Item 6 - Self Assessment Report
North Lanarkshire Council · 31 August 2022
Back to IJB Performance, Finance and Audit Committee — 31 August 2022 and its agenda
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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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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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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.