Item 3 - Minute of IJB Performance, Finance and Audit Committee held on 16th February 2022
North Lanarkshire Council · 31 August 2022
Back to IJB Performance, Finance and Audit Committee — 31 August 2022 and its agenda
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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