additional services to continue to respond to the Covid‐19 pandemic may not be available. Hospital admissions may not be avoided and discharges from hospital may be delayed. General Medical Services may not be sustainable. There are whole system capacity constraints across primary care services impacting on Acute Services. 5. Discharges from hospital may impact on care at home, residential care, nursing care and respite provision. 6. There is an increase in demand for a range of health and social care services as a result of the Covid‐19 pandemic. There is insufficient workforce capacity and there is a risk the Working Time Directive may be breached. There is insufficient equipment for key areas e.g. ventilators, pumps, etc. Personal Protective Equipment and supplies may be limited. The required service specification and standard may not be procured. There may be insufficient mobile IT devices. 7. There may be constraints in respect of the supply of vaccinations. 8. There are significant risks associated with the mutation of the Covid‐19 virus and the new variants. 9. There is an adverse impact on the progress of transformation service redesign opportunities including implementing agreed efficiency savings. 10. Prioritising the impact of the response to the Covid‐19 pandemic may divert limited resources away from key essential services which may lead to additional resource requirements and costs over the medium to longer term. 11. There may be a lack of HSCP management capacity and resilience to co‐ordinate the response to the pandemic. This may lead to an adverse impact on service delivery and financial overspends. 12. The risk status across NHS Lanarkshire has been moved to 'Black', the highest risk level. VERY HIGH CONTROLS 1. Scottish Government and COSLA guidance is being complied with. 2. NHS National Services Scotland are supporting primary care and social care services. PPE is available in line with Health Protection Scotland guidance. 3. Chief Medical Officer guidance as adopted by the four nations has been published, put into effect and endorsed by the Scottish Government/COSLA. Updates are also adopted. 4. Scottish Government are focusing on the care home sector to support continuity of service delivery. A national protocol to support discharge of Covid‐19 patients is in place. Care home liaison nurses are in place. 5. Remote working and flexible working arrangements are also in place. There is an increase in the number of agile workers and an increase in the number of laptops/tablets provided. A blended approach to home/work‐based working is being developed going forward. 6. Arrangements are in place across the partnership to review service user and carer prioritisation in terms of accessing service and support. Resources are targeted to those with critical or substantial needs. 7. Arrangements are in place to support carers in their caring role, working in partnership with voluntary organisations to provide early intervention and preventative supports. 8. Reliance is being placed on the Social Care Sustainability Payments by External Social Care Providers up to 30 June 2022. The HSCP continues to liaise and support providers to ensure there is early identification of problems and early intervention if necessary. 9. The Response, Recovery and Redesign Remobilisation Plan has been developed and is regularly updated. Response, Recovery and Redesign Plans are in place across the IJB and both partners. 10. Safe systems of working have been adopted. Regular cleaning regime is in place across all premises. All workplace appropriate social distance signage is in place. 11. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 12. The Scottish Government is taking appropriate action to mitigate the impact of the variants of the Covid‐19 virus as far as possible. ACTIONS 1. Emergency Command and Control structures have been established by each partner. Infection Prevention Control and Social Distancing requirements are being complied with. 2.Up‐to‐date information is disseminated to all staff across the HSCP as the situation develops and a consistent communication strategy is in place with employees across IJB, NHSL and NLC websites 3.IJB and partner business continuity plans are being regularly reviewed. 4.The HSCP is actively engaging with the third and independent sector in relation to service opportunities to meet the low/moderate needs of service users/patients and their associated costs. 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid‐19 funding was confirmed on 25 February 2022. 6. The vaccination programme is continuing to be rolled out. 7. Having regard to the assessment of risk across NHS Lanarkshire as 'Black', action is being taken to mitigate the impact of the Covid‐19 pandemic over the winter period and COP26 in consultation with the Scottish Government. The position is being closely monitored. VERY HIGH M EDIUM Report Prepared by Christine Jack on behalf of the Chief Officer Page 3 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements Due To the Covid‐19 Pandemic 1. There is a risk that the intensity of the required response to Covid‐19 could result in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended Covid‐19 legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. ACTIONS 1. Staff health and well being is a key priority for both partners and all key stakeholders. The commitment to staff health and well being is being actively promoted through all available forums. M EDIUM LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 30.06.22 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g. Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff well‐ being programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation. 4. Staff being encouraged to submit proposals for use of targeted funding & some programmes already in place. HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 30.06.22 IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. The financial support for social care providers during the Covid‐19 pandemic is being reviewed. Payments in respect of under‐occupancy in care homes were extended to 30th June 2022. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. Staff and visitor testing in place. 4. All care homes advised to use PPE in line with national addendum. High medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 30/06/2022 Report Prepared by Christine Jack on behalf of the Chief Officer Page 4 of 4
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1 REPORT Item No: 6 SUBJECT: Self-evaluation of the North Lanarkshire Health and Social Care Integration Joint Board (IJB) TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT 1.1 Integration Joint Board (IJB) are aware of the requirement for local authorities to ensure arrangements are in place to secure continuous improvement in performance for all the functions and activities undertaken to deliver services and improve outcomes. 1.2 The Best Value duty applies to other bodies as required by Section 106 of the Local Government (Scotland) Act 1973, notably health and social care integration joint boards (IJBs). As such, in 2021 the Accounts Commission reported their intention to develop an approach to auditing Best Value in health and social care integration joint boards (IJBs) that is proportionate, risk- based, and which will provide public assurance on the extent to which IJBs are meeting their statutory Best Value duty. 1.3 The new Best Value audit arrangements being developed by the Accounts Commission were due to be introduced as part of the next round of external audit appointments to IJBs, scheduled to begin in 2022/23. In advance of this, the IJB agreed to undergo a self- evaluation exercise to assess the effectiveness of current arrangements and ascertain how well the Board was meeting its intended outcomes. This was undertaken towards the end of 2021/22 1.4 However, in light of the significant uncertainties in the current IJB operating environment and the matters arising from developments around the National Care Service (NCS) for Scotland, the Accounts Commission subsequently agreed not to proceed with the proposed rollout of Best Value in IJBs. They
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did however agree that they will “continue to provide robust, independent oversight and public reporting at both national and local level on the current performance of IJBs.” 1.5 Notwithstanding the changes in the Accounts Commission’s approach to auditing Best Value in IJBs, it is considered that the self-evaluation has been a worthwhile exercise bearing in mind that independent oversight and scrutiny will continue to be undertaken on the current performance of IJBs. The findings from the self-evaluation exercise also serves to reassure the new members of the IJB (both Elected Members and executive members) of the effectiveness of the current arrangements for the Board and its supporting governance and sets out the priorities for improvement in this respect. 1.6 This report outlines the findings from this self-evaluation exercise which demonstrate the extent of the positive results and good practice examples arising from the online survey. In light of this, the areas for improvement highlighted by the Improvement Service were This paper is coming to the IJB for: For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By Head of Planning, Performance and Quality Assurance 3. RECOMMENDATIONS It is recommended that the Integration Joint Board: (1) Recognise the extent to which the results of the self-evaluation exercise demonstrates the effectiveness of the current arrangements for the North Lanarkshire Health and Social Care IJB, and identifies how well the Board is meeting its intended outcomes, (2) Note the areas for improvement set out in paragraph 2.7 (and the supporting Improvement Plan in Appendix 3) which aim to further strengthen existing arrangements and add value to existing practices rather than fill any gap or address any significant issue in terms of ineffectiveness,
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3 (3) Endorse the next steps outlined at paragraph 2.9 to ensure continuous improvement and ongoing assurance on the extent to which the IJB is meeting its statutory Best Value duty, and (4) Note the findings from the self-evaluation exercise will be reported to the next meeting of the IJB. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 CMT will recall the report in September 2021 updating on the intentions of the Accounts Commission to develop a new approach to auditing Best Value in health and social care integration joint boards (IJBs). The Accounts Commission had intended that this approach would provide public assurance on the extent to which IJBs are fulfilling their statutory Best Value duty. 5.2 The new Best Value audit arrangements were to be developed in time to be introduced as part of the next round of Accounts Commission / Auditor General for Scotland external audit appointments to IJBs, beginning in 2022/23 and running through to 2026/27. 5.3 In advance of the national Best Value audits, the IJB agreed at their meeting in September 2021 to undertake a self-evaluation exercise. This was noted by the CMT and incorporated into the Strategic Self-Evaluation Framework rolling review programme, which CMT will recall endorsing in July 2021 prior to approval at the Audit and Scrutiny Panel in September 2021. 5.4 The Strategic Self-Evaluation Framework aims to ensure improvement actions arising from the supporting self-evaluation review programme contribute to the achievement of the shared ambition set out in The Plan for North Lanarkshire. It also aims to ensure that improvements are focused, where appropriate, on enhancing the supporting processes, plans, policies, and strategies designed to deliver the services and improved outcomes required to achieve the vision. 5.5 As agreed at the meeting in July 2021, members of the CMT have been assigned as Champions for each self-evaluation exercise to be undertaken in line with the Strategic Self-Evaluation Framework rolling review programme. For the self-evaluation of the North Lanarkshire health and social care IJB the Head of Performance, Planning, and Quality Assurance was assigned the role of Champion. Champion roles and responsibilities were agreed at CMT in July 2021; their purpose is to: • Provide leadership, commitment, motivation, and recognition to the introduction and execution of the self-evaluation exercise. Yes No N/A
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• Communicate the purpose and the benefits, and challenge resistance. • Ensure resultant improvement actions are valid and used to inform improvements to what the council ultimately aims to achieve. 5.6 Independently facilitated by the Improvement Service, the self-evaluation of the North Lanarkshire health and social care IJB was subsequently undertaken towards the end of 2021/22. This self-evaluation exercise took the form of a checklist developed by the Improvement Service to allow IJBs to assess their own performance at board level against the expectations of the Public Bodies (Joint Working) (Scotland) Act 2014. It focuses primarily upon the effectiveness of current arrangements and how well the Board meets its intended outcomes. 5.7 This report (from the Head of Performance, Planning, and Quality Assurance in her role of Champion for this particular self-evaluation) concludes the self- evaluation exercise and presents the CMT with an overview of the process, together with a summary of the results from the online survey as well as the areas of good practice and areas where there may be scope for improving the operation of the Board in order to maximise its impact (as identified by the assessment team). 5.8 Since undertaking the self-evaluation exercise matters have evolved nationally and in light of the significant uncertainties in the current IJB operating environment, and the matters arising from the developments around the National Care Service (NCS) for Scotland, the Accounts Commission subsequently agreed at their meeting on 12th May 2022 not to proceed with the proposed rollout of Best Value in IJBs. 5.9 However, the Accounts Commission agreed at their meeting on 9th June 2022 that they will “continue to provide robust, independent oversight and public reporting at both national and local level on the current performance of IJBs. This will be through ongoing annual audit work in IJBs and related audit reporting until the point at which the NCS becomes operational and IJBs become Community Health and Social Care Boards (CHSCBs).” 5.10 Notwithstanding the changes in the Accounts Commission’s approach to auditing Best Value in IJBs, it is considered that the self-evaluation has been a worthwhile exercise bearing in mind that independent oversight and scrutiny will continue to be undertaken on the current performance of IJBs. The findings from the self-evaluation exercise will also serve to provide the new members of the IJB (both Elected Members and executive members) with assurances in terms of the effective operation of the Board and its supporting governance arrangements as well as provide a clear set of priorities for improvement.
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5 Self-evaluation of the North Lanarkshire health and social care integration joint board (IJB) 5.11 A synopsis of the self-evaluation exercise is set out in Appendix 1; this includes the following: • An outline in terms of what the self-evaluation aimed to achieve. • The assessment framework and statements - this comprises a checklist developed by the Improvement Service covering six themes and 31 statements. The six themes covered the IJB response to Covid-19, leadership and relationships, governance and accountability, community engagement and participation, outcomes and impact, and performance management and use of evidence. • The assessment process and timescales - from the online survey process to the consensus and improvement planning session with assessment team participants. • Participants in the assessment team - i.e. members of the North Lanarkshire health and social care IJB. • Headline results - the aggregated RAG status for each of the six themes as well as the 31 statements compiled from the results of the online survey. 5.12 The self-evaluation exercise began with an online survey, independently facilitated by the Improvement Service, which was completed by 15 participants from the identified assessment team. This asked participants to: • Rank each of the 31 statements in terms of how much they agreed or disagreed with the statement. • Provide positive examples of where the IJB had worked well in relation to each of the six themes. • Provide details of how the IJB could improve its approach in relation to each of the six themes. How well are we doing?
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5.13 A RAG status was applied to each of the 31 statements based on how much assessment team participants agreed or disagreed with the statement (i.e. blue = strongly agree, green = agree, amber = disagree, red = strongly disagree, and grey = don’t know). The aggregated RAG status for each of the six themes is summarised in Table 1 below. A more detailed RAG status for each of the 31 statements is contained within Appendix 1. A. IJB response to covid-19 B. Leadership and relationships C. Governance and accountability D. Community engagement and participation E. Outcomes and impact F. Performance management and use of evidence Table 1: Aggregated RAG status for each of the six themes 5.14 The results from the online survey (in Appendix 2) shows the extent of positive feedback provided by assessment team participants in terms of their opinion of the effectiveness of current arrangements and how well the IJB currently meets its intended outcomes. This is quantified in Table 2 below: theme strongly agree / agree strongly disagree / disagree don’t know A. IJB response to Covid-19 97% 3% 0% B. Leadership and relationships 83% 12% 5% C. Governance and accountability 84% 12% 4% D. Community engagement and participation 90% 7% 3% E. Outcomes and impact 83% 12% 5% F. Performance management and use of evidence 89% 9% 2% Table 2: Average response from the online survey for each of the six themes (n=15) 5.15 There are 3 of the 31 statements (listed in Table 3 below) which can be considered to be areas of good practice as 100% of the assessment team strongly agreed or agreed with each of these statements.
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7 statement theme 1. The IJB can evidence examples of how it worked well together in response to Covid-19. A. IJB response to Covid-19 3. The IJB can demonstrate effective partnership working through local NHS mobilisation plans and local authority recovery and renewal planning A. IJB response to Covid-19 5. The IJB should look to permanently retain new ways of working developed during the response to Covid-19 A. IJB response to Covid-19 Table 3: Areas of good practice How can we do better? 5.16 Following work to collate and analyse the online survey results, the Improvement Service identified six areas for improvement that were discussed with assessment team participants at the consensus session. It should be noted however that the Improvement Service recognised the extent of the positive results and good practice examples arising from the online survey. In light of this, the areas for improvement highlighted by the Improvement Service were identified through the qualitative feedback aspects of the online survey and aim to further strengthen existing arrangements and add value to existing practices, rather than fill any gap or address any significant issue in terms of effectiveness. 5.17 Following further evidence presented through the discussions at the consensus session and an online voting process, assessment team participants agreed to take forward three areas for improvement which are set out in Table 4 below. Areas for improvement (1) Look at evidence how health and social care spending contributes to prevention and early intervention. (2) Look to embed learning and new ways of working in the IJB from the response to the pandemic to ensure plans, governance, etc, are fit for purpose. (3) Review how performance information is used by the IJB to ensure it is timely, relevant, and provides a good measure of progress towards agreed outcomes. Table 4: Areas for improvement 5.18 The three areas for improvement were further discussed in specific detail at the improvement planning session. This comprised three separate development groups through which the Improvement Service facilitated the development of an Improvement Plan; this is attached at Appendix 3. Next steps
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5.19 The self-evaluation has recognised the extent to which the assessment team considered the current arrangements for the North Lanarkshire health and social care IJB to be effective and has identified how well the Board is meeting its intended outcomes. To ensure continuous improvement in this respect will be ongoing, the next steps include: 1. Delivery of the actions identified in the Improvement Plan in Appendix 3 by the identified officers. 2. Ongoing monitoring of progress by the IJB in terms of delivery of the actions in the Improvement Plan and realisation of the intended outcomes set out therein. 3. Consideration of the need for a future follow up self-evaluation exercise (where appropriate within the context of developments around the future of the National Care Service (NCS) for Scotland) to provide ongoing assurance on the extent to which the IJB is meeting its statutory Best Value duty. 6. CONCLUSIONS 6.1 The effectiveness of the governance, accountability, leadership, and performance management arrangements in place for the North Lanarkshire health and social care IJB continue to be reflected positively through the ongoing annual audit work and related audit reporting which will be scrutinised by the Accounts Commission. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The contents of this report relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Implementation of a corporate approach to self-evaluation through the Strategic Self- Evaluation Framework and the rolling review programme ensures compliance with Best Value and Good Governance principles. This approach also contributes towards the mitigation of the risks on the council’s Corporate Risk Register for Governance, Leadership, and Decision Making and Managing Strategic Change.
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9 The self-evaluation exercise also supports the IJB Risk Register which requires, for example, identification of any risks within North Lanarkshire Council and NHS Board Risk Registers which relate to the delegated functions and may impact on the ability of the IJB to deliver its Strategic Commissioning Plan (SCP). 7.5 PEOPLE The self-evaluation exercise will ensure improvements focus on enhancing our plans, policies and strategies, all of which will have a wider impact on our people. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix 1: Synopsis Appendix 2: Results from the online survey Appendix 3: Improvement Plan CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332001
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Appendix 1 Synopsis SELF-EVALUATION OF: North Lanarkshire health and social care integration joint board (IJB) ASSESSMENT FRAMEWORK AND STATEMENTS: WHAT THE EVALUATION AIMS TO ACHIEVE: The Best Value duty applies to health and social care integration joint boards (IJBs). As such, IJBs are subject to Accounts Commission scrutiny through robust, independent oversight and public reporting that is carried out through ongoing annual audit work in IJBs and related audit reporting. To provide improvement support to IJBs and help them demonstrate the extent to which they are meeting their statutory Best Value duty, the Improvement Service has developed a national self-assessment checklist. This is designed for IJBs to assess their own performance at board level against the expectations of the Public Bodies (Joint Working) (Scotland) Act 2014. It focuses primarily upon the effectiveness of current arrangements and how well the Board meets its intended outcomes. HEADLINE RESULTS: Following completion of the online survey which asked the participants in the assessment team to rank each of the 31 statements - in terms of strongly agree, agree, disagree, strongly disagree, or don’t know - the aggregated RAG status for each of the 6 themes is depicted below. A more detailed RAG status for each of the 31 statements is set out in the next page. A. IJB response to covid-19 B. Leadership and relationships C. Governance and accountability D. Community engagement and participation E. Outcomes and impact F. Performance management and use of evidence
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11 There are 6 themes and 31 statements within the national self- assessment checklist developed by the Improvement Service. ASSESSMENT PROCESS: • December 2021 - Development of assessment process by the Project Team and the Facilitators from the Improvement Service. • Assessment issued to all participants in the Assessment Team on 22nd December 2021 - completion date 21st January 2022 • Consensus and improvement planning session on Teams facilitated by the Improvement Service - 128th February 2022. • Findings and improvement plan reported to the Corporate Management Team - 21st June 2022. • Report to the IJB - 21st September 2022. ASSESSMENT TEAM: • Council’s independent Project Team: Morag Dendy - Head of Planning, Performance, and Quality Assurance (Champion), Susan Lawrie - Strategy and Performance Manager. • Independent Facilitators: Barry McLeod (Programme Manager, Transformation, Performance and Improvement Team) and Thomas Boyle (Project Manager, PSIF and Self-Assessment) from the Improvement Service. • Assessment Team: Members of the IJB = Avril Osborne * Brian Moore * Ally Boyle * Neil Findlay * Cllr Paul Kelly * Cllr Jordan Linden * Cllr James Logue * Cllr Sandy Watson * Alison Gordon * Marie Moy * Tyra Smyth * Trudi Marshall * Kenneth Dagg * Cathy McGinty * John Watson * Liz Seaton * Harry Robertson * Maddy Halliday * Des Murray * Heather Knox * Neena Mahal * Maggs Thomson * Diane Fraser * Lucy Munro * Christine Jack * Ross McGuffie. HOW WELL ARE WE DOING? HOW DO WE KNOW? HOW CAN WE DO BETTER? The results of the self-evaluation exercise demonstrate the extent to which the assessment team considered the current arrangements for the North Lanarkshire health and social care IJB to be effective. It also identified how well the assessment team considered the Board to be meeting its intended outcomes. Average results from the online survey were positive, with between 83% and 97% of assessment team participants strongly agreeing or agreeing how effective the IJB was in terms of each statement. Self-Evaluation exercise with 15 participants from the assessment team responding to the online survey which focused on the 31 assessment statements.
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Following work to collate and analyse the online survey results, the Improvement Service identified six areas for improvement that were discussed with assessment team participants at the consensus session. Following further evidence presented through the discussions at the consensus session and an online voting process, assessment team participants agreed to take forward three areas for improvement which are set out below. (1) Look at evidence how health and social care spending contributes to prevention and early intervention. (2) Look to embed learning and new ways of working in the IJB from the response to the pandemic to ensure plans, governance, etc, are fit for purpose. (3) Review how performance information is used by the IJB to ensure it is ti m el y, re le v a nt , a n d pr o vi d e s a g o o d m e a s ur e of pr o gr ess towards agreed outcomes. It should be noted that the Improvement Service recognised the extent of the positive results and good practice examples arising from the online survey. In light of this, the areas for improvement highlighted by the Improvement Service were identified through the qualitative feedback aspects of the online survey and aim to further strengthen existing arrangements and add value to existing practices, rather than fill any gap or address any significant issue in terms of effectiveness.
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13
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FULL RESULTS: Following completion of the online survey, the RAG status for each of the 31 statements is shown on the graph on the right. This is displayed in line with the 6 themes. Key: Blue = strongly agree Green = agree Amber = disagree Red = strongly disagree Grey = don’t know
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15 Appendix 2 Results from the online survey Contents A. IJB Response to COVID-19 1. The IJB can evidence examples of how it worked well together in response to COVID-19. 2. The IJB has provided effective leadership during COVID-19. 3. The IJB can demonstrate effective partnership working through local NHS mobilization plans and local authority recovery and renewal planning. 4. The IJB can evidence examples of how resources were used to best support hard to reach individuals and communities during COVID-19. 5. The IJB should look to permanently retain new ways of working developed during the response to COVID-19. • Positive examples of where the IJB had worked well in relation to the Response to COVID-19 • Details of how the IJB could improve its approach in relation to the Response to COVID-19 B. Leadership and Relationships 6. The IJB has strong and effective shared leadership and an understanding of their shared duties, powers and responsibilities. 7. IJB meetings take place within a positive spirit of transparency, openness and trust. 8. IJB members effectively communicate decisions of the IJB within their own organisation. 9. The Health and Social Care Strategic Plan is reflected clearly in the resource allocation processes/ decisions made by members of the IJB (including spending less money on acute care, disinvesting and transferring this money to prevention and anticipatory care services in the community). 10. All IJB members are active participants in meetings and contribute effectively. 11. The individuals involved in the IJB are sufficiently empowered and influential to significantly advance the key issues. • Positive examples of where the IJB had worked well in relation to Leadership and Relationships • Details of how the IJB could improve its approach in relation to Leadership and Relationships C. Governance and Accountability 12. The IJB has appropriate structures and processes to support shared, effective decision making. 13. The agenda for Board meetings allows for strategic planning and debate around service development and transformation. 14. The IJB has an effective mechanism in place for managing collective risks, which is regularly reviewed. Self-Evaluation: North Lanarkshire health and social care integration joint board (IJB) Compiled by the Improvement Service February 2022
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15. The IJB’s accountability arrangements are clear, understood and implemented by all on the Board. 16. The IJB holds individual Board members to account for their performance and contribution to the outcomes in the Health and Social Care Strategic Plan. • Positive examples of where the IJB had worked well in relation to Governance and Accountability • Details of how the IJB could improve its approach in relation to Governance and Accountability D. Community Engagement and Participation 17. The IJB has effective engagement mechanisms for understanding the needs of service users and communities. 18. The IJB has developed and agreed a common understanding of local needs and opportunities. 19. The IJB has effective mechanisms for communicating with key stakeholders/ individuals/communities and service users. 20. Agreed priorities and outcomes in the Health and Social Care Strategic Plan reflect the key challenges of the area identified through any data analysis and community engagement activity. • Positive examples of where the IJB had worked well in relation to Community Engagement and Participation. • Details of how the IJB could improve its approach in relation to Community Engagement and Participation E. Outcomes and Impact 21. By working together, the IJB has delivered improvements which could not have been delivered by individual organisations. 22. The IJB has undertaken an analysis of what it spends on health and social care services and activities and how this contributes towards its agreed outcomes. 23. The long-term improvements in outcomes that the IJB is seeking to achieve over the next decade (as set out in the Health and Social Care Strategic Plan) are supported by immediate outcomes, indicators, and targets against which progress can be measured in the short and medium term. 24. The IJB realigns resources in order to better deliver early intervention and prevention approaches. 25. There is evidence that the IJB’s actions around early intervention and prevention are having an impact. • Positive examples of where the IJB had worked well in relation to Outcomes and Impact • Details of how the IJB could improve its approach in relation to Outcomes and Impact
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17 F. Performance Management and Use of Evidence 26. The performance information considered by the IJB is timely, relevant and provides a good measure of progress towards the desired outcomes and key time specific targets. 27. The IJB actively uses performance information to facilitate constructive strategic discussion and, where required, to instigate corrective action in order to address under- performance against key targets. 28. The targets set for the IJB are ambitious and stretching, whilst being realistic. 29. The IJB has a good understanding of the distribution of health inequalities across its area and the range of equalities groupings (e.g. age, race, gender). 30. There is a publicly available, easy to understand performance report, which demonstrates progress (including successes and failures) of the Health and Social Care Strategic Plan, and is clear about the difference the IJB is making to improve the lives of local people. 31. The IJB has effective arrangements to evaluate its own performance. • Positive examples of where the IJB had worked well in relation to Performance Management and Use of Evidence • Details of how the IJB could improve its approach in relation to Performance Management and Use of Evidence
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A. IJB Response to COVID-19 1. The IJB can evidence examples of how it worked well together in response to COVID- 19. Answer Choices Response Percentage Response Total 1 Strongly Agree 73.33% 11 2 Agree 26.67% 4 3 Disagree 0.00% 0 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 2. The IJB has provided effective leadership during COVID-19. Answer Choices Response Percentage Response Total 1 Strongly Agree 66.67% 10 2 Agree 26.67 4 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 3. The IJB can demonstrate effective partnership working through local NHS mobilization plans and local authority recovery and renewal planning. Answer Choices Response Percentage Response Total 1 Strongly Agree 73.33% 11 2 Agree 26.67% 4 3 Disagree 0.00% 0 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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19 4. The IJB can evidence examples of how resources were used to best support hard to reach individuals and communities during COVID-19. Answer Choices Response Percentage Response Total 1 Strongly Agree 46.67% 7 2 Agree 46.67% 7 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 5. The IJB should look to permanently retain new ways of working developed during the response to COVID-19. Answer Choices Response Percentage Response Total 1 Strongly Agree 60.00% 9 2 Agree 40.00% 6 3 Disagree 0.00% 0 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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Based on the statements above, please share details of where your IJB has worked well, in response to COVID-19. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1 whole system working across Lanarkshire through the NHS and local authority Gold command structures has been very effective as has the work done through the Lanarkshire LRP 2 Whole system working across the IJB, the HSC Partnership and with the LA and HB 3 Staff and volunteers worked together to minimise the effects of Covid-19 to members of the public. 4 partnership working, whole system view taken, engaged with acute sector 5 innovative cross discipline working 6 Board united in dealing with Covid. 7 Supporting cross-sector COVID response Supporting community and voluntary sector provision of community-based support for vulnerable groups through recurrent and increased funding
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21 Based on the statements above, please share details of where your IJB has worked well, in response to COVID-19 8 I joined the IJB at the latter part of 2021 so some of my experience is based on papers submitted and discussions help during NHS Board and Committee meetings. I was particularly struck with the supportive way that the IJB responded to the pandemic, it was clear that staff well-being along with doing the right thing for communities was a priority. I think there was real cohesion and consensus from IJB members around key issues and this has been reflected in the agile way the IJB responded. I thought there was real emphasis on the third sector and using their expertise to find the best solutions for people. I also felt that the communication to members was another strength. 9 Working in partnership with community organisations, ensuring whole system partnership working. 10 The IJB and both partners have a positive and supportive working relationship. VANL is also a key partner and leads the partnership working across the the third and voluntary sector. 11 The IJB reviewed its governance early in the pandemic to create as flexible and agile an approach as possible, ensuring a whole system focus on the pandemic. The Chief Officer was part of the Gold command structures in both NHSL and NLC and was also a member of the Local Resilience Partnership throughout, which is not replicated across Scotland. The Chair, Vice Chair and Chief Officer have continued to meet weekly throughout the pandemic to ensure appropriate linkages between the IJB and partner orgs and any items requiring escalation can be resolved quickly. 12 The IJB has continued to meet throughout the pandemic with on-line committees offering a robust response to the pandemic, if not even enhancing the participation through ease of participation. The IJB has maintained a strong oversight of the recovery and remobilization planning and decision making and has sought to align the plans closely with the ambitions articulated in the Strategic Commissioning Plan 2020-23. Reporting on the impact of C19 at every cycle and mitigations in place to identify and support areas of particular impact has enhanced the response to the pandemic. Regularity of IJB, PFA meetings has been augmented by quarterly Strategic Planning Group meetings and quarterly staff roadshows enhancing the engagement, information sharing and engagement throughout the pandemic. The IJB have shown particular concern for staff health and wellbeing throughout The creation of a change fund to support transformation, incorporating the learning from C19 is a strong commitment to a different future shape. The chair and vice chair have written a letter of thanks to staff which was well received. The Chair and vice chair have met weekly with the Chief Officer to create
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regular support and direction. Answered 15 Skipped 0
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23 Based on the statements above, please provide details of how your IJB response could have been improved during COVID-19. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. Potentially earlier engagement with VASlan and VANL 2. Unrelenting pressure on staff would have been eased by adequate core funding for services 3. In my opinion I do not feel that any improvement could have been made 4. Further working to develop more resilience in home care workforce and redeployment 5. increased interim reporting/updating to IJB board members 6. Unknown, 7. more time to agree and deploy additional funds to support the COVID response 8. As I was not on the IJB during the first year+ of the pandemic I am unable to answer this effectively. 9. More briefing during the course of the pandemic response given the infrequency of IJB meetings. 10. The legislation underpinning the creation of IJBs requires to be reviewed. Decision-making is delayed as a result of the legislation and the infrastructure e.g. the IJB requires to meet to take a decision and issue a direction to each partner as appropriate. Each partner then needs to comply with its own decision-making arrangements before action. There is therefore a risk that recruitment is delayed, and outcomes cannot be achieved as quickly as possible. The IJB and both partners do however aim to work together to progress priorities at pace. IJB Members have also been available to attend IJB Special meetings as and when required. 11. Over time, the response has been able to evolve, so the main learning is probably for the early stages of the pandemic response. Taking this learning to update pandemic plans, governance in the IJB etc so that if the same was to happen again, we are fully prepared from day 1. 12. It is difficult to get the level and format of communication right within a sea of emails and notifications but if anything could be improved it would be on ensuring whole system visibility beyond the IJB - wider community, wider staff group. 13. The decision to stand down Partnership Boards and Locality Planning Groups (LPGs), left a vacuum. It may have been wiser to change the terms of reference for these groups to focus on a targeted COVID response. Greater resourcing of the COVID Champions Network, linked more clearly to the Leadership from the IJB would have sent a stronger message. The perception was that the establishment of the COVID Champions Network was not linked to the IJB. 14. No Comment 15. Whilst the lessons learned during the pandemic have been of huge value, now is also the time to reflect and not simply embed certain decisions or activities that may have been necessary due to a certain phase or pressure, but may not be required or there may be better alternatives in a more stable endemic environment. Full 360 over the weeks and months ahead, including incorporation of next stage NCS announcements. Answered 15 Skipped 0
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B. Leadership and Relationships 6. The IJB has strong and effective shared leadership and an understanding of their shared duties, powers and responsibilities. Answer Choices Response Percentage Response Total 1 Strongly Agree 66.67% 10 2 Agree 26.67% 4 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 7. IJB meetings take place within a positive spirit of transparency, openness and trust. Answer Choices Response Percentage Response Total 1 Strongly Agree 60.00% 9 2 Agree 33.33% 5 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 8. IJB members effectively communicate decisions of the IJB within their own organisation. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 46.67% 7 3 Disagree 0.00% 0 4 Strongly Disagree 0.00% 0 5 Don’t Know 13.33% 2 Answered 15 Skipped 0
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25 9. The Health and Social Care Strategic Plan is reflected clearly in the resource allocation processes/ decisions made by members of the IJB (including spending less money on acute care, disinvesting and transferring this money to prevention and anticipatory care services in the community). Answer Choices Response Percentage Response Total 1 Strongly Agree 13.33% 2 2 Agree 60.00% 9 3 Disagree 20.00% 3 4 Strongly Disagree 6.67% 1 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 10. All IJB members are active participants in meetings and contribute effectively. Answer Choices Response Percentage Response Total 1 Strongly Agree 33.33% 5 2 Agree 33.33% 5 3 Disagree 20.00% 3 4 Strongly Disagree 6.67% 1 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 11. The individuals involved in the IJB are sufficiently empowered and influential to significantly advance the key issues. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 46.67% 7 3 Disagree 13.33% 2 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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27 Please provide positive examples to evidence how the IJB is performing in terms of leadership and relationships. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. IJB members vary in their contribution to discussion and decision making. 2. The combination of public facing meetings (IJB and PFA) and private briefings (Liaison) ensures full and comprehensive understanding of issues being addressed. The Integration Scheme Review embedded the principle of ‘no surprises’ across the whole system of LA, HB and IJB, and this pays dividends in ensuring thorough scrutiny, challenge and support for decisions that the IJB takes. 3. Non-voting members are not always given information in time to consult with carer groups. 4. support of cross sector working during pandemic acute huddle calls. 5. reports are well compiled, thorough, and delivered well in a way that instils trust in leadership. 6. Excellent Chair. 7. Good communication and trust. 8. I think the leadership and shared aspirations are a real strength and you can see by the fact these are whole system that the relationships are strong. We had several whole system meetings and events around inequalities, and I think you will hear the same intentions and phraseology used across the partner organisations...no mean feat! I also think the consultation around the National Care Service was another example of the very strong relationships that the partner agencies have. 9. Constructive, collaborative relationships are evident during course of meetings. 10. The status of the IJB is enhanced by its membership. The IJB Chief Officer is pro-active and led the review of the HSCP structure. An effective two-way communication strategy is also in place across the HSCP and all colleagues are encouraged to identify improvement opportunities. 11. The IJB membership is comprised of Non-Executive Directors and senior Elected Members, providing a really strong basis. The role of voting members has clearly developed, with it now being quite common for the Political Groups to ask for discussion on key papers, showing that key decisions are being considered through the partner organisations. The IJB works on a 'no surprises' basis, ensuring that key strategic decisions are trailed through the partner organisations before final approval at the IJB. Liaison sessions with voting members provide the opportunity for broader understanding around key topic areas ahead of strategic decisions. 12. The Strategic Commissioning Plan and supporting Programme of Work is developing to support much more openness and transparency of the whole system. The more systematic flow of work through the governing bodies is designed to make sure that all key areas of work have visibility through the IJB and the wider public. The IJB have been supportive of the development of this approach and realistic about the operational pressures making it difficult. The IJB supported the review of integration and agreed the structure reforms needed to change the operating model. More recently addressing the challenges of the Section 95 Officer working across two health and social care partnerships will further strengthen the senior leader capacity. Working across parent bodies is complex but worked through effectively. Recent agreement to adjustments to support Delivering for Communities, works with both the NHSL and NLC drive to reducing inequalities and increasing place-based approaches. Workforce planning, development of Care Academy, workforce for the future is a key priority for the IJB. 13. The commitment to provide multiyear funding for the Community Solutions
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29 Please provide details of how the IJB can improve its approach to leadership and relationships. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. Perhaps more unstructured briefing and engagement sessions may help? 2. The model is well established and could be referenced by other areas of Scotland. Constant focus on top leadership and the contribution the leads make to the system is important. The whole system approach should be embedded so that any changes of actual leaders will have minimal impact. Constant agreed strategic focus on inequality, poverty, health inequality as well as the key indicators for shifting the balance of care needs to the common vision. The context of the IJB in the broader areas of strategy, particularly driven by the LA is also recognised and needs to be consolidate. There is commonality of vision and this needs to be taken forward in a managed time framed way. 3. Non-voting members could be included in pre-meeting discussion 4. N/A 5. increase effectiveness of communications to those on the ground, including hard to reach groups, where workload is a barrier to reading e.g. staff bulletins 6. Unknown. 7. More time to discuss substantive issues. 8. I think the leadership and relationships are fantastic, the limitation on delivering is often down to the very difficult financial choices that have to be made. 9. Strong reliance on pre meetings which may dilute the quality of discussions at formal IJB meeting. Less reliance may strengthen the effective of IJB governance arrangements. 10. The set-aside concept is fundamentally flawed. Neither partner has sufficient recurring funding to meet current and future demand for health and social care services. This therefore limits the opportunities to disinvest from current services, particularly Acute Services, in order to realign funding to community-based services and services primarily focussed on early intervention and prevention. 11. One potential negative of papers going through partner organisations first is that by the time they reach the IJB, much of the detail has been worked through, meaning that it could be argued debate and discussion at the IJB is then reduced. Further work is required to fully align the budget process with the ambitions of the Strategic Commissioning Plan 12. A Who's Who and structure chart including senior team of the H&SCP and the key members of the IJB would be a good way of increasing visibility of leaders. Participation in meetings could be enhanced through more presentation and time for discussion. Balance between breadth and depth of reports. Papers being circulated earlier in advance of meetings would enhance the opportunity for people to digest often complex and technical detail, particularly in relation to finance and performance. Development sessions supporting the IJB might facilitate the need to make sure that the formality of meetings does not stifle debate, contribution, or challenge. Important to maintain a sense of openness and avoid defensive positions. Refresh of the induction and OD plan for the IJB and supporting structures would be helpful. 13. Earlier distribution of Board and Committee papers would be helpful to allow service user, carer and third sector representatives to review the papers and engage more widely with other interested parties. The volume of papers and complexities of the issues also make it difficult for non-voting members to fully contribute.
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Please provide details of how the IJB can improve its approach to leadership alationships. C. Governance and Accountability 12. The IJB has appropriate structures and processes to support shared, effective decision making. Answer Choices Response Percentage Response Total 1 Strongly Agree 46.67% 7 2 Agree 33.33% 5 3 Disagree 13.33% 2 4 Strongly Disagree 0.00% 0 5 Don’t Know 6.67% 1 Answered 15 Skipped 0 13. The agenda for Board meetings allows for strategic planning and debate around service development and transformation. Answer Choices Response Percentage Response Total 1 Strongly Agree 33.33% 5 2 Agree 60.00% 9 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 1 Answered 15 Skipped 0 14. The IJB has an effective mechanism in place for managing collective risks, which is regularly reviewed. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 53.33% 8 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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31 15. The IJB’s accountability arrangements are clear, understood and implemented by all on the Board. Answer Choices Response Percentage Response Total 1 Strongly Agree 53.33% 8 2 Agree 40.00% 6 3 Disagree 0.00% 0 4 Strongly Disagree 6.67% 1 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 16. The IJB holds individual Board members to account for their performance and contribution to the outcomes in the Health and Social Care Strategic Plan. Answer Choices Response Percentage Response Total 1 Strongly Agree 6.67% 1 2 Agree 53.33% 8 3 Disagree 26.67% 4 4 Strongly Disagree 0.00% 0 5 Don’t Know 13.33% 2 Answered 15 Skipped 0
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Please provide positive examples to evidence how the IJB is performing in terms of governance and accountability. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. Overall this works well some members are less engaged 2. Whole system approach to strategy, contained in the SCP, and reflected in the delivery of services during the Pandemic, and in the recovery and remobilisation strategy are fully sighted by the IJB and signed off as appropriate. Finance, audit and Risk all well managed and always with clear audit statement 3. The Risk Register is updated at every IJB Meeting 4. accountability through reports at regular meetings 5. excellent reports, with good time allowed for discussion and dissection, but invariably are seen as to be agreed/accepted. 6. Unknown 7. good documentation of proposals and decisions 8. The leadership of the IJB work extremely hard at building cohesion and there are many opportunities to discuss any areas of concern in the various planning and preparatory meetings as well as at the formal meetings. I think the risk mapping process is a superb example of how to get it right. It is robust, very frequently reviewed and reassessed and it is presented in a really effective way. 9. Work plan and programme for reporting on key themes in the Strategic Plan Positive internal and external audit evaluations. Regular review and implementation of audit recommendations Use of development sessions 10. Standard reports and regular updates are included on the IJB agenda to ensure effective governance and accountability. This includes risk register updates, action plan updates, strategic commissioning intentions and financial monitoring reports. 11. There has been a lot of development around the IJB's governance, with significant improvements noted around risk management and agenda planning, ensuring the IJB has continued sight of all SCP programmes of work. The SCP itself was based around a significant amount of community and staff engagement, setting out an ambitious future for NL. The Board reviews its annual performance report and is implementing an annual review of the programme of work, to provide further assurance on progress against the SCP. 12. Clear meeting structure in place and increasing effectiveness in agenda setting to get the right reports at the right forum for decision making and oversight. Expectation that POW oversight will increase with advanced action planning and business intelligence to increasingly understand and stretch positive impacts Financial reporting throughout the pandemic has been complex - good oversight and detail in interplay between core budgets, additional funding, covid recovery monies and reserves Creation of the Change Fund supports the ambition of transformational change. Relationships with Community Boards, wider planning partners is developing. Response to the National Care Service consultation was robust and whole system 13. The involvement of a wider range of stakeholders through the Strategic Planning Group is very good, with an increase in the frequency through the Pandemic has been welcomed. 14. No Comment 15. Fiscal management/track record given multiple challenges Answered 15 Skipped 0
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Please provide details of how the IJB can improve its approach to governance and accountability. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. see previous comments 2. Availability of time is the only feature that would strengthen governance. This has been curtailed due to working under the emergency and emergency powers, in order to fee s leaders for operational duties. When the crisis is over, time should be expanded for the and the IJB to strengthen scrutiny 3. I do not feel changes are necessary 4. N/A 5. light touch is appreciated by members, but I don't know how current arrangements benchmark against other IJBs 6. Unknown 7. review of individual contributions and their support needs 8. Probably because of my limited time on the IJB...and how well it is done, I have no suggestions. 9. Review purpose of IJB pre meeting and liaison session, particularly in context of potential membership change post local government elections. 10. More effective medium to long term financial planning would further enhance governance, accountability, and strategic planning opportunities. Further consideration should be given to decision-making arrangements between the IJB and both partners. 11. There is work required to ensure the IJB and IJB PFA Committees have a better split of responsibilities, with some crossover at present, which is evident through the action logs of both having actions for the same activity. Further work is required around evidencing achievement of outcomes in relation to the SCP, though this is moving in the right direction through the development work and reporting around the programme of work. 12. Reports could be circulated better in advance of the meetings Fairer Scotland Duty and Equality Impact Assessments could be competed more rigorously but there is also a need to review the supporting factors to increase governance and accountability. Increased use of such re- equipment would also increase focus on the need to complete effectively The IJB focus on targeting to those in greatest need is complex but worth considering in detail 13. The timeous circulation of papers (as noted in previous section) Elevate the prominence of the Risk Register through Board and Committee meetings as agreed during the Development Session in October 2021 Implement the use of the Direction Tracker agreed in 2018 14. The volume and timeous circulation of Board and Committee papers would help members to contribute more fully to meetings. 15. Longer term modelling and design - however, this will require structural redesign to partners funding frameworks (multi-year settlements) Answered 15 Skipped 0
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35 D. Community Engagement and Participation 17. The IJB has effective engagement mechanisms for understanding the needs of service users and communities. Answer Choices Response Percentage Response Total 1 Strongly Agree 20.00% 3 2 Agree 66.67% 10 3 Disagree 0.00% 0 4 Strongly Disagree 6.67% 1 5 Don’t Know 6.67% 1 Answered 15 Skipped 0 18. The IJB has developed and agreed a common understanding of local needs and opportunities. Answer Choices Response Percentage Response Total 1 Strongly Agree 33.33% 5 2 Agree 60.00% 9 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 19. The IJB has effective mechanisms for communicating with key stakeholders/ individuals/communities and service users. Answer Choices Response Percentage Response Total 1 Strongly Agree 26.67% 4 2 Agree 60.00% 9 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 6.67% 1 Answered 15 Skipped 0 20. Agreed priorities and outcomes in the Health and Social Care Strategic Plan reflect the key challenges of the area identified through any data analysis and community engagement activity. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 53.33% 8 3 Disagree 6.67% 1
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4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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37 Please provide positive examples to evidence how the IJB is performing in terms of community engagement and participation Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. there is a lot of really good work done greater use could potentially be made by the IJB of the data and information gained through the CPPs 2. Clear strategy signed off. Engagement at the heart of all strategic proposals that come before the IJB. 3. Community engagement and participation is through the Partnership for Change assimilation meetings where the papers for the IJB meetings are discussed. 4. a number of specific local initiatives implemented 5. I may be wrong but my impression from all reports whether written or oral, is that there is genuine engagement with and attempts to understand service users and their needs 6. Unknown 7. Health and Social Care NL and the IJB are strongly commitment to community engagement and participation with a range of good practice. 8. Due to the significant investment that has been made in the Local Authority's links with communities and this being in the process of being further enhanced, I think the IJB was well placed to gather the views of the community. In addition, the strong relationship with the third sector has brought real value in this area. 9. Strategic plan is underpinned by strong engagement and communication with community representatives. Detailed assessment of local need undertaken through use of NLC data. 10. Most recently, Roadshow events were held in January 2022 and participation from a wide and diverse range of stakeholders was actively encouraged. 11. The IJB has a strong track record of engagement. The Engagement and Participation Plan sets out the wide range of engagement mechanisms in place, and this has been regularly reviewed. The Strategic Planning Group has moved to quarterly meetings throughout the pandemic, with 70-80 attendees. The HSCP has also recently recommenced staff roadshows, which are also taking place on a quarterly basis. 12. IJB agreed the appointment of a paid role to support Participation and Engagement IJB signed off a Participation and Engagement Strategy and receives updates on progress Locality profiles used to consult on the SCP and inform its development IJB encourages active participation in Community Boards and supports place-based approaches Endorsing the Programme of Work to support the SCP ambitions offers greater opportunity to promote active engagement in areas of importance and interest 13. The strategic commitment to engagement and participation is strong with mechanisms embedded to ensure this takes place 14. Funding for third sector support for users and carers to engage with the changes around health and social care. 15. Clearly established role across all Corporate and community workstreams. Answered 15 Skipped 0
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Please provide details of how the IJB can improve its approach to community engagement and participation. Please provide details of how the IJB can improve its approach to community engagement and participation Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. work more closely with the CPPs 2. More of the same as we move to the next SCP and MH Strategy 3. It may be possible to include non-voting members more 4. wider engagement with third sector stakeholders 5. ensure there is a representative, cross population level of engagement 6. Unknown 7. HSCNL has commissioned a review of community engagement and participation to identify and progress improvement opportunities 8. I would like to see us move forward with ways of formally recognising people for their commitment and contribution and to use this process to give people skills, opportunities or other assistance that will enhance their lives. 9. Provide evidence of positive outcomes at locality level through implementation of Strategic Plan 10. The challenge continues to be the availability of sufficient recurring funding to establish sustainable and pro-active responses to the needs identified through community engagement and participation. 11. The development of the Community Boards in NL provides an additional mechanism for community engagement, which we haven't maximised at this stage. At this stage, the IJB is possibly better at community engagement in developing the plan than in continued participation in the roll out, which is an area for development. 12. More systematically evaluate the impact of Fairer Scotland Duties Assessments Increasingly target resources to address the greatest inequalities 13. • Complete the review of Engagement and Participation and implement the findings. Commit to recurring funding to ensure Engagement and Participation in the long-term. 14. Improvements can be maintained by listening and consulting with users and carers affected by the changes. 15. Next stage engagement and support of our new Community Boards as they continue to evolve - links to recent structural changes which evidence this support is in motion. Answered 15 Skipped 0
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39 E. Outcomes and Impact 21. By working together, the IJB has delivered improvements which could not have been delivered by individual organisations. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 53.33% 8 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 22. The IJB has undertaken an analysis of what it spends on health and social care services and activities and how this contributes towards its agreed outcomes. Answer Choices Response Percentage Response Total 1 Strongly Agree 26.67% 4 2 Agree 60.00% 9 3 Disagree 13.33% 2 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 23. The long-term improvements in outcomes that the IJB is seeking to achieve over the next decade (as set out in the Health and Social Care Strategic Plan) are supported by immediate outcomes, indicators and targets against which progress can be measured in the short and medium term. Answer Choices Response Percentage Response Total 1 Strongly Agree 20.00% 3 2 Agree 60.00% 9 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 13.33% 2 Answered 15 Skipped 0 24. The IJB realigns resources in order to better deliver early intervention and prevention approaches. Answer Choices Response Percentage Response Total 1 Strongly Agree 6.67% 1
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2 Agree 80.00% 12 3 Disagree 13.33% 2 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 25. There is evidence that the IJB’s actions around early intervention and prevention are having an impact. Answer Choices Response Percentage Response Total 1 Strongly Agree 6.67% 1 2 Agree 60.00% 9 3 Disagree 20.00% 3 4 Strongly Disagree 0.00% 0 5 Don’t Know 13.33% 2 Answered 15 Skipped 0
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41 Please provide positive examples to evidence how the IJB is performing in terms of outcomes and impact. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. high resource users work would be one very good example 2. IJB always constrained by inadequate Gvt settlement. 3. The Covid-19 pandemic has made progress impossible under these circumstances 4. limited experience of these impacts 5. there was a report... 6. Unknown 7. The investment in the Community Solutions programme supporting community and voluntary organisations to provide community-based support to vulnerable groups has delivered good personal outcomes and strengthened sector capacity to do more. 8. The IJB has a clear plan to improve the lives of the citizens of the communities of North Lanarkshire. There is an emphasis on detailed and SMART actions that are all aimed towards making the long-term sustainable difference that is needed. 9. Progress against national and local indicators though performance not on target in all areas. 10. Robust and transparent performance monitoring arrangements are in place. Performance outcomes are regularly reviewed, and action taken to address emerging issues as appropriate. 11. The IJB has a clear direction of travel set out within the Strategic Plan and the SCP. While the pandemic has impacted on immediate roll out of the 2020-23 plan, there are still a range of positive examples of integrated working and developments that the IJB has led, such as the development of integrated rehab teams, locality modelling, developments within the MH Strategy and new upstream developments such as first point of contact, the development of PDD, Home First and Discharge to Assess. The further expansion and now recurring funding of the Community Solutions programme is another great example, which can evidence positive outcomes for the NL community. 12. Prevention and early intervention activities supported Community Solutions / VANL funded on an ongoing basis rather than year to year. Community Solutions reports welcomed at IJB - good mix of quantitative and qualitative data Rehab and reablement priorities clearly supported, development of Planned Date of discharge, Integrated rehab teams, Discharge to assess, and now Home First. Digital developments to support improved outcomes Care opinion supported Focus on carers within the IJB 13. The agreement to commit to multi-year funding for the Community Solutions Programme is welcome and demonstrates a commitment to realign resources to better deliver early intervention and prevention approaches. Discussions around the use of additional multi-year funding from the Scottish Government for early intervention and prevention approaches is also welcome, however the specific detail is unknown. 14. No Comment 15. This needs to be viewed against the context of recent demands and unique system pressures - reactive has unfortunately been a necessity but therefore remains new scope to refocus back upon preventative through lessons learned. Answered 15 Skipped 0
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43 Please provide details of how the IJB can improve its approach to outcomes and impact. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. using patient and user feedback more consistently alongside the existing very comprehensive needs analysis work 2. All aspects of prevention and early intervention at the core of the overall strategy. Pressure on the system upstream, lack of adequate GVt resourcing and limitations of staff availability (Social Care, Psychology etc) are limiting factors 3. No progress will be achieved until Covid-19 is under control 4. see above 5. no response 6. Unknown 7. invest more in the community and voluntary sector 8. I think it is difficult to work on the very long-term work without being diverted by short/medium term imperatives. In addition, it is incredibly difficult to drive investment toward meaningful preventative work when there is a significant financial pressure to deliver the services that are needed here and now. Despite excellent partnership working and shared priorities it is still very difficult to work round the individual budgets of partner agencies. 9. Further develop approach to performance monitoring with emphasis on localities. 10. The analysis of how health and social care spend contributes to IJB outcomes needs to be further developed and assessed. Sufficient recurring funding has not been available to meet the current level of health and social care service demands. It has therefore not been possible to identify sufficient recurring funding to invest in sustainable early intervention and prevention alternatives. 11. There is still further scope to improve the performance framework to better demonstrate the impact on individual outcomes (an outstanding action from the SCP is the agreement and roll out of a multi-agency outcome framework). The performance framework needs to continue to evolve to support the partnership to demonstrate the impact of new service areas (such as PDD, Home First etc) 12. in pressurized times the focus can be more on system and flow than articulated around people Outcome frameworks could be strengthened 13. More explicit plans on how core IJB resources can be used to shift the balance of care from acute services to early-intervention and prevention approaches would be welcome, currently most plans focus on additional resources allocated by the Scottish Government. 14. We know what the IJB are planning around early intervention and prevention, but we don't know what the impact will be. It is important to continue to consult with user and carers about the outcomes and impacts of the investment (good and bad) and doing something about it where necessary. 15. See above. Answered 15 Skipped 0
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45 F. Performance Management and Use of Evidence 26. The performance information considered by the IJB is timely, relevant and provides a good measure of progress towards the desired outcomes and key time specific targets. Answer Choices Response Percentage Response Total 1 Strongly Agree 33.33% 5 2 Agree 46.67% 7 3 Disagree 20.00% 3 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 27. The IJB actively uses performance information to facilitate constructive strategic discussion and, where required, to instigate corrective action in order to address under- performance against key targets. Answer Choices Response Percentage Response Total 1 Strongly Agree 40.00% 6 2 Agree 46.67% 7 3 Disagree 6.67% 1 4 Strongly Disagree 6.67% 1 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 28. The targets set for the IJB are ambitious and stretching, whilst being realistic. Answer Choices Response Percentage Response Total 1 Strongly Agree 33.33% 5 2 Agree 60.00% 9 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0
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29. The IJB has a good understanding of the distribution of health inequalities across its area and the range of equalities groupings (e.g. age, race, gender). Answer Choices Response Percentage Response Total 1 Strongly Agree 53.33% 8 2 Agree 40.00% 6 3 Disagree 6.67% 1 4 Strongly Disagree 0.00% 0 5 Don’t Know 0.00% 0 Answered 15 Skipped 0 30. There is a publicly available, easy to understand performance report, which demonstrates progress (including successes and failures) of the Health and Social Care Strategic Plan, and is clear about the difference the IJB is making to improve the lives of local people. Answer Choices Response Percentage Response Total 1 Strongly Agree 20.00% 3 2 Agree 60.00% 9 3 Disagree 13.33% 2 4 Strongly Disagree 0.00% 0 5 Don’t Know 6.67% 1 Answered 15 Skipped 0 31. The IJB has effective arrangements to evaluate its own performance Answer Choices Response Percentage Response Total 1 Strongly Agree 26.67% 4 2 Agree 66.67% 10 3 Disagree 0.00% 0 4 Strongly Disagree 0.00% 0 5 Don’t Know 6.67% 1 Answered 15 Skipped 0
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47 Please provide positive examples to evidence how the IJB is performing in terms of performance management and use of evidence. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. more work needed on the needs of seldom heard from communities 2. The papers and agenda of the PFA reflect adequate use of performance management data and evidence 3. The Annual Report provides details of performance throughout the year. 4. limited experience of working in the IJB but see clear accountability and performance metrics presented at Boards 5. excellent publicly available website with all reports 6. Unknown 7. Effective evaluation and reporting of the Community Solutions programme 8. The Performance Finance and Audit Committee is really well managed and is focussed on the 'so what' question. The desire is to see what change we have made (rather than what we have delivered) and to ensure we are measuring outcomes in a way that reflects the changes we want to see. 9. Regular reports to PFA 10. The ongoing and dynamic response to the Covid pandemic. 11. A real strength of the IJB is its focus on health inequalities, which is a common focus of the Lanarkshire system as a whole. All partners have picked this up as a core focus for the years ahead, with understanding that all CPP partners will have a role to play, evidenced by recent workshops to further the planning around this agenda. The IJB has a performance framework in place, which has been agreed with both partners, with quarterly integrated operational performance reviews through the HSCP and via the IJB. While further work is required to continue its development, some of this is constrained by the roll out of new electronic systems (e.g. SWIS replacement, Morse roll out will provide the opportunity to get a much fuller understanding of service performance and how this impacts on outcomes). 12. Measures to improve specific areas of challenging performance has supported permanent appointment of staff (above establishment) in hard to fill areas - CAMHS, SALT, psych therapies etc 13. The on-going commitment to review and self-evaluation is clear and is highlighted by this self-evaluation exercise. 14. No comment 15. Strong focus at an individual and organizational level - open and transparent reporting and peer review and challenge across stakeholders. Answered 15 Skipped 0
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Please provide details of how the IJB can improve its approach to performance management and use of evidence. Answer Choices Response Percentage Response Total 1 Open-Ended Question 100.00% 15 1. see above 2. More time, post pandemic to analyse and present data 3. The system does not allow for timely actions to be implemented. 4. see above 5. Performance management of individuals employed within it and other organisations perhaps more important 6. Unknown 7. more funding to support evaluation, learning and improvement across different programmes 8. This is not a reflection of the IJB but a general and well-rehearsed observation. The problem with the volume and multi-faceted nature of activity is that it is very difficult indeed to identify what it was that made the difference. 9. Use of development sessions to address particular areas of concern or underperformance 10. The outcome of this current self-evaluation exercise will prove beneficial to improving the IJB's approach to performance management and the use of evidence. 11. Some of the national outcome indicators are reported with such a time lag that there is limited value in them. Localised alternatives that are able to be viewed more regularly would add significant value to the IJB's oversight 12. Increase accessible format performance reporting Increase place-based reporting 13. Performance reports are reviewed on a quarterly basis, however some of the information can be a couple of quarters old and it is limited to the under- performing targets, which lacks a broader understanding of performance across the whole system. Under-performance in some key target areas (CAMHS and Psychological Services) has been consistent since the establishment of the IJB (including prior to the Pandemic), with no real service changes considered and wider national staffing shortages being highlighted as the reason. 14. No Comment 15. Need to challenge role of such information and interpretation by wider stakeholders - undermines proactive and drives reactive services. Answered 15 Skipped 0
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49 Appendix 3 Improvement Plan Improvement actions Lead Implications [Risk, Cost, Resource] Target date Measures Outcomes (1) Look to evidence how health and social care spending contributes to prevention and early intervention. 1. Review of Strategic Commissioning Plan - Strengthen outcome 5 around inequalities. Strategic Commissioni ng Plan Programme Board Risks • Don’t know how this work will be impacted by National Care Service Review. • Capacity to progress this work - needs protected. • Funding not recurring – Money currently directed to pressure points. Risks if action not implemented • Equalities gap Review completed end of summer 2022 with agreement for new plan early 2023 • Updated Strategic Commissioning Plan. • Quantify resources committed to Prevention and Early Intervention. • Prevention and early intervention question included in reports. • Locality profiles developed. • Academic Research • Strategic commissioning intentions achieved. • Prevention and Early Intervention funded on a secured basis. • A recurring sustainable financial plan over the medium to longer term which evidences best value. • Service improvements, better outcomes 2. Immediate review of opportunities against resources. Need to be clear on what we are seeking to achieve – clarify performance difference. Governance of this improvement action will be overseen by the IJB. Morag Dendy main contact with support from others depending on action. April 2022 3. Look to include a question in all Board papers regarding how it impacts upon prevention and early intervention. April 2022 4. Undertake a review of good practice from across Scotland. Autumn 2022
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5. Ring-fence funding for prevention and early intervention as part of Reserves Strategy. Engage with Scottish Government regarding recurring funding. Capacity needed to support this work. increases. • Increase in demand for reactive services. Costs • Significant costs - funding fragile June 2022 into benefits of investment. • Findings from review of good practice. and greater equality of service provision. 6. Engage with Academia to establish how we measure success – locality profiles, baselines, etc. Initial phase - April 2022. Locality profiles aspect - end of summer 2022 7. Look to evidence how existing work links to prevention and early intervention and how this aligns to outcomes End of Summer 2022
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51 Improvement actions Lead Implications [Risk, Cost, Resource] Target date Measures Outcomes (2) Look to embed learning and new ways of working in the IJB from the response to the pandemic to ensure plans, governance, etc. are fit for purpose. 1. Review what worked well during the pandemic and what did not as a starting point. Develop Scoping Paper with the wider team to pick out the key areas to retain. Once Scoping Paper is completed and actions agreed, then the IJB in June (with new members) can attribute owners and share actions identified across the full team. IJB then has to take ownership then to drive these forward. Risks • Duplication of effort if not careful. How does this work fit with other organisations looking at this? Can we get a collective view? • Issue of funding reducing after the pandemic. • Is the 10 year plan still fit for purpose? • What are the implications of the NCS for the Need to begin review quickly, but split out what learning needs to be looked at now and what can be looked at later. Need to remember still in the recovery phase, so time is limited. • Develop Scoping Paper to go to IJB in June 2022. • Feedback gathered from staff and service users. • Lessons learned from the pandemic are recorded in a permanent way. • People with lived experience have told their stories/experienc es to the IJB. We have successfully moved to a new way of working that has been co- designed with staff and public and is focussed on delivering improved experiences and outcomes for our communities. 2. Need to take forward the work with community groups and organisations to ensure that this does not disappear. Keep these relationships and strengthen them. Part of this is to fix digital exclusions to support work of such groups.
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3. Consider what can be done now to keep up the continuous improvement momentum developed during the pandemic, for instance, governance became much more agile. Need to now maintain that ability to respond rapidly and not be afraid to take actions. Christine Jack and wider team to take forward work on the Scoping Paper for IJB in June. IJB? Costs • Should not be afraid to fund the Third Sector. 4. Look to capture the lessons learned during the pandemic about the journey to be recorded in a permanent way in case of future emergencies. 5. Need to ensure that whatever lessons learned are implemented have longevity. These have to be fit for use whatever structures emerge in health and social care.
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53 Improvement actions Lead Implications [Risk, Cost, Resource] Target date Measures Outcomes 6. Look to consider what insights can be gained from service users and their journey during the pandemic and also from staff. This should be used to feed into scoping around what worked and what did not. (3) Review how performance information is used by the IJB to ensure it is timely, relevant and provides a good measure of progress towards agreed outcomes. 1. Identify specific service areas of concern in high level reports to the Board and link these to the Risk Register. Morag Dendy / Graeme Cowan / Lucy Munro Risks Without improved reporting of performance there is a risk of not being able to evidence the impact that investment and resources are having on achieving the intentions set out in the HSC strategic plan and being able to demonstrate the There are 2 key milestones for the one collective action: 1. By end June 2022 need to sign off performance scorecard for the year ahead - review the • A structured regular flow of reporting to the IJB and PFA showing service performance in line with the risk register and enabling the right discussions about improvement in the right forum (e.g. CE • Ensuring a performance framework that drives intelligence, actions, and results - a plan/do/review cycle that shapes what we are doing and informs continuous improvement in 2. Develop a better understanding of the audience for performance reports - who the audience is, what information do they need, etc.
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3. Consider what the IJB need in terms of performance reporting and what the public need, ensuring this is presented in a user friendly format - what are the gaps in this respect that need to be addressed? benefits to local people and communities. Costs • Costs in terms of IT systems (i.e. Swis) are already committed (so there are no additional implications in that respect). measures, information and identify what will be measured in the year ahead. 2. An outcome framework piece (as described in the collective actions) will take longer as it will performance reviews). • Strengthening the dual focus on performance and the shared datasets running through each (a) IJB having a strategic overview and looking at overall health outcomes for the people of NL. • Ensuring performance reporting that demonstrates value for money to the public and ensures transparency and 4. Review the content of what is reported to ensure information is presented in full and within the appropriate context, i.e. whole system / end to end reporting
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55 Improvement actions Lead Implications [Risk, Cost, Resource] Target date Measures Outcomes (e.g. delayed discharge is a good example of a service area which requires several pieces of info in order to fully inform the live position). • There should also be no additional costs in respect of the gathering of performance information – the information is all there, it’s about making better use of it, keeping it fresh and need agreement from all professional groups so implementatio n date would be by March 2023. performance in terms of is our strategy working? And being able to use the performance information to drive the strategic plan in the right direction, and (b) operational delivery through HSC. accountabilit y. 5. Improve the reporting of outcomes and how these have improved the lives of service users.
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6. Ensure the work around the development of IT systems allow for data capturing to be simplified to reduce the number of manual processes. updated. • A business case has already been completed for an additional performance resource. • Better use of satisfaction surveys with people and local communities should help to inform how we target communications / performance reporting. • Evidencing that reporting has shifted from what working in partnership has achieved through what we’re doing anyway to what we’ve done to collectively make a difference (e.g. the work through breastfeeding) and
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57 Improvement actions Lead Implications Risk, Cost, Resource] Target date Measures Outcomes using this to inform and shape discussions at NLP level. • Evidence that we’ve tapped into the learning and experiences of others (e.g. housing) to captured shared experiences of end to end processes.
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1 REPORT Item No: 7 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB): For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 30 June 2022 (Health Care Services and 24 June 2022 (Social Work and Housing Services). 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; (2) Note that the financial outturn at June is an underspend of £3.290m (NHSL - £2.249m; NLC - £1.041m). 4. VARIATIONS TO DIRECTIONS SUBJECT: Financial Monitoring Report 2022/2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Marie Moy, Chief Financial Officer DATE: 31st August 2022 Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. This is the final financial monitoring report presented in respect of the financial year 2022/2023. 6. CONCLUSIONS 6.1 The financial position as at June 2022 is summarised as follows: there is a net underspend of £2.249m on the core budgets within Health Care Services; details of which are provided at Appendix 1. there is a net underspend of £1.041m on the core budgets within Social Care and Housing Services; details of which are provided at Appendix 2 The total underspend of £3.290m represents approximately 0.58% of the total financial envelope available. 6.2 The Covid-19 pandemic has created significant financial management and financial planning challenges for both partners and the IJB. These challenges have centred around the difficulties in predicting the costs associated with the response to and recovery from the Covid-19 pandemic and the constantly evolving funding allocations from the Scottish Government. 6.3 Additional Scottish Government funding was confirmed on 25 February 2023 which met in full the 2021/2022 Covid-19 costs included in the Lanarkshire Remobilisation Plan for both partners. Spend against this in 2021/22 was £13.412m which left a balance of £31.686m uncommitted at 31 March 2022. This was transferred to a ring-fenced reserve to address ongoing Covid-19 costs in 2022/2023 6.4 The Covid-19 funding transferred to the ring-fenced reserve can be used to support continuation of costs which were funded in 2021/2022 as a direct result of Covid-19. The use of these allocations to meet Covid-19 expenditure must be agreed by the IJB Chief Finance Officer and the NHS Board Director of Finance. It is important to note that the funding should be targeted at meeting all additional costs of responding to the Covid-19 pandemic in the Integration Authority as well as the NHS Board. 6.5 Any proposed utilisation of the earmarked reserves to meet new expenditure that had not been funded in 2021/2022 will require the prior agreement of the Scottish Government in advance of the expenditure being incurred. It also remains important that reserves are not used to fund recurring expenditure, given the non- recurring nature of Covid-19 funding. The Covid-19 financial position is being closely monitored. 6.6 Of the Covid-19 reserve Health Care Services have utilised £0.805m as at June and Social Care and Housing Services are projecting to utilise £2.838m during 2022/23.
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3 6.7 The main factors contributing to the financial position are summarised at sections 7 and 8. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES 7.1 Locality and Other Services 7.1.1 There is a net underspend of £0.797m. 7.1.2 The net underspend on pay costs totals £0.765m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. 7.1.3 In respect of non-pay costs, there is a net overspend totalling £0.320m. The overspend is mainly due to payments in respect of Strathcarron Hospice (£0.142m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. The overspend across non-pay costs is partly offset by underspends in respect of drug and travel costs. 7.2 Addiction Services 7.2.1 There is an underspend of £0.117m. 7.2.2 The underspend across pay costs is £0.068m. An underspend of £0.049m is reported in respect of non-pay costs. 7.3 Medical and Nursing Directorate 7.3.1 There is a net underspend of £0.029m. 7.3.2 An underspend of £0.020m is being reported in respect of the medical directorate. There is an overspend across pay costs of £0.005m which is offset by an underspend of £0.025m in respect of non-pay costs. 7.3.3 The nursing directorate is underspent by £0.009m. There is an overspend across pay costs of £0.001m and an underspend of £0.010m in respect of non-pay costs. 7.4 Prescribing 7.4.1 A breakeven position has been reported. 7.5 Out of Area Services 7.5.1 There is a net underspend of £0.190m across non-pay costs. 7.6 Area Wide Services 7.6.1 There is a net underspend of £0.022m mainly in respect of Pharmacy Services (£0.041m). 7.6.2 Area Wide Services include corporate services, health promotion services, pharmacy services, winter planning services and the refugee area. The
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4 underspend comprises of an overspend of £0.040m across pay costs and an underspend of £0.062m across non-pay costs. 7.7 Hosted Services Led By North Lanarkshire 7.7.1 There is a net underspend in the hosted services which are led by the North Lanarkshire HSCP. The net underspend is £1.094m which includes the following significant variances: Mental Health and Learning Disability Services £0.266m underspend Children and Adolescents Mental Health Services £0.483m underspend Podiatry Services £0.049m underspend Speech and Language Therapy Services £0.255m underspend Childrens Services £0.059m underspend Immunisation Service (£.0.093m) overspend 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.7.2 The net underspend on Mental Health and Learning Disability Services is £0.266m. There is a net underspend across pay costs of £0.237m. This is due to vacancies mainly in nursing posts with some vacancies in psychology posts and administration posts (£0.569m). The underspend has been partly offset by overspends totalling £0.332m. This includes locum costs across Medical Services (£0.114m) and other overspends totalling £0.218m which include the use of bankaide across the inpatient areas and incremental increases within the community areas. There is a net underspend across non-pay costs of £0.029m. The total underspend to date is £0.174m however this is offset by overspends totalling £0.145m. The overspend relates mainly to the Forensic Psychiatry Services (£0.028m), Psychology (£0.054m) and Perinatal and Infant Mental health (£0.010m) 7.7.3 The net underspend within Children and Adolescents Mental Health Services is £0.483m and is due to vacancies across nursing and administration posts. There is also an overspend on non-pay costs (£0.022m). 7.7.4 There is an underspend of £0.049m within Podiatry Services which is mainly due to podiatrist vacancies (£0.049m) and a breakeven across non-pay. 7.7.5 There is an underspend of £0.255m within Speech and Language Therapy Services which is mainly due to vacancies (£0.231m) and an underspend across non-pay costs of £0.024m. 7.7.6 There is an underspend of £0.059m within Childrens Services which is mainly due to vacancies (£0.086m) and an overspend across non-pay costs (£0.027m). 7.7.7 There is an overspend within Immunisation Services of £0.093m which is partly due to an overspend on pay costs (£0.053m) together with an overspend on non- pay costs in respect of the cost of drugs (£0.040m). 7.7.8 In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any
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5 underspends which may be used to offset the overspends. This arrangement has been in place since 1 April 2016. 7.7.9 The IJB was previously advised that the hosted services principal is currently being reviewed. The outcome of the review will be reported to future meetings of both the North Lanarkshire IJB and the South Lanarkshire IJB for approval. 7.8 Hosted Services Led By South Lanarkshire 7.8.1 The hosted services which are led by the South Lanarkshire HSCP, in-line with the hosted services agreement, a break-even position is reported. 7.8.2 Primary Care Services are a hosted service which is led by the South Lanarkshire IJB. The Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund are ring-fenced funding allocations. Any underspend is therefore retained for use across Lanarkshire and is not used to offset other overspends incurred by the South Lanarkshire IJB. 7.9 Covid-19 Pandemic – Additional Health and Social Care Costs 7.9.1 The additional costs which have been incurred in response to the Covid-19 pandemic continued to be reported to the Scottish Government through the Lanarkshire Mobilisation Plan. The actual costs incurred for Covid-19 for 2022/2023 total £0.805m. These have been met from existing IJB Covid-19 reserve. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.10 Average Vacancy Factor 7.10.1 The vacancy position against the funded establishment at 30 June 2022 is summarised as follows: Establishment Actual Variance 2,730 WTE 2,627 WTE 103 WTE vacancies 100% 96% 4% 7.10.2 The staff resource is 103 WTE (4%) under-established over the period. Additional hours are worked through bank aide, overtime and excess part time hours, the cost of which is included within the financial position reported and these are included in the final figure. 8. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES 8.1 A net underspend of £1.041m is reported as at 24 May 2022. The main factors contributing to this year-to-date financial position are highlighted below. 8.2 A net underspend of £0.662M is reported within employee cots which relates slippage in relation to the recruitment of posts linked to the “Winter Planning and Enhanced Supports” business case. 8.3 An underspend of £0.210m is reported within Admin costs, mainly as a result of less than anticipated spend within Carers budgets. 8.4 There is an underspend of £0.251m across payments to other bodies. The underspend is primarily due to the staff shortages within the Care at Home sector
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6 who provide services to individuals via the Self-Directed Support commissioning framework. It is anticipated that these are in-year underspends only and these budgets will be required in full in 2023/2024. 8.5 Income is under-recovered by £0.086m, which is an adverse variance. This is a result of the committed income recovery from NHSL, in respect of the Integrated Equipment and Adaptations Service, being lower than the historic budget level; coupled with lower than budgeted receipts from charges for Community Alarms and the Integrated Day Services. 8.6 This is partly due to the under-recovery of income from the community alarm charge, Home Support Services and Integrated Day Care Services which is lower than anticipated as a result of the Covid-19 pandemic. The implementation of the charge for community alarms was delayed due to the impact of the Covid-19 pandemic. The charge is now in place. Social Care Services continue to closely monitor the changes in the uptake of this essential service and are pro-actively responding to enquiries. The previously agreed NHS Lanarkshire partner contribution to the Integrated Equipment and Adaptations Service is also less than the actual cost of the service. This is currently being monitored. 8.7 The additional social care costs which have been incurred in response to the Covid-19 pandemic are also continuing to be reported to the Scottish Government through the 2021/2022 Lanarkshire Mobilisation Plan. 8.8 The projected Covid-19 costs for 2021/2022 will be met by Scottish Government funding. As highlighted at 6.4, uncommitted 2021/2022 Covid-19 funding at 31 March 2022 will be transferred to a ring-fenced reserve to meet ongoing 2022/2023 Covid-19 costs. 9. 2022/2023 SAVINGS 9.1 Financial Strategy 2022/2023 9.1.1 On 23 March 2022, the IJB approved the financial strategy for 2022/2023. The funding gap of £5.504m will be addressed by budget realignments (£3.264m), a projected recurring prescribing budget underspend (£1.493m), prescribing efficiency savings (£0.387m) and reliance on reserves (£0.361m). 9.2 Health Care Savings 9.2.1 No health care savings have been agreed for 2022/2023. 9.3 Social Care Savings 9.3.1 This financial year 2022/2023 is the third year of the three-year Efficiency Programme approved by the IJB and the NLC partner in March 2020. The gross savings target is £2.025m. The NLC partner is therefore progressing the previously agreed savings plans. 9.3.2 The Service uses a variety of information, records and processes to monitor achievement of its approved budget savings; the Service anticipates £0.653m (32%) will be delivered by the financial year-end. 10. RESERVES
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7 10.1 The reserves balance as at 31 March 2022 were as follows: £m % Ring-fenced reserves 45.718 38% Ear-marked reserves 70.050 59% Contingency reserves 3.684 3% Total 119.452 100% 10.2 There has been no draw down from these reserves at this stage of the year. 10.3 The 2022/2023 IJB Reserves Strategy will be reviewed and presented to Directors at a future Board meeting. 11. RISK 11.1 Risk management arrangements are in place for the IJB and each partner. The main risk associated with the in-scope budget during 2022/22 is that either or both partners would overspend. However as detailed within this report the financial outturn for the year is projected to be an underspend 11.2 Although a non-recurring underspend has been reported, health and social care services continue to face demand pressures including home support, self-directed support, direct payments, independent care home placements, hospice care and health care services recovery plans. 11.3 The operational and financial impact of the response to the Covid-19 pandemic continues to be monitored by the IJB and both partners in line with their agreed emergency response arrangements and also the recovery, redesign and remobilisation work to reinstate services. The whole system approach continues to be adopted by NHSL, NLC and South Lanarkshire Council. 11.4 Risk management arrangements are in place for the IJB and each partner. The respective risks are managed by both NHSL and NLC through their detailed budget management processes. In addition to these mitigating actions, the IJB Financial Plan 2022/2023 is closely monitored and the IJB Medium to Long Term Financial Pan is being updated. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A
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8 12.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 11. The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 12.5 PEOPLE None 12.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the North Lanarkshire IJB. 12.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 12. IMPLICATIONS (CONT.) 12.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 13. BACKGROUND PAPERS None. 14. Appendices North Lanarkshire Health Care Services Financial Outturn 2021/2022 Appendix 1 North Lanarkshire Social Care Services Financial Outturn 2021/2022 Appendix 2 ........................................... CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591
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Appendix 1 9 North Lanarkshire Health Care Services Financial Outturn 2022/2023 £000's Annual Budget YTD Budget YTD Actual YTD Variance North West Localities 19,077 4,769 4,331 438 North East Localities 15,946 3,990 3,689 301 Adults Services 18,719 4,702 4,564 138 Childrens Services 36,821 7,671 6,981 690 Mental Health 71,925 18,003 17,611 392 North Mgmt Team 1,936 411 287 124 Medical Director 776 195 175 20 Nursing Director 3,610 902 893 9 Apprenticeship Levy 524 131 129 2 BBV 1,529 382 307 75 Hospice - - 142 142- Out of Area Services 4,568 1,142 952 190 Resource Transfer 22,965 5,741 5,725 16 Integration Fund / DD 290 73 73 - Boundary SLA's 8,115 2,029 2,047 18- Commissioned Services 6,799 1,700 1,687 13 Unscheduled Care - - - - Social Care funding 22,514 5,629 5,629 - ADP/LIF 3,063 696 705 9- Mobilisation costs 479 479 479 - COVID-19 326 326 326 - Planning 438 190 202 12- TOTAL 240,420 59,161 56,934 2,227 Prescribing 70,239 17,560 17,560 - TOTAL 310,659 76,721 74,494 2,227 Share of Area Wide Services 22 OVERALL TOTAL 2,249
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Appendix 2 10 North Lanarkshire Social Work Services Financial Outturn 2021/2022 CATEGORY BUDGET ACTUAL YEAR TO DATE TO DATE TO DATE VARIANCE EMPLOYEE COSTS 16,748,540 16,086,172 662,368 PROPERTY COSTS 1,955,569 1,955,559 10 SUPPLIES & SERVICES 949,645 947,973 1,672 TRANSPORT & PLANT 324,561 323,131 1,430 ADMINISTRATION COSTS 209,756 0 209,756 PAYMENTS TO OTHER BODIES 14,659,007 14,407,516 251,491 OTHER EXPENDITURE 1,057 1,057 0 APPORTIONED EXPENSES 0 0 0 CFCR 0 0 0 CAPITAL EXPENDITURE 0 0 0 TOTAL EXPENDITURE 34,848,135 33,721,408 1,126,727 NLC CONTRIBUTION 42,854,562 42,854,562 0 NLC CONTRIBUTION - HOUSING 1,870,010 1,870,010 0 NLC CONTRIBUTION - TRANSPORT 169,458 169,458 0 INCOME FROM HEALTH 2,943,152 2,913,761 (29,391) FEES AND CHARGES 248,968 175,374 (73,594) OTHER LOCAL AUTHORITIES 6,921 6,921 0 USE OF IJB RESERVES 0 0 0 OTHER INCOME 31,603 48,857 17,254 TOTAL INCOME 48,124,674 48,038,943 (85,731) NET EXPENDITURE (13,276,539) (14,317,535) 1,040,996
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1 REPORT Item: 8 SUBJECT: Performance Update – Quarter 2 (January – March 2022) TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author of Report: Graeme Cowan Manager, Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The purpose of the report is to provide an update to the Board on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 January to 31 March 2022 (Quarter 4). 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Manager, Planning, Performance and Quality Assurance Reviewed By: Head of Planning, Performance & Quality Assurance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to note the contents of the report and its appendix. 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. 4.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions.
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2 5. AREAS FOR IMPROVEMENT 5.1 The areas for improvement and corrective actions are attached as Appendix 1. 6. CONCLUSIONS 6.1 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 The Chief Executive Performance Review process is structured in a way to allow performance levels to be assessed against each of the 9 national outcomes. 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL None 7.4 PEOPLE None 7.5 INEQUALITIES EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix One - Areas for Improvement (Quarter 2, July - September 2021) ............................................................................. HEAD OF PLANNING, PERFORMANCE AND QUALITY ASSURANCE Members seeking further information about any aspect of this report, please contact Graeme Cowan on telephone number 07946702861.
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3 Appendix 1 – Areas for Improvement (Quarter 4, January – March 2022) 1. Delayed Discharge / Home Support / Reablement Target 2021/22 2021/22 Q3 2021/22 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Delayed discharge bed days - standard delays 23,725 Q1 - 5,915 Q2 - 5,980 Q3 - 5,980 Q4 - 5,850 6,381 7,124 ê ê Reablement - Number Of People Completing Reablement Process 2,000 (500 per quarter) 916 1170 ê ê Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 67.7% 63.1% ê ê Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 53.2% 52.2% ê ê Narrative & Corrective Action A wide range of activity is underway, both locally and nationally, to drive further improvement in performance in how we support timely discharges. These include: Whole system improvement work on the PDD process Home Support recruitment – over 200 applicants in latest round, though important to note this could impact on independent sector capacity Lanarkshire is a demonstrator site for Home First/Discharge without delay. Rapid response, focused on supporting people at home, is having an impact Expanding Hospital at Home service and considering expanding to under 65s Additional CSWs are being recruited so that District Nursing Teams can enhance the care offering to those on both Home Support and District Nursing caseloads, freeing up further Home Support capacity to concentrate on other cases Home Assessment Team (HAT) / Home First
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4 The HAT team for HSCNL went live on 25 April 2022. During its soft launch phase HAT has demonstrated its potential to positively impact on the flow of the hospital team as its intervention has prevented admission into hospital as well as reducing hospital stays. A plan is underway within UHW for accommodation to include the HAT team when working from UHW. The team will be based with the hospital social work team and discharge coordinators. A full and comprehensive overview of patient user journeys show that, as a result of HAT input, a number of patients/service users have been turned around at the hospital front door preventing admission. This turn-around provides a positive outcome, whereby assessment can take place within a patient’s/service user’s own home environment, as opposed to an unfamiliar, busy, hospital environment. Next tasks to be completed: Agree plan for scale-up of HAT and review timeline for roll-out of HAT Resolve issues regarding management of AHPs to enable recruitment to be progressed Ongoing training Evaluation of service to continue on a 3-monthly basis Technology to be explored further – twitter/yammer to be set up for whole team Admin support to be explored Permanent pharmacist to be discussed/explored Satellite stores for small stock of aids/adaptations to be set up for equipment (possible piggyback on IRT stores) and require OOH store. Current recommendation is Dalziel as OOH based in building. Access to TrakCare clinical portal Joined up working with South Lanarkshire HSCP Working rota as HAT develops and grows. At this time social work remain working a 5-day week Mon/Thurs 08:45 am to 16:45pm and Friday 08:45am to 16:15pm Leaflet to be complete with first HAT patient included (with patients’ permission) Communications to be involved to ensure the public and others are aware of the team and their role Reablement Capacity within our reablement teams has been limited for a significant period of time during the pandemic, as resources have been prioritised to focus on operational pressures across the Home Support service. This has been particularly acute during periods of significant C-19 infection / isolation amongst staff over the past two years. However, efforts continue to re-establish capacity across all our reablement teams to ensure individuals are offered support to retain and regain their skills and confidence to live independently in their own homes.
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5 A Home Support Programme Board was established in 2021 to oversee the redesign of the Home Support Service, and there is a dedicated workstream focusing on our Reablement and Intensive service. Progress to date: Weekly meetings have been re-established across all teams. Daily handovers are also being re-established; however, accommodation continues to present difficulties within some teams. Teams have noted a decrease in referral activity since the introduction of the Enhanced District Nursing Service. Next tasks to be completed: Review capacity/resources within reablement teams to ensure flow from Home Assessment Team to the reablement service. Review practice across localities and agree criteria and working model to ensure consistency across the service. The Reablement / Intensive Workstream will examine and review existing teams’ practice across localities to agree the criteria and working model to ensure consistent practice. 2. CAMHS Target 2021/22 2021/22 Q3 2021/22 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of patients commencing treatment within 18 weeks of referral 90% 69.5% 80.0% é é Narrative & Corrective Action There has been an improvement in CAMHS performance since March 2020. The waiting list validation exercise was completed, reducing the waiting list by 13% (n= 170). As of March, the waiting list was 1917. There continues to be an increased demand (urgent presentations) which impacts on capacity across the service. In addition to this, recruitment has been challenging and at times, slow to progress due to the NHS boards competing for the same pool of staff. There are particular posts which are harder to fill and the service are linking with HR to explore innovative ideas to attract staff to NHS Lanarkshire CAMHS. There is ongoing work around Trakcare to improve the reporting systems within the service. The CAMHS Modernisation Board has been established and this will drive forward a number of workstreams aimed at improving the service.
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6 The new CAMHS facility in Udston Hospital opens to patients on w/b 20th June. The facility was co-designed with children and young people and we aim to take the learning from this to upgrade the existing NL facilities to create consistency across all sites. Work has commenced to update the CAMHS performance framework, with learning for other services. The framework will be expanded to pick up third sector provision (linked to the MH&WB funding ~£1m in each TSI); school counselling (~£800k per LA); DBI in schools; CAPA triage; RTT; and Demand, Capacity and Queue info. 3. Psychological Therapies Target 2021/22 2021/22 Q3 2021/22 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of patients commencing treatment within 18 weeks of referral 90% 81.5% 85.5% é é Narrative and Corrective Action The overarching performance across Adult Psychology services continues to improve. In adult Psychological Therapies teams (PTTs) the focus is on reconfiguring allocation of resources across PTT localities which has led to sustained improvement The focus of the adult PTTs Action Plan consists of continued consideration of resource allocation across PTT localities, to ensure that those who have waited the longest are seen first. There is evidence of greater homogeneity across localities in adult Psychological Therapies - Cross-locality working is managed and monitored on a weekly basis. Remote working has seen Adult PTTs routinely sharing patients across the whole of Lanarkshire. This chronological macro-management of those waiting, irrespective of locality, affords greater equity of access. Routine use of Near Me video appointments, along with increasing availability of face to face appointments, is helping with throughput and reducing outliers across all Psychology services Our new centrally managed digital group psychological intervention programme has led to an increased use of our digital group treatment and we will continue to support that mode of delivery throughout and wherever it is reasonable to do so. Recent staff recruitment (1.5WTE) in Neuropsychology has improved our overarching ‘longest wait’ An increasing range of online therapeutics (cCBT programs) is available for all adults in Lanarkshire, with ongoing promotion of these via liaison with local Communications and Health Promotion teams. Self-referrals and clinician referrals alike are processed within days – usually sooner – and so there is no waiting list to access them. Further novel online approaches are planned. Continued support and use of Quality Improvement Methodology (QI) across all psychology services will form a significant part of our improvement plans.
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7 4. Waiting Times Performance – AHP and Community Services Target 2021/22 2021/22 Q3 2021/22 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 50% 33.7% 24.0% ê é Narrative & Corrective Action The main issue is staffing capacity for recovery. We have had recovery funding and have recruited to this- we have also had staff leaving the service so unfortunately we are in a position where at the end of March 2022 we had fewer staff than in 2021. SLT service March 2021 March 2022 Establishment 127.06 127.05 Current WTE 118.58 112.42 Action Plan Skill mix posts to recruit to band 5 – we have just recruited 4 band 5 staff for adult service and 4 band 5 staff for CYP service who we expect to start by August 2022. We continue to change our service model to a tiered approach (Universal/Targeted/Specialist) and note a downward trend in children requiring specialist input- illustrated below
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8 We have appointed a waiting list co-ordinator to optimise appointments We have regular supervision to look at case management and discharge/throughput We are looking at staff wellbeing, staff stress risk assessments and working with staff care on supporting staff. We now have an AHP Workforce group We are working with SLT leaders nationally on job planning We are working with the RCSLT Scotland Office to influence supply of SLTs/ HEI places longer term
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1 REPORT Item No:9 SUBJECT: Whole System Performance Framework for North Lanarkshire TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief officer Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: 1. Endorse the performance management approach outlined within the paper; 2. Agree to the promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26 and development of a Whole System Performance Framework 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 With the engagement and participation fully underway now to work with a wide range of local stakeholders to produce the HSCP Strategic Commissioning Plan for 2023-26, work is also commencing on the development of the Performance Framework. 5.2 With an increased emphasis on a whole system approach to health and social care in North Lanarkshire, this report sets out some of the foundational expectations supporting whole system impact being developed through a revised Performance Framework. 5.3 Building on relationships and partnerships in health and social care as well as through community planning partners there has never been a more important time to take a whole system approach to addressing: • The needs of people • The importance of individual services and supports delivered through health and social care • Addressing inequalities which have been widened as a result of covid 19 and will be exacerbated further by the cost-of-living crisis. 5.4 Improving the physical and mental health outcomes and wellbeing of people in North Lanarkshire while reducing health inequalities requires action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires working with communities and partner agencies. Summary of Key Issues 5.5 The Health and Social Care Partnership has long been committed to a whole system approach, recognising the co-dependencies. Ensuring engagement and participation in the development of the SCP across the whole system then clearly building performance frameworks which reflect the whole system will change meeting structures, governance arrangements and strengthen partner involvement. A whole system approach needs understand activity across: Community supports and activities Proactive and preventative activity First or initial responses Change services such as rehabilitation, recovery, treatment and reablement Ongoing interventions Complex and statutory interventions Acute or in-patient responses Whole System Performance Framework for North Lanarkshire
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3 5.6 A whole system working group will seek to draw together and build on the opportunity that the overarching strategies for North Lanarkshire offer in doing things differently. 5.7 Considering CAMHS services as an example of developing a whole system Performance Framework, demonstrates the richness of contribution across key partners not usually presented as a complete suite of metric. 5.8 Local Outcome Improvement Plans (LOIPs) have been produced with local people, community groups, elected members, partners and the voluntary sector. Priorities in each of the 9 Community Boards identifying Board areas include: 8 localities identifying Mental Health and Emotional Wellbeing 8 localities identifying tackling poverty in inequality, including food inequality 3 localities identifying youth engagement and supporting children and young people. 5.9 The Plan for North Lanarkshire Management and Monitoring Framework brings the opportunity to report on progress to the Community Boards, NLP’s Strategic Leadership Board and key organisations on making a difference and helping to empower communities. 5.10 Reporting on the LOIPs has direct relevance to the overall achievement of CAMHS whole system approach. 5.11 Education and Families services have worked in partnership to publish The Mental Health, Wellbeing and Resilience Delivery Plan, as the local plan driven by national policy through the National Improvement framework. This plan encompasses four key strands: • Nurture and resilience • Promoting positive mental health and suicide prevention including school based counselling services • Mental Health curriculum incorporating Healthy Schools • Staff wellbeing: promoting positive mental health and emotional resilience 5.12 Reporting on The Mental Health, Wellbeing and Resilience Delivery Plan has direct relevance to the overall achievement of CAMHS whole system approach. 5.13 The Community Solutions Strategy and Investment Plan describes delivery of supports to children and young people (age range of 5-24 & up to 26 for care experienced young people) in their local communities. The aim is to enhance local provision and deliver on the ambitions within the Community Mental Health and Wellbeing Framework that target issues of mental wellbeing and emotional distress and is based on prevention and early intervention. 5.14 The Community Mental Health and Wellbeing fund from the Scottish Government and is being managed by VANL, as part of the Health and Social Care NL Community Solutions Programme, which VANL hosts. 5.15 The purpose of the fund is to contribute to: • improved mental health and wellbeing • reduction in mental health inequalities • reduction in stigma around mental health and illness
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4 5.16 Through consultation and collaboration with local people and communities, the community and voluntary sector and local partners identify key health and wellbeing priorities or themes. Specific supports include home visiting and befriending network and. children, young people and families network. 5.17 Reporting on the Community Mental Health and Wellbeing Framework has direct relevance to the overall achievement of CAMHS whole system approach. 5.18 The Alcohol and Drug Partnership Strategy and Investment Plan states Priority area 3 as Children and families affected by alcohol and drug use will be safe, healthy, included and supported, with one of the 5 key Workstreams recognising the importance of a whole family approach. 5.19 The range of work to scope strengths and challenges in current arrangements, place the experience of people with lived experience and families at the centre of developments, and engagement with all stakeholders will inform investment plans, reshape commissioning intentions and create a robust response to the challenge of avoidable drug deaths in North Lanarkshire. 5.20 Reporting on the Whole Family Approach has direct relevance to the overall achievement of CAMHS whole system approach. 5.21 Scottish Government expectations for CAMHS is that referral to treatment time will be 100% on target by March 2023. National metrics evidencing clinical interventions to support eating disorder, self-harm, mental health and complex behaviours. 5.22 CAMHS Tier 3 and Tier 4 services sit in the wider context outlined above. Only by considering the whole system approach will there be effective understanding of how effectively children and families receive support and services that are appropriate to their needs. 6. CONCLUSIONS 6.1 Health and wellbeing are profoundly influenced by what happens in places and communities and by how the services interconnect. Health and social care, local authorities and other local agencies need to work closely together, co-ordinating the services that are deliver to people. Partnerships with citizens and communities must be developed further, recognising the vital contribution of the voluntary and community sector. These principles are at the heart of a population health approach, which aims to improve health outcomes, promote wellbeing and reduce health inequalities across North Lanarkshire. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S)
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5 The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the Whole system Performance Framework. This paper has been reviewed by Finance: Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the Whole System Performance Framework. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Wide range of engagement activity planned and will be further enhanced following feedback from the engagement and participation stakeholder group 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development of First Point of Contact. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# This content in this paper links directly to the following: • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic-Comm- Plan-20-23-FINAL.pd 9. APPENDICES
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6 ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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1 REPORT Item No: 10 SUBJECT: Covid-19 Update TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Ross McGuffie Chief Officer DATE: 31st August 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Performance, Finance and Audit Committee: For approval For endorsement To note 1.2 This paper sets out the actions taken to date during the pandemic response. 2. ROUTE TO THE IJB PFA 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The PFA Committee is asked to: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 COVID-19 was declared a pandemic by the World Health Organisation on 12 March 2020, with spread of COVID-19 within all communities in the UK in the intervening period. 5.1.2 Command structures were immediately put in place in both North Lanarkshire Council and NHS Lanarkshire, with the Health and Social Care Partnership fully participating in both. In addition, the pan Lanarkshire Resilience Partnership has supported cross-agency developments. Yes No N/A
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2 5.1.3 An overview of the current developments around Covid-19 is included below: 5.2 Update on Numbers 5.2.1 As at 11th August, the seven-day case rate within North Lanarkshire is 87.4 per 100k population, which is a continued decrease to the figures last presented to the IJB on 22nd June when it was 103 per 100k. 5.2.2 The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at 12th August, there are 91 covid positive inpatients and a further 10 in offsite facilities. 5.2.3 On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. 5.3 Care Homes 5.3.1 One of the greatest areas of focus has been around supporting the Care Home sector, covering key areas of work such as: Testing, outbreak management and ongoing surveillance Infection, prevention and control including PPE and cleaning requirements Education and training Supportive reviews and visits. Workforce requirements and supply of mutual aid 5.3.2 Across Lanarkshire, work began to strengthen the management and oversight of outbreaks in care homes in March 2020, enhancing the supports we had offered routinely up until then. This included: Social Work Quality Assurance Section – existing contact Care home Liaison Team Support – existing weekly contact HPT Management of outbreaks – daily contact during outbreaks Weekly conference calls with sector by HSCP, established March 2020 Established early contact with Care Inspectorate Care home Assurance Group, meets daily, established 23rd April 2020 Bronze care home sub group, meeting twice weekly, established 24th April 2020 Development of Care Home Strategy 23rd April 2020 Access to staff bank to enable sustainable rotas with supporting governance framework Enhanced PPE recommendations that sector move to table 4 on 1st May 2020 Prioritised programme of testing for care homes commenced 5th May 2020 Workforce group established to support screening programme established 14th May 2020 Additional support arrangements for Care Homes confirmed until June 2022, with £1,326,353 allocated as part of the Remobilisation Plan funding in June 2021. 5.3.3 Following communication from the Cabinet Secretary on 17th May 2021, which outlined the additional requirements regarding accountability for provision of nursing leadership; professional oversight; implementation of infection prevention control measures; use of PPE; and quality of care; we have undertaken significant work to map our current provision of support and ongoing workforce and resource requirements to deliver this new request:
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3 Care Home Assurance Group – initially established on 23rd April 2021, group was expanded to include Chief Social Work Officers, Chief Officers and the Medical Directors. The group has also undertaken a thematic analysis of Care Homes, identifying support needs around access to updated HPS guidance; management of outbreaks; standard infection prevention and control measures; and staff support around mental health and wellbeing. Huddle - All 93 care homes in Lanarkshire have registered to use the national safety huddle template hosted on TURAS. There is a daily safety huddle meeting involving social work, care inspectorate, health protection team and nursing staff where they review this information and respond to any escalations or concern’s raised. Work continues with the Care Homes to improve completion rates, particularly at weekends. Enhanced support from Social Work Quality Assurance – including coordinated timetable of audits for each Care Home; supporting action plan development; coordinating links with colleagues in Care Home Liaison, Infection Prevention and Control, Care Inspectorate etc; and support for Homes to claim financial assistance where appropriate. Care Home Liaison – establishment increased by 0.8wte B7 and 3.4wte B6 to move to a 7 day service and enhance contact with each home in Lanarkshire. The team have undertaken visits; managed daily data returns; acted as an escalation point for PPE issues; and participated in the prioritised engagement visits as required. Health Protection Team – To enhance the outbreak management and screening testing in Care Homes, an additional 0.6wte B7, 3wte B5, 1wte B4 and 3wte B2 staff have been brought into the team. Testing – All staff continue have access to weekly asymptomatic PCR staff testing through either the social care portal or NHS laboratory testing. In addition to weekly PCR testing care home staff are now also requested to undertake twice weekly Lateral Flow Testing. Infection, Prevention and Control – In conjunction with Care Home Liaison, the IPC team provide advice and support covering virtual visits, attendance at Care Inspectorate unannounced inspections and providing support to Homes as required. Senior Nursing Leadership – a team is being developed under the leadership of a Deputy Chief Nurse to provide an immediate response during early stages of an outbreak similar to acute care setting where the focus is on early containment. This team would build on the existing care home liaison team and would have additional workforce requirements as detailed below, including IPC expertise. The outbreak testing team would be embedded within the team. 5.3.4 In November 2020 a Care Home Outbreak Oversight Group was established, chaired by a Public Health Consultant, to provide oversight of all active outbreaks. To date, Fifty-six care home outbreaks have been recorded and 37 IPC outbreak supportive visits have been undertaken by IPC specialist nurses. As an outbreak is declared the care home assurance team deploy an IPC nurse to support the care home manager to review practice and identify any immediate issues. This is in addition to routine IPC audits and support visits. Feedback from these outbreak visits is provided to the Oversight Group and common themes recorded. This supports the targeting of messaging, education and support for care homes. 5.3.5 As at 12th June, there are 7 outbreaks in care homes covering 51 residents and 28 members of staff cumulatively.
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4 5.4 Personal Protective Equipment (PPE) 5.4.1 One of the biggest challenges during the early phases of the pandemic was the supply of PPE to frontline staff. The national PPE guidance has evolved over time, but overall the service has been able to maintain supplies to frontline staff in line with guidance. 5.4.2 There are no ongoing issues to report. 5.5 Delayed Discharge/System Pressures/Home Support 5.5.1 Following the first wave of Omicron, delayed discharge performance improved significantly and in early February has gone back down to 50s and 60s, as it had been in October and November. However, the second Omicron wave created significant challenges across the system, with delays returning to the 70s and 80s. 5.5.2 Despite very positive performance in June and through to mid-July, delays have become a greater challenge as acute and service pressures increase, averaging in the low to mid 70s. 5.5.3 As at 12th August, delays are 94, with the increase largely as a result of having 59 referrals in a single day on 8th August and a total of 151 referrals for the week (highest number ever recorded, surpassing 132 as the previous high in November 2021). On 12th August, a further 19 discharges are planned and it is hoped the delay number will drop back to normal performance levels quickly. 5.5.4 The winter business case was approved at a special meeting of the IJB on 16th February 2022, with recruitment underway to support the development of the new models proposed, including: Home Assessment Teams in each Locality to support early discharge as well as admission prevention Expanded Home Support and Reablement capacity in each Locality New resource in District Nursing teams to proactively support Care Managed patients (those identified as being at the highest risk of admission) Expanded Integrated Rehabilitation Teams to create additional rehabilitation capacity for both discharge support and admission prevention 5.5.5 Updates on progress are planned for future IJB meetings. 5.6 Testing 5.6.1 Staff testing has continually evolved in line with the Scottish Government guidance throughout the pandemic. We have seen a gradual reduction in testing requirements over recent months and continue to follow the national guidance in full. 5.7 Covid Vaccination 5..1 The Covid vaccination programme continues at pace, with uptake as at 6th June as follows: Total doses administered 1,588,731 Individuals with at least 1 dose 555,767
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5 Partially vaccinated 28,421 Fully vaccinated 95,292 Boosters 433,061 5.7.2 The vaccination programme continued with the announcement of the spring programme running concurrently with the roll out for all 5 to 11 year olds: 5 to 11 year olds o Commenced 25th March Spring booster programme o Care Homes o Over 75s o Outreach visits o Severely immunosuppressed 2nd booster o Immunosuppressed >12s 2nd booster o House calls for all who are eligible, though recognising maximum efficiency is achieved by clinic attendance 5.7.3 The winter flu and covid vaccine delivery will soon commence. The following groups will be offered both vaccinations: aged 50 or over a resident or staff working in a care home for older adults a younger adult in long stay nursing and residential care settings a frontline health or social care worker aged 5 to 49 years with an eligible health condition, including those with poorly controlled asthma aged 5 to 49 years and are a household contact of someone with a weakened immune system an unpaid carer or a young carer (16 years or over) pregnant 5.7.4 In addition, the following groups will be eligible for the flu vaccine individually: people aged 16 to 49 with an eligible health condition, including well controlled asthma children aged 6 months to 2 years with an eligible health condition all children aged 2 to 5 (not yet at school) all primary or secondary school pupils non-frontline health or social care workers nursery, primary or secondary school staff or pupil-facing support workers in local authority or independent settings prison officers or support workers who deliver direct front-facing detention services. 6. CONCLUSIONS 6.1 There has been a tremendous effort across the whole system (including third and independent sectors, communities and public partners) in building our response to the pandemic.
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6 6.2 The dedication, bravery and commitment of all of our frontline staff should be commended in supporting us to continue to deliver a strong service to our residents in North Lanarkshire. 6.3 The delivery of the Covid Vaccination campaign is now at an advanced stage, with Lanarkshire comparing very positively against the Scottish averages. 6.4 NHS Lanarkshire moved back into black status on 27th July due to sustained staffing and bed pressures, with command structures proportionately in operation. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and is currently rated at very high. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None.
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7 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 11 SUBJECT: First Point of Contact – Three Conversations Highlight Report TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief officer Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement x To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 1. Seeking endorsement of our approach from IJB PFA 2. Seeking endorsement of the approach to exploring the principles of First Point of Contact to inform the Strategic Commissioning Plan 2023-26 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 North Lanarkshire faces a significant increase in service demand as a result of demographic change as well as the impact of the pandemic. It is recognised that there needs to be a focus on assets, adopting a strength-based approach to continue to shift the balance of care and develop services, focusing on prevention, early intervention, and self-management. There is a need to build on the areas of excellence across the HSCP by continuing to demonstrate compassion, continuity, clarity in communication and shared decision-making across all services/supports. 5.2 Access Social Work is the main entry point into social work services. To inform a baseline position, analysis was carried out over three separate weeks 24th February 2020, 13th July 2020 and 5th October 2020. The review highlighted that response to contacts by or on behalf of the public varied considerably not only between services but also within services. Some people’s journey into the service and their outcomes were very clear and well recorded. Other interventions however were very service driven and focussed on outputs, typically by the provision of equipment and/or services. There was clear evidence of people encountering one part of the service then in short time periods coming into a different part of the service again as a new user. Essential knowledge was not always shared across teams. There were multiple handovers between services and often duplication. 93% of referrals received over the three separate weeks, were handled by more than one service and 18% of all referrals received for adult services were handled by more than two services. Where this was the case, there was potentially missed opportunities to take a preventative approach and to build people’s resilience. Background to the 3 Conversation Approach 5.3 Partners4change are a change management organisation committed to innovation and financial sustainability specialising in the 3-conversation approach. They have evidenced working with 75 council areas in the UK in relation to reform, redesign, financial sustainability, and personalisation. Of the 75 councils, 35 councils delivered whole system change through the 3- conversation approach. 5.4 In March 2020 a subgroup of the First Point of Contact (FPOC) steering group visited Edinburgh HSCP who had developed the 3 conversations approach across adult services. The learning from this visit highlighted they had made significant differences in service delivery with financial benefits. 5.5 Additionally, there was noted non-financial benefits such as increased productivity, improved staff satisfaction and improved service user outcomes. The 3 Conversations Model 5.6 The three conversations model is described in more detail in appendix 1 but includes: Conversation 1 – listening and connecting
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3 Conversation 2 – working intensively with people in crisis Conversation 3 – building a good life. 5.7 There are very specific rules associated with the 3 conversations approach that are necessary to produce desires outcomes including a very different culture, practice and behavior in comparison with the usual default system. These include the exhaustion of conversations 1 and 2 which focus on community, family, and individual support before moving to conversation 3 which involves a major input from statutory services. Throughout the early stages there are no hand offs, referrals, triage, or use of waiting lists or allocation process. If someone is in a complex situation then work is undertaken with them on what needs to change intensively for a short period of time, and this may or may not lead to service provision. One of the most important rules is that there must be no long-term planning with people in crisis, it is essential to avert the crisis first. Motherwell Innovation Site 5.8 Partners4Change supported an innovation site in Motherwell locality to test the 3-conversation approach across adult services including Access Social Work, hospital social work, GP link workers and the 3rd Sector. Partners4Change commenced working for a six-month period in July 2021. Introductory briefing meetings were held with staff across the NLHSCP to highlight the approach and look for willing volunteers to become involved. Additionally, the FPOC steering group agreed to support a locality to be an innovation site. The agreed innovation site was Motherwell Locality including adult social work, health colleagues from the locality, acute services, and 3rd Sector partners. 5.9 A project group was created to support the innovation site and they meet on a fortnightly basis to understand activity, offer guidance, problem solve and learn from the activity undertaken. The project group consisted of members of the FPOC steering group and first line managers in the locality with a breadth of social work, social care, 3rd Sector and health services experience. One of the initial tasks of the project group was to record an organisational story, attached at appendix 2. This story captured the baseline values, principles and what matters to the HSCP, partners and the people living in North Lanarkshire. Creating this story acted as a starting point of the innovation site in telling staff about this area of work and encouraging their involvement. 5.10 The 3 conversations innovation site started in November 2021 and ran until March 2022. It started with 9 innovation team members, reducing to 7 because of system pressures and further reducing to 6 with data protection issues impacting on the 3rd Sector representative. 5.11 Steps undertaken Initial response Conversation 1, 2 or 3 Focus on family, friends, neighbours, and community
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4 Initial action – treatment, rehab, reablement, recovery Outcome focus Innovators and connectors working together Ongoing supports only when necessary 5.12 Organisational Our Story, Our People and Our Change? 82 people had meaningful conversations with 6 people requiring longer term supports. There were 82 conversation 1s, 2 conversation 2s and 19 conversation 3s. People connected to the innovation site were seen within one or two days of a referral being made. The response from the team was quick and effective with limited handovers and no duplication of service. There was time for reflection and learning throughout. The focus was on prevention and early intervention with people being supported through conversation to find the solutions to their difficulties as the starting point for intervention. The strength in this was the multi- disciplinary aspect of the team and the focus being community based where possible. The accent was on getting things right first time and listening to what people felt was important to them. Having an occupational therapist aligned to the team gave service users direct access to technology as well as to some equipment to support independence. Innovators were the staff involved in the site and they all reported an increase in job satisfaction and in their learning through shared experience. The use of a short meeting/huddle with everyone in the innovation site each morning, in exploring options for people kept the group focused. Connectors were a variety of people across services and partners that offered advice, information, and community opportunities. Service users’ expectations and wishes were adjusted when discussions focussed on reablement and wellbeing and the use of natural supports. £1000 was available to finance small purchases which would prevent services being introduced. Very little of this money was used as people focused on what they could do for themselves rather than what social work or services could do for them. Only low-level equipment was used to support people. Only one individual budget through Self Directed Support (SDS) intervention at a reduced level was initiated with family and friends dovetailing with individualised support codesigned through the principles of SDS. Recording was simple and was accepted by services and others as being adequate and containing all pertinent information.
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5 5.13 Achievements Quick response Good conversations built on trust and committment Innovation site activity during the pandemic Multidisciplinary approach Colocation Clear objectives identified in ‘Our Story’ Good, quality conversations Shared learning Focus on prevention and early intervention Flexibility Outcome focus Limited resources with successful outcomes Improved responses Less duplication Limited handovers Community and partner support Increased job satisfaction Increased innovators and connectors knowledge and skills Service development Potential for further development The evidence that the prevention and early intervention focus should be at the first response with 3rd Sector 5.13 Challenges Withdrawals from the innovation site midway as a result of system pressures External Management advised to be at arm- length Partners4change didn’t fully support the evaluation process Recording issue impact on innovators especially 3rd Sector innovator Service challenges/barriers Direct involvement of NHSL in the innovation site was limited Unprecedented service demands Other pressure points
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6 Further awareness needed across the HSCP Measures of success 5.14 The Motherwell Innovation Site was a success with much learning. 5.15 The team was dynamic, energetic, and enthusiastic in their pursuit of following the 3-conversation approach. 5.16 The emphasis was an introduction to a whole system, multi-disciplinary team approach embodying coordination, collaboration really focusing on communities and person-centred approaches. The sharing of knowledge and experience at the daily huddles supported the teams learning and meeting people’s outcomes. 5.17 The protected time brought a speedy response to people and facilitated a depth to conversations. 5.18 The colocation of innovators added value to everyday practice and supported people’s outcomes. The different way of working reduced barriers and the basic recording system met legislative needs. It was found that 3rd Sector links were better as early as possible for quality outcomes and supporting people with better lives. 5.19 The focus on outcomes led to the success of the innovation site and ultimately success for people in our communities. The engagement with people was meaningful and there was limited access to services for longer term supports. 5.20 All innovators were of equal value. The protected time for the innovators assisted planning, preparation and strengthened the whole system collaboration. 5.21 Unfortunately the 3rd Sector innovator could not access electronic records to comply with data sharing requirements. 5.22 Appendix 3 provides more detailed analysis of the data from the innovation site work. 5.23 Appendix 4 provides stories gathered to demonstrate the impact of 3 Conversations. 6. CONCLUSIONS 6.1 One of the most important ambitions of the Health and Social Care Partnership is to ensure that when people make contact with health or social work services that the response is quick and effective, with a focus on helping people to help themselves first and getting things right first time. The development of First Point of Contact requires good conversations. The three conversations approach was tested in an innovation site in Motherwell Locality over a three-month period. A multidisciplinary team was established to work through the model, focusing on what people feel is most important to them, and building on the assets, strengths and capabilities of people, families, and communities. This paper summaries the findings from the innovation work.
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7 6.2 Recommendations Development of further innovation work with the 3rd Sector, building on the increased capacity through the Winter Planning and Enhanced Support Business Case Addressing how we bridge the gap between 3rd Sector and statutory services, creating trusted pathways. Further emphasis on prevention and early intervention. Further embed an awareness of the 3-conversation approach across the HSCP and partners including a programme of training across IRT, Home Assessment Team and across HSCP locality teams Build on the success of the Motherwell locality innovation work and recognise their willingness to be actively involved in the next steps. Build clear links with the range of work across the whole system supporting improved first point of contact, informing the development of the 2023-26 Styrategic Commissioning Plan – in particular: GP link workers Mental Health in Primary Care Developments Development of the CAPA (Choices and Partnership Approach) model in CAMHS Home assessment team High resource users work Rapid rehousing 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S) The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the SCP 2023-26 This paper has been reviewed by Finance:
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8 Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the SCP 2023-26. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Discussion at the First Point of Contact Steering Group 7.6.2 Through the range of structures supporting the Motherwell Innovation Site 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development of First Point of Contact. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# This content in this paper links directly to the following: • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic-Comm- Plan-20-23-FINAL.pd 9. APPENDICES Appendix 1 – 3 Conversations Approach Appendix 2 – Presentation Appendix 3 – 3 Conversations Pilot Breakdown of Data Appendix 4 – Good News Stories
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9 ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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10 Appendix 1 ‘3 Conversations’ Approach Partners for Change The Three Conversations Approach is a paradigm shift in how to deliver adult social care, and how it collaborates with NHS, Housing, Voluntary Sector, and other colleagues to make the whole joined up system of community-based support work differently and better. It seeks to replace the ‘contact, re-ablement, then assessment for services, culture with a new approach based on the assets, strengths and capabilities of people, families, and communities. It is built on and has proven the assumption that if you collaborate with, and allow people to be co-designers of their support, then their quality of life goes up, and their use of health and social care resources goes down. There are very precise rules associated with these conversations that are necessary in order to produce a very different culture, practice and behaviour in comparison with the default system. These include – you have to exhaust conversations 1 and 2 before you are allowed to move to conversation 3, you are not allowed, ever, to plan long term with people in crisis, you are never allowed to hand off or refer people, or triage them, or use a waiting list or allocation process. If someone is in crisis you ‘stick to them like glue’ and work with them on what needs to change intensively for a short period of time. Making it happen is a huge challenge because of the power of the status quo to reinvent itself. So we have to learn to stop using some key words, phrases and associated activities – that includes assessment, review, respite, services, triage, referral, signposting etc. Instead after socialising these ides and finding out where ‘the grain’ is i.e., who really wants to do it, we create innovation site with their own new and different rules. Our innovation sites have included ‘the front door’, long term teams, GP ‘at risk of admission’ lists, an acute hospital ward, people waiting for a review and more. Innovation sites collect data every day about what happens to people when we approach them different. What we have learnt is – if you change the conversation then people’s lives change. Appendix 1 ‘3 Conversations’ Approach Partners for Change The Three Conversations Approach is a paradigm shift in how to deliver adult social care, and how it collaborates with NHS, Housing, Voluntary Sector and other colleagues to make the whole joined up system of community based support work differently and better. It seeks to replace the ‘contact, re -ablement, then assessment for services’ culture with a new approach based on the assets, strengths and capabilities of people, families and communities. It is built on, and has proved the assumption that if you collaborate with and allow people to be co-designers of their support – then their quality of life goes up, and their use of health and social care resources goes down. There are very precise rules associated with these conversations that are necessary in order to produce a very different culture, practice and behavior in comparison with the default system. These include – you have to exhaust conversations 1 and 2 before you are allowed to move to conversation 3, you are not allowed, ever, to plan long term with people in crises, you are never allowed to hand off or refer people, or triage them, or use a waiting list or allocation process. If someone is in crisis y ou ‘stick to them like glue’ and work with them on what needs to change intensively for a short period of time. Making it happen is a huge challenge because of the power of the status quo to reinvent itself. So we have learnt to stop using some key words, phrases and associated activities – that include assessment, review, respite, services, triage, referral , signposting etc. Instead after socialising these ideas and finding out where ‘the grain’ is i.e. who really wants to do it, we create innovation sites with their own new and different rules. Our innovation sites have included ‘the front door’, long term teams, GP ‘at risk of admission’ lists, an acute hospital ward, people waiting for a review and more. Innovation sites collect data every day about what happens to people when we
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11 The results: the numbers of people with ongoing packages of formal care significantly goes down – we aim to halve it – with the consequent savings to health and social care budgets. People and families say how much they like the different approach – where workers are allowed to really listen and be interested in them as people, where they do what they say, and where the response is fast and effective. Staff satisfaction and productivity shoots up, and they say things, ‘I love my job, it is inspiring’, ‘don’t make me go back to the old way of working’. We have learnt that you can usually make rapid progress and at the same time achieve seismic change. Our programme usually looks something like: Month 1 and 2: socialize these ideas and co-design your innovation sites. Month 3 to 5: run your first phase of innovation – collecting data every day. Month 6: evaluate – collect and share your compelling evidence form your data about what happens when you work differently – both numbers, and ‘stories of difference’. Month 7 to 9: run an expanded area of innovation to prove you can scale it and deal with any challenges from phase one. Month 10 to 12: evaluate and get ready for business as usual. We have now done this enough times in enough different environments to know, and be able to prove, that it works with all areas, and all people. We really can support
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12 better lives for people and families, more satisfying and productive jobs for our staff, and save significant amounts of health and social care resource. Appendix 2 FPOC%20-%203%20 Conv%20Our%20Story%20Pres%20v5%20-%20created%2014%20July%2021.pptx
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13 Appendix 3 Conversations Pilot breakdown of data Referral Routes During the first 13 weeks of the pilot, referrals were received via multiple routes. The most referrals were received via Access Social Work, our first point of contact for all social work referrals. The total number of new people seen was 87. Access – 34 Switchboard – 11 Hospital – 20 Community Care – 11 Rehab – 6 Other – 4 Explanation of traditional referral process detailed below:-
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14 *bathing – some people may have had to be passed to Rehab depending on ability to use equipment **stairs – if handrails in situ these would be passed to rehab ***SDS/carers assessment/Social Opportunities – these would have been passed to community care. Conversation Type: Number of Conversation 1 – 61 Number of Conversation 2 – 2 Number of Conversation 3 – 19 Number of Conversation 1 who then transferred to Conversation 3 – 6 Non-Engagement – 5 Emerging Themes: Training for staff regarding updating knowledge of occupational therapy and physiotherapy in relation to bathing assessments and walking aids. Significant number of requests for bathing assessments. Consideration must be given regarding bath environment. Often it can be wrong type/style of bath, consideration may have to be given by housing regarding future proofed housing stock. Current system hub/Access as first point of contact, staff have to be able to highlight possible outcome of request i.e., bathing assessment but often people require wet floor but do not want to remove bath. If this information was passed to them at initial contact stage, people would have more realistic expectation of outcome and be able to make an informed decision. Overall, there was a lack of request for people to access social activities. This may be a result of the pandemic. Even when we talked about it there was an overall reluctance to engage. Connectors were viewed as positive by team. Quick response either regarding advice, update on social opportunities, or follow up visits. Data shows that we responded quickly to requests which in turn created a positive response from people. Information was given that this was a pilot and therefore a time limited intervention. Overall people responded positively to this resulting in a positive experience. The team started with no current work therefore if required people could, and were, seen often. This allowed development of relationships and discussions around options and impact this could have on their life. Intervention was person centred as options were provided and people could make the best decision for themselves. The main difference in the 3 Conversation Approach is involvement quickly on contacting Social Work department and access to connectors. Observation was made regarding current system. We have developed a culture of gatekeeping rather than holistic assessment. Through the multi-disciplinary approach of 3 Conversations and use of connectors, particularly OT, we have been able to provide a holistic assessment often in the first visit. It is hoped that this will results in less referrals or crises developing. Consideration should be
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15 given to tracking people that 3 Conversations have worked with to see if/when they return to service. Numbers of new people each week for the 13-week pilot: Response Time: Out of the all the individuals on the spread sheet, 82 had information about 1st contact and 1st discussion and on average there was 1.39 business days to respond. 47 individuals out of the 83 were contacted on the same day they contact Social Work or when the pilot group was passed the information. Outcomes: There was a wide range of outcomes generated from the referrals with a wide range of outcomes. in 3 conversation approach is involvement quickly on contacting with SW department and access to connectors Observation was made regarding current system. We have developed a culture of gatekeeping rather than holistic assessment. Through the multi-disciplinary approach of 3 conversations and use of connectors, particularly OT, we have been able to provide a holistic assessment often in the first visit. It is hoped that this will result in less rereferrals or crisis developing. Consideration should be given to tracking people that 3 conversations have worked with to see if/when they return to service. Numbers of new people each week for the 13 week pilot: Response Time Out of all the individuals on the spread sheet 82 had information about 1st contact and 1st discussion and on average there was 1.39 business days to respond. 47 individuals out of the 83 were contacted on the same day they contacted SW or when the pilot group was passed the information. 3 6 9 15 9 16 9 1 4 6 8 2 1 WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6 WEEK 7 WEEK 8 WEEK 9 WEEK 10 WEEK 11 WEEK 12 WEEK 13 NEW PERSONS SEEN PER WEEK OF PILOT FROM WEEK BEGINNING 11/11/21 UNTIL WEEK BEGINNING 31/01/22 Persons seen
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16 Information for chart above: Local Groups – 11 7% 14% 24% 14% 3% 4% 3%1% 7% 5% 4% 3%1%5%1%1%1%1%1% Coversation Outcomes local groups11 Home care equipment and adaptations ot assessment care homes housing physio/rehab link with GP Community alarm keysafe lanarkshire carers FIT SWF Not engaged no needs Deceased respite blue badge driving licence lesson grant
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17 Homecare – 22 Equipment/Adaptations – 36 OT Assessment – 22 Care Homes – 5 Housing – connect to/applications/ repairs – 6 Link with physio/rehab – 5 Link with GP – 1 Community Alarm – 10 Keysafe – 8 Lanarkshire Carers – 6 Link with FIT – 5 SWF – 2 Not Engaged – 7 No Needs – 1 Deceased – 2 Respite – 2 Blue Badge – 1 Driving Licence Lesson Grant – 1 Hospital Discharge – 20 Duplicate Referral – 1 Fire Safety Home Visit – 3 SDS – 3 Deep clean of house – 1 Handyman – 1 Food Parcel – 1 Hospice – 1 Number of people with business concluded by innovator response:
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18 21 concluded and 77 are ongoing Waiting List/Connectors: We never had to implement a waiting list although we recognise that if we had continued taking request this may have had to change. Connectors – workers linked in with connectors in various ways either email, telephone, referral, face to face. Occupational Therapy – 16 Physiotherapy – 4 Lanarkshire Carers – 5 Befriend Motherwell – Community Mental Health Team – 1 Disability Forum – 2 Wellness Hub – 1 IDS/Locality Groups – 3 Locality Social Work Manager – 2 Use of Huddle: Huddle was daily for approximately one hour, longer if required. No data available regarding who was discussed, if we needed to, we discussed situation, we also decided who was taking work. Very democratic system. Team was made of workers who knew each other and others who did not. Daily huddle allowed us to develop as a team by sharing knowledge in relation to any work that we were dealing with. Observation is that although we had staff in office, we would also have others working from home, we still created positive, professional working relationships. Peer support is the overall benefit of daily huddles. Allowing for sharing of experiences, concerns (given this was a new approach of working) and questions. Result was that everyone in huddle benefitted from sharing and hearing knowledge and possible solutions to situations. Leading to upskilling of all the team members. Huddles also allowed us to be more confident in contacting co-working for advice/guidance at any time. Clear evidence of good relationships having been built. Conclusions/Recommendation: We found conversation paperwork succinct, and outcome focused. No issues were raised by a service who received Conversation paperwork, all relevant information was included, paperwork had been disseminated to home support,
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19 care homes, LPG and Locality Social Work Manager for SDS. Given this it would be our recommendation that Conversation paperwork be adopted within IT system. It is felt that the paperwork is compatible with the requirements of Community Care, hospital social work, rehab team and Access. By utilising Conversation paperwork, which is less time consuming that current assessment paperwork, staff would have the capacity to undertake more work resulting in waiting list decreasing. Innovation sites should be multi-disciplinary and DAILY huddles should be adopted. This allows discussion regarding sharing of outstanding work and for multi-disciplinary approach being utilised. This also provides peer support, which in the current climate is essential particularly for newly qualified staff or students. We were able to develop this even when using hybrid model of office based and working from home. Feedback from Members of Steering Group From Disability Forum Aspiration At the start of this process, we were excited, as we already work in a person centred, solution focussed way providing light touch (Conversation 1) and sometimes more involved support. We are always looking for new supports in NL and make sure we have a database that is up to date which is available to anyone who needs it. We felt that our expertise could benefit the other members of the Innovations Site and it felt inclusive to be able to share our knowledge. Involvement NLDF was keen to be a part of this work and committed one member of staff, as mentioned we are already committed to providing low level supports to those in NL with a need. Due to data protection issues it was agreed after a five-week period that an integrated approach would not be possible, and we continued as a connector, which worked well. With this being one of the big aims coming from this work it did come as a disappointment. Participation When it was realised that we could not work within the hub, communication was poor, and it took five weeks for this to become a decision. This was an obstacle, and it felt that the time and expertise of our worker was not valued, and it would have felt more inclusive for the conversations to have taken place much quicker and being more transparent. I have continued to attend the Project group and steering group as I want to show my commitment to the next stages of innovation of H&SC and as Chair of the SDS Network through Community Solutions, I believe there is a real link there is terms of facilitation and would welcome further opportunities to explore this. Moving On We are now keen to seen where Phase 2 takes us. I feel a more important part of the process is for the voluntary organisations in NL to be recognised as experts in their own field, there are also trained professionals working in voluntary organisations with
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20 degrees, with life experience and with excellent communication skills. The people we work with don’t have to fit in a box or go on a waiting list. We are very efficient and work collaboratively with other organisations – voluntary and statutory. I feel with some planning this could be offered in a structured way and would perhaps offer that trust in 3rd Sector that I voiced from others at today’s meeting. Funding being invested in the 3rd Sector to tackle the lower-level work would not only alleviate busy statutory workers but would also offer a sense of commitment and buy in by HS&SCNL to the voluntary sector, boosting the sector’s capacity. Conversations around the Innovation Site are about taking it outside of ‘Service Land’ but to do that ‘Service Land’ must let others be involved or have confidence in the organisations who have been doing it successfully for a number of years.
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21 Appendix 4 Good News Stories Example 1 Mrs J was discharged from hospital after a two-week admission with no clear reason as to what had caused her to become ill. Her husband was provided with social work out of hours number and advised to contact them if further service was required. He did this as Mrs J was struggling with toileting, resulting in her soiling herself. Community care senior was advised of outcome of contact with SWEG: weekend district nurse team contacted; continence garments provided. SWEG felt that a further visit was required. As couple meet 3 conversation criteria, innovation site progressed. Writer contacted Mrs J’s husband, arranging a visit for the following day, as it was evident neither was feeling confident in their circumstance. Writer also contacted GP surgery and arranged GP consultation for the couple, as they evidently needed some medical advice as well as referral to continence team, which has to come from GP. Writer visited with another colleague who could carry out bathing assessment. We talked to both Mrs J and her husband, they advised that bathing was the main issue. Consideration was given to which aids and adaptations would be most suitable after consideration it was agreed that installation of rails would provide the most appropriate solution. The couple also agreed to community alarm and key safe being installed. They were managing other aspects of day-to-day life. Everything was in place within two weeks and MRs J and her husband were happy with the HSCP intervention. Mrs J’s health was settling, and she was not struggling to was or toilet herself. They had the extra security of community alarm and key safe. Mr J advised that they were happy for HSCP to withdraw and gave us 5 out of 5, in the following weeks he also sent a card thanking us. Example 2 A is 47-year-old woman who lives with her husband and her daughter, who is the youngest of her four children. A was diagnosed with multiple sclerosis (MS) four years ago. She has since given up working and spends most of her days in her home. Her daughter, who has just turned 21 is her main carer. Access team had received a letter from MS nurse requesting assessment for aids and adaptation for A as she was struggling currently. Unfortunately, there was a delay in receiving this letter. It was agreed innovation site would work with A. On first engagement with A, it was evident that she was struggling with accepting her diagnosis and the impact it was having on her life. She was resistant to accepting any MS groups or more information as her sister has been diagnosed with MS for about 6 years. She talks about MS dominating her life, we talked about what she wanted which was to feel like her old self again getting dressed up putting makeup on and going out, engaging with others, having a purpose. Since working with A I have carried out 4 visits, 2 with OT colleague, each lasting approximately an hour. By our last meeting we have provided A with options about possible adaptations she could do to her home and what would future proof it for her.
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22 She has external rails fitted to her back stairs; this was a significant request for A as she has been resistant to accepting any adaptations. At last visit she was provided with a walking stick, again a significant step. She was also provided with a list of community-bases activities in her local area, we agreed that on next visit she will have identified a group that she is interested in. Her daughter has also been linked in with Lanarkshire carers for support. My observation of my involvement with A is that if A had gone through her initial referral pathway, she would have had an initial visit from access worker I believe she would have not been able to identify anything that she required, A would have said she was coping, and initial referral was made at a bad time in her life. Given the pressures on Access system they would have withdrawn advising to contact department if anything changed. Example 3 E is 86 years old and lives with her husband A who is her main carer. Both E and A were referred to Access Social Work by their son and daughter-in-law to request carer support for A and home care support for E. E was diagnosed with Alzheimer’s in February 2021 and her husband who has his own health issues has been struggling to care for his wife. Daughter-in-law has recently moved into the property as E cannot be left alone. Daughter-in-law has been allowed to work from home at the property by her employer, but this only a temporary measure and she and A have been struggling to assist E with personal care tasks including getting up in the morning to take medication at breakfast time and assist with a shower. E can be quite grumpy with A, and he often does not get much sleep or respite. A and E used to be very active, but this is no longer possible, and A can no longer drive due to his own health issues. Family report that E cannot accept she needs help, and this has resulted in a log of stress for her husband and family. A would like carer support and advice on caring for E. E will not go out anywhere without her husband. Family would like advice on local community resources they could both attend. E has support from CPN and community nurses and has been invited to attend a wellbeing group with A. There is a stairlift and wet room in place at home and family have requested home care help morning and evening to relieve the pressure on A. E often does not get up until late in the day and does not take her medication without prompting. E is prescribed a lot of medication and it is vital she takes this 4 times a day and is assisted to get up in the morning and supported with medication without prompting. 3 conversation workers visited the following day after referral and met A and his son and daughter-in-law. E was asleep in bed and family reported concerns about the stress A was under and difficulty having a routine for E to get up in the mornings to take prescribed medication. A often does not get much sleep and E will not attend any resources without him. A follow up home visit was completed the following week with E present and home care support was requested and commenced within a week. Lanarkshire carers referral was completed and connector for Innovation team from Lanarkshire Carers contacted A and he was registered as a carer and given lots of advice and support groups. A stated this feeling of recognition and support as a carer
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23 had made him feel much better and he would look to access community resources / support groups once home care has started giving him a much-needed break from his caring role. Example 4 Mr B’s son contacted the HSCP requesting an assessment for his father with a view to possible supports. Mr B is an 82-year-old man who lives alone in a single level home within a sheltered housing complex. His wife died in 2020 and his son and daughter live in England. Discussions have taken place with the son as he would like his father to move to be near him however Mr B is happy and does not wish to move. Son is concerned regarding his father’s ability to manage medication and meals. On discussing his son’s concerns at the initial visit with Mr B he advised he did not wish support however was finding using his microwave difficult to heat his meals. Microwave was large and the buttons and heating instructions were complicated. A simpler microwave was purchased in the hope that this would help him remain independent and there would be no need for services. Medication was also checked. This is delivered from the local pharmacy in blister pack and on checking all medication that as required to be taken was – appears to be no issues. He advised on one occasion he had taken it at the wrong time as he had woken through the night and was confused regarding the time, as it is dark, he assumed it was 3pm and not 3am. He assured the worker that this was an isolated incident. On checking on further visits Mr B is managing this task without difficulty. During the visit Mr B advised he was feeling isolated and at times lonely as most of his friends had died and most recently his wife. He has COPD, angina, mobilises with the aid of a walking stick and has low blood pressure therefore only manages to walk to his local shop due to extreme breathlessness. Befriender service was discussed with Mr B, and he agreed for a referral to be made to Befriend to support with isolation. Mr B appeared to be managing his daily tasks albeit slowly and at his own pace however on speaking to his daughter after the festive period she had raised concerns regarding his poor personal hygiene and struggle he has with doing his laundry. Mr B had visited with his family at this time and had refused to shower in over a week and his son had noticed the large amount of clothes in his laundry basket. Writer carried out a home visit to discuss the concerns his daughter had raised. Mr B said that he is struggling to shower due to lack of confidence and the effort that it takes for him to complete this task. He is left exhausted therefore has not had a proper wash in some time. Homecare support was identified to assist him to shower twice weekly. Laundry service was also discussed, and Mr B was happy to pay for this service. Writer arranged with Scrubbers Laundry Service who will pick up and drop off laundry on a weekly basis. Support was given to contact Sky TV on his behalf and arrange for an engineer to attend his property free of charge to fix his Sky box. Mr B was not receiving the full package of channels he was paying for each month. This has been rectified.
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24 Mr B is happy with all the support that has been provided and is keen for the Befriender Service to start. The writer had kept his daughter abreast of the situation with Mr B’s permission and she is very pleased that her father has engaged and is receptive to the support as she stated it gives herself and her brother peace of mind. My observation is that as Mr B was part of 3 Conversation time was taken to provide him with the appropriate support he needed. A good rapport was built up over several visits whereby Mr B was more comfortable with discussing his needs and difficulties he was having day to day. It allowed for better more in-depth discussions to take place thus providing Mr B with a better service. Example 5 OT Connector 64-year-old gentleman with following health conditions, type 2 diabetes, peripheral vascular disease, Ischaemic gout, left above knee amputation, pulmonary fibrosis. C requires to use wheelchair both indoors and outdoors. Currently in hospital SW (innovation site) facilitating assessment for hospital discharge. C is currently living in a local authority tower block with his wife. The tower block is due to be demolished. NLC housing are currently trying to identify alternative suitable property. C is currently a car driver and enjoys shopping, social outings, and day trips with his wife. Request from SW to look at property identified by housing as suitable for C and his wife. Joint visit carried out with SW, C and Housing Officer. Property was unsuitable due to restricted turning space in hallway, unable to access bathroom due to door width (which couldn’t be altered), restricted wheelchair access into bedroom. Viewed second property (dispersed property) which again was identified as suitable for wheelchair access. OT was able to respond quickly again unfortunately there were 3 steps to access the property and was unsuitable for wheelchair access. The property would not allow C to access his local community or outings independently. Linking promptly with SW has allowed me to intervene and advice C not to accept properties which are unsuitable in meeting his needs and allowing him independence. The second property identified was a dispersed property which I viewed myself in the 1st instance so as not to raise any expectations C would have with regards to being offered a suitable tenancy to allow his discharge from hospital. Example 6 OT Connector P is 80 years of age and lives with her husband in a terraced property with bedrooms upstairs and a bathroom on the ground floor. P’s husband made contact with departments to request aids and adaptations to support his with within her home environment. P was connected to OT via SW. Before OT was able to arrange appointment P was admitted into hospital therefore OT assessment did not take place until she was discharged. Upon discharge from hospital OT carried out a joint visit with SW.
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25 P has the following health conditions, chronic obstructive airways disease, arthritis, hypertension, type 2 diabetes, wears an ankle support due to her leg being shattered in an accident many years ago. P was admitted into hospital due to fluid retention, she still has some level of fluid in her left knee. P currently mobilises with the use of a wheeled walking aid indoors. P has a stairlift in situ therefore is able to access the upstairs of her home independently, she has a bed rail in situ and transfers in/out of bed independently. The main area P was having difficulty was transferring off her chair due to the lack of exercise and deterioration in her mobility whilst in hospital. P was sitting in a suitable high back chair with arm rests, the chair was appropriate for her height. On assessment P demonstrated attempting to stand this was carried out with effort. OT gave advice on alternate way to transfer from the chair, P was encouraged to bring herself to the edge of the chair before attempting to stand. P demonstrated this and was able to stand with less effort. P was experiencing some breathlessness and pain in her knees when carrying out the transfer she does not have confidence and feels she is going to fall back if her legs give way. Both her and her husband felt she required a riser recliner chair and requested that this be provided. OT recommended that a period of physiotherapy intervention would be beneficial to strengthen P’s muscles and practice chair transfers to build her confidence. P advised she would give it a try and her husband was also very supportive. SW will connect with Physiotherapist from Integrated Rehab Team to arrange assessment and intervention. P will also be supplied with a wheeled trolley to enable her to transport items from the kitchen. Within the innovation team OT had the capacity to visit P within a few days of her discharge, this was crucial to identifying there was rehab potential, and a riser recliner chair was not required. Having access to Connect to physiotherapist will allow the intervention required to strengthen P’s muscles, improve her ability to carry out safe transfers and improve her mobility which would allow her to return to enjoying outings with her husband and participate in managing household tasks which she has missed. Example 7 OT Connector T 75 years of age he lives with his wife in a mid-terraced property with bedrooms and bathroom upstairs. He has the following health conditions, Parkinson’s disease, type2 diabetes, arthritis, cataract, bulging discs. T is very independent and enjoys socialising with his wife. He has recently had to give up driving, they used to enjoy driving holidays. T’s wife now does all the driving they enjoy day trips and socialising with friends. T would like to resume holidaying in the near future and is keen to try a coach trip. T is also keen to return to his Rotary club as he enjoys socialising and the charity work they do. OT has been connected at the request of SWA (innovation site) who informed that T was having difficulty negotiating the internal stairs. SWA became involved when T made contact requesting an assessment for any aids/ equipment which would support
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26 his independence within his home. OT was able to respond quickly and attend and carry out stair assessment. T mobilises slowly he has a shuffling gait with poor balance, her requires to use a walking stick at present he feels he does not require any further walking aids. T advised he is experiencing pain hi his legs and back when he negotiates the stairs, his balance is poor, and he feels he is going to fall. For this reason, his wife supports him on the stairs to ensure his safety. OT observed T negotiating the stairs he was very slow and was unable to place his full foot on the stair this was causing him to be unsteady, he also experienced pain when lifting his foot as this was putting pressure on his back. He required to hold onto the banister and his wife was behind him offering support. This was putting both of them at risk. On completion of the task T was breathless and exhausted with the effort he was unable to descend the stairs immediately. OT recommended installation of a stairlift as this would enable T to negotiate the upstairs of his home in a safe and independent manner. This would also reduce the risk of injury to his wife when supporting him. OT discussed recommendation at housing solution meeting this was agreed. OT completed paperwork requesting survey and quotation for installation once this was received the stairlift was ordered via care plan. T is independent with selfcare tasks he has a shower cubicle in situ., which he wasn’t very confident in accessing. OT has provided rails and shower stool to support independence. A raised toilet seat and external rails were also provided. The small aids provided has made such a difference and increased his confidence especially when accessing outdoors. Upon request for a stair assessment T’s assessment was carried out very quickly due to the fact that a referral did not have to be made to Rehab Team where the referral would have been placed on a waiting list. During this period T could have fallen on the stairs causing himself or his wife serious injury and possible hospitalisation, this has been prevented due to being part of a full multi-disciplinary team and not having to refer onto another team for assessment. Both T and his wife were very grateful for the quick response to their request for supports as they were both becoming very anxious and had concerns around T’s limited availability to access the upstairs of his home independently.
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1 REPORT Item No: 12 SUBJECT: Strategic Commissioning Plan 2023 - 26 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief officer North Lanarkshire Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 1. Seeking endorsement of our approach from IJB PFA 2. Seeking promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019- 20) then a three-year plan for 2020–23. The 2023–2026 SCP will be the final plan within the ten-year strategy. 5.2 Along with Safer, Healthier, Independent Lives 2016–2026, the SCP is informed and shaped by The Plan for North Lanarkshire and Achieving Excellence. Achieving Excellence, a plan for person-centred, innovative healthcare for people in Lanarkshire, is currently being refreshed. 5.3 The SCP is further underpinned by key strategies and plans including but not limited to: a) Community Solutions Strategy and investment Plan b) Mental Health and Wellbeing Strategy for Lanarkshire c) North Lanarkshire Children’s Services Plan d) Alcohol and Drug Partnership Strategic Plan e) Tackling Poverty Strategy f) Engagement and Participation Strategy g) Market Facilitation Plan h) North Lanarkshire Strategy for Adult Carers and Young Carers i) Lanarkshire Advocacy Plan j) Lanarkshire Healthy Weight Strategy k) Digital and IT Strategy 5.4 The 9 Local Outcome Improvement Plans developed through each of the Community Boards capture local priorities and actions (noted below) which both inform and are informed by the work of the Health and Social Care Partnership and shape the Strategic Planning process. Mental Health and Wellbeing Public and community transport Tackling poverty and inequalities Community Safety Health inequalities Community Engagement Food inequality Digital Inclusion Covid 19 recovery Youth engagement and consultation Town centre and hub development Social interaction and inclusion Greenspace maintenance and environmental quality Summary of Key Issues
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3 5.5 The development of the Strategic Commissioning Plan 2023–26 is underway with discussions already commenced across a range of important forum, including Strategic Leadership Team, Strategic Planning Group, Chairs and Co- chairs of Locality Planning Groups and Partnership Boards, as well as discussion with key partner organisations and engagement forums. These discussions have helped on shaping the next steps of engagement and participation in the Strategic Commissioning Planning process as well as draw a range of related activities together to refresh how they are undertaken and aligned to use resources smartly. Further embedding a Whole System Approach 5.6 The Health and Social Care Partnership has long been committed to a whole system approach, recognising the co-dependencies. Ensuring engagement and participation in the development of the SCP across the whole system then clearly building performance frameworks which reflect the whole system will change meeting structures, governance arrangements and strengthen partner involvement. A whole system approach needs understand activity across: Community supports and activities Proactive and preventative activity First or initial responses Change services such as rehabilitation, recovery, treatment and reablement Ongoing interventions Complex and statutory interventions Acute or in-patient responses Strengthening engagement and participation 5.7 The Engagement and Participation Strategy, Framework and Principles 2021- 24 clearly outlines the importance of, and the approach to, ensuring strong voices inform and shape the work undertaken through the Health and Social Care Partnership. 5.8 Whilst significant progress has been made in engagement and participation, in aspiring a more co-productive approach, there is more to be done. The voice of communities is embedded through Community Solutions supporting local consortia who have a broad and wide reach. The voice of carers is well represented through North Lanarkshire Carers Together. Good progress has been made in representing the voice of people with lived experience, discussions are being undertaken to invest in future approaches which robustly enhance this to increase the focus on underrepresented groups. 5.9 Frontline staff and wider stakeholders are also important in wider engagement and participation. Quarterly staff roadshows are an important vehicle to augment local arrangements and facilitate easier information sharing and participation. Delivering on major change as well as business as usual
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4 5.10 The 6 key ambitions of the SCP 2020-23 is achieved through 41 programmes of work, previously noted through the IJB relating to the DELIVERY of services and supports, ENABLING, SUPPORTING and GOVERNING factors. It is also worthy of note however that there are several transformational change programmes being supported simultaneously, in particular: a) Child and Adolescent Mental Health Service change b) Community Nursing Review c) Development of Mental Health in Primary Care Services d) Development of Home First approach incorporating Home Assessment Teams, Integrated Rehabilitation Teams and modernisation of Home Support Services e) Development of Alcohol, Drugs and Mental Health Services The learning and development achieved through these programmes of change need to feed into the SCP 2023-26. Active governance and refresh of performance 5.11 Developing the Whole System Approach described at 5.6 above, includes revision to performance reviews to promote active governance. Increasingly data will be used to assure, anticipate, and prioritise, within the Health and Social Care Partnership, with key partners and through the role governance committees play in scrutinising data in detail. 5.12 The construction of performance reviews will develop the revised structures within the Health and Social Care Partnership, using the two Sector and 3 main Area Wide constructs to promote integrated approaches, cross cutting learning and shared ambition. The review groupings in the first instance will become: North West Sector (including Airdrie, Coatbridge and North Localities); North East Sector (including Bellshill, Motherwell and Wishaw localities); Children’s health services including CAMHs Addiction, Learning Disability and Mental Health Services across health and social care Area wide health and social work services which will include home support services 5.13 Proposals to also introduce a whole system performance review are being developed to more actively include the voice of communities, the voice of carers, the voice of people with lived experience, representation of the independent sector, colleagues from acute services. Representing South H&SCP hosted services and the North Core Team. 5.14 Bringing the key considerations together, dates are being identified to facilitate 5 key engagement sessions to analyse and discuss the Strategic Needs Assessments and Local Outcome Improvement Plans for each locality and area wide services. These sessions will be held in August and will inform both the development of the SCP 2023-26 and establish the revised performance review groups. Invitation will be made to IJB members to participate in events.
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5 6. CONCLUSIONS 6.1 The Strategic Commissioning Plan (SCP) is crucial to achieving the strategic ambitions for people in North Lanarkshire. Wide engagement which brings together Strategic Needs Assessments, Locality Outcome Improvement Plans, national and local strategies, and plans, as well as learning and lessons from the transformational change agendas is being planned and developed for late August 2022. The engagement sessions, and others to be agreed with stakeholders will be designed to genuinely share, listen, and act in the complex whole system approach. 6.2 A draft SCP will be presented to the IJB in late 2022. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S) The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the SCP 2023-26 This paper has been reviewed by Finance: Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the SCP 2023-26. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Wide range of engagement activity planned and will be further enhanced following feedback from the engagement and participation stakeholder group
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6 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development of First Point of Contact. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# This content in this paper links directly to the following: • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic-Comm- Plan-20-23-FINAL.pd 9. APPENDICES Appendix 1 – Programme of Engagement Activity ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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7 Appendix 1 Programme of Engagement Activity July 2022 27 July 2022, 9.30am – 11.00am Adult SW Governance Group In person Health Professional & Ops Group August 2022 4 August 9.30am- 11am Staff Roadshow MS Teams 31 August 9-12pm NE Sector In person 22 August 12-3pm NW Sector In person 19 August 1-4pm Area Wide Health & SW In person 24 August 1-4pm Children’s Services In person 19 August 1-4pm Mental Health Event In person 23/8/2022, 6.30pm – 8.00pm Shotts Community Board 24/8/2022, 6.30pm – 8.00pm Northern Corridor Community Board 25/8/2022, 6.30pm – 8.00pm Cumbernauld Community Board 30/8/2022, 6.30pm – 8.00pm Coatbridge Community Board 31/8/2022, 6.30pm – 8.00pm Wishaw Community Board 1/9/2022, 6.30pm – 8.00pm Kilsyth Community Board September 2022 1 September Addictions, LD & MH Partnership Board In person, Dalziel 6 September Adult Social Work, Care & Wellbeing Committee In person, Council Chambers 6/9/2022, 6.30pm – 8.00pm Motherwell Community Board 7/9/2022, 6.30pm – 8.00pm Airdrie Community Board 7 September IJB Liaison In person 8/9/2022, 6.30pm – 8.00pm Bellshill Community Board 15 September, 6.30pm – 8.00pm Community Board Strategic Engagement Session 1 Online via Cisco WeBex 29 September, 6.30pm – 8.00pm Community Board Strategic Engagement Session 2 Online via Cisco WeBex November 2022 22 November, 6.30pm – 8.30pm Shotts Community Board 23 November, 6.30pm – 8.30pm Northern Corridor Community Board
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8 24 November, 6.30pm – 8.30pm Cumbernauld Community Board 29 November, 6.30pm – 8.30pm Coatbridge Community Board 20 November, 6.30pm – 8.30pm Wishaw Community Board 1 December, 6.30pm – 8.30pm Kilsyth Community Board 6 December, 6.30pm – 8.30pm Motherwell Community Board 7 December, 6.30pm – 8.30pm Airdrie Community Board 8 December, 6.30pm – 8.30pm Bellshill Community Board