Agenda Pack
North Lanarkshire Council · 16 November 2022
Back to IJB Performance, Finance and Audit Committee — 16 November 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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A meeting of the Performance Finance & Audit Committee will be held on Wednesday 16th November 2022 at 2.00pm via Microsoft Teams If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. AGENDA CHAIR: Brian Moore No Time Item Action Attachment Reporting 1. Welcome and Apologies B Moore 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes Performance, Finance & Audit Committee For Approval Attachment B Moore 4. Matters Arising - Action Log For Approval Attachment R McGuffie GOVERNANCE 5. P,F & A Risk Register For noting Attachment R McGuffie 6. Analogue to Digital Telecare Transition For Noting Attachment R McGuffie 7. Primary Care Improvement Plan Update For Endorsement Attachment R McGuffie 8. Integration Review For Approval Attachment R McGuffie FINANCE & AUDIT 9. Financial Monitoring Report 2022/2023 For Noting Attachment A Kilburn 10. Progress Report on Agreed Actions For Endorsement Attachment A Kilburn
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11. IJB Reserves Strategy 2022/2023 For Endorsement Attachment A Kilburn PERFORMANCE 12. Covid Update For Noting Attachment R McGuffie 13. ADP Self-Assessment For Noting Attachment M Dendy 14. Service recovery, Winter Planning and Supporting the Health and Social Care System For Noting Attachment M Dendy 15. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls B Moore 16. Date of Next Meeting: TBC
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 31st August 2022 2pm-3.40pm Present: Voting Members: Ally Boyle NHS Lanarkshire Non Exec Director Councillor Tracy Carragher (Vice Chair) North Lanarkshire Council Nominated Councillor Neil Findlay NHS Lanarkshire Non Exec Director Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Councillor Ayeshah Khan North Lanarkshire Council Nominated Councillor Councillor Kirsten Larson North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Harry Robertson North Lanarkshire Carer Together John Watson Unison Rep In Attendance: Stacey Connor (Minutes) Minute Secretary Nicola Lynch Finance Manager NLC Thomas Moan Partnership for Change Development Worker Apologies: Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Maddy Halliday Chief Exec, VANL Third Sector Rep Trudi Marshall Nurse Director North HSCP Cathy McGinty Unison Staff Side Rep (NHSL) James Muir NHS Lanarkshire Non Exec Director Elizabeth Seaton Partnership for Change User Rep ACTION 1. Welcome and Apologies
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2 The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. Welcome was made in particular to Amanda Kilburn and Cllr Khan attending their first IJB committee. 2. Declaration of Interests There were no declarations of interest raised. 3. Minutes 16th February 2022 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Ross McGuffie shared an updated action log to reflect the progression of work since the last committee. Updates were as listed below: Item 1- Reserves Strategy- Ross McGuffie proposed to change the timeline to December committee to allow Amanda Kilburn to prepare the information; the committee agreed this. Item 5- Integration Review- Amanda Kilburn has now commenced post of CFO this item can be closed. Item 9- Finance- This will be challenging to update as still not aware of all requirements within NCS. The chair suggested align updates to when the NCS bill progresses in line with Scottish Government time table. It was noted IJB chairs and Vice chairs have participated in briefing sessions. Item 10- Comms- Work is underway to develop the North HSCP website to be hosted on the council platform. 5. PF & A Risk Register Ross McGuffie 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 are currently two risks rated as Very High on the IJB risk register. ▪ IJB 08/21 – Financial Implications of Responding to Covid ▪ IJB 09/21 – Impact on the Strategic Plan due to Covid These risks refer to the Financial planning for 2021/22 and will be reviewed by the new CFO for the
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3 IJB and either closed or updated to reflect the financial plan and attendant risks identified for 2022/23 There are four high rated risks on the IJB risk register. ▪ IJB 01/21 - Financial Challenges ▪ IJB 04/21 - Notional Set Aside Budget ▪ IJB 13/21 - Impact on discharge performance linked to care homes. ▪ IJB 12/21- Staff Health & wellbeing At the IJB meeting in June 2022, it was agreed that the following risks should be reviewed with potential to add to the IJB Risk Register; ▪ Impact of Cost of Living on IJB strategic objectives ▪ Unscheduled Care & patient flow ▪ Community Alarms ▪ Development of National care service & impact on Business Continuity Once these risks have been developed and reviewed, they will be presented to the next IJB in September for approval. Ally Boyle proposed an explicit comment on papers to show risk have been considered. Ross McGuffie noted this will be picked up as part of quality assurance of future committee papers. The IJB Performance, Finance & Audit Committee agreed the following recommendations: The PFA Committee noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of PFA Committee business. 6. IJB Self-Assessment Report 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 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 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”.
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4 The report tabled 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. The self-evaluation had 31 different statements which the groups were asked to respond to, appendix 1 outlines the red, amber and green (RAG) status against these. 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. • 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. Cllr Paul Kelly noted thanks to those involved in the work, this was supported by other members of the committee. Brian Moore noted there was previously reference to 6 areas for improvement was this consolidated within the 3 main areas within the report. Ross McGuffie confirmed further details will be brought when action plans are tabled for updates. Once the new IJB membership is embedded consideration will be given to hosting a development session to further explore the self-evaluation work; this was noted. The IJB agreed the following recommendations: (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, (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 RMcG
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5 (4) Note the findings from the self-evaluation exercise will be reported to the next meeting of the IJB. 7. Financial Monitoring Report This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 30 June 2022 (Health Care Services and 24 June 2022 (Social Work and Housing Services). The financial position as at June 2022 is summarised as follows: (1) there is a net underspend of £2.249m on the core budgets within Health Care Services; details of which are provided at Appendix 1. (2) there is a net underspend of £1.041m on the core budgets within Social Care and Housing Services; details of which are provided at Appendix 2 The total underspend of £3.290m represents approximately 0.58% of the total financial envelope available. Section 9 highlights the anticipated savings to be achieved this year. Reserves remain the same with no draw down of reserves yet but the reserve strategy will be reviewed and shared at the December IJB committee. Ally Boyle queried the timescales for Strathcarron hospice update. Ross McGuffie confirmed commitment to Strathcarron has remained unchanged but there is some work on continuing care beds coming to future committee which may free up some funding for this. There has been no movement of reserves to date it was questioned why is this the case. Nicola Lynch confirmed these will begin to move once the IJB approves the strategy and with the appointment of Amanda Kilburn as new CFO now taken up post. There are plans already drafted for the spend just require approval. The report will include reference to cost of living challenges. Neil Findlay noted inability to draw reserves down is partially due to recruitment issues as discussed at the NHS Board meeting, he asked if the money is not drawn down would there be a risk that Scottish Government would claim money back. Ross McGuffie confirmed this is a risk but also need to be mindful funding can only be used on delegated functions for the IJB. Councillor Paul Kelly noted already aware local authorities will not be receiving any additional funding for covid costs.
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6 Brian Moore drew attention to section 9. 32 asked if there is any update on the savings proposal. Ross McGuffie advised the end point is the closure of Muir park which is in progress, have delayed closure activity due to inpatient constraints within NHS Lanarkshire. The PFA noted the following recommendations: (3) Note the contents of the report; (4) Note that the financial outturn at June is an underspend of £3.290m (NHSL -£2.249m; NLC - £1.041m). 8. Quarter 4 Performance Report The purpose of the report tabled is to provide an update to the Board on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 January to 31 March 2022 (Quarter 4). Delayed Discharge performance has been positive but July and August has been challenging. Rolling out planned date of discharge across all sites to enable care packages being in place to allow timely discharges. Reablement services is a recovering service now got all 6 localities stood back up and multidisciplinary team meetings. Got 63% of cases going through reablement first the target is 70% so still some work required. CAMHS- 80% was met RTT target, if urgent cases are seen first it artificially inflates the overall figure so not always a true picture. RTT will drop as now starting to see patients who have already breached the 18 week wait time. A report is being taken to the Board PPRC committee and should come to IJB committee in September. Psychological Therapies- 87% against target and no waits over 12 months. Expect to move towards new 100% target by end of financial year Speech and Language Therapy has recruitment issues for the service which is a challenge for all Boards. So have approved additional posts to aid recovery but unfortunately have been unable to fill. So now considering additional management resource for the service to review requirements. Brian Moore asked of the new staff that have been recruited are we retaining them. Ross McGuffie noted some of the new posts in reablement are being well received but in other services like home support have seen significant staffing turn over. From national discussions picked up some staff are moving Health Board areas as they think it will be less challenging but they have then then been looking to come back to their initial board. The committee noted the improvements which has been made by the staff since the pandemic. Brian Moore asked for an update on school counselling services. Ross McGuffie advised 6% of high school children are currently
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7 open to school counselling services. Early engagement work is being undertaken to ensure there is enough capacity in the system to match future demand. The IJB PFA noted the report. 9. Whole System Performance Framework for North Lanarkshire With the engagement and participation fully underway now to work with a wide range of local stakeholders to produce the HSCP Strategic Commissioning Plan for 2023-26, work is also commencing on the development of the Performance Framework. With an increased emphasis on a whole system approach to health and social care in North Lanarkshire, this report sets out some of the foundational expectations supporting whole system impact being developed through a revised Performance Framework. The paper sets out CAMHS as an example of what the aim of the performance framework aims to achieve. Going forward this will feed into the Chief Executive performance reviews. Ally Boyle asked if for future themes to highlight the co-production of the public voice being included in this work. Ross McGuffie will fed this back to Morag Dendy for inclusion within further updates in due course. The PFA Committee agreed the following recommendations: 1. Endorse the performance management approach outlined within the paper; 2. Agree to the promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26 and development of a Whole System Performance Framework 10. Covid Update As at 11th August, the seven-day case rate within North Lanarkshire is 87.4 per 100k population, which is a continued decrease to the figures last presented to the IJB on 22nd June when it was 103 per 100k. As of today has 64 covid positive inpatients. Predictor at the start of today is -132 bed position in Lanarkshire so work is on-going to support the system pressures. There are 4 outbreaks across Lanarkshire care homes. Scottish care has raised concerns on the viability of care homes in relation to the cost of living cost increase. There are currently 69 delays in North. The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at
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8 12th August, there are 91 covid positive inpatients and a further 10 in offsite facilities. On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. The Vaccination programme is continuing at pace with the winter programme starting on 5th September initially for eligible staff to receive their covid booster and flu vaccines then this will be rolled out to the wider population. Neil Findlay noted care home providers concerns about viable to run services so due to underfunding of publically funded places which could mean individual are then charged higher rates in future. Ross McGuffie noted in the resilience plan if care home providers were to close North Lanarkshire would support the process. Hill end view is an example of a care home moving through a closure process. As part of this had to support over 70 residents to find alternative accommodation. John Watson noted should be declaration of an emergency with Scottish Government with the increase of cost of living. The NHS Board have already agreed to raise on the National Gold group. Ally Boyle asked how do we review which care homes registered are able to deliver a service. Ross McGuffie noted the care home assurance already review any concerns raised and offer additional support if required but would need to consider how review this from a finance perspective in future. Brian Moore noted further updates will be brought back as updates are available. The PFA Committee agreed the following recommendations: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 11. First Point of Contact (Evaluation of Learning) North Lanarkshire faces a significant increase in service demand as a result of demographic change as well as the impact of the pandemic. It is recognised that there needs to be a focus on assets, adopting a strength- based approach to continue to shift the balance of care and develop services, focusing on prevention, early intervention, and self-management. There is a need to build on the areas of excellence across the HSCP by continuing to demonstrate compassion, continuity, clarity in communication and shared decision-making across all services/supports.
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9 Access Social Work is the main entry point into social work services. To inform a baseline position, analysis was carried out over three separate weeks 24th February 2020, 13th July 2020 and 5th October 2020. The review highlighted that response to contacts by or on behalf of the public varied considerably not only between services but also within services. Some people’s journey into the service and their outcomes were very clear and well recorded. Other interventions however were very service driven and focussed on outputs, typically by the provision of equipment and/or services. There was clear evidence of people encountering one part of the service then in short time periods coming into a different part of the service again as a new user. Essential knowledge was not always shared across teams. There were multiple handovers between services and often duplication. 93% of referrals received over the three separate weeks, were handled by more than one service and 18% of all referrals received for adult services were handled by more than two services. Where this was the case, there was potentially missed opportunities to take a preventative approach and to build people’s resilience. The 3 conversation model is around the first conversation to build a rapport with individual, then second conversation is when someone is in crisis. Then the final conversation is to build a longer term approach for the individual. 82 individual participated in the programme. The aim going forward it to look at the pilot and build it into learning going forward as part of early intervention across a number of key services. Ross McGuffie advised need to create capacity within the service to make this pilot happen which will see a reduction in demand going forward. Mark Dell is working to pull together individuals feedback to promote this way of work. Scottish Ambulance service are undertaking work to review high resource users. They plan to have a conversation early on with individuals to identify the problems rather than being reactive. It has been agreed NHS and SAS will work together on this to share learning The plan is for this work to come through the commissioning planning process. Councillor Ayeshah Khan asked what the staff buy in has been for the approach. Ross McGuffie advised overall staff have been positive for the impact they have had on service users and keen to expand the work. The PFA agreed the below recommendations: 1. Seeking endorsement of our approach from IJB PFA 2. Seeking endorsement of the approach to exploring the principles of First Point of Contact to inform the Strategic Commissioning Plan 2023-26 12. Strategic Commissioning Plan –Progress Report on Programme of Work
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10 Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020–23. The 2023–2026 SCP will be the final plan within the ten-year strategy. The development of the Strategic Commissioning Plan 2023–26 is underway with discussions already commenced across a range of important forum, including Strategic Leadership Team, Strategic Planning Group, Chairs and Co- chairs of Locality Planning Groups and Partnership Boards, as well as discussion with key partner organisations and engagement forums. These discussions have helped on shaping the next steps of engagement and participation in the Strategic Commissioning Planning process as well as draw a range of related activities together to refresh how they are undertaken and aligned to use resources smartly. Engagement session events have been shared with the committee with an open invitation to attend any of these. The final plan will be shared at the December committees then final engagement will take place between January-March with final sign off by the IJB in March. The committee agreed to cancel the IJB liaison session on 7th September. The IJB PFA noted the below recommendations: 1. Seeking endorsement of our approach from IJB PFA 2. Seeking promotion of and participation in the of the engagement events supporting the development of the Strategic Commissioning Plan 2023-26 13. Risk Ross McGuffie to consider care home providers finance viability and how this can be monitored. Already identify the risk of discharges to care homes so can review this expand the risk to cover this. 14. Date of Next Meeting 16th November 2022 at 2pm
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ITEM 4 1 Performance, Finance & Audit Committee ITEM 4 ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 28.5.19 & 27.8.19 Item 11 & Item 5 Reserves Strategy R McGuffie M Moy Detail on exit strategies for services funded from reserves to be included in report at next meeting. Update: Deferred to IJB 22nd June 2021 where the IJB Reserves Strategy 2021/2022 was approved. The report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. 9.11.21 – verbal update given and further update due at IJB in December 2021. 16.2.22 - Reference to Reserves included within the Financial Plan Progress Update item on Agenda 16.2.22 Original date - November 2020 New date – November 2021 – deferred to February 2022. Ongoing – to be reviewed by North IJB CFO for September IJB 2022 On agenda 2. Feb/March 2020 Comments received from circulated papers Internal Audit Plan 19/20 Progress Report M Moy 1. Update on Actions identified within report. Agreed to remain as standing item on agenda until all actions complete. Updates on progress with completion on actions given on 25.5.21, 24.8.21, 9.11.21 & 16.2.22 Ongoing until completion of all actions Ongoing
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ITEM 4 2 2. Service Level Agreement to be drafted around disaggregation of Children’s & Families & Justice Social Work Budgets. Revised timescale – September 2022 Ongoing Update on agenda for Nov 22 meeting 3. 25.5.21 Item 8 Alcohol & Addiction services M Dendy 1. ADP risk register to be developed and presented to PF&A 2. NLADP Strategic Plan and Investment Plan to be presented to future PF&A meeting. 3. An update on accommodation issues to be presented. November 2021 ADP Strategy presented to IJB 21.9.21 Complete Complete Complete 4. 24.8.21 Item 13 First Point of Contact M Dendy Committee to receive updates on learning from the Innovation Site. 16.2.22 Deferred to August PFA as evaluation on learning not yet complete due to delayed start in October 2021 February 2022 (Deferred to next PF&A in August 2022) Complete Complete 5. 24.8.21 Item 6 Integration Review R McGuffie 1. Finalise last remaining action from the audit around Chief Financial Officer support Update: Discussions have commenced with colleagues in South Lanarkshire, but currently on hold due to current operational priorities 16.2.22 – Verbal update on HR recruitment process noted. October 2021 – deferred to December 2021. Update given Feb 2022 Closing report on Nov 22 meeting agenda
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ITEM 4 3 6. 9.11.21 Item 6 Participation & Engagement M Dendy Arrangements for the 2 existing Partnership Boards to be reviewed. Update report to be provided to next PF&A. 16.2.22 - Review of participation & engagement underway with report with recommendations due to be presented to IJB February 2022 (complete) September 2022 Complete Complete 7. 9.11.21 Item 9 Quarter 1 Performance Report M Dendy Agreed that a more rounded set of indicators and measures should be included within future Performance reports particularly around Referral to Treatment Targets (RTT). A new set of Measures around CAMHS was being developed and would be brought to the next meeting. February 2022 Complete 8. 9.11.21 Item 13 Staff Health & Wellbeing R McGuffie 1. Details of Sickness Absence rates within the partnership requested. 2. The Risk rating around staff health & wellbeing was to be reviewed. February 2022 Included in performance reports – complete 2.Complete - Risk rating reviewed & approved at IJB in December 2021 9. 16.2.22 Item 6 Finance M Moy/CFO Report on financial implications of the Feeley report to be brought back to a future meeting. 24.8.22 – note requirement for further details on NCS to be made available to allow this work to be undertaken To be discussed with new North IJB CFO to confirm date Ongoing Updates to align to SG timelines
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ITEM 4 4 10. 16.2.22 Item 6 Comms M Dell Update requested on development of H&SC NL website August 2022 Ongoing 11. 16.2.22 Item 6 Finance M Moy/CFO Longer term SLA to be developed for Hosted service arrangements. February 2023 Ongoing 12. 16.2.22 Item 16 Fairer Scotland Duty M Dendy Report to be provided setting out the refreshed approach which will include performance measures to evidence effective use/implementation of FSD. 24.8.22 Collaborative approach being taken by NHSL/NLC/SLC around support for EQIA &FSD including training & updated templates etc February 2023 Ongoing 13. 16.2.22 Item 9 Financial Plan M Moy Update to be provided within Financial Plan on 10% budget being committed to frontline MH staffing February 2023 Ongoing 14. 16.2.22 Item 13 Alcohol & Addictions service M Dendy Additional Information on Drug use & achievement of MAT standards was requested & agreed to provide information in future report Update to be provided to the IJB in September 2022 Complete
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1 REPORT Item No: 5 1. PURPOSE OF REPORT This paper is coming to the IJB; The purpose of this report is to provide a summary to the Integration Joint Board (IJB) on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE PERFORMANCE, FINANCE & AUDIT COMMITTEE This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. SUBJECT: Risk Management: IJB Risk Register TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 16th November 2022 For approval For endorsement To note Yes No N/A
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2 5.2 The PF&A Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PF&A committee considered the risk register at its last meeting on 31st August 2022. No changes to the risk rating were recommended at that meeting however the actions associated with each risk have been updated. 5.3 Four new risks were added to the IJB Risk Register and agreed at the September meeting of the IJB: IJB 15/22 – Cost of Living impacts IJB 16/22 – National Care Service IJB 17/22 – Unscheduled Care and patient flows IJB 18/22 – Community Alarms 5.4 There are currently three risks rated as Very High on the IJB risk register. IJB 08/21 – Financial Implications of Responding to Covid IJB 09/21 – Impact on the Strategic Plan due to Covid IJB 17/22 – Unscheduled care and patient flows 5.5 These risks were reviewed on 2nd November 2022 and will be subject to further review with the new Chief Finance Officer as part of the financial planning exercise for 2022/23. 5.6 There are seven high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing IJB 14/22 - CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service 5.7 There are a number of high/very high rated operational risks recorded on NHSL and NLC risk systems that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services. No/Ref Risk Risk Rating Lead Organisation/Area 2115 CAMHS Service - There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non-clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of NHSL High NHSL Corporate
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3 1710 Public Protection: There is a risk that NHSL could fail to identify harm to any vulnerable person, child or adult, or prevent harm to others resulting from the complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. High NHSL Corporate 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. Very High NHSL Corporate 2126 Sustaining Out of Hours Primary Care Service Very High NHSL Corporate 2086 Sustaining GP Services Very High NHSL Corporate 2129 Sustaining Whole System Patient Flow Very High NHSL – Corporate NLC RIA0000446 Unable to deliver services due to funding issues Very High NLC - Social Care/Social Work NLC RIA0000448 Availability of workforce to deliver services within legislative and regulatory compliance requirements. High NLC – Social Care/Social Work NLC RIA0000449 Information & Data Protection – non-compliance with information governance legislation, standards and processes and data security and inability to retrieve relevant data with deadlines High NLC – Social Care/Social Work NLC RIA0000450 Health & Safety of staff in SW & partnership companies – failure to ensure the health safety and welfare at work of the service, employees, partners and provider agencies High NLC – Social Care/Social Work NLC RIA0000453 Supplier failure or services not provided to required standard. Insufficient number of providers. High NLC – Social Care/Social Work NLC RIA0000457 Inadequate supervision, governance and monitoring across professional workforce High NLC – Social Work/Social care NLC RIA0000458 IT system not fit for purpose High NLC – Social Work/Social care NLC RIA0000459 Integration – there is a risk that services and not integrated effectively thus impacting on improving the outcomes for individuals receiving care and support High NLC – Social Work/Social care
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4 NLC RIA0000460 Performance & planning – increasing expectations and changing performance demands will result in a failure to provide performance information internal, external and including S Govt, High NLC – Social Work/Social care NLC RIS0000414 Community alarm and assistive technology – unable to continue to support people with a community alarm system and develop use of assistive technology Very High NLC – Social Work/Social care NLC RIS0000415 Mental Health Officers – Failure to comply with legal obligations High NLC – Social Work/Social care NLC RIS0000417 Communications strategies and engagement plans – Inadequate strategies not aligned with strategic objectives High NLC – Social Work/Social care NLC RIS000419 Non- compliance with Information Governance & Data Protection High NLC – Social Work/Social care NLC RIS000426 Analogue to digital transition & ability to provide a working community alarm service High NLC – Social Work/Social care 6. CONCLUSIONS 6.1 The IJB currently has 18 risks identified on its IJB risk register with ten risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Financial risks are identified in the risk register. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE N/A
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5 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and fully contribute to approval and amendments to the IJB risk register. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY 8. BACKGROUND PAPER None. 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752591. Yes No N/A
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB02. 21 Financial Reputational 01/04/2021 Ineffective Governance Arrangements There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Planned Procurement and Standing Financial Instructions presentations at Extended SLT by 31 March 2022. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.03.22 Previously IJB6. Reviewed and updated on 15 May 21. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 31.12.2022 IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programmes which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. 16. Additional Scottish Government funding to address Covid‐19 costs and to progress the Remobilisation and Recovery Plan in 2021/2022 is not sufficient. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2021/2022 has been agreed and is being reviewed regularly. The IJB Financial plan 2022/23 is being developed. 7. Capacity plans in place to maximise efficiency. 8. IJB Integration Scheme setting out the budget recovery processes. 9. IJB Financial Regulations and financial procedures. 10. Consultation and involvement with key stakeholders including service users and carers. 11. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 12. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. Financial sustainability payment arrangements in place to 30 June 2022 to support external social care providers. 16. A Change Fund of £6.076m has been agreed with the Scottish Government. 17. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. The Scottish Government announced on 9 December 2021 the indicative Scottish Budget 2022/2023. Work is ongoing to confirm recurring and non‐recurring funding allocations. 19. Lanarkshire Mobilisation Plan 2021/2022 Funding has been confirmed which meets the additional costs of the Covid‐19 pandemic, including the underachievement of savings. The cost of the recovery and remobilisation of health and social care services in 2022/2023 continues to be monitored. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2022/2023 is being progressed. 3. The review and update of the IJB Medium to Long Term Financial Plan is ongoing. 4. The Business Case to take forward the remobilisation and recovery of services and also transformational changes is being developed. 5. The Lanarkshire Mobilisation Plan 2021/2022 costs for quarter 3 were submitted to the Scottish Government on 31 January 2022. 6. Confirmation was received on 25 February 2022 of the additional funding for 2021/2022 to address the costs incurred in 2021/2022 in respect of the Covid‐19 pandemic and also the remobilisation and recovery of services. On conclusion of the financial year 2021/2022, any uncommitted funding will be ring‐fenced as an IJB reserve to meet Covid costs in 2022/2023. The financial implications of this are being monitored. 7. Ongoing consultation with the Scottish Government in respect of the IJB Reserves Strategy 2022/2023 and the anticipated additional costs in 2022/2023 will be progressed by the IJB Chief Financial Officer. 8. The implementation of the approved Business Case to invest the Change Fund and the 2022/2023 recurring Scottish Government funding to maximum effect over the following 2 to 3 year period. HIGH Report Prepared by Christine Jack on behalf of the Chief Officer Page 1 of 6
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2021/2022. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. ACTIONS 1. North and South IJBs will undertake a review the financial principles in respect of the hosted services to further develop the current arrangements in line with emerging good practice and guidance. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs Prescribing costs may escalate due to increases in prescribing activity and increasing price volatility, new drugs becoming available, the response to the Covid‐19 pandemic and the impact of EU withdrawal. M edium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. ACTIONS 1.. Locality Prescribing Action Groups. 2. Continuation of Scriptswitch. M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 Previously IJB11. Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB03. 21 Financial Strategic 01/04/2021 Impact of European Union Withdrawal There is a risk that the IJB is unable to implement the Strategic Plan because of the operational and financial challenges posed by European Union (EU) withdrawal leading to a failure to achieve the desired strategic aims and an adverse impact on both operational service delivery and the achievement of financial balance. The impact on health and social care services of leaving the EU continues to be difficult to forecast. The following significant risks continue to be monitored at a national level. (1) The UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology. (2) In respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. (3) There is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. (4) The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. (5) There continues to be a risk of disruption to the supply chains, part of the risk in respect of which was minimised with mitigating actions such as stockpiling. (6) The future of Scottish patients' healthcare in other European countries and the impact of reciprocal healthcare and the free movement of healthcare including the impact of the changes to the European Health Insurance Card (EHIC). M edium CONTROLS 1. Silver command' group formed for HSCP. 2. On 24 December 2020 a new EU‐UK trade and co‐operation deal was agreed. 3. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 4. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 5. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 6. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 7. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 3 stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. 9. Reciprocal health care is subject to the Withdrawal Agreement, the collection of guidance outlining the rules in each state, the completion of relevant visa applications and the payment of the Immigration Health Surcharge in order to access NHS services (where applicable). The rights of access for EU citizens who need work or study in the UK for less than six months was still being decided. Global Health Insurance Cards have been implemented to cover both urgent and routine medical treatment. 10. In respect of reciprocal health care, the rights of access to health care for UK citizens who move to the EEA after the transition period is being decided independently by each member state and will differ substantially between them. ACTIONS 1.HSCP fully participates in the NLC and NHSL resilience arrangements. 2.HSCP workshops undertaken. 3. Business Continuity Plans revisited and updated for all services and sites. Report Prepared by Christine Jack on behalf of the Chief Officer Page 2 of 6
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 Previously IJB16. IJB08. 21 Financial Strategic 01/04/2021 Financial Implications of Responding to and Recovering from the Covid‐19 Pandemic There are a range of IJB risks associated with the response to and recovery from the Covid‐19 pandemic. Additional funding was received from the Scottish Government in 2020/2021 to meet the additional costs of the Covid‐19 pandemic. Further funding for 2021/2022 has been confirmed by the Scottish Government to meet the additional costs of responding to and recovering from the Covid‐19 pandemic. The IJB projected out turn 2021/2022 is not available to meet the 2021/2022 Covid‐19 costs. The projected underspend requires to be retained to implement the Business Case and to recover and redesign health and social care services. Insufficient reimbursement of funding from the Scottish Government would impact on the implementation of the Response, Recovery and Redesign Plans in 2022/23. The 2022/2023 Savings Plans may also not be achieved in part or in full due to key resources continuing to be diverted to respond to the Covid‐19 pandemic. This risk could lead to significant operational, financial, legal and/or reputational harm to the HSCP and also adversely impact on the Strategic Plan outcomes. VERY HIGH CONTROLS 1.Governance arrangements are in place in respect of the approval and monitoring of additional Covid‐19 costs and the recovery and redesign plans. 2 Delivery of savings will continue to be tracked and monitored. 3.The financial position is being monitored on an ongoing basis by SLT, IJB PFA and IJB. 4. The IJB Chief Officer and the Chief Financial Officer are actively engaging with the Scottish Government and other Networks and providing regular updates on the mobilisation and remobilisation plans and the associated costs. ACTIONS 1. All costs associated with responding to the Covid‐19 pandemic are being tracked and reported to the Scottish Government through the completion of the Remobilisation Plan Financial Returns. 2. A financial tracker on Covid‐19 related expenditure (as part of the Local Remobilisation Plan) is updated on a 4 weekly basis. Quarterly updates are submitted to the Scottish Government. 3. The IJB Reserves Strategy 2021/2022 has been discussed with the Scottish Government Officers. 4. The IJB Reserves Strategy 2021/2022 is being implemented. The IJB Reserves Strategy 2022/2023 is being developed. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.11.22 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.11.22 IJB09. 21 Financial Strategic 01/04/2021 Impact on the Strategic Plan Due to the Covid‐19 Pandemic 1. Social Care providers continue to be significantly impacted by the Covid‐19 pandemic. There are risks associated with the ongoing financial stability of providers during the Covid‐19 pandemic and some external providers may be unable to continue operating without ongoing financial and operational support. If providers are unable to safely staff services, there could be a risk of harm to service users and failure of the provider. 2. Providers are operating under unique and significantly detrimental conditions including continuity of service being disrupted due to the requirement to focus on priority services only, increased infection control measures and associated costs, increased staff absence and associated costs, reduced availability of back‐up staff and social distancing requirements. Premises may not be suitable to deliver services in these circumstances. 3. Increased reporting requirements to provide data to regulatory bodies are stretching limited resources. 4. Sufficient emergency/additional services to continue to respond to the Covid‐19 pandemic may not be available. Hospital admissions may not be avoided and discharges from hospital may be delayed. General Medical Services may not be sustainable. There are whole system capacity constraints across primary care services impacting on Acute Services. 5. Discharges from hospital may impact on care at home, residential care, nursing care and respite provision. 6. There is an increase in demand for a range of health and social care services as a result of the Covid‐19 pandemic. There is insufficient workforce capacity and there is a risk the Working Time Directive may be breached. There is insufficient equipment for key areas e.g. ventilators, pumps, etc. Personal Protective Equipment and supplies may be limited. The required service specification and standard may not be procured. There may be insufficient mobile IT devices. 7. There may be constraints in respect of the supply of vaccinations. 8. There are significant risks associated with the mutation of the Covid‐19 virus and the new variants. 9. There is an adverse impact on the progress of transformation service redesign opportunities including implementing agreed efficiency savings. 10. Prioritising the impact of the response to the Covid‐19 pandemic may divert limited resources away from key essential services which may lead to additional resource requirements and costs over the medium to longer term. 11. There may be a lack of HSCP management capacity and resilience to co‐ordinate the response to the pandemic. This may lead to an adverse impact on service delivery and financial overspends. 12. The risk status across NHS Lanarkshire has been moved to 'Black', the highest risk level. VERY HIGH CONTROLS 1. Scottish Government and COSLA guidance is being complied with. 2. NHS National Services Scotland are supporting primary care and social care services. PPE is available in line with Health Protection Scotland guidance. 3. Chief Medical Officer guidance as adopted by the four nations has been published, put into effect and endorsed by the Scottish Government/COSLA. Updates are also adopted. 4. Scottish Government are focusing on the care home sector to support continuity of service delivery. A national protocol to support discharge of Covid‐19 patients is in place. Care home liaison nurses are in place. 5. Remote working and flexible working arrangements are also in place. There is an increase in the number of agile workers and an increase in the number of laptops/tablets provided. A blended approach to home/work‐based working is being developed going forward. 6. Arrangements are in place across the partnership to review service user and carer prioritisation in terms of accessing service and support. Resources are targeted to those with critical or substantial needs. 7. Arrangements are in place to support carers in their caring role, working in partnership with voluntary organisations to provide early intervention and preventative supports. 8. Reliance is being placed on the Social Care Sustainability Payments by External Social Care Providers up to 30 June 2022. The HSCP continues to liaise and support providers to ensure there is early identification of problems and early intervention if necessary. 9. The Response, Recovery and Redesign Remobilisation Plan has been developed and is regularly updated. Response, Recovery and Redesign Plans are in place across the IJB and both partners. 10. Safe systems of working have been adopted. Regular cleaning regime is in place across all premises. All workplace appropriate social distance signage is in place. 11. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 12. The Scottish Government is taking appropriate action to mitigate the impact of the variants of the Covid‐19 virus as far as possible. ACTIONS 1. Emergency Command and Control structures have been established by each partner. Infection Prevention Control and Social Distancing requirements are being complied with. 2.Up‐to‐date information is disseminated to all staff across the HSCP as the situation develops and a consistent communication strategy is in place with employees across IJB, NHSL and NLC websites 3.IJB and partner business continuity plans are being regularly reviewed. 4.The HSCP is actively engaging with the third and independent sector in relation to service opportunities to meet the low/moderate needs of service users/patients and their associated costs. VERY HIGH M EDIUM Report Prepared by Christine Jack on behalf of the Chief Officer Page 3 of 6
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements Due To the Covid‐19 Pandemic 1. There is a risk that the intensity of the required response to Covid‐19 could result in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended Covid‐19 legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. ACTIONS 1. Staff health and well being is a key priority for both partners and all key stakeholders. The commitment to staff health and well being is being actively promoted through all available forums. M EDIUM LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.22 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 31.12.22 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g. Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff well‐ being programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation. 4. Staff being encouraged to submit proposals for use of targeted funding & some programmes already in place. HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 31.12.22 IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. The financial support for social care providers during the Covid‐19 pandemic is being reviewed. Payments in respect of under‐occupancy in care homes were extended to 30th June 2022. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. Staff and visitor testing in place. 4. All care homes advised to use PPE in line with national addendum. High medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 31.12.22 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid‐19 funding was confirmed on 25 February 2022. 6. The vaccination programme is continuing to be rolled out. 7. Having regard to the assessment of risk across NHS Lanarkshire as 'Black', action is being taken to mitigate the impact of the Covid‐19 pandemic over the winter period and COP26 in consultation with the Scottish Government. The position is being closely monitored. Report Prepared by Christine Jack on behalf of the Chief Officer Page 4 of 6
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Controls ‐ 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant national investment to fully implement new service model 4. Active review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 50% of gap by end of May 2022 6. Continuous review and validation of the waiting list Action 1. Incremental implementation of the new service model Very High medium Ross M cGuffie M orag Dendy IJB,PF&A, SLT 30.11.22 IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups High Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.22 SLT, IJB 31.12.22 SLT, IJB PFA, IJB 30.11.22 IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 23 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equpiment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand Very High M edium Ross M cGuffie Ross M cGuffie CONTROLS 1. NLC Silver command group stood up focused on cost of living 2. NHSL commenced review through CMT 3. Population Health Committee to review activity around cost of living ACTIONS 1. Survey of NLC hybrid workers to see if home working remains financially viable 2. Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3. 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost 4. Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of living supports that could be offered High M edium Ross M cGuffie Ross M cGuffie IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High Report Prepared by Christine Jack on behalf of the Chief Officer Page 5 of 6
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/06/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High CONTROLS 1. Working group established to coordinate all activity 2. Oversight through Home Support Programme Board 3. Reporting to Adult Social Work, Care and Wellbeing Committee 4. Reporting to IJB ACTIONS 1. NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas 2. NLC part of SG once for Scotland procurement process for a new digital alarm receiving centre 3. Communication out to all community alarm service users 4. Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational 5. Engagement with telecommunication suppliers to ensure sight of roll out plans across NL M edium Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 31.12.22 Report Prepared by Christine Jack on behalf of the Chief Officer Page 6 of 6
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1 REPORT Item No: 6 SUBJECT: Analogue to Digital Telecare Transition TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer. North HSCP Author(s) of Report Bobby McClung, Senior Officer Assistive Technology + Analogue to Digital Project Lead DATE: 16th November 2022 1. PURPOSE OF REPORT 1.1. This paper is coming to the IJB for: For approval For endorsement To note 1.2. This report provides an update on the analogue to digital telecare transition within North Lanarkshire Health and Social Care Partnership and for approval to move forward with the purchase of alarm devices to assist with the transition. 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: Prepared by the analogue to digital project team and reviewed and endorsed by senior management.
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2 3. RECOMMENDATIONS 3.1. The PFA committee is asked to: a) Note the progress of the project to date b) Note the risk of early telephone migration by telephone providers c) To approve the purchase of 5500 alarm devices to support the transition to digital telecare. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Background to Analogue to Digital Transition 5.1. Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout is scheduled to be completed by 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. 5.1.1 North Lanarkshire Council currently provides telecare services to around 6500 service users using dispersed analogue community alarms. North Lanarkshire also provides a telecare service to around 800 users within sheltered accommodation. Within this service there is a crucial response element to support service users in their own home. 5.1.2 The Digital Office for Local Government is currently supporting North Lanarkshire through the transition with subject experts and through a defined National support network. 5.1.3. A project board has been established within the organisation with membership from all areas with a direct or linked connection to the community alarm service alongside representatives from senior management, finance, joint equipment store, NHS and enterprise and communities. Alarm Receiving Centre 5.2. In 2021 North Lanarkshire’s community alarm service facilitated 485,016 analogue telephone calls into the service. 5.2.1. Tunstall Healthcare currently provides the software used within the community alarm receiving centre which is known as Tunstall PNC 8.1. This software currently processes call through analogue signals. Yes No N/A
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3 5.2.2. The requirement of a digital alarm receiving centre to allow for the transition has allowed North Lanarkshire to work with the Digital Office for Local Government to build a tender for a National Shared Digital Alarm Receiving Centre. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. The tender for this solution is due for release on November 11th, 2022, with an implementation scheduled to begin in Spring 2023. Dispersed Alarm Equipment 5.3. North Lanarkshire has prominently used Tunstall Lifeline Vi analogue alarm’s that are placed within a person’s home to allow them to contact the alarm receiving centre. There are still currently around 5500 of these alarms within the community. 5.3.1 North Lanarkshire currently supply Tunstall analogue and GSM alarms within the homes to allow users to contact our alarm receiving centre. 5.3.2. North Lanarkshire current community alarm supplier, Tunstall, has experienced significant difficulties for some time in being able to supply the required analogue or GSM based alarm devices for deployment to service users. 5.3.3 Given the lack of available alarm units from the Council’s incumbent supplier and the risk this presented to the wellbeing of service users, North Lanarkshire was able to procure 1000 analogue/digital hybrid alarms from Careium UK (Formerly known as Doro UK). These alarms do not work over a telephone line, however work through a provided SIM card that is inbuilt into the device. These alarms allowed North Lanarkshire to provide a working solution to those without a phone line or who’s phone line was migrated to a digital equivalent. There are currently 664 of these devices within the community. 5.3.4. Procurement has been engaged to look at the route North Lanarkshire requires to take to purchase the remaining 5500 alarm devices required for the digital transition. Telecare Peripherals 5.4. There are currently numerous telecare peripherals linked to the community alarm service within the community, such as linked smoke, heat and fire alarms, bed sensors, epilepsy sensors and door contacts. 5.4.1 Work is underway with procurement to ensure that North Lanarkshire and the new winning supplier of alarm devices can provide the same level of peripheral equipment to keep the people of North Lanarkshire safe. Key Issues 5.5. Telephone lines in the UK are being upgraded to digital technology at pace by the major telephone service providers including BT and Virgin Media. Currently North Lanarkshire is working alongside Virgin Media to identify telecare users within Airdrie, Coatbridge and Cumbernauld who will be affected by a mass migration of analogue services to a digital equivalent. North Lanarkshire is currently replacing analogue alarms at a rate of 20 per day which has depleted current level of stock that can be used within a home with a digital line.
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4 5.5.1. The national shared alarm receiving centre solution has currently been delayed from June 2022 until November 2022 due to issues with legal wording in the tender documentation. This has impacted on North Lanarkshire’s timescale to deliver a working solution as quickly as possible to assist with the telephone providers digital migrations. 5.5.2. Current equipment supplies chains have been heavily affected by shortages of microchips which has led to long delays for alarms, and this has been forecasted to remain an issue until late 2023/early 2024. 6. CONCLUSIONS 6.1. The analogue to digital transition requires to be completed by 2025 to ensure that North Lanarkshire can provide a working and reliable community alarm service. This will require the system used within the community alarm service to be a digital receiving software and for all equipment in the community to work through a digital means of signalling. 6.1.2 The analogue to digital transition in North Lanarkshire is still currently on track with work already underway in several key areas. Digital device roll out plan Data cleanse of current system Management and functionality of new alarm receiving centre at host provider (Digital Office for Local Government) 6.1.3. A business case around the analogue to digital telecare transition has been agreed and signed off at the Enterprise Architecture Govern Group and CORE. 6.1.4. 6.2. The vision had been that the in-home equipment would be procured once a decision had been made on the Alarm Receiving Centre, ensuring a high level of compatibility between the two. It is recognised that service users continue to be moved by their telecom provider to their digital offering, often at pace, without communication. The analogue to digital project team therefore recommend that the organisation looks to move forward with a direct award purchase of 5500 alarm devices that will be able to support the organisations digital telecare transition. 7. IMPLICATIONS 7. NATIONAL OUTCOMES 7.1. The analogue to digital transition is supported through the National Digital Health and Care strategy.
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5 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Finance have not reviewed this current paper; however, finance have been consulted throughout the life of the project and are currently members of the analogue to digital board. Yes No N/A 7.3.1. The analogue to digital transition currently has capital funding of £2 million to support with the replacement of the alarm receiving centre, dispersed community alarms and peripherals associated with the community alarms. 7.3.2. There will be a revenue cost to the organisation for the subscription to the national shared alarm receiving centre. 7.3.3 There will be a revenue cost associated with the SIM cards placed within the analogue/digital hybrid and then fully digital devices. 7.3.2. Indicative costs for the transition have been scoped alongside the Digital Office for Scotland and are noted below: Costs: Cost Element Capital Revenue 3 Year Cost Notes Telecare solution setup and recurring contract costs: £10,000 (First year) £35,000 per year Disaster Recovery - £0 £ 105,000 Disaster Recovery - £0 Indicative costs supplied by the Digital Office New in-home digital alarm equipment: £1,193,500 (alarms only, no peripherals) £264,000 per annum if not within bundle (costed at £4 per month per sim) £48,000 for current digital alarms that are within the community £2,129,500+ (Cost of devices over first year and then sim charge over 3 years) £264,000 sim card cost is for the further 5500 alarms that we will require to buy for this. £48,000 will be required additionally to manage the current 1000 digital alarms we have within the organisation. Total £1,203,500 £ 347,000 £ 2,234,500 7.3.3 As of the finance cost above the ask would be to allow 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1. All risks around the analogue to digital transition are managed by the analogue to digital project board.
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6 7.4.2. The analogue to digital transition is also on the organisational risk register with updates on a 6 monthly basis. 7.4.3. If the organisation is unable to obtain a supply of analogue/digital hybrid alarms, we run the risk of being unable to provide a high risk service. 7.5 PEOPLE 7.5.1. The communities of North Lanarkshire will continue to be informed of the analogue to digital telecare transition and users of the service will be contacted directly to allow the instillation of new equipment. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS Scotland Digital Health and Care Strategy - Digital health and care strategy - gov.scot (www.gov.scot) Digital Office National Telecare Briefing Document - Digital Telecare Playbook · LAUNCH OF THE NATIONAL BRIEFING DOCUMENT (digitaloffice.scot) 9. APPENDICES None. ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following. Bobby McClung – McClungR@northlan.gov.uk
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REPORT Item No: 7 SUBJECT: New General Medical Services 2018/ Primary Care Improvement Plan (PCIP) Update TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Lucy Munro, Medical Director Author(s) of Report Linda Findlay, Medical Director, South Lanarkshire HSCP DATE: 16th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: update members on the progress of Primary Care Improvement Plan implementation For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared and approved by the South Lanarkshire IJB. This paper has been: Prepared Reviewed Endorsed 3. RECOMMENDATIONS The Integration Joint Board is asked to approve the following recommendation(s): - 1) That the report and progress is noted; and 2) That the proposed revitalised reporting regime be approved. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The purpose of general practice is to provide continuing, comprehensive, coordinated and person-centred health care to patients in their communities. Since the inception of the NHS, general practice has developed as an independent contractor model. Most general practices are run as independent businesses and provide services for NHS boards. On behalf of IJBs, NHS boards specify what healthcare services they need and then fund the GPs to do this work through an arrangement called the General Medical Services (GMS) contract. Yes No N/A
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5.2 The 2018 GMS Contract was developed by the Scottish General Practitioners Committee (SGPC) of the British Medical Committee (BMA) and the Scottish Government. The 2018 GMS Contract recognised the reality of projected general practitioner numbers; and the value of a greater emphasis on care being provided by multi-disciplinary teams. A Memorandum of Understanding (MOU) between the Scottish Government, the BMA, IJBs and NHS Boards for the 2018 GMS contract was agreed in April 2018. This MOU set out the principles by which primary care redesign would be delivered. 5.3 As a result of the 2018 Contract, all IJBs and Health Boards developed locally- agreed Primary Care Improvement Plans (PCIPs). PCIPs were designed to support the delivery of the national GMS contract aim of refocusing the role of GPs as expert medical generalists, working with a wider team to provide more healthcare in the community. 5.4 The initial Lanarkshire PCIP was agreed by NHS Lanarkshire, North and South Lanarkshire IJBs and the NHS Lanarkshire GP Sub-Committee by the end of July 2018. South Lanarkshire Health and Social Care Partnership (HSCP) oversees the implementation of the PCIP as part of its hosting arrangements. It was initially agreed that PCIP progress would be formally reported on locally at six monthly intervals, national reporting was annually. However, with the demands of the Covid- 19 pandemic, it was accepted that both the delivery of PCIPs would inevitably be disrupted and delayed; and that reporting periods would be elongated. With the move of the NHS into a remobilisation phase, this report is being brought forward to revitalise more regularised and proportionate reporting. 5.5 A revised MoU for the period 2021-2023 was published by Scottish Government in July 2021. This MOU 2 reaffirmed the direction of travel, revised delivery time scales and brought in Transitionary Arrangements (payments) where Health Boards failed to deliver the contract within the revised timescales. The focus of the MoU 2 remains the delivery of the transfer of provision of service from general practice to HSCPs and Health Boards, with a focus on the following three services for 2021-22: Vaccine Transformation Programme (VTP) Community Treatment and Care (CTAC) Pharmacotherapy 6. PCIP Progress Pre-Pandemic 6.1 Pre-pandemic Lanarkshire’s position was a strong one. This was achieved by a programme underpinned by a clear governance structure; that utilised project management and quality improvement, with an evaluation framework in place from the commencement; and a dedicated improvement and general management resource. 6.2 Progress During the Pandemic Whilst the first wave of the pandemic saw the standing down of the PCIP, the structure that was in place allowed for the stepping back up in May 2021 (as resources allowed) enabling the reviewing and revision of project plans. The resulting planning and preparatory work undertaken enabled continued progress to be made on delivery as soon as system pressures allowed.
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6.3 Progress on the three Prioritised Areas 6.3.1 Vaccination Transformation Programme (VTP) - was fully achieved and service provision transferred over (April 2022). 6.3.2 Community Treatment and Care (CTAC) – all aspects of agreed Treatment Room Services were implemented, albeit operating at the levels effected by Covid. There has been progress with the initiation of a test of change for Chronic Disease Monitoring (CDM) put in place from May 2022 to date (as at 22 August 2022) with discussions underway to progress a Lanarkshire-wide roll out programme between September 2022 and March 2023. A learning report from the test of change is being prepared to enable and inform systems and processes that are required for the successful transfer of CDM from April 2023. 6.3.3 Pharmacotherapy – there has been steady progress of the Lanarkshire model, which (as with the national picture) has been adversely affected by available funding and workforce. The model allows 1 whole time equivalent (WTE) Pharmacist per 15,000 patient list size (some larger practices also benefit from technician resource), plus the development of a Pharmacotherapy HUB model. The latter utilises a staffing mix of Technicians and Pharmacy Support Workers to support with the delivery of a Level One Pharmacotherapy Service. A project plan is in place for the continuation of the implementation of this model in 2022-23, and this will be informed and revised by a Pharmacotherapy Quality Improvement Group. This group was established following an audit during 2022 that determined current levels of delivery, and has the remit to develop optimised process. 6.4 PCIP Reporting Status A RAG report is maintained against the three priority workstreams. The position as of 22 August 2022 is detailed in Appendix 1. 6.5 Progress on Other Areas Additional Professional Services: 6.5.1 The GP Community Link Worker programme is now fully implemented across Lanarkshire. Every practice has access to both generic and financial and welfare link workers. 6.5.2 The redesign of the Challenging Patients Service - now the Challenging Behaviour Service (CBS) - has seen a more sustainable model developed and become operational. This Service provides General Medical Services to patients who for a variety of reasons cannot have services delivered in mainstream general practice. 6.5.3 A small cohort of Advance Practice Physiotherapists (APPs) is in place, with learning being captured to inform future model should funding allow. 6.5.4 The growth and development of our Advance Practice Nurse (APN) workforce, testing relating to the urgent care model are being undertaken. 6.6 Urgent Care (delivery due 2023/24): 6.6.1 The Urgent Care in Hours Workstream was stepped back up in February 2022 with an initial remit of reviewing the appropriateness of the agreed pre-pandemic model: i.e. to recruit, train and deploy an ANP team to deliver on patients’ requests for urgent GP home visiting.
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6.6.2 The pandemic saw the redeployment of ANPs to support the Covid Assessment Service; and then on stepping this down, redeployment of those staff to practices in two geographic areas - Cumbernauld and East Kilbride. This redeployment gave the opportunity for a Test of Change in respect of ANP delivery across a number of practices. 6.6.3 In March 2022 the Workstream group commissioned a number of pieces of work to review the context of urgent care delivery and inform the GMS Oversight Executive Group regarding a future plan for sustainable GP Urgent Care-in-Hours delivery. The findings of this significant scoping exercise was as follows: Delivery definition remains “Initial Clinical Assessment and the Primary Care Management of unscheduled medical, surgical and mental health urgent issues ' The biggest challenge to service delivery is public behaviour, confusion and perception as to where to present in an increasingly complex and disconnected array of choices with “go to your GP” often perceived as the default Current PCIP ANPs and general practice staff are spread too thinly to deliver or collaborate effectively on changes to service delivery. There is no anticipated immediate solution to this workforce challenge and there is an acknowledgement that this is likely to persist into the next three-to-five-year planning period Requests for GP input to patients recently discharged from hospital and those with multiple complexity have increased exponentially largely as a result of changes in systems external to GP practices themselves. Co-location, adequate workspace and IT are essential to be in place prior to service go live to reduce journey times and inefficiencies 6.6.4 The following recommendations are now being linked with the wider urgent care redesign and will be progressed to realise delivery by the revised MoU date of 2023- 24: Consolidation of the current, available GMS urgent care provision. Criteria for this is to be clarified but must include sufficient space, infrastructure, and appropriate IT for the service to deliver its roles Progressing an exit strategy from the current model; and, based on review of evidence and outcomes of commissioned work to-date, that a revised Urgent Care in-Hours Service is progressed That the service should not be solely dependent on the PCIP ANP workforce but is seen as a whole system model with dedicated input from the wider Partnerships and NHSL secondary care (including the Flow Navigation Centre), administrative and quality improvement support plus protected professional leadership. This would be required to ensure the project achieves its aims of reducing GP workload to allow them to more safely provide existing service against a background of ever-increasing demand The development of services should be underpinned by quality improvement and co- produced, which will ensure engagement with GPs and all partners (including patients) to allow them to influence development That it is recognised that significant public and system engagement is required to challenge unrealistic expectations of ‘go see your GP’, as such that any changes will be accompanied by a communications plan which includes key messages to help the public understand the most appropriate healthcare service for them to attend. Key messages are already being shared with stakeholders to maximise the audience reached.
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6.7 Evaluation The PCIP in Lanarkshire is an ambitious transformational programme. Evidence is needed to demonstrate how effectively the agreed outcomes are being achieved. As previously agreed, a contribution analysis approach to this evaluation as recommended in the National Monitoring and Evaluation Strategy is being applied. The national outcome frameworks - for people using Primary Care, the workforce, and the system as a whole - will be used to collate evidence of their achievement. 6.8 Communication and Engagement A Communication and Engagement Strategy is in place for PCIP, specifically to focus on ensuring that there are: Engaged and knowledgeable GPs and general practice teams Engaged and knowledgeable wider health and social care system Engaged and knowledgeable public 6.9 Conclusion 6.9.1 While it is evident that progress continues to be made - with plans in place, including where necessary mitigation in response to challenges - there remains clear risks to the overall delivery of the PCIP. The unprecedented scale of change resulting from managing the response to the pandemic has created new opportunities and challenges in delivering on-going reform of Primary Care and the PCIP. As such, across the PCIP, consistent review and appropriate revision is being made along with mitigation specifically focused on addressing these areas. 6.9.2 Given this, a twice-yearly reporting regime is proposed with an annual overview presented to the IJB in the autumn (to correspond with annual reporting submissions to Scottish Government) and an interim report presented to the Performance and Audit Sub-Committee in-year. These reports will also be shared with the Population Health & Primary Care and Community Care Governance Sub-Committee of the NHS Lanarkshire Board. 7.1 NATIONAL OUTCOMES The PCIP workstream impact on all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) The activity described within this report contributes to mitigation of a number of identified risks within the NHS Lanarkshire risk register, notably ability to maintain existing GMS across NHS Lanarkshire. There are emerging risks associated with the overall Plan as well as individual workstreams. Each PCIP work stream has an individual Risk Register which feed to an overarching risk register for the programme, the highest rated risks remain around workforce, funding and infrastructure. An agreed project plan underpins the ongoing delivery of the PCIP and the mitigation of these risks. 7.3 CLIMATE CHANGE, SUSTAINABILITY AND ENVIRONMENTAL IMPLICATIONS Where clinically appropriate tele-health is being used across models. Where resource allows, there is a mix of CTAC delivery across treatment rooms; and a peripatetic approach to reduce patient travel.
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7.4 FINANCIAL Financially, implementation of the PCIP is complex. It requires a balance in expenditure between different workstreams, recycling of existing expenditure and efficiency of “back office” functions. Despite review and skill mixing the PCIP is not fully deliverable within the financial envelope indicated and this has been highlighted to Scottish Government. This paper has been reviewed by Finance: Yes No N/A 7.5 RISK ASSESSMENT/RISK MANAGEMENT GP sustainability sits on the IJB and NHSL Risk Registers. 7.6 PEOPLE This report contributes to the performance measurement approach committed within the current IJB Strategic Commissioning Plan. The areas of performance described within this report contribute to the delivery of a number of strategic priorities within the current IJB Strategic Commissioning Plan, notably: Sustaining statutory social care and core health care functions Improving unscheduled care and increasing intermediate care The intention of the GMS contract, the MoU and the local PCIP taken together is to allow clinicians to work at a high level in expanded and integrated teams. This will have implications for many employees over the coming years and should be broadly welcomed by all involved. There are implications for those in changing roles, the development of new roles and the need to explore Transfer of Undertakings (Protection of Employment) (TUPE) for a number of, but not all staff currently employed by GPs. For example, the contract is explicit about the development of Practice Nursing and Practice Manager roles, both of which will remain practice employees. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A There is no requirement to carry out an Equality Impact Assessment in terms of the proposals contained within this report. However, consultation will continue to be extensive. The EQIA for the programme is being refreshed. 7.7.1 Consultation and engagement across a wide range of stakeholders is pivotal to the successful implementation of the PCIP. 8. BACKGROUND PAPERS List of Background Papers Audit Scotland (2019) General Medical Services contract in Scotland: A short guide https://www.audit- scotland.gov.uk/uploads/docs/report/2019/briefing_190516_general_medical_services. pdf
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The national GMS Memorandum of Understanding 2: https://www.sehd.scot.nhs.uk/publications/Memorandum_of_Understanding%202- GMS_Contract_Implementation_for_PC_Improvement%2030_July_2021.pdf 9. APPENDICES Appendix 1 South Lanarkshire IJB Report Appendix 2 RAG Status Appendix 3 GMS Oversight Exec CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Lucy Munro on telephone number 01698 752 751 Lucy.munro@lanarkshire.scot.nhs.net
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Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 20 September 2022 Report by: Director, Health and Social Care Subject: Primary Care Improvement Plan - Update 1. Purpose of Report 1.1. The purpose of the report is to: - [purpose] update members on the progress of Primary Care Improvement Plan implementation [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the report and progress is noted; and (2) that the proposed revitalised reporting regime be approved. [1recs] 3. Background 3.1. The purpose of general practice is to provide continuing, comprehensive, coordinated and person-centred health care to patients in their communities. Since the inception of the NHS, general practice has developed as an independent contractor model. Most general practices are run as independent businesses and provide services for NHS boards. On behalf of IJBs, NHS boards specify what healthcare services they need and then fund the GPs to do this work through an arrangement called the General Medical Services (GMS) contract. 3.2 The 2018 GMS Contract was developed by the Scottish General Practitioners Committee (SGPC) of the British Medical Committee (BMA) and the Scottish Government. The 2018 GMS Contract recognised the reality of projected general practitioner numbers; and the value of a greater emphasis on care being provided by multi-disciplinary teams. A Memorandum of Understanding (MOU) between the Scottish Government, the BMA, IJBs and NHS Boards for the 2018 GMS contract was agreed in April 2018. This MOU set out the principles by which primary care redesign would be delivered. 3.3 As a result of the 2018 Contract, all IJBs and Health Boards developed locally- agreed Primary Care Improvement Plans (PCIPs). PCIPs were designed to support the delivery of the national GMS contract aim of refocusing the role of GPs as expert medical generalists, working with a wider team to provide more healthcare in the community. Appendix 1
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3.4 The initial Lanarkshire PCIP was agreed by NHS Lanarkshire, North and South Lanarkshire IJBs and the NHS Lanarkshire GP Sub-Committee by the end of July 2018. South Lanarkshire Health and Social Care Partnership (HSCP) oversees the implementation of the PCIP as part of its hosting arrangements. It was initially agreed that PCIP progress would be formally reported on locally at six monthly intervals, national reporting was annually. However, with the demands of the Covid- 19 pandemic, it was accepted that both the delivery of PCIPs would inevitably be disrupted and delayed; and that reporting periods would be elongated. With the move of the NHS into a remobilisation phase, this report is being brought forward to revitalise more regularised and proportionate reporting. 3.5 A revised MoU for the period 2021-2023 was published by Scottish Government in July 2021. This MOU 2 reaffirmed the direction of travel, revised delivery time scales and brought in Transitionary Arrangements (payments) where Health Boards failed to deliver the contract within the revised timescales. The focus of the MoU 2 remains the delivery of the transfer of provision of service from general practice to HSCPs and Health Boards, with a focus on the following three services for 2021-22: Vaccine Transformation Programme (VTP) Community Treatment and Care (CTAC) Pharmacotherapy 4. PCIP Progress Pre-Pandemic 4.1 Pre-pandemic Lanarkshire’s position was a strong one. This was achieved by a programme underpinned by a clear governance structure; that utilised project management and quality improvement, with an evaluation framework in place from the commencement; and a dedicated improvement and general management resource. Progress During the Pandemic 4.2 Whilst the first wave of the pandemic saw the standing down of the PCIP, the structure that was in place allowed for the stepping back up in May 2021 (as resources allowed) enabling the reviewing and revision of project plans. The resulting planning and preparatory work undertaken enabled continued progress to be made on delivery as soon as system pressures allowed. Progress on the three Prioritised Areas 6.9 VTP - was fully achieved and service provision transferred over (April 2022). 6.10 CTAC – all aspects of agreed Treatment Room Services were implemented, albeit operating at the levels effected by Covid. There has been progress with the initiation of a test of change for Chronic Disease Monitoring (CDM) put in place from May 2022 to date (as at 22 August 2022) with discussions underway to progress a Lanarkshire-wide roll out programme between September 2022 and March 2023. A learning report from the test of change is being prepared to enable and inform systems and processes that are required for the successful transfer of CDM from April 2023.
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6.11 Pharmacotherapy – there has been steady progress of the Lanarkshire model, which (as with the national picture) has been adversely affected by available funding and workforce. The model allows 1 whole time equivalent (WTE) Pharmacist per 15,000 patient list size (some larger practices also benefit from technician resource), plus the development of a Pharmacotherapy HUB model. The latter utilises a staffing mix of Technicians and Pharmacy Support Workers to support with the delivery of a Level One Pharmacotherapy Service. A project plan is in place for the continuation of the implementation of this model in 2022-23, and this will be informed and revised by a Pharmacotherapy Quality Improvement Group. This group was established following an audit during 2022 that determined current levels of delivery, and has the remit to develop optimised process. PCIP Reporting Status 6.12 A RAG report is maintained against the three priority workstreams. The position as of 22 August 2022 is detailed in Appendix 1. Progress on Other Areas 6.13 Additional Professional Services: 6.13.1 The GP Community Link Worker programme is now fully implemented across Lanarkshire. Every practice has access to both generic and financial and welfare link workers. 6.13.2 The redesign of the Challenging Patients Service - now the Challenging Behaviour Service (CBS) - has seen a more sustainable model developed and become operational. This Service provides General Medical Services to patients who for a variety of reasons cannot have services delivered in mainstream general practice. 6.13.3 A small cohort of Advance Practice Physiotherapists (APPs) is in place, with learning being captured to inform future model should funding allow. 6.13.4 The growth and development of our Advance Practice Nurse (APN) workforce, testing relating to the urgent care model are being undertaken. 6.14 Urgent Care (delivery due 2023/24): 6.14.1 The Urgent Care in Hours Workstream was stepped back up in February 2022 with an initial remit of reviewing the appropriateness of the agreed pre-pandemic model: i.e. to recruit, train and deploy an ANP team to deliver on patients’ requests for urgent GP home visiting. 6.14.2 The pandemic saw the redeployment of ANPs to support the Covid Assessment Service; and then on stepping this down, redeployment of those staff to practices in two geographic areas - Cumbernauld and East Kilbride. This redeployment gave the opportunity for a Test of Change in respect of ANP delivery across a number of practices. 6.14.3 In March 2022 the Workstream group commissioned a number of pieces of work to review the context of urgent care delivery and inform the GMS Oversight Executive Group regarding a future plan for sustainable GP Urgent Care-in-Hours delivery. The findings of this significant scoping exercise was as follows:
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Delivery definition remains “Initial Clinical Assessment and the Primary Care Management of unscheduled medical, surgical and mental health urgent issues ' The biggest challenge to service delivery is public behaviour, confusion and perception as to where to present in an increasingly complex and disconnected array of choices with “go to your GP” often perceived as the default Current PCIP ANPs and general practice staff are spread too thinly to deliver or collaborate effectively on changes to service delivery. There is no anticipated immediate solution to this workforce challenge and there is an acknowledgement that this is likely to persist into the next three-to-five-year planning period Requests for GP input to patients recently discharged from hospital and those with multiple complexity have increased exponentially largely as a result of changes in systems external to GP practices themselves. Co-location, adequate workspace and IT are essential to be in place prior to service go live to reduce journey times and inefficiencies 6.14.4 The following recommendations are now being linked with the wider urgent care redesign and will be progressed to realise delivery by the revised MoU date of 2023- 24: Consolidation of the current, available GMS urgent care provision. Criteria for this is to be clarified but must include sufficient space, infrastructure, and appropriate IT for the service to deliver its roles Progressing an exit strategy from the current model; and, based on review of evidence and outcomes of commissioned work to-date, that a revised Urgent Care in-Hours Service is progressed That the service should not be solely dependent on the PCIP ANP workforce but is seen as a whole system model with dedicated input from the wider Partnerships and NHSL secondary care (including the Flow Navigation Centre), administrative and quality improvement support plus protected professional leadership. This would be required to ensure the project achieves its aims of reducing GP workload to allow them to more safely provide existing service against a background of ever-increasing demand The development of services should be underpinned by quality improvement and co- produced, which will ensure engagement with GPs and all partners (including patients) to allow them to influence development That it is recognised that significant public and system engagement is required to challenge unrealistic expectations of ‘go see your GP’, as such that any changes will be accompanied by a communications plan which includes key messages to help the public understand the most appropriate healthcare service for them to attend. Key messages are already being shared with stakeholders to maximise the audience reached. Evaluation 4.9 The PCIP in Lanarkshire is an ambitious transformational programme. Evidence is needed to demonstrate how effectively the agreed outcomes are being achieved. As previously agreed, a contribution analysis approach to this evaluation as recommended in the National Monitoring and Evaluation Strategy is being applied. The national outcome frameworks - for people using Primary Care, the workforce, and the system as a whole - will be used to collate evidence of their achievement.
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Communication and Engagement 4.10 A Communication and Engagement Strategy is in place for PCIP, specifically to focus on ensuring that there are: Engaged and knowledgeable GPs and general practice teams Engaged and knowledgeable wider health and social care system Engaged and knowledgeable public Conclusion 4.11 While it is evident that progress continues to be made - with plans in place, including where necessary mitigation in response to challenges - there remains clear risks to the overall delivery of the PCIP. The unprecedented scale of change resulting from managing the response to the pandemic has created new opportunities and challenges in delivering on-going reform of Primary Care and the PCIP. As such, across the PCIP, consistent review and appropriate revision is being made along with mitigation specifically focused on addressing these areas. 4.12 Given this, a twice-yearly reporting regime is proposed with an annual overview presented to the IJB in the autumn (to correspond with annual reporting submissions to Scottish Government) and an interim report presented to the Performance and Audit Sub-Committee in-year. These reports will also be shared with the Population Health & Primary Care and Community Care Governance Sub-Committee of the NHS Lanarkshire Board. 5. Employee Implications 5.1. The intention of the GMS contract, the MoU and the local PCIP taken together is to allow clinicians to work at a high level in expanded and integrated teams. This will have implications for many employees over the coming years and should be broadly welcomed by all involved. There are implications for those in changing roles, the development of new roles and the need to explore Transfer of Undertakings (Protection of Employment) (TUPE) for a number of, but not all staff currently employed by GPs. For example, the contract is explicit about the development of Practice Nursing and Practice Manager roles, both of which will remain practice employees. 6. Financial Implications 6.1. Financially, implementation of the PCIP is complex. It requires a balance in expenditure between different workstreams, recycling of existing expenditure and efficiency of “back office” functions. Despite review and skill mixing the PCIP is not fully deliverable within the financial envelope indicated and this has been highlighted to Scottish Government. 7. Climate Change, Sustainability and Environmental Implications 7.1. Where clinically appropriate tele-health is being used across models. Where resource allows, there is a mix of CTAC delivery across treatment rooms; and a peripatetic approach to reduce patient travel. 8. Other Implications 8.1. This report contributes to the performance measurement approach committed within the IJB Strategic Commissioning Plan 2022-25. The areas of performance described within this report contribute to the delivery of a number of strategic priorities within the IJB Strategic Commissioning Plan 2022-25, notably:
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Sustaining statutory social care and core health care functions Improving unscheduled care and increasing intermediate care 8.2 The activity described within this report contributes to mitigation of a number of identified risks within the NHS Lanarkshire risk register, notably ability to maintain existing GMS across NHS Lanarkshire. 8.3 There are emerging risks associated with the overall Plan as well as individual workstreams. Each PCIP work stream has an individual Risk Register which feed to an overarching risk register for the programme, the highest rated risks remain around workforce, funding and infrastructure. An agreed project plan underpins the ongoing delivery of the PCIP and the mitigation of these risks. 9. Equality Impact Assessment and Consultation Arrangements 9.1. There is no requirement to carry out an Equality Impact Assessment in terms of the proposals contained within this report. However, consultation will continue to be extensive. The EQIA for the programme is being refreshed. 9.2. Consultation and engagement across a wide range of stakeholders is pivotal to the successful implementation of the PCIP. 10. Directions 10.1. Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire Soumen Sengupta Director, Health and Social Care Date created: 1 September 2022 Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities
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People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing People who use Health and Social Care Services are safe from harm People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services Previous References none List of Background Papers Appendix 1 – Lanarkshire PCIP RAG status Audit Scotland (2019) General Medical Services contract in Scotland: A short guide https://www.audit- scotland.gov.uk/uploads/docs/report/2019/briefing_190516_general_medical_services. pdf The national GMS Memorandum of Understanding 2: https://www.sehd.scot.nhs.uk/publications/Memorandum_of_Understanding%202- GMS_Contract_Implementation_for_PC_Improvement%2030_July_2021.pdf Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Name: Linda Findlay, Medical Director Phone: 01698 453844 Email: Linda.Findlay@lanarkshire.scot.nhs.uk
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Appendix 2 Lanarkshire Primary Care Improvement Plan: RAG Reporting Status (March 2022) Service Lanarkshire Service Progress RAG Vaccine Transformation Programme (VTP) Pre-school programme NHS Lanarkshire had an established pre-school programme, pre 2018, delivered by managed services (health visiting). G School based programme Stat NHS Lanarkshire had an established school based programme, pre 2018, delivered by managed services (school immunisation team). A process for out of schedule has been confirmed. G Travel vaccination and travel health advice NHS Lanarkshire has procured a service provision via Community Pharmacy Lanarkshire. Since April 2022, there are 7 community pharmacists now offering a travel health vaccination and advise service to residents of and registered patients with a GP across Lanarkshire. There is continued engagement with additional community pharmacies to be contracted in across NHS Lanarkshire to offer this service. G Mass Vaccination Programme (MVP) The delivery of public (children and adults) and staff influenza vaccination programme in tandem with covid19 booster is now in place. Pneumococcal, and Shingles vaccinations are being progressed for delivery via the respective vaccination centres set up to deliver covid and influenza vaccines. Pneumococcal vaccine offer will be completed August 2022. Following this, there will be a pilot for people aged 79 and over whose eligibility is about to expire. People will receive a letter with details of their appointment and alternative arrangements if it is not suitable. Learning from this pilot will inform a wider roll-out of the shingles vaccine in early 2023, after the covid-19 booster and flu vaccination programmes have completed. The wider roll-out will include all other eligible people and those who have not had an opportunity to receive the shingles vaccine due to covid. There are a number of adhoc vaccinations which require to be delivered, mostly coming from secondary care (for example, patients who need further vaccination after a bone marrow transplant, or patients requiring pneumococcal vaccine outside of usual scheduled vaccinations due to commencing immunosuppressant’s). Referrals are being received and a process has been developed for these patients to receive their vaccination G
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in Ravenscraig vaccination centre. Once processes are mature, it would be intended to deliver this across all vaccination centres. Feedback was received from some GP practices that they were receiving requests from non-Lanarkshire secondary care departments for Lanarkshire residents. Discussions have taken place with colleagues in other WoS boards and an agreement reached to ensure information on all WoS referral pathways disseminated to relevant departments. Further contact between the Vaccination Service and specific departments (specifically haemato-oncology) has taken place. Community Treatment and Care (CTAC) NHS Lanarkshire benefited from an established Treatment Room Services (TRS) provision across all Localities, PCIP has invested additional resource to enhance board wide TRS to enable transfer of • Phlebotomy, • The management of minor injuries and dressings, • Ear syringing, and • Suture removal. There is a need to be cognisant that plans are being progressed in line with current Treatment Room Services provision which is affected by covid pandemic. There is an allocation of 49WTE Band 5 community nurses to support CTAC. In order to achieve the locality allocation levels, recruitment has been completed from Band 5 nursing staff previously deployed to the Mass Vaccination Programme returning, newly qualified nurses and external recruitment programmes underway in respective localities. G Chronic disease monitoring • Basic disease data collection and biometrics (such as blood pressure) A test of change is currently underway within the Hamilton Locality with 4 volunteer general practices involved currently to gather data and learning of the proposed CDM model to inform a future model for Board wide implementation by March 2023 using the Vision Anywhere system. There is the intention to recruit additional GP practices within this locality to further support the gathering of required intelligence. There has been positive feedback from staff, patients and general practice teams on the test of change to date. A Pharmacotherapy A clear model has been approved which will utilise a skill mix of Pharmacists, Pharmacy Technicians and Pharmacy Support Workers to provide a pharmacotherapy service delivered via practice based staff (1wte per 15,000 patients) and locality hubs. This model has been identified as the optimum delivery approach, within the available funding allocation, to progress towards achievement of what is outlined in the GMS contract as a full pharmacotherapy service. The contract offer details three levels of pharmacotherapy service and while there is an emphasis on implementing the level one element there are interdependencies between all three levels that require focus on the R
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delivery of the service as a whole, currently all practices receive a partial service. The quality improvement workgroup has been established and is progress recommendations identified in the June 2021 regarding variation and opportunities to ensure optimum service delivery. There are challenges relating to accommodation for hubs, with currently 5 Localities not having identified accommodation, this has been escalated via Board and HSCP structures.
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1 Oversight Executive Group ToR v0.1 Terms of Reference 1. Title NHS Lanarkshire GMS2018 Oversight Executive Group 2. Reporting and Accountability The group reports to and is accountable to The Primary Care Strategy Board 3. Purpose The objective of this work stream is to oversee and decide on matters relating to all the work streams for GMS2018 which require more senior agreement to progress in line with the mandate of the General Medical Services (GMS) 2018 contract. Decisions may be taken by the group or remitted to the Primary Care Strategy Board (PCSB). 4. Key Responsibilities and Objectives The roles and responsibilities of the NHS Lanarkshire GMS2018 Oversight Executive Group are as described below: Write and ensure adherence to the overarching Primary Care Improvement Plan (PCIP); Provide subject matter expertise plus links to other groups; Facilitate resolution of any disagreement or disputes between work stream leads and its members; Approve documentation and processes as appropriate to reflect the work stream plans; Provide advice and approve key decisions as required; Manage any project interdependencies and identify and recognise synergies with work ongoing at both a local and national level, including but not limited to, other GMS2018 work streams; Manage any risks and issues in relation to the implementation of GMS2018 services; Inform the risk register maintained by the Primary Care Improvement Team; Ensure members take responsibility for, and lead where appropriate on, relevant activities and report on progress to the group; Ensure members consult more broadly within their organisation / professional group on areas of particular interest to the group, and therefore create a feedback process. Appendix 3
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2 Oversight Executive Group ToR v0.1 5. Membership Organisation/Division Responsibilities Medical Director, South HSCP Chair of the GMS Oversight Executive Group Provide link to Urgent Care (in hours) Group Provide links and advice in regards to Lanarkshire Health & Social Care Partnerships Medical subject matter expert Medical Director, North HSCP Provide links and advice in regards to Lanarkshire Health & Social Care Partnerships Link to Community Treatment & Care Modelling & Planning Group Associate Medical Director, South HSCP Provide links and advice in regards to Lanarkshire Health & Social Care Partnerships Associate Medical Director, North HSCP Provide links and advice in regards to Lanarkshire Health & Social Care Partnerships Director of Nursing, North/South HSCP Provides nursing expertise and links to senior nursing management in NHSL & HSCPs 2x GP Sub Committee representatives Represent the interests of primary care doctors Provide communication & engagement links to Lanarkshire GP Sub committee Head of Health, South HSCP Provides operational links to South HSCP Head of Health, North HSCP Provides operational links to North HSCP Head of Commissioning & Planning, South HSPC/Interim Head of Commissioning & Planning, North HSCP Provide strategic commissioning and planning links to HSCPs Deputy Director of Finance Provides financial expertise Monitors PCIP finances Provides links to national finance groups Primary Care Services Manager Provides links to General Practices in Lanarkshire Service Manager, Primary Care Improvement Plan (PCIP) Provides links to PCIP work stream operational issues Senior Improvement Manager, Primary Care Improvement Team Provides improvement methodology expertise and links to the PCIP Support Team Project Support Officer, PCIP Schedules meetings Produces action & decision log
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3 Oversight Executive Group ToR v0.1 The Group shall have the right to invite representatives and expertise to any of its meetings when deemed appropriate. 6. Conduct of Business (Frequency, reporting, Quorum, Chair/deputy, agenda, minutes, actions, ToR review) Chair: The Medical Directors shall act as Co‐Chairs with a GP Sub representative as Vice Chair with the authority to nominate a deputy in their absence. Decision Making: The three‐year action plans for all work streams will be developed with the project leads and subject matter experts. Following an iterative development process, these will be collated into the Primary Care Improvement Plan (PCIP). Changes to the PCIP will be through the GMS Oversight Executive Group and identified lead author. Any such change shall only become operative after approval of the Chair of the Group in consultation with the Primary Care Strategy Board (PCSB). The GMS Oversight Executive Group will take decisions as often as possible within the Group to ensure progress of work streams in accordance with the established principles of implementation, as agreed by PCSB. Where sufficient clarity does not exist, decisions will be required by the PCSB. It is hoped that by including the key responsible officers within the meeting, there will be sufficient capacity to agree a way forward. Meeting Frequency: Meetings will take place 4 weekly with a review of the frequency taking place by the chair at an appropriate stage. Meetings will be two weeks after and two weeks before the PCSB. Meetings of this group will last approximately 2 hours and the appropriate quorum of membership is at the discretion of the Chair. Meeting Organisation: The Chair, in collaboration with the Project Support Officer will be responsible for arranging meetings, issuing and managing calendar invitations and associated tasks. All meetings should be arranged in line with the agreed frequency as set out within the group ToR and calendar invitations should be issued to group members up to 1 year in advance. Agenda/Papers: Agendas and relevant papers should be developed by the Project Support Officer; Decisions and actions from the meeting will be recorded within an action and decision log. It is the responsibility of each of the members to ensure actions assigned to them are completed and an update provided. The agenda will be managed by the Chair with input from Vice Chair and agenda items shall be given one week in advance of the meeting. A Highlight Report updating the progress of each of the work stream groups will be circulated prior to each meeting. Detailed minutes will not be produced; rather action points and timescales will be circulated within one week of the meeting. The LanGMS2018 mailbox (LanGMS2018@lanarkshire.scot.nhs.uk) should be included within all meeting invitations and relevant correspondence including meeting papers. A distribution list should be maintained by the Project Support Officer ensuring all invitees/ recipients are required and removing/adding those who no longer require to receive correspondence in regards to the group. Meeting Delivery: The Project Support Officer (PSO) will attend all group meetings to develop and maintain action and decision log. The PSO is responsible for version control and accuracy of the decision log and will be responsible for following up with action owners to provide updates on outstanding actions. The PSO will also be responsible for ensuring the most up to date action note document is provided prior to the next meeting for circulation alongside other relevant meeting papers to the members of the group. A nominated group member will capture actions and decisions in the PSOs absence. An up‐to‐date action log will be contained within the papers for the meeting. This should be
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4 Oversight Executive Group ToR v0.1 updated following the meeting and a new version dd‐mm‐yyyy draft v0.1 created for the date of the meeting. A final version dd‐mm‐yyyy v1.0 will be created following approval by the project lead(s) and circulated to group members no later than one week after the meeting. ToR Review: Changes to the ToR, functions or membership of the group may be proposed at any meeting of the group with due notice of the proposed change having been issued with the agenda of the meeting. Any such change shall only become operative after approval of the Chair of the Group in consultation with the Primary Care Strategy Board. Lifespan: This group will meet until April 2023 in line with the revised timescales set out within the GMS2018 contract. 7. Confidentiality Organisation confidentiality will be maintained. Any papers resulting from these meetings will be open to public scrutiny. 8. Review Date Date of review – 21/09/2022 Date of approval at GMS Oversight Executive Group ‐ Date of next review – 21/09/2023 or earlier as referenced in section 6 – ToR Review
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1 REPORT Item No: 8 SUBJECT: Conclusion of North Lanarkshire Integration Review TO: Performance, Finance and Audit Sub-Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 16th November 2022 1. PURPOSE OF REPORT This paper is coming to the Sub-Committee: For approval For endorsement To note 2. ROUTE TO THE IJB Sub-Committee This paper has been: Prepared Reviewed Endorsed 2.1 The paper was prepared by the Chief Officer and agreed by members of the Senior Leadership Team. 3. RECOMMENDATIONS 3.1 The Sub-Committee is asked to: Note the completion of all outstanding actions from the Integration Review process 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 set out the legislation governing health and social care in Scotland with the intention of improving outcomes for the population. The legislation sets out options for Local Authorities and Health Boards and in North Lanarkshire, as in most of Scotland, the decision to opt for a “body corporate” model was taken. This required the formation of the Integrated Joint Board (IJB) with delegated functions from both the Health Board and Local Authority that were set out in an Integration Scheme, which was formally enacted on 1st April 2016. 5.2 In September 2018 North Lanarkshire Council set out a new vision for the future direction of the council in ‘We Aspire’. The document set out a plan to revise the Integration Scheme and transfer the discretionary delegated functions for children, families and justice social work services to the newly reshaped Education and Families service within the council. 5.3 Section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014, notes that “the local authority and the Health Board must carry out a review of the integration scheme before the expiry of the relevant period for the purpose of identifying whether any changes to the scheme are necessary or desirable”. The legislation clarifies the “relevant period” as “the period of five years beginning with the day on which the scheme was approved”. 5.4 Given the changes proposed in the ‘We Aspire’ report, it was agreed to instigate a review of integration, building on the learning to date and agreeing the best direction of travel moving forwards. 5.5 The review consisted of three main elements: themed workstreams; self-assessment exercise and structural review. 5.6 The review was approved at the IJB on 12th June 2019, with a request to create a full action plan and report this back through the IJB Sub-Committee. 5.7 The audit action plan is attached in Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG Leadership Review the remaining Kings Fund OD programme Programme fully focused on developing the relational aspects of health and social care teams Sharon Simpson Sep 19 Complete. Existing programme halted and new programme developed, which will commence following completion of the
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3 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG Creation of a Joint HR and Workforce Planning Forum Subject matter reference group in place Continued development of joint TU / Staff side group Fiona Whittaker John White Sep 19 Complete. Group now operational. Share the Community Capacity Building and Carer Support model Rebranding and updated communications framework for the programme Morag Dendy Sep 19 Complete. Presented to Senior Leadership Team Operational Structure Roll out of the updated strategic group structures across the partnership, including update terms of reference Agree meeting structures Ross McGuffie Sep 19 Complete. The new management meeting structures for the partnership came into place on 7th June 2021. This includes new Core; Senior Leadership Team; Support, Care and Clinical Governance; and Strategic Commissioning Plan structures (now part of SLT). Update TOR to reflect changed arrangements Ross McGuffie Oct 19 Complete. Through the Programme Board, terms of reference have been updated. A future review of Partnership Boards and Locality Planning Groups will take place once all of the new structures are fully bedded in. Appoint to the posts of Head of Health and Head of Adult Social work Permanent post holders in place Ross McGuffie Dec 19 Complete. Head of Health post recruited. Head of Adult Social Work post has been recruited with a start date of 19th January 2021.
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4 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG Appoint to the post of Head of Planning, Performance and Quality Assurance Permanent post holder in place Ross McGuffie Dec 19 Complete. Disaggregation of Social Work Services Professional identity of SW retained Linkages between services clear Alison Gordon Margaret French Oct 19 Complete. Disaggregation agreed, including synergy in operational structures and some retained joint functions (e.g. Quality Assurance, Performance etc). Internal Audit review of the process noted appropriate due diligence of the financial arrangements had been satisfactorily undertaken. Agree the Locality and Area Wide operational structures Key responsibilities and linkages agreed Ross McGuffie Maggs Thomson Margaret French Sep 19 Complete. Operational structures agreed for both Adult Health and Social Care and Education and Families, ensuring strong synergies remain. Implement locality and area wide structures Maggs Thomson Morag Dendy Nov 19 Complete. New structure commenced on 4th January 2021. Review Tier 3 Manager posts in line with the new locality and area wide structures Operational responsibilities of the two teams of three localities and 4 area wide service groupings in place Ross McGuffie Margaret French Maggs Thomson Sep 19 Complete. Operational structures agreed for both Adult Health and Social Care and Education and Families, ensuring strong synergies remain. HR agreement to revised roles and responsibilities Fiona Whittaker John White Nov 19 Complete. Job descriptions and job roles updated in conjunction with both
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5 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG HR teams and new posts out to advert. Tier 3 post holders in place Morag Dendy Maggs Thomson Jan 20 Complete. As noted above, target date had been moved to Mar 20, but Covid caused further delay. Tier 3 interviews completed in September 20 with all posts now with permanent postholders. Finance Continue to develop the financial monitoring of the IJB to support the implementation of the SCP and directions Review of support arrangements for the H&SC partnership Ross McGuffie Marie Moy Nov 19 Complete. Following whole system options appraisal exercise, new structure agreed and NL CFO in post from 22nd Aug 2022. Develop the use of directions through the SCP for 2020-23 Morag Dendy Mar 20 Complete. New Scottish Government guidance on Directions received and report with recommendations going to IJB in September 2020 Develop further integrated financial planning Learning from other partnership areas will be taken into account Marie Moy Ross McGuffie Jan 20 Complete. Discussed through Chief Officer and Chief Finance Officer groups. Aware of range of solutions in place across Scotland. Increase awareness of all IJB members, elected members, senior officers of overall finance issues pertinent to H&SC OD programme to support awareness Marie Moy Ross McGuffie Dec 19 Complete. Session held with Committee conveners to highlight financial challenges across both health and social care. Further IJB Liaison session scheduled for March 20 once budgets are confirmed. Set medium term financial plans Medium term financial plan is developed and Marie Moy Nov 19 Complete. Medium term financial plan
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6 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG agreed to inform direction presented to IJB liaison in March 2020. However, impact of Covid means that this will require to be updated to set out the new financial reality. Progress work on set aside budgets Financial challenges managed as a whole system approach Marie Moy Ross McGuffie Dec 19 Complete. While this is an ongoing development across a range of workstreams, agreement across local partners on the key areas of urgent care, Planned Date of Discharge, bed modelling and inequalities. Realistic targets to be identified in conjunction with the budget setting process Revise target setting in line with national guidance, SCP 20-23, and organisational governance requirements Marie Moy Ross McGuffie Jan 20 Complete. Targets for the 20/21 financial year set in conjunction with both Chief Executives and agreed process in place for annual review of targets. Consider options to improve the interface between strategic and operational finance functions Roles and responsibilities are clear within the revised H&SC structures Marie Moy Ross McGuffie Dec 19 Complete. Following whole system options appraisal exercise, new structure agreed and NL CFO in post from 22nd Aug 2022. SCP process will more clearly link financial impact and involve IJB members SCP20-23 engagement Marie Moy Morag Dendy Dec 19 Complete. Locality engagement sessions throughout Sep and Nov 2019. Additional sessions with elected members, IJB members and other key groups and committees between Sep and Dec 2019. SCP 2020-23
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7 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG approved by IJB in March 20. SCP 20-23 finalised and published Ross McGuffie Mar 20 Complete. IJB approved SCP 2020-23 in March 20. Strategic Planning Review of the key roles and responsibilities to ensure clarity of all stakeholders in planning, objective setting, commissioning and service delivery All partnership strategic groups are reviewed Clarity and consistency in decision making is achieved Engagement of staff, service users, carers and communities is as joined up as possible to ensure local empowerment Morag Dendy Oct 19 Complete. Partnership strategic groups reviewed and corporate objectives also reviewed, updated and allocated to groups. As outlined above in review of meeting and planning structures, final review of operational structures to be finalised once new post holders in place. Extend the collaborative planning approach to cover wider delegated hospital services Participation and Engagement working across delegated hospital services Morag Dendy Mar 20 Complete. Participation and Engagement Steering Group re-formed and strategy updated. Update paper scheduled for IJB in December 2020. Review and maximise the use of data to drive improvement Ensure that data is available to all revised operational and professional governance structures. Updated Locality profiles to be created. Morag Dendy Graeme Cowan Mar 20 Complete. Locality profiles updated ahead of Sept 2019 SCP engagement sessions. Programme of development of new service dashboards for Home Support, Care Homes, SDS and Delayed Discharge. Governance Update the TOR for the Support Care and Clinical Governance Group and linked committees Review takes account of the new national guidance to be shared in September 2019 Anne Armstrong Oct 19 Complete. S,C,CG ToR updated, however, new national guidance still awaited, following national consultation events in Jan 20.
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8 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG Develop OD programme to support revised TOR Anne Armstrong Sharon Simpson Dec 19 Complete. OD programme will commence once national guidance launched. Work with the Participation and Engagement Steering Group to strengthen voice of people with lived experiences and carers Voice of people is strengthened through the Support, Care and Clinical Governance arrangements Sharon Simpson Anne Armstrong Dec 19 Complete. Participation and Engagement Steering Group re-formed and strategy updated. Work ongoing to update expenses policy. Update papers scheduled to Dec 2020 IJB. Update the Integration Scheme Revised Scheme reflects the new arrangements Christine Jack Mar 20 Complete. The Integration Scheme has been out to public consultation and has now been submitted to the Cabinet Secretary for final approval. Develop OD programme to clearly define roles and responsibilities of the operational committees and the IJB Sub committee Members of the groups and wider staff understand the role and function of the groups Sharon Simpson Dec19 Complete. Forms part of the new OD plan, which will launch on completion of the new operational structures. King’s Fund sessions in place for all of the new operational units, commencing at the start of November 2020. Letters of direction will be issued after each IJB with associated finance clearly identified The direction process will be developed and will take account of revised national guidance Ross McGuffie Morag Dendy Mar 20 Complete. New Scottish Government guidance received on directions. IJB approved new approach in September 2020, with the report template now updated to identify directions from each report,
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9 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG which will be sent as soon as possible following the end of each meeting by the Chief Officer and Chair. Information sharing Continue the development of the IJB’s Annual Report Best practice and shared learning achieved Graeme Cowan Mar 20 Complete. Process in place to allow the H&SCP to continue to attend national sessions to support the development and participated in the national best practice sharing exercise undertaken by Scottish Government. Annual Report was published in July 19 in line with guidance. Continued development of the eCare system Consistent use across health and social care teams Ross McGuffie Mar 20 Complete. eCare development programme approved by the Data Sharing Partnership Board. Develop systems to support integrated managers to access management systems within both organisations Ensure that data is available to all revised operational and professional governance structures to drive improvement Ross McGuffie Dec 19 Complete. LDSP Board Terms of Reference have been updated to include information sharing requirements for integrated teams. Microsoft Office 365 is now being actively rolled out across both organisations, with the HSCP core management team now transferred over. Continued development around digitisation within both organisations Participation in DigitalNL and eHealth strategy groups Ross McGuffie Morag Dendy Maggs Thomson March 20 Complete. Representation at all digital workstreams in both orgs reviewed to ensure H&SCP well represented. Progress
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10 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG accelerated due to the pandemic response. Engagement Deliver the Participation and Engagement Steering Group Actions Full roll out of the identified actions from the Coalition of Carers Report “Equal, Expert and Valued” Sharon Simpson March 20 Complete. Participation and Engagement strategy and action plan refreshed, including expenses policy. Papers scheduled to Dec 2020 IJB. Membership of the Strategic Planning Group is reviewed to ensure the voices of children and young people are reflected Revised strategic structures fully engage with all stakeholder groups, particularly those most disadvantaged in the process Sharon Simpson Alison Gordon Dec 19 Complete. SPG membership updated for the December meeting. 5.8 A range of significant actions have been undertaken as part of the review, including: 5.9 Since the last report, the new meeting structures for the partnership have been rolled out from 7th June 2021, with terms of reference created for each. This has included: Implementation of new operational structures across the HSCP New management team meeting structures, including fortnightly Core Management Team and Senior Leadership Team meetings in place Strategic Commissioning Plan Board in place to provide oversight around all key strategic deliverables set out within the IJB’s Strategic Commissioning Plan Updated Support, Care and Clinical Governance arrangements to match the new operational structure, with subgroups in each sector and unit across the partnership and reporting to the partnership’s SCCG Committee. Onward reporting to the NHS Board’s HQAIC Committee and NLC’s Adult Social Work, Care and Wellbeing Committee are still in place The Lanarkshire Data Sharing Partnership Board has been reviewed with new terms of reference and the previous thematic subgroups replaced by an Officer’s Group and Task and Finish Groups as required The Joint HR Group has been reviewed and is now operational again North Lanarkshire Council and NHS Lanarkshire have signed up as early adopters around Microsoft 365 federation as part of a national approach between COSLA and NHS Scotland
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11 5.10 There were two outstanding areas from the Integration Review awaiting completion, namely the review of participation and engagement structures and the review of operational and strategic finance. 5.11 The review of participation and engagement structures was independently led and reported to the IJB in September 2022. 5.12 Following a joint review of operational and strategic finance structures with colleagues in South Lanarkshire IJB, North Lanarkshire Council, South Lanarkshire Council and NHS Lanarkshire, an options appraisal approach was taken which identified the preferred option of each partnership having their own Chief Finance Officer. 5.13 The new North Lanarkshire Chief Finance Officer commenced on 22nd August 2022, concluding the final outstanding action of the original review. 6. CONCLUSIONS 6.1 Following the conclusion of the two remaining actions, the Integration Review can now be concluded. Despite some delays due to the Covid pandemic, the review has supported some significant change programmes over the last three years. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1.1 The review impacts on all nine national health and wellbeing outcomes. 7.2 ASSOCIATED MEASURE(S) No further measures. 7.3 FINANCIAL 7.3.1 There are no direct financial implications outlined in the review, though the future model of financial management within the partnership is subject to further review. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4 There are no remaining risks associated with the review on the risk register. 7.5 PEOPLE 7.5.1 The structural review will include changes to some senior roles, with the respective employee relations departments and Trade Unions/staff side fully engaged in the process.
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12 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1: Integration Review Action Plan ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 858 119.
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13 Appendix 1 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG Leadership Review the remaining Kings Fund OD programme Programme fully focused on developing the relational aspects of health and social care teams Sharon Simpson Sep 19 Complete. Existing programme halted and new programme developed, which will commence following completion of the G Creation of a Joint HR and Workforce Planning Forum Subject matter reference group in place Continued development of joint TU / Staff side group Fiona Whittaker John White Sep 19 Complete. Group now operational. G Share the Community Capacity Building and Carer Support model Rebranding and updated communications framework for the programme Morag Dendy Sep 19 Complete. Presented to Senior Leadership Team G Operational Structure Roll out of the updated strategic group structures across the partnership, including update terms of reference Agree meeting structures Ross McGuffie Sep 19 Complete. The new management meeting structures for the partnership came into place on 7th June 2021. This includes new Core; Senior Leadership Team; Support, Care and Clinical Governance; and Strategic G
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14 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG Commissioning Plan structures (now part of SLT). Update TOR to reflect changed arrangements Ross McGuffie Oct 19 Complete. Through the Programme Board, terms of reference have been updated. A future review of Partnership Boards and Locality Planning Groups will take place once all of the new structures are fully bedded in. G Appoint to the posts of Head of Health and Head of Adult Social work Permanent post holders in place Ross McGuffie Dec 19 Complete. Head of Health post recruited. Head of Adult Social Work post has been recruited with a start date of 19th January 2021. G Appoint to the post of Head of Planning, Performance and Quality Assurance Permanent post holder in place Ross McGuffie Dec 19 Complete. G Disaggregation of Social Work Services Professional identity of SW retained Linkages between services clear Alison Gordon Margaret French Oct 19 Complete. Disaggregation agreed, including synergy in operational structures and some retained G
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15 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG joint functions (e.g. Quality Assurance, Performance etc). Internal Audit review of the process noted appropriate due diligence of the financial arrangements had been satisfactorily undertaken. Agree the Locality and Area Wide operational structures Key responsibilities and linkages agreed Ross McGuffie Maggs Thomson Margaret French Sep 19 Complete. Operational structures agreed for both Adult Health and Social Care and Education and Families, ensuring strong synergies remain. G Implement locality and area wide structures Maggs Thomson Morag Dendy Nov 19 Complete. New structure commenced on 4th January 2021. G Review Tier 3 Manager posts in line with the new locality and area wide structures Operational responsibilities of the two teams of three localities and 4 area wide service groupings in place Ross McGuffie Margaret French Maggs Thomson Sep 19 Complete. Operational structures agreed for both Adult Health and Social Care and Education and Families, ensuring strong synergies remain. G
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16 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG HR agreement to revised roles and responsibilities Fiona Whittaker John White Nov 19 Complete. Job descriptions and job roles updated in conjunction with both HR teams and new posts out to advert. G Tier 3 post holders in place Morag Dendy Maggs Thomson Jan 20 Complete. As noted above, target date had been moved to Mar 20, but Covid caused further delay. Tier 3 interviews completed in September 20 with all posts now with permanent postholders. G Finance Continue to develop the financial monitoring of the IJB to support the implementation of the SCP and directions Review of support arrangements for the H&SC partnership Ross McGuffie Marie Moy Nov 19 Complete. Following whole system options appraisal exercise, new structure agreed and NL CFO in post from 22nd Aug 2022. G Develop the use of directions through the SCP for 2020-23 Morag Dendy Mar 20 Complete. New Scottish Government guidance on Directions received and report with recommendations going to IJB in September 2020 G
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17 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG Develop further integrated financial planning Learning from other partnership areas will be taken into account Marie Moy Ross McGuffie Jan 20 Complete. Discussed through Chief Officer and Chief Finance Officer groups. Aware of range of solutions in place across Scotland. G Increase awareness of all IJB members, elected members, senior officers of overall finance issues pertinent to H&SC OD programme to support awareness Marie Moy Ross McGuffie Dec 19 Complete. Session held with Committee conveners to highlight financial challenges across both health and social care. Further IJB Liaison session scheduled for March 20 once budgets are confirmed. G Set medium term financial plans Medium term financial plan is developed and agreed to inform direction Marie Moy Nov 19 Complete. Medium term financial plan presented to IJB liaison in March 2020. However, impact of Covid means that this will require to be updated to set out the new financial reality. G Progress work on set aside budgets Financial challenges managed as a whole system approach Marie Moy Ross McGuffie Dec 19 Complete. While this is an ongoing development across a range of workstreams, agreement across local G
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18 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG partners on the key areas of urgent care, Planned Date of Discharge, bed modelling and inequalities. Realistic targets to be identified in conjunction with the budget setting process Revise target setting in line with national guidance, SCP 20-23, and organisational governance requirements Marie Moy Ross McGuffie Jan 20 Complete. Targets for the 20/21 financial year set in conjunction with both Chief Executives and agreed process in place for annual review of targets. G Consider options to improve the interface between strategic and operational finance functions Roles and responsibilities are clear within the revised H&SC structures Marie Moy Ross McGuffie Dec 19 Complete. Following whole system options appraisal exercise, new structure agreed and NL CFO in post from 22nd Aug 2022. G SCP process will more clearly link financial impact and involve IJB members SCP20-23 engagement Marie Moy Morag Dendy Dec 19 Complete. Locality engagement sessions throughout Sep and Nov 2019. Additional sessions with elected members, IJB members and other key groups and committees between Sep and Dec 2019. SCP 2020-23 G
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19 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG approved by IJB in March 20. SCP 20-23 finalised and published Ross McGuffie Mar 20 Complete. IJB approved SCP 2020-23 in March 20. G Strategic Planning Review of the key roles and responsibilities to ensure clarity of all stakeholders in planning, objective setting, commissioning and service delivery All partnership strategic groups are reviewed Clarity and consistency in decision making is achieved Engagement of staff, service users, carers and communities is as joined up as possible to ensure local empowerment Morag Dendy Oct 19 Complete. Partnership strategic groups reviewed and corporate objectives also reviewed, updated and allocated to groups. As outlined above in review of meeting and planning structures, final review of operational structures to be finalised once new post holders in place. G Extend the collaborative planning approach to cover wider delegated hospital services Participation and Engagement working across delegated hospital services Morag Dendy Mar 20 Complete. Participation and Engagement Steering Group re-formed and strategy updated. Update paper scheduled for IJB in December 2020. G
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20 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG Review and maximise the use of data to drive improvement Ensure that data is available to all revised operational and professional governance structures. Updated Locality profiles to be created. Morag Dendy Graeme Cowan Mar 20 Complete. Locality profiles updated ahead of Sept 2019 SCP engagement sessions. Programme of development of new service dashboards for Home Support, Care Homes, SDS and Delayed Discharge. G Governance Update the TOR for the Support Care and Clinical Governance Group and linked committees Review takes account of the new national guidance to be shared in September 2019 Anne Armstrong Oct 19 Complete. S,C,CG ToR updated, however, new national guidance still awaited, following national consultation events in Jan 20. G Develop OD programme to support revised TOR Anne Armstrong Sharon Simpson Dec 19 Complete. OD programme will commence once national guidance launched. G Work with the Participation and Engagement Steering Group to strengthen voice of people with lived experiences and carers Voice of people is strengthened through the Support, Care and Clinical Governance arrangements Sharon Simpson Anne Armstrong Dec 19 Complete. Participation and Engagement Steering Group re-formed and strategy updated. Work ongoing to update expenses policy. Update papers G
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21 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG scheduled to Dec 2020 IJB. Update the Integration Scheme Revised Scheme reflects the new arrangements Christine Jack Mar 20 Complete. The Integration Scheme has been out to public consultation and has now been submitted to the Cabinet Secretary for final approval. G Develop OD programme to clearly define roles and responsibilities of the operational committees and the IJB Sub committee Members of the groups and wider staff understand the role and function of the groups Sharon Simpson Dec19 Complete. Forms part of the new OD plan, which will launch on completion of the new operational structures. King’s Fund sessions in place for all of the new operational units, commencing at the start of November 2020. G Letters of direction will be issued after each IJB with associated finance clearly identified The direction process will be developed and will take account of revised national guidance Ross McGuffie Morag Dendy Mar 20 Complete. New Scottish Government guidance received on directions. IJB approved new approach in September 2020, with the report template now updated to identify directions from each report, G
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22 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG which will be sent as soon as possible following the end of each meeting by the Chief Officer and Chair. Information sharing Continue the development of the IJB’s Annual Report Best practice and shared learning achieved Graeme Cowan Mar 20 Complete. Process in place to allow the H&SCP to continue to attend national sessions to support the development and participated in the national best practice sharing exercise undertaken by Scottish Government. Annual Report was published in July 19 in line with guidance. G Continued development of the eCare system Consistent use across health and social care teams Ross McGuffie Mar 20 Complete. eCare development programme approved by the Data Sharing Partnership Board. G Develop systems to support integrated managers to access management systems within both organisations Ensure that data is available to all revised operational and professional governance structures to drive improvement Ross McGuffie Dec 19 Complete. LDSP Board Terms of Reference have been updated to include information sharing requirements for integrated teams. G
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23 Report Recommendation Improvement Action Milestone detail Lead Timeline Comment/RAG RAG Microsoft Office 365 is now being actively rolled out across both organisations, with the HSCP core management team now transferred over. Continued development around digitisation within both organisations Participation in DigitalNL and eHealth strategy groups Ross McGuffie Morag Dendy Maggs Thomson March 20 Complete. Representation at all digital workstreams in both orgs reviewed to ensure H&SCP well represented. Progress accelerated due to the pandemic response. G Engagement Deliver the Participation and Engagement Steering Group Actions Full roll out of the identified actions from the Coalition of Carers Report “Equal, Expert and Valued” Sharon Simpson March 20 Complete. Participation and Engagement strategy and action plan refreshed, including expenses policy. Papers scheduled to Dec 2020 IJB. G Membership of the Strategic Planning Group is reviewed to ensure the voices of children and young people are reflected Revised strategic structures fully engage with all stakeholder groups, particularly those most disadvantaged in the process Sharon Simpson Alison Gordon Dec 19 Complete. SPG membership updated for the December meeting. G
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1 REPORT Item No: 9 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee: For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 31 August 2022 (Health Care Services) and 1 April 2022 to 16 September 2022 (Social Work and Housing Services). 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The PFA Committee is asked to agree the following recommendations: (1) Note the contents of the report; and (2) Note that the financial position in September is an estimated underspend of £7.212m (NHSL - £3.232m; NLC - £3.980m). This excludes the impact of further recruitment challenges and staff turnover and any potential new Scottish Government funding. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 The financial position as at September 2022 is summarised as follows: there is a net underspend of £3.232m on the core budgets within Health Care Services SUBJECT: Financial Monitoring Report 2022/2023 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer North HSCP DATE: 16th November 2022 Yes No N/A
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2 there is a net underspend of £3.980m on the core budgets within Social Care and Housing Services The total underspend represents approximately 1% of the total financial envelope available. 6.2 The Covid-19 pandemic has created significant financial management and financial planning challenges for both partners and the IJB. These challenges have centred around the difficulties in predicting the costs associated with the recovery from the Covid-19 pandemic. 6.3 The 2022/2023 Covid-19 costs are being reported to the Scottish Government through the Lanarkshire Finance Performance Return on a monthly basis. There continues to be a significant degree of uncertainty in respect of the financial implications of the Covid-19 pandemic however the Scottish Government have advised IJBs that they will reclaim surplus Covid-19 reserves to be redistributed across the sector to meet current Covid-19 priorities. There is ongoing dialogue with the Scottish Government in respect of this potential reclaim. 6.4 The budget variance is analysed by care services at appendix 1 and the main factors contributing to the financial position are summarised at sections 8 and 9. 7. BUDGET ADJUSTMENTS 7.1 The reconciliation of the budget adjustments between April 2022 and September 2022 is attached at appendix 4 for information. 8. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES 8.1 Locality and Other Services 8.1.1 There is a net underspend of £1.028m. 8.1.2 The net underspend on pay costs totals £1.382m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities totalling 65.43 FTE. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. 8.1.3 In respect of non-pay costs, there is a net overspend totalling £0.354m. The overspend is mainly due to payments in respect of Strathcarron Hospice (£0.237m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. 8.2 Prescribing 8.2.1 A break-even position is reported at this stage. 8.2.2 The prescribing budget has reduced by £0.657m since 31 March 2022. The majority of the budget reduction relates to the savings target and a change in Scottish Government tariff prices. The budget reduction has been partly offset by a 2% inflation uplift. 8.2.3 Prescribing activity figures for the period from April 2022 to July 2022 have been received. Prescribing activity is 1% lower when compared to the same period last year. The cost per item is also lower due to a reduction in the tariff price.
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3 8.2.4 There continues to be significant risk in respect of prescribing activity and the costs, and it is highly likely that the uncertainty and volatility experienced throughout 2021/22 will continue for the foreseeable future. Prescribing costs will continue to be closely monitored. 8.3 Hosted Services Led By North Lanarkshire 8.3.1 The hosted services which are led by the North Lanarkshire HSCP are outlined at Appendix 2. There is a net underspend of £1.755m which includes the following significant variances: Mental Health and Learning Disability Services £0.344m underspend Children and Adolescents Mental Health Services £0.778m underspend Speech and Language Therapy £0.402m underspend 8.3.2 Within Mental Health and Learning Disability Services there is a net underspend on pay costs totalling £392k and a small overspend in Medical due to locum costs. Learning Disability Services, Medical, Rehab and Recovery and Perinatal and Infant Mental Health are awaiting further funding from Scottish Government, which will increase the overall underspend. Current vacancies within this area totals 58.72 FTE and are mostly within Old Age Psychiatry and Forensic Psychiatry. 8.3.3 Children and Adolescents Mental Health Services underspend is mainly within pay costs as the service currently has 44.27 FTE vacant posts within nursing and admin and clerical. 8.3.4 Speech and Language Therapy are also experiencing high vacancies totalling 27.34 FTE which equates to £0.355m of the reported underspend. 8.4 Hosted Services Led By South Lanarkshire 8.4.1 The hosted services which are led by the South Lanarkshire HSCP are outlined at Appendix 3. In-line with the hosted services agreement, a break-even position is reported. 8.5 Covid-19 Pandemic – Additional Health Care Costs 8.5.1 The additional health care costs which have been incurred in response to the Covid-19 pandemic continue to be reported to the Scottish Government through the Financial Performance Return. The year-to-date costs of £1.727m are included within the financial position reported and will be met by an existing IJB Covid-19 reserve. 8.6 Average Vacancy Factor 8.6.1 The vacancy position against the funded establishment at 31 August 2022 is summarised as follows: Establishment Actual Variance 2,811 FTE 2,636 FTE 175 FTE vacancies 100% 93.8% 6.2% 8.6.2 To help cover the current vacant posts, additional hours are worked through bankaide, overtime and excess part time hours, the cost of which is included within the financial position reported.
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4 8.7 Notional Set-Aside Allocation 8.7.1 The set-aside budget is a notional budget which represents the consumption of hospital resources by North Lanarkshire residents. Based on the 2020/2021 activity data from the Information Services Division (ISD) at the 2021/2022 prices, the budget was restated to £65.164m. 8.7.2 In respect of the financial year 2022/2023, the notional set-aside budget is restated to reflect the 2% inflationary uplift on the recurring baseline (£1.303m) and National Insurance uplift (£0.391m). The notional set-aside budget for 2022/2023 is therefore £66.858m. 8.7.3 In line with the accounting policy previously agreed, this notional set-aside budget will be included in the IJB Annual Accounts 2022/2023 as an estimate of expenditure. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB however it has been endorsed as an acceptable approach pending further updates from Information Services Division (ISD). 9. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES 9.1 A net underspend of £3.980m is reported as at 16 September 2022. The main factors contributing to this year-to-date financial position are highlighted below. 9.2 Employee Costs 9.2.1 As previously highlighted, there are ongoing challenges in terms of recruitment and retention due to limited availability of the skills mix required within the workforce market. These are issues that are being faced by IJBs across Scotland, not only in North Lanarkshire. 9.2.2 Expenditure in Home Support Services has also increased as the service continues to support delayed discharges and demand. However, these additional employee costs are being offset by earmarked reserve funding and current underspends as a result of vacancies. A net underspend across employee costs of £2.366m is therefore reported. 9.3 Payments to Other Bodies 9.3.1 There is an underspend of £0.905m across payments to other bodies. The underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the Self-Directed Support commissioning framework. 9.3.2 There is also an underspend in package costs due to slippage in Self-Directed Support service start dates however, it is anticipated that these are in-year underspends only and the full budget will be required in 2023/2024. 9.4 Administration Costs 9.4.1 An underspend of £0.613m is reported in respect of administration costs. This is mainly due to an underspend across the carers budget. The anticipated underspend is reflective of the part-year implementation of contracts and additional funding from the Scottish Government for carers pressures in 2022/2023. As these pressures become evident within social care budgets, the funding will be moved to the relevant care package.
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5 9.5 Covid-19 Pandemic – Additional Social Care Costs 9.5.1 Covid-19 additional costs for 2022/2023 is estimated to be £2.106m. This forecast is related to continued support to care providers in relation to sustainability payments. In line with the current Scottish Government guidance, this is expected to continue until March 2023. 10. RESERVES 10.1 The current reserve balances as at September 2022 are as follows: 10.2 The 2022/2023 IJB Reserves Strategy is presented to the Performance, Finance and Audit Committee in an additional paper and gives full details of all year-to-date movement and reserves balances. 11. 2022/2023 PROJECTED OUTTURN 11.1 The Scottish Government are currently implementing a plan to recover uncommitted Covid-19 reserves and have also advised IJBs that some 2022/2023 funding will only be made available once all respective reserves have been depleted. This will increase pressure on current budgets and provides uncertainty for funding in future years. There is also increased winter period pressures when costs tend to escalate along with the uncertainty of future Covid-19 costs as we continue through the recovery stage. 11.2 On the assumption that 2022/2023 funding will be made available when if needed and excluding the impact of further recruitment challenges and staff turnover, the projected outturn at year end is estimated to be an underspend of c£14m. 11.3 Subject to IJB approval, this underspend will be allocated to manage, on a non- recurring basis, ring-fenced commitments, additional future business plans and any funding gap which may be highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023-2026. 11.4 The total costs and funding available for 2022/2023 is being closely monitored by both partners and the IJB. 12. RISK 12.1 Risk management arrangements are in place for the IJB and each partner. The IJB risk register has been reviewed and updated. The reassessment of the strategic financial risks is included in a separate report to the IJB. The main risk associated with the in-scope budget is that either or both partners may overspend. However as detailed within this report the financial outturn for this year is projected to be an underspend. Opening Balance As At Transfers To / From Drawdown from Revised Balance As At £m £m £m £m NHSL Ring-Fenced Reserves 66.590 0.000 (15.774) 50.816 NHSL & NLC Earmarked Reserves 27.081 3.090 (0.812) 29.359 NHSL & NLC Risk-Based Reserves 22.000 (3.090) 0.000 18.910 NHSL Contingency Reserves 3.782 0.000 0.000 3.782 119.452 0.000 (16.586) 102.866 LEAD SUMMARY Total
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6 12.2 Although a non-recurring underspend is being reported, health and social care services continue to face demand pressures including home support, self-directed support, direct payments, independent care home placements, hospice care and health care services recovery plans. 12.3 The operational and financial impact of the response to the Covid-19 pandemic is being monitored by the IJB and both partners in line with their agreed emergency response arrangements and the recovery, redesign and remobilisation work to reinstate services. The whole system approach continues to be adopted by NHSL, NLC and South Lanarkshire Council. 12.4 Risk management arrangements are in place for the IJB and each partner. The respective risks are managed by both NHSL and NLC through their detailed budget management processes. In addition to these mitigating actions, the IJB Financial Plan 2022/2023 is closely monitored and the IJB Medium Term Financial Plan 2023 - 2026 is being compiled. 13. IMPLICATIONS 13.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 13.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. The IJB Medium Term Financial Plan 2023 -2026 is currently being completed. 13.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 13.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 12. The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 13.5 PEOPLE None 13.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the North Lanarkshire IJB. 13.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A
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7 13.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 14. BACKGROUND PAPERS None. 15. APPENDICES North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Hosted Services Led by North Lanarkshire Appendix 2 Hosted Services Led by South Lanarkshire Appendix 3 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 ........................................... Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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8 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Expenditure Annual Budget Budget Actual General Ring-Fenced Total 2022/2023 August 2022 August 2022 August 2022 August 2022 August 2022 £m £m £m £m £m £m Health Care Services Locality and Other Services 48.216 20.197 19.169 1.028 0.000 1.028 Addiction Services 3.094 1.310 0.953 0.357 0.000 0.357 Medical and Nursing Directorate 4.479 1.857 1.802 0.055 0.000 0.055 Prescribing 69.582 28.993 28.993 0.000 0.000 0.000 Out of Area Services 4.571 1.905 1.905 0.000 0.000 0.000 Area Wide Services 10.432 3.858 3.821 0.037 0.000 0.037 Hosted Services 158.307 62.327 60.572 1.755 0.000 1.755 Family Health Services 107.097 47.089 47.089 0.000 0.000 0.000 Set-Aside Budget 66.858 27.858 27.858 0.000 0.000 0.000 Covid-19 1.727 1.503 1.503 0.000 0.000 0.000 Total Expenditure - NHSL 474.364 196.897 193.665 3.232 0.000 3.232 Social Care Services Social Care Services Gross Expenditure 241.772 89.862 85.928 3.933 0.000 3.933 Social Care Services Gross Income (Including Covid-19 Income) (2.829) (7.959) (8.006) 0.047 0.000 0.047 Social Care Services Net Expenditure 238.943 81.902 77.922 3.980 0.000 3.980 Housing Revenue Account Expenditure 1.870 0.883 0.883 0.000 0.000 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 241.364 82.955 78.975 3.980 0.000 3.980 Social Care and Housing Services Sub-Total 241.364 82.955 78.975 3.980 0.000 3.980 Total Expenditure - NHSL and NLC 715.727 279.852 272.640 7.213 0.000 7.213 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (457.778) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.799) Scottish Government Funding - Covid-19 and Remobilisation (1.727) Transfer from Reserves (Approved) (14.859) Total Funding - NHSL (527.548) NLC Funding - Social Care Services (185.759) NLC Funding - Housing Services (1.870) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (188.180) Total Funding - NHSL and NLC (715.727) Year To Date Year To Date Variance 2022/2023
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9 Hosted Services Appendix 2 Led by the North Partnership Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 2.789 1.189 1.150 0.039 1.422 0.606 0.567 0.039 1.367 0.583 0.583 0.000 Continence Services 2.361 0.984 0.998 (0.014) 1.204 0.502 0.516 (0.014) 1.157 0.482 0.482 0.000 Immunisation Services 1.898 0.506 0.586 (0.080) 0.968 0.258 0.338 (0.080) 0.930 0.248 0.248 0.000 Speech and Language Therapy Services 6.083 2.540 2.138 0.402 3.102 1.295 0.893 0.402 2.981 1.245 1.245 0.000 Children and Adolescents Mental Health Services 16.447 4.604 3.826 0.778 8.388 2.348 1.570 0.778 8.059 2.256 2.256 0.000 Childrens Services 11.565 4.822 4.761 0.061 5.898 2.459 2.398 0.061 5.667 2.363 2.363 0.000 Integrated Equipment and Adaptations Store 0.567 0.236 0.229 0.007 0.289 0.120 0.113 0.007 0.278 0.116 0.116 0.000 Dietetics Services 3.738 1.563 1.522 0.041 1.906 0.797 0.756 0.041 1.832 0.766 0.766 0.000 Podiatry Services 4.316 1.809 1.753 0.056 2.201 0.923 0.867 0.056 2.115 0.886 0.886 0.000 Prisoner Healthcare Services 1.698 0.708 0.709 (0.001) 0.866 0.361 0.362 (0.001) 0.832 0.347 0.347 0.000 Blood Borne Viruses Services 1.529 0.636 0.574 0.062 0.780 0.324 0.262 0.062 0.749 0.312 0.312 0.000 Hospital at Home 2.225 0.922 0.862 0.060 1.135 0.470 0.410 0.060 1.090 0.452 0.452 0.000 Mental Health and Learning Disability Services 71.909 29.646 29.302 0.344 36.674 15.119 14.775 0.344 35.235 14.527 14.527 0.000 TOTAL 127.125 50.165 48.410 1.755 64.834 25.584 23.829 1.755 62.291 24.581 24.581 0.000 North Share of South Hosted Services 31.182 12.162 12.162 0.000 Hosted Services Total 158.307 62.327 60.572 1.755 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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10 Hosted Services Appendix 3 Led by the South Partnership Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Annual YTD September 2022 YTD September 2022 YTD September 2022 Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 6.906 2.959 2.737 0.222 3.522 1.509 1.509 0.000 3.384 1.450 1.228 0.222 Brain Injury Unit 1.639 0.673 0.742 (0.069) 0.836 0.343 0.343 0.000 0.803 0.330 0.399 (0.069) Out of Hours Services 8.962 3.603 3.569 0.034 4.571 1.838 1.838 0.000 4.391 1.765 1.731 0.034 Palliative Care Services 7.111 2.992 2.974 0.018 3.627 1.526 1.526 0.000 3.484 1.466 1.448 0.018 Physiotherapy Services 10.192 4.260 3.943 0.317 5.198 2.173 2.173 0.000 4.994 2.087 1.770 0.317 Primary Care Services 0.748 0.315 0.290 0.025 0.381 0.161 0.161 0.000 0.367 0.154 0.129 0.025 Occupational Therapy Services 7.802 3.293 3.293 0.000 3.979 1.679 1.679 0.000 3.823 1.614 1.614 0.000 Diabetic Services 4.936 2.741 2.701 0.040 2.517 1.398 1.398 0.000 2.419 1.343 1.303 0.040 Sub Total 48.296 20.836 20.249 0.587 24.631 10.626 10.626 0.000 23.665 10.210 9.623 0.587 Ring Fenced Funding Primary Care Improvement Fund 12.846 3.012 3.012 0.000 6.551 1.536 1.536 0.000 6.295 1.476 1.476 0.000 Primary Care Transformation Fund 0.000 0.000 (0.015) 0.015 0.000 0.000 0.000 0.000 0.000 0.000 (0.015) 0.015 Sub Total 12.846 3.012 2.997 0.015 6.551 1.536 1.536 0.000 6.295 1.476 1.461 0.015 TOTAL 61.142 23.848 23.246 0.602 31.182 12.162 12.162 0.000 29.960 11.686 11.084 0.602 South Share of North Hosted Services 62.291 24.581 24.581 0.000 Hosted Services Total 123.433 48.429 47.827 0.602 TOTAL South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share
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11 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 2022/23 NHSL Financial Allocation to North Lanarkshire HSCP £m 2022/23 NLC Financial Allocation to North Lanarkshire HSCP £m 2022/22 North Lanarkshire HSCP Financial Allocation 506.931 2022/22 North Lanarkshire HSCP Financial Allocation 132.575 Add: Set-Aside Budget 66.858 NLC Funding - Housing Services 1.870 Less: Budget Adjustments NLC Funding - Transport Services 0.551 Social Care Fund -22.964 Add: Budget Adjustments Resource Transfer -23.421 Social Care Fund 22.964 Commissioned Services -6.799 Resource Transfer 23.421 NHSL Financial Allocation at 31 May 2022 520.605 Commissioned Services 6.799 NLC Financial Allocation at 16 September 2022 188.180 Additions: Draw Down from Reserves 1.949 Increase to Employers NI 1.262 NES Trainee 1.021 Other Budget Adjustments 0.425 NHSL Financial Allocation at 30 June 2022 525.262 Additions: Draw Down from Reserves 0.460 Junior Medical Income -0.040 Other Budget Adjustments 0.023 NHSL Financial Allocation at 31 July 2022 525.705 Additions: Draw Down from Reserves 0.453 Child Death Review Funding 22-23 0.024 Increase to Hosted Services Led by South 1.146 Other Budget Adjustments 0.220 NHSL Financial Allocation at 31 August 2022 527.548 Budget Adjustments Posted in Month 4 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 5
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1 REPORT Item No: 10 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee: For approval For endorsement For noting 1.2 This report provides an outline of the actions agreed with the External Auditor, Internal Audit and the Senior Management Team to further develop the IJB governance framework. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The PFA Committee is asked to agree 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 any ongoing actions. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Recommendations to further strengthen the IJB governance framework were made by both External and Internal Audit. The Senior Management Team (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements. 5.2 The original reports from External and Internal Audit and the SMT were previously reported in full to the IJB and PFA Committee as appropriate. This report summarises the agreed recommendations and provides an update on the progress made to date against each action. Further details are attached at appendices 1 to 3. 5.3 Any actions which are reported as complete will be removed from the next progress report to the PFA Committee. SUBJECT: Progress Report on Agreed Actions TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer North HSCP DATE: 16th November 2022 Yes No N/A
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2 6. CONCLUSIONS 6.1 An update on the progress made to date was reported to the PFA Committee on 16 February 2022. A summary of the current position statement is shown in the table below: 6.1 The ongoing actions are measured against the revised timeline set out at appendices 1 to 3. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This report relates to all national outcomes as effective governance arrangements will ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. 7.2 ASSOCIATED MEASURE(S) The implementation of agreed actions will contribute to the ongoing development of the internal control framework and will also inform the Annual Governance Statement for 2022/2023. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT When reviewing the current position and achievable timescales, the risks associated with this have been considered. 7.5 PEOPLE None 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A Source Total Actions Completed Actions Ongoing Actions External Audit 4 2 2 Internal Audit 9 4 5 Senior Management 7 3 4 TOTAL 20 9 11 45% 55%
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3 8. BACKGROUND PAPERS None. 9. APPENDICES External Audit Actions Appendix 1 Internal Audit Actions Appendix 2 Senior Management Actions Appendix 3 ........................................... Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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4 Update on External Audit Actions Appendix 1 Ref Finding Recommendation Management Response Current Position 1 Disaggregation of children, families and justice social work services. An exercise is ongoing to align the finances with the revised integration scheme over an 18- month period. The work to disaggregate the budgets for some more complex areas where the services cut across delegated and non-delegated services is ongoing. There is a risk that the budget disaggregation exercise extends beyond the 18-month transition period and the IJB financial monitoring reports and accounts do not accurately reflect delegated services in 2020/21. Original The IJB should monitor progress against the improvement actions identified in the governance statement and the internal audit review in relation to the transfer of children, families and justice services. Internal Audit Follow Up Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised; (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Agreed The budget disaggregation exercise will be concluded in 2020/2021 and a revised direction issued by the IJB to NLC to reflect the total budget transfer in respect of Children, Families and Justice Services and also the hosting arrangements for cross- cutting and support services. Chief Financial Officer Original Timeline: March 2021 Revised Timeline: September 2021 Revised Timeline: June 2022 Revised Responsible Officer: Head of Adult Social Work Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. The finalisation of the Service Level Agreement is overdue as per the original timeline of March 2021 which was initially revised to September 2021 but has been extended again to June 2022. Ongoing The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service. 2 Financial Management Financial monitoring reports do not provide a forecast of the outturn position for health care services until towards the end of the year and the accuracy of forecasts could improve. The timing of meetings and availability of information means that the IJB is not receiving a financial monitoring report until five months into the year. There is a risk that financial pressures are not identified and managed in a timely manner. Original The CFO should continue to work with partners to improve the timing of financial reporting and outturn forecasts. Agreed In consultation with both partners, further improvements will be implemented to the IJB financial monitoring arrangements to ensure the financial information is reported timeously and forecast projections are accurate. It is noted however that the financial implications of the Covid-19 pandemic have increased the financial uncertainty for the IJB and both partners. Chief Financial Officer Original Timeline: September 2021 Revised Timeline: June 2022 Complete In respect of the current financial year 2021/2022, the first financial monitoring report was presented to the PFA Committee on 24 August 2021. This related to the period to June 2021. On 5 October 2021, additional funding of £300m was announced nationally by the Scottish Government to address winter pressures across Health and Social Care Services. The availability of additional in-year funding is welcomed however the late notification of the funding impacts on the projected outturn. The particular challenges in 20020/2021 as a result of the Covid-19 pandemic are continuing in 2021/2022. These challenges include uncertainty about the impact of the ongoing Covid-19 pandemic on services, in particular the step up / step down of services over the critical winter period, and the totality of the Covid-19 funding which will be made available for 2021/2022. This is expected to be confirmed in February 2022. Notwithstanding these challenges, an indicative projected outturn for the financial year 2021/2022 has been included by the IJB Chief Financial Officer within the IJB Financial Monitoring Report 2021/2022 which is being presented to the PFA on 9 November 2021. This indicative projection is based on the current financial information available. Due to the timing of the closure of the year end accounts, 2022/23 financial reports are not produced from Social Care and Health until mid-June. The timings of the IJB and PFA Committee did not allow for the financial position to be presented for the current financial year until 31 August for the PFA Committee and 21 September for the IJB. Board papers need to be available to members in advance of each committee meeting which further limits the timespan available to produce financial monitoring reports. This is in line with other HSCPs who tend to provide the first update for the financial year at their August/September boards. The CFO will continue to produce timely reports to be submitted to each pre-agenda in line with committee timetables as per North Lanarkshire Financial Framework.
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5 Update on External Audit Actions (Cont.) Appendix 1 (Cont.) Ref Finding Recommendation Management Response Current Position 3 Hosted service The management of financial resources for hosted services is agreed in principle each year. The accounting policy is clear that the host is responsible for managing the overspends and underspends on these services and this is how the hosted services are being managed in practice, but this is not set out in a formal agreement for future years. There is a risk that this becomes an area of dispute. Original The IJB should set out the arrangements that exist in practice for the management of financial risk for hosted services on a permanent basis. Agreed The financial arrangements for hosted services will be reviewed and will take into consideration the practical experience to date of the current hosted services principles. Following the review, the hosted services arrangements will be set out in a formal agreement to be approved by the North Lanarkshire IJB and the South Lanarkshire IJB. Chief Financial Officer Original Timeline: September 2021 Revised Timeline: June 2022 Complete The review of the financial arrangements for hosted services is overdue as per the original timeline of September 2021 which has been extended to June 2022. Work on this action is being progressed. The impact of the Covid-19 pandemic on the hosted services is currently being taken into consideration before the review of the accounting policy is finalised. Hosted Services paper agreed at Corporate Management Team dated 12 October 2017 outline the financial arrangements for hosted services. Due to the introduction of the National Care Service, this agreement will remain in place for the foreseeable future however, if either North or South HSCPs encounter a future problem before the introduction of the NCS, it will be their responsibility to recommend corrective action. 4 Medium to long term financial plan The IJB now has a medium to long term financial plan that spans the period 2020/21 to 2029/30 but this will need to be updated to reflect the impact of Covid-19 and EU withdrawal. There is a risk that the financial planning assumptions in the medium to long term financial plan may be inaccurate. Original The IJB’s medium to long term financial plan should be reviewed due to the impact of Covid-19 and EU withdrawal. Agreed The IJB medium to long term financial plan will be reviewed to reflect the impact of the Covid-19 pandemic, EU withdrawal and other emerging health and social care cost pressures. The potential impact on the Scottish Government financial settlements both in-year and in future years will also be assessed. Chief Financial Officer Original Timeline: March 2021 Revised Timeline: March 2022 Revised Timeline: March 2023 Ongoing An update on the approach to the preparation of the IJB Financial Plan for 2022/2023 was presented to the IJB on 8 December 2021. This included the key financial planning assumptions underpinning the budget setting process for both partners and the IJB at this stage. The IJB Medium to Long Term Financial Plan is also being updated. This will take into consideration the additional national investment funding announced by the Scottish Government, the proposed North Lanarkshire IJB Business Case, the ongoing and legacy costs of the Covid-19 pandemic and the EU withdrawal, as far as this can be quantified. The Medium-Term Financial Plan 2023 – 2026 is currently underway and will align with the Strategic Commissioning Plan 2023 -2026. It will address the impact of Covid-19, EU withdrawal and the current cost of living as far as this can be quantified.
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6 Update on Internal Audit Actions Appendix 2 Ref Risk Management Maturity Audit Report Adequate Assurance (Audit Ref: NL04/18) Recommendations / Management Response Current Position 1 Although the IJB has agreed and is implementing a procedure with the Health Board for considering shared risks, this is not reflected in the Risk Management Strategy (RMS). Similar arrangements have not been established with the Local Authority. There is a risk that the IJB and Council may not have a shared approach to these risks and escalation between the two bodies may be ineffective. The RMS does not reflect actual practice. (Priority: Amber) Original A similar approach to that adopted between the IJB and Health Board will be discussed and agreed with the Local Authority. The RMS will also be updated to reflect the revised arrangements. Original Responsible Officer: Chief Officer Original Timeline: March 2020 Revised Responsible Officer: Head of Adult Social Work Services Revised Timeline: June 2021 Revised Timeline: March 2022 Chief Officer Revised timeline: December 2022 Complete A report on the risk register was included on the IJB agenda on 24 March 2020. A further report was considered by the IJB on 22 September 2020. On 25 May 2021, the risks relating to the remit of the PFA Committee were reviewed, the mitigating actions were updated, and the risk ratings were amended. These amendments were subsequently approved by the IJB on 22 June 2021. The current IJB Risk Register is presented to the PFA Committee on 16 February 2022 for approval. Risk Management Strategy has been updated to include how risk is shared, managed, and escalated between partner bodies. In continuing to strengthen the risk management partnership, discussion with internal auditors is continuing to agree a form similar to NHSL to capture future risks. Once formalised, this will be taken to PFA Committee and IJB for approval. The IJB and PFA Committee meetings include risk as a standing agenda. All IJB and PFAC reporting templates have been updated to include operational risk. 2 Whilst the Risk Register is subject to continuous review and is updated regularly, there has not been a fundamental review involving all IJB members and referencing partner body Risk Registers. The Risk Register may not take into account the knowledge and views of all IJB members, and the lessons learned from updating the Strategic Commissioning Plan. (Priority: Amber) Agreed A specific Board Development Event will be organised to review the Risk Register which will take into account lessons learned from the production of the Strategic Commissioning Plan, including potential obstacles to its delivery. The relevant risks from NL, NHSL and SL Risk Registers will also be considered. Original Responsible Officer: Operational & Business Manager Original Timeline: March 2020 Revised Responsible Officer: Head of Performance, Planning and Quality Assurance Revised Timeline: June 2021 Revised Timeline: June 2022 Complete The development event on risk was undertaken at the IJB Liaison Group in March 2020 and, as highlighted in response to action 1 above, the review of the IJB Risk Register has been completed. The current IJB Risk Register includes the strategic risks in respect of the Strategic Commissioning Plan 2020/2023 and also references the partner’s risks, as appropriate. Internal Audit previously advised that the revisions to the Risk Register only considered strategic financial risks and that other risks associated with the strategic planning role of the IJB had still to be fully developed. Management agreed to ensure that risks associated with the strategic planning role of the IJB, and in particular those associated with the Strategic Commissioning Plan 2020/2023, are developed and the IJB Risk Register updated to reflect these. The development event with IJB members is complete. The IJB Risk Register is complete and will be continuously updated with new risks as and when they are identified. IJB and PFA Committee meetings include risk as a standing agenda item which gives assurance to board members and keeps all risks under regular review. 3 The PFA Committee does not receive an annual assurance report on risk management and there are no defined KPIs or performance measures for risk management. There is a risk that the PFA Committee may not be able to conclude on the overall adequacy and effectiveness of Risk Management arrangements. (Priority: Amber) Agreed An appropriate methodology for assessing the adequacy and effectiveness of risk management arrangements will be developed. This will include suitable KPIs and performance measures. Performance Manager Original Timeline: March 2020 Revised Timeline: March 2022 Revised Timeline: March 2023 Ongoing As previously advised, the annual review of the current suite of indicators and targets has been completed. An appropriate methodology for assessing the adequacy and effectiveness of risk management arrangements will be developed. This will include consideration of suitable key performance indicators and performance measures as part of the current review of the HSCP’s performance framework.
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7 Update on Internal Audit Actions (Cont.) Appendix 2 (Cont.) Ref Risk Management Maturity Audit Report Adequate Assurance (Audit Ref: NL04/18) Recommendations / Management Response Current Position 4 Board and PFAC papers do not routinely report on the Risk Management implications of the issues raised. Decisions may not fully reflect Risk Management considerations. The risk register may not reflect issues highlighted within performance management and other assurance reports. IJB and PFAC papers should contain a section on risk which considers whether issues raised should be included within the risk register and overtly reflect the impact on any existing strategic risks. Performance reports should reference relevant strategic risks and assess whether scores are accurate and whether actions intended to reduce risk to target level are on track. (Priority: Amber) Agreed The format and content of IJB and PFAC reports will be reviewed to ensure that the management of risks is transparent and effective. Original Responsible Officer: Operational & Business Manager Original Timeline: March 2020 Revised Responsible Officer: Chief Officer Revised Timeline: June 2021 Revised Timeline: June 2022 Complete The review of the IJB Risk Register has been concluded. An assessment of risks, current and emerging, is undertaken at the end of each IJB and PFAC meeting. The new IJB and PFAC report template has been amended and includes a specific sub-section on risk assessment and risk management implications. Internal Audit highlighted that were a high proportion of reports submitted to the IJB and the PFAC where the revised template had not been used. This is currently being addressed and action is being taken to ensure that all IJB reports adhere to the correct version of the IJB and PFAC reporting template and the sub-section on risk assessment and risk management within the implication’s sections must be populated for all relevant strategic risks. The IJB Risk Register is complete and will be continuously updated with new risks as and when they are identified. IJB and PFAC meetings include risk as a standing agenda item which gives assurance to board members and keeps all risks under regular review. 5 Improvements are needed to the way in which performance information is reported to better enable Committee members to exercise effective oversight, scrutiny, and challenge. It is considered there is scope for significant improvement in what and how this information is presented. There is a risk that the IJB may not provide adequate performance information to key stakeholders to enable them to make informed decisions and recommend remedial actions to address concerns arising. The IJB Performance, Finance and Audit Committee may not therefore be in a position to fulfil its remit which includes the requirement to ‘Review quarterly performance and recommend remedial action to address concerns’ and to ‘Ensure effective arrangements are in place to register all performance and operational risks’. (Priority: Amber) Agreed Management will undertake a formal review of the current arrangements for monitoring and reporting performance to reflect on whether reports are fit for purpose and contain relevant, comprehensive information useful to stakeholders. This could include comparison with other IJB published reports. Particular consideration should be given to the following areas: an overview of all indicators on the performance scorecard including a mechanism to provide an update on indicators previously reported but now considered satisfactory; proposed actions with timescales, progress with these and how effective they are; greater use of benchmarking with other IJBs and trend information; and incorporating reporting by locality. Performance Manager Original Timeline: January 2020 Revised Timeline: March 2022 Revised timeline: March 2023 Ongoing As previously advised, the annual review of the current suite of indicators and targets has been completed. In August 2022, the IJB’s Performance, Audit and Finance Committee endorsed the development of a revised whole system performance framework for the partnership. The current engagement and participation activity taking place in relation to the development of the new Strategic Commissioning Plan will draw together and build upon the richness of contribution across key partners. A whole system working group will be established to support the performance framework for the emerging Strategic Commissioning Plan. The richness of information that will comprise whole system performance reports will allow Committee members to exercise effective oversight, scrutiny, and challenge.
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8 Update on Internal Audit Actions (Cont.) Appendix 2 (Cont.) Ref Performance Management Audit Report Adequate Assurance (Audit Ref: 0600/2019/004) Recommendations / Management Response Current Position 6 There is no formal record of the setting and approval of targets and trajectories for indicators on the performance scorecard. Internal Audit noted that targets and trajectories for underlying performance measures are discussed and agreed at the Chief Executives’ Performance Review meetings but no formal record of this is retained. There is therefore no formal documented record or clear rationale for the targets and trajectories set. (Priority: Amber) Agreed Management should ensure that a formal record is retained detailing the rationale for and approval of the targets and trajectories set for the indicators on the performance scorecard and this information should be shared with the Performance, Finance and Audit Committee. Performance Manager Original Timeline: October 2019 Revised Timeline: March 2022 Revised Timeline: December 2022 Ongoing The annual review of the current reporting arrangements was rescheduled as a result of the Covid-19 pandemic. This work however is now being progressed in line with the revised timeline. The annual review of the current reporting arrangements will be reported to the IJB in December 2022 and will set out the agreement for future years. From 23/24 onwards, this will be presented to the board each year in line with quarter one performance cycle. 7 There were a number of issues identified with regards to the methodology and calculation of the Social Work indicator ‘Integrated Equipment and Adaptations Service – percentage of deliveries achieved within 7 working days. The guidance/definition sheet for this particular indicator is not clear or comprehensive. There is a risk that the expected methodology may not be clearly understood or consistently applied, which increases the risk that reported performance information may be inconsistently prepared, inaccurate and/or misleading. (Priority: Green) Agreed Management should review current arrangements for recording, collating, and calculating this Social Work indicator to ensure that: a clear, detailed and unambiguous definition of the indicator is documented; the guidance/definition sheet contains clear and detailed instructions on the methodology to be used in calculating the indicator; and a full record of all adjustments/exclusions is retained. Original Responsible Officer: Service Manager Original Timeline: October 2019 Revised Responsible Officer: Head of Adult Social Work Services Revised Timeline: March 2022 Complete All arrangements for recording, collating, and calculating have been reviewed. KPIMeasurementEA S.docx
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9 Update on Internal Audit Actions (Cont.) Appendix 2 (Cont.) Ref Financial Due Diligence Audit Report Adequate Assurance Recommendations / Management Response (Audit Ref: 0700/2020/003) Current Position 8 Management needs to formalise and agree the proposed arrangements for those services with a ‘cross cutting function’, to be hosted by either Health and Social Care or Education and Families, and following the approval of the IJB and NLC, to finalise and process the agreed transfer of the remaining cost centres, in relation to the disaggregation of Children, Families and Justice Social Work Services, and their resultant budget. (Priority: Amber) Agreed. IJB management will: (1) liaise with relevant Council officers to ensure that the transfer of the remaining cost centres, and the resultant resources transferred, are agreed/completed as a matter of urgency; (2) in conjunction with Education and Families, determine, agree, and fully document the proposed arrangements for those functions to be ‘hosted’ by Education and Families and accessed by Adult Health and Social Work Services and vice versa, including giving consideration as to whether there should be a recharge system; (3) in conjunction with relevant Council officers, ensure that both the IJB and NLC approve the proposed ‘hosting’ arrangements for the budgets in respect of the cross-cutting services; and (4) liaise with the Council to resolve any other outstanding issues with regards to the disaggregation of Children, Families and Justice Services’ budgets and the treatment thereof. Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised; (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Original Responsible Officer: Chief Officer Original Timeline: October 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Ongoing The finalisation of the Service Level Agreement is overdue as per the original timeline of March 2021 which was initially revised to September 2021 but has been extended again to June 2022. Once finalised, the Service Level Agreement will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service.
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10 9 There is a need for a more formal record of the methodology adopted for disaggregation/the resultant figures/cost centres being transferred from Health and Social Care to Education and Families and the associated risks as a result of changes to the Integration Scheme to be formally reported to key stakeholders (i.e. the IJB and relevant Council Committee). (Priority: Amber) Agreed IJB management should, in conjunction with relevant Council officers, ensure that a report is submitted to the IJB setting out the methodology for the disaggregation of cost centres and budgets associated with Children, Families and Justice Social Work Services, detailing the implications of the full disaggregation. Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised. (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Original Responsible Officer: Chief Officer Original Timeline: October 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Timeline: June 2022 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Ongoing The finalisation of the Service Level Agreement is overdue as per the original timeline of March 2021 which was initially revised to September 2021 but has been extended again to June 2022. Once finalised, the Service Level Agreement will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. These reports will also include the detail of the disaggregated budgets which have been agreed. The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service. Update on Senior Management Actions Appendix 3 Ref Annual Governance Statement Continuous Improvement Actions Current Position 1 Further consideration of the Ministerial Strategic Group (MSG) proposals. Original Responsible Officer: Chief Officer Original Timeline: March 2021 Revised Responsible Officer: Chief Officer Revised Timeline: March 2022 Ongoing A range of actions were agreed across the partnership to take forward the MSG proposals. These actions were included as part of the overall North Lanarkshire Integration Review and Self-Assessment. An update report on the total of 38 actions was presented to the IJB PFA Committee on 24 August 2021. 35 actions have been completed and 3 actions remain outstanding. Two of the outstanding actions relate to the finance workstream. This includes a review of the support arrangements for the Chief Financial Officer and the link between strategic and operational finance. On 8 December 2021, the North Lanarkshire IJB agreed to create a full-time Chief Financial Officer for each IJB. On 25 January 2022, the South Lanarkshire IJB also agreed to this approach. This option is now being progressed. Complete The third outstanding action relates to the development of systems to support integrated IT arrangements. The Lanarkshire Data Sharing Partnership Board was reviewed, and new structures have been agreed. The role out of Microsoft 365 across all partners is the current priority. The MSG had previously indicated that a second self-evaluation will be undertaken in 12 months to assess progress. The follow up was rescheduled due to the Covid-19 pandemic. The second self-evaluation is currently being progressed in February 2022. Work is also progressing nationally in respect of the development of the National Care Service. The Improvement Service is carrying out a self-evaluation of the function of the IJB as part of a national best value audit. Effective from February 2022, a review of current participation and engagement structures is also being progressed. Complete 2 Review the IJB governance arrangements Ongoing
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11 This will include the review of the following: IJB joint internal audit arrangements IJB Code of Corporate Governance IJB emergency response arrangements and the further development of the IJB website. Original Responsible Officer: Chief Financial Officer Original Timeline: March 2021 Revised Responsible Officer: Chief Financial Officer Revised Timeline: March 2022 Revised Timeline: March 2023 Work is progressing. The outcome of the overall North Lanarkshire Integration Review and Self-Assessment was reported to the IJB PFA Committee on 24 August 2021. The review of the North Lanarkshire Integration Scheme included consideration of governance arrangements. The governance structure moving forward proposed key interfaces around clinical and care governance. The understanding of the governance requirements underpinning health and social care integration continues to develop and includes an increased awareness of decision-making responsibilities. The further development of collaborative leadership and building relationships with key stakeholders continue to be key improvement actions. The outcome of the National Care Service Consultation will also influence future governance arrangements for the IJB and both partners. The External Audit of the North Lanarkshire IJB Annual Accounts 2020/2021 has now been completed. The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2020/2021 give a true and fair view of the state of affairs and of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report. The findings of the audit process have also been reported to the IJB and an action plan approved as set out in the External Auditor’s Annual Audit Report. Current process will remain however further work may be required due to the introduction of the National Care Service. The working group continue to develop the IJB website which will be complete by March 2023.
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12 Update on Senior Management Actions (Cont.) Appendix 3 (Cont.) Re f Annual Governance Statement Continuous Improvement Actions Current Position 3 Continue to develop the financial framework. This will include the review of the following: IJB Medium to Long Term Financial Strategy IJB Financial Plan (Annual) IJB Financial Regulations IJB Financial monitoring reports IJB reserves strategy the alignment of resources to partner directions and locality needs and finance capacity. Original Responsible Officer: Chief Financial Officer Original Timeline: March 2021 Revised Responsible Officer: Chief Financial Officer Revised Timeline: March 2022 Complete Work continues to progress. In respect of the current financial year 2021/2022, the core budgets and the Lanarkshire Mobilisation Plan funding are being monitored in consultation with the Scottish Government. complete Additional Scottish Government funding has been announced for 2021/2022 and also 2022/2023. The financial implications of these recent funding announcements are being confirmed for both the current financial year 2021/2022 and future financial years. complete The IJB Financial Plan 2022/2023 is being developed. complete The medium to long term financial strategy is being reviewed. Complete and will be superseded by Medium Term Financial Plan 2023 – 2026. Both North and South Chief Finance Officers will continue to update plans and review regulations and strategies as part of everyday business. 4 Finalise the budget transfer from the IJB to NLC, in line with the revised Integration Scheme This will include the following: the conclusion of the budget disaggregation exercise for the transfer of the remaining cost centres and their resultant budgets the finalisation of the Service Level Agreement including the arrangements for those services with a ‘cross cutting function’ the issue of a revised direction to reflect the 2020/2021 financial allocations Original Responsible Officer: Chief Officer Original Timeline: September 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross- cutting services are finalised; (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Ongoing Once finalised, the Service Level Agreement will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service.
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13 Update on Senior Management Actions (Cont.) Appendix 3 (Cont.) Re f Self-Evaluation of the North Lanarkshire Health and Social Care Integration Joint Board (IJB) Current Position 5 Evidence how Health and Social Care spending contributes to prevention and early intervention This will include the following: review of the Strategic Commissioning Plan to strengthen outcome 5 around inequalities review of opportunities against resources include a question in all board papers regarding how it impacts upon prevention and early intervention undertake a review of good practice from across Scotland ring-fence funding for prevention and early intervention as part of the Reserves Strategy engage with Academia to establish how we measure success evidence how existing work links to prevention and early intervention and how this aligns to outcomes Original Responsible Officer: Head of Planning, Performance and Quality Assurance and Chief Finance Officer Original Timeline: February 2023 Ongoing Both the Strategic Commissioning Plan 2023-2026 and Medium-Term Financial Plan 2023-2026 are currently underway and will align to strengthen outcomes against resources. By ensuring good practise and lessons learned, both plans will review future funding and reserves to link with outcomes around prevention and early intervention. 6 Embed learning and new ways of working in the IJB from the response to the pandemic to ensure plans and governance are fit for purpose This will include the following: develop scoping paper to pick out key areas of what did and did not work well during the pandemic keep and strengthen relationships with community groups and organisations consider actions to keep up the continuous improvement momentum developed during the pandemic capture lessons learned during the pandemic in a permanent way in case of future emergencies ensure lessons learned have longevity and are fit for purpose within the Health and Social Care structures consider what insights can be gained from service users and staff, from their journey during the pandemic Original Responsible Officer: Head of Planning, Performance and Quality Assurance and Performance Manager Original Timeline: Scoping paper June 2022 Complete During 2022, discussions at Staff Roadshows considered and reviewed the areas of work which were effective during the pandemic and those which presented more of a challenge. These discussions were informed by key inputs from members of the Strategic Leadership Team. These lessons have been shared with a wider audience as part of the engagement events in relation to the development of the new Strategic Commissioning Plan and have been further expanded and built upon with discussion from stakeholders across our communities and localities. These insights will be reflected in the new Strategic Commissioning Plan and its associated Programme of Work. 7 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 This will include the following: identity specific service areas of concern in high level reports to the Board, linking these to the risk register develop a better understanding of the audience for performance reports consider what the IJB and public need from performance reporting, ensuring this is presented in a user-friendly format review the content of what is reported to ensure information is presented in full and within the appropriate context improve the reporting of outcomes and how these have improved the lives of service users ensure the development of IT systems allow for data capturing to be simplified to reduce the number of manual processes Original Responsible Officer: Medical Director and Head of Planning, Performance and Quality Assurance Original Timeline: March 2023 Complete In August 2022, the IJB’s Performance, Audit and Finance Committee endorsed the development of a revised whole system performance framework for the partnership. The current engagement and participation activity taking place in relation to the development of the new Strategic Commissioning Plan will draw together and build upon the richness of contribution across key partners. A whole system working group will be established to support the performance framework for the emerging Strategic Commissioning Plan. The richness of information that will comprise whole system performance reports will allow Committee members to exercise effective oversight, scrutiny and challenge.
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1 REPORT Item No: 11 SUBJECT: IJB Reserves Strategy 2022/2023 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer North HSCP DATE: 16th November 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves and seeks endorsement to establish new reserves in line with the planned commitments and Scottish Government guidance. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Finance Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The PFA Committee is asked to agree the following recommendations: (1) Note the 2021/2022 closing balance on the IJB reserves at 31 March 2022; (2) Endorse the allocation of the Scottish Government funding to the ring-fenced reserves as outlined at section 8.1; (3) Endorse the allocation of funding to the risk based, earmarked and contingency reserves as detailed at sections 8.2, 8.3 and 8.4; (4) Endorse the re-allocation of reserves as detailed at section 9.1; (5) Note the update from Scottish Government with regards to reclaiming surplus Covid-19 reserves at section 6.4; and (6) Note the review of reserves is ongoing in consultations with operational colleagues to confirm the amount and timing of planned commitments and to align the reserves accordingly. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Consistent with a number of other Health and Social Care Partnerships, an underspend was reported by the IJB at 31 March 2022. This 2021/2022 underspend included funding received to meet the ongoing cost and recovery to the Covid-19 pandemic and also funding made available by the Scottish Government to progress policy commitments and national priorities. Yes No N/A
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2 5.2 The underspend reported at 31 March 2022 was £74.67m (NHSL - £58.697m; NLC - £15.973m). The factors contributing to the underspend were included in the financial monitoring report to the IJB on 22 June 2022. The proposed 2022/2023 IJB Reserves Strategy has been developed in consultation with the Director of Finance of NHS Lanarkshire (NHS) and the Head of Financial Solutions of North Lanarkshire Council (NLC). 6. CONCLUSIONS 6.1 The IJB Reserves Strategy 2022/2023 provides an opportunity to strengthen long- term financial sustainability by considering the allocation of the 2021/2022 underspend to the strategic priorities of the IJB and both partners. Although reserves funding is non-recurring, some of the reserves proposals extend the duration of the funding for more than one year. This provides greater stability for essential health and social care services and the transformational change programmes to deliver required outcomes post pandemic. It will also enable more time for a recurring funding solution to be identified and agreed, where necessary. The IJB Reserves Strategy 2022/2023 will enable the IJB and both partners to balance current commitments whilst planning and addressing financial risks. An extract from the IJB Reserve Policy detailing the specific use and purpose of creating reserves is at appendix 4. 6.2 The funding transferred to the IJB reserves is required to progress the agreed commitments in 2022/2023 which include ADP initiatives, Mental Health Action 15 Services, Children and Adolescent Mental Health Services, Carers Act support and the ongoing costs and recovery from Covid-19 pandemic. The IJB Reserves Strategy 2022/2023 is therefore in line with North Lanarkshire IJB Strategic Commissioning Plan 2020-2023 and Scottish Government directions for the use of the ring-fenced funding. 6.3 It is essential for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that section 106 public bodies do not over- commit themselves financially. 6.4 The PFA Committee is asked to note that the Scottish Government provided an update to the continued holding and use of surplus Covid-19 reserves. Due to several significant changes to Public Health policies in relation to the pandemic over the summer, resulting in the profile of spend reducing significantly compared to when funding was provided to IJBs, the Scottish Government will reclaim surplus Covid-19 reserves to be redistributed across the sector to meet current Covid-19 priorities. The detail, process and timetable will follow through further communications. 7. OVERVIEW OF RESERVES CLOSING BALANCE AT 31 MARCH 2022 7.1 A total of £8.335m has been drawn down from reserves during 2021/2022 (NHSL - £7.564m; NLC - £0.771m). Excluding the 2021/2022 underspend, the reserve balances as at 31 March 2022 were as follows: Summary £m % Ring-Fenced Reserves 14.032 31% Earmarked Reserves 12.166 27% Risk-Based Reserves 14.902 33% Contingency Reserves 3.683 8% Total 44.783 100%
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3 7.2 The underspend at 31 March 2022 totalled £74.67m (NHSL - £58.697m, NLC - £15.973m). The total reserves balance at 1 April 2022 was therefore £119.452m. 7.3 In line with External Audit guidance, the underspend reported in the financial monitoring report at 31 March 2022 is reconciled to the movement in the reserves and shown in the 2021/2022 North Lanarkshire IJB Annual Accounts: 8. IJB RESERVES STRATEGY 2022/2023 8.1 Ring-fenced Reserves 8.1.1 Funding has been received from the Scottish Government for specific purposes. The PFA Committee is therefore asked to retrospectively endorse the transfer of the NHSL funding totalling £52.557 to the ring-fenced reserves summarised in the table below. 8.1.2 A detailed list of the ring-fenced reserves is at appendix 1. Movement in Reserves during 2021/2022 Total Reserves General Fund Balance £m Opening Balance at 1 April 2021 53.118 NHSL Drawdown from Reserves (7.564) NLC Drawdown from Reserves (0.771) NHSL Underspend 58.697 NLC Underspend 15.973 Closing Balance at 31 March 2022 119.452 Ring-Fenced Reserve £m Covid-19 Funding 31.621 Alcohol and Drug Partnership Funding 2.134 Children and Adolescent Mental Health Services 4.383 Mental Health and Learning Disability Services - Action 15 3.016 Mental Health and Learning Disability Services - Distress Brief Intervention 1.444 Mental Health and Learning Disability Services - Recovery and Renewal 1.840 Psychology Services - Recovery and Renewal 0.614 Multi-Disciplinary Teams 1.160 Area Wide Services - Pharmacy, NES, PCIP, Pre School Vision Screening, Displaced Persons 1.681 Health Care Support Funding 0.634 Hospital at Home Services 0.414 Care Home Allocations 0.318 Diagnostic Support Service - Dementia Funding 0.429 Scottish Government Priorities 2.869 Total Ring-Fenced Reserve 52.557
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4 8.2 Risk-based Reserves Proposals 8.2.1 Work is currently underway to complete the Medium-Term Financial Plan 2023-2026 and the Strategic Commissioning Plan 2023-2026. Uncertainty continues around the future demands and pressures for the partnership due to fluctuating cost of living pressures and continued increasing demand on all services. The probability of using reserves in 2023-26 to help achieve financial balance remains high. The PFA Committee is therefore asked to retrospectively endorse the transfer of £5.945m to the risk-based reserves summarised in the table below. 8.2.2 A detailed list of the risk-based reserves is at appendix 3. 8.3 Earmarked Reserves Proposals 8.3.1 Part of the underspend reported in 2021/2022 was in respect of core services. This was mainly due to underspends in direct employee costs reflecting recruitment delays and ongoing difficulties recruiting to specialist posts. 8.3.2 Following consultation with the NHSL and NLC partners, the PFA Committee is asked to retrospectively endorse the following earmarked reserves summarised in the tables below. 8.3.3 A detailed list of the earmarked reserves is at appendix 2. Risk-Based Reserve £m Financial & Strategic Planning 2023/2026 5.416 Social Care Demand 0.529 Total Risk Based Reserve 5.945 Earmarked Reserve - NHSL £m Operational Demands 1.930 Childrens Services 1.570 Minor Repair And Replacement Programme of Works 1.000 Area Wide Services 0.512 Podiatry Services 0.459 Children and Adolescent Mental Health Services 0.346 Dietetics Services 0.224 Total Earmarked Reserve 6.041 Earmarked Reserve - NCL £m Shifting the Balance of Care - Winter Business Case 4.839 Digital and IT Strategy 2.394 Financial Strategy - Changes to LA Services 1.411 Carers Act Support 0.852 Operational Demands 0.279 Adapations Demand 0.253 Total Earmarked Reserve 10.028
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5 8.4 Contingency Reserves Proposal 8.4.1 The balance of contingency reserves at 31 March 2022 was £3.683m. The PFA Committee is asked to retrospectively endorse the transfer of NHSL funding totalling £0.099m to the contingency reserve summarised in the table below. 8.4.2 A detailed list of the contingency reserves is at appendix 3. 8.4.3 Taking into consideration the contingency reserves and the risk-based reserves, the funding available to mitigate both risks and unplanned events totals £22.986m. This represents 3.2% of the financial envelope available. This is in line with the North Lanarkshire IJB Medium to Long Term Financial Plan 2020/2021 to 2029/2030, which recommended that the risk-based and general contingency reserves are established at 3% for 2022/2023 rising to 5% from 2023 onwards. Year 2020/2021 2021/2022 2022/2023 2023 to 2030 Contingency Reserve % 1% 2% 3% 5% 8.4.5 The PFA Committee is asked to endorse the principle that the total reserve of £22.986m is sufficient to mitigate risks and unplanned events during 2022/2023. 9. ON-GOING COMMITMENTS 9.1 A further analysis and review was carried out with both partners in respect of all reserves to ensure the reserves carried forward into 2022/2023 (excluding new reserves already highlighted in section 8) were still required and sufficient to cover on-going pressures or re-allocated to help with future demand pressures. Details of these proposed changes can be found below: Contingency Reserve £m Contingency Balance Held By NHSL 0.099 Total Contingency Reserve 0.099 Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC Advocacy Services 0.123 0.061 0.184 NLC Assistive Technology Contract x 12 months (ATC) - 0.090 0.090 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 3.776 NLC Home Support Development 0.217 (0.217) - NLC Planned Date of Discharge - Discharge To Assess 0.200 0.241 0.441 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.055 0.096 0.151 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 0.075 1.642 3.075 0.000 4.717 Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC IJB Financial Plan Contingency - Allocated to NLC 3.000 (3.000) - NLC Social Care Demand 6.117 (0.075) 6.042 9.117 (3.075) 0.000 6.042 TOTAL EARMARKED RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES 2022/23 LEAD EARMARKED RESERVES
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6 9.2 The analysis also found that the earmarked reserve held against digital and IT strategy for the Home Support Scheduling System is insufficient to cover the potential cost commitment needed by the partnership. The 4-year investment is estimated at £3.776m with currently only £1m identified and earmarked in reserves. A business case to progress with this project is underway and will seek approval from the partnership and Enterprise Architecture Governance Group (EAGG). 9.3 Pending approval of the business case, a proposed transfer of an additional £2.776m has been earmarked to cover the 4-year investment. This project, once formally approved, is likely to begin 2023/2024 however, if the recommendation is to defer or reject the business case, the proposed earmark reserve will re-route to a contingency based reserve. 9.4 Full details of the funding held in earmarked reserves for the current and proposed digital and IT strategy projects are shown in the table below: 9.5 An on-going update on the use and remaining balances of reserves will be included in future finance monitoring reports and presented to both the PFA Committee and the IJB. A further review will be carried out in conjunction with the new Medium Term Financial Plan 2023 -2026. 9.6 Below is the total summary of current reserves. 10. RISK 10.1 The extent to which Scottish Government will continue to request the return of uncommitted ring-fenced reserves is unknown. To date, the Scottish Government are currently implementing a plan to recover uncommitted Covid-19 reserves and have also advised IJBs that some 2022/2023 funding will only be made available once all respective reserves have been depleted. The establishment of earmarked and contingency reserves is therefore a key element of the overall governance arrangements to mitigate financial risk. Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m Digital and IT Strategy Technology Improvements - Community Alarms 0.694 0.694 Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 3.776 Digital and IT Strategy Technology Improvements - Other 0.566 0.566 Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 TOTAL 2.960 2.776 0.000 5.736 EARMARKED RESERVES Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 66.590 0.000 (15.774) 50.816 NHSL & NLC Earmarked Reserves 26.802 3.075 (0.812) 29.065 NHSL & NLC Risk-Based Reserves 21.894 (3.075) 0.000 18.819 NHSL Contingency Reserves 4.167 0.000 0.000 4.167 119.452 (0.000) (16.586) 102.866Total SUMMARYLEAD
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7 10.2 As reserves funding is non-recurring, any agreement to fund recurring costs with reserves will need to be risk managed. To help mitigate this risk, the Chief Finance Officer will agree the exit strategy with partners before the funding is exhausted or identify a potential recurring funding solution. 11. IMPLICATIONS 11.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 9. 11.5 PEOPLE None 11.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC have both been consulted on the proposed IJB Reserves Strategy 2021/2022 for the North Lanarkshire IJB. 11.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 11.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 12. BACKGROUND PAPERS None. 13. APPENDICES Ring-Fenced Reserves Appendix 1 Earmarked Reserves Appendix 2 Risk-Based & Contingency Reserves Appendix 3 IJB Reserves Policy – Extract Appendix 4 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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8 Appendix 1 Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown of Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.154 (1.962) 1.192 NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 0.167 NHSL Adult Neurodevelopmental Pathway Pilot - Recovery & Renewal Fund 0.050 0.050 NHSL Adult Social Care Winter Preparedness Fund 1.941 1.941 NHSL Area Wide Services - Audiology Equipment 0.011 0.011 NHSL Area Wide Services - Mental Health Pharmacy, PCIP and NES SLA with GPs 1.048 (1.048) - NHSL Area Wide Services - NES Training 0.132 (0.132) - NHSL Area Wide Services - Pre School Vision Screening 0.075 0.075 NHSL Area Wide Services - Refugees and Displaced Persons 0.400 (0.076) 0.324 NHSL Area Wide Services - Update CHI 0.015 0.015 NHSL Blood-Borne Viruses Services 0.146 0.146 NHSL Care Homes Allocation 0.318 0.318 NHSL Children and Adolescent Mental Health Services 5.283 (3.865) 1.418 NHSL Community WIFI 0.342 0.342 NHSL Covid-19 Funding 29.677 (1.711) 27.966 NHSL Covid-19 Funding - Unscheduled Care 1.944 1.944 NHSL Development of Health Promoting Culture 0.141 0.141 NHSL Diagnostic Support Service - Dementia Post 0.429 0.429 NHSL Dietetics Services - Diabetes Type 2 and Adult Weight Management 0.024 0.024 NHSL Distinction Awards 0.036 0.036 NHSL Eating Disorders Funding 0.176 (0.176) - NHSL Health Care Support Workers - Band 3 0.634 (0.413) 0.221 NHSL Health Inequalities Funding 0.024 0.024 NHSL Health Inequalities - Health Promotion Posts 0.006 0.006 NHSL Health Inequalities - Screening 0.098 0.098 NHSL Hospital at Home Services - Support Development 0.414 (0.288) 0.126 NHSL Integrated Authority Support 6.076 6.076 NHSL Joint Equipment Store 0.500 0.500 NHSL Long Acting Buprenorphine 0.255 0.255 NHSL Maternity and Neonatal Psychological Interventions 0.044 0.044 NHSL Medical Director - Child Death Review Funding 0.021 (0.021) - NHSL Mental Health and Learning Disability Services - Action 15 3.019 (3.019) - NHSL Mental Health and Learning Disability Services - Distress Brief Intervention 1.552 (1.444) 0.108 NHSL Mental Health and Learning Disability Services - Mental Health Improvement Fund 0.254 0.254 NHSL Mental Health and Learning Disability Services - Veteran's First Point 0.026 0.026 NHSL Mental Health Improvement Fund - Psychology 0.084 (0.068) 0.016 NHSL Mental Health Infant - NES Funding 0.013 0.013 NHSL Mental Health Innovation Funding 0.120 0.120 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 (0.149) 1.691 NHSL Mental Health Support for Those Hospitalised with Covid-19 0.172 (0.114) 0.058 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 NHSL Multi-Disciplinary Teams 1.160 (0.050) 1.110 NHSL Nursing Services - District Nurse 0.292 (0.292) - NHSL Nursing Services - Family Nurse Partnership 0.033 0.033 NHSL Nursing Services - School Nursing 0.162 (0.162) - NHSL Nursing Services - Queens Nursing Institute Grants 0.004 0.004 NHSL Psychology Services- Capacity Building 0.117 (0.117) - NHSL Psychology Services - Improving Access 0.095 0.095 NHSL Psychology Services - Recovery and Renewal Phase 1 & 2 0.614 (0.614) - NHSL Public Health Intelligence Data Analysts 0.061 0.061 NHSL Sexual Health Services - Health & Homeless Post 0.004 (0.004) - NHSL Sexual Health Services - Forensic Medical - Exam Suite 0.028 0.028 NHSL Sexual Health Services - Forensic Medical Examination Regional Funding 0.182 0.182 NHSL Shielding - Social Care Support Fund 0.038 0.038 NHSL Staff Wellbeing 0.254 0.254 NHSL Test and Protect Funding 0.520 0.520 NHSL Third Sector Initiatives To Improve Health 0.306 0.306 NHSL Vulnerable Population Post - Health Improvement Funding 0.068 0.068 66.589 0.000 (15.774) 50.815TOTAL RING-FENCED RESERVES RING-FENCED RESERVESLead 2022/23
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9 Appendix 2 Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC Adaptations Fund 0.289 0.289 NHSL Administration Support Services 0.240 (0.001) 0.239 NLC Adult Protection (share with C&F and NHSL) 0.050 0.050 NLC Advocacy Services 0.123 0.061 0.184 NHSL Area Wide Services - Admin 0.080 (0.080) - NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 0.123 NHSL Area Wide Services - Locality Funding 0.432 0.432 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 (0.021) 0.013 NHSL Assistant Support Worker - Promise 0.026 0.026 NLC Assistive Technology Contract x 12 months (ATC) - 0.090 0.090 NLC Business Case - Non-Recurring NLC Costs 5.380 5.380 NLC Carers Act 2018 - Support 0.852 0.852 NLC Carers Act 2018 - Waving of Charges 0.580 0.580 NHSL Champions Board Funding 0.045 0.045 NHSL Children and Adolescent Mental Health Services - Choice and Partnership Approach (CAPA) Team 0.717 0.717 NHSL Children and Adolescent Mental Health Services - Service Improvement Post (Band 7 - 18 months) 0.088 0.088 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 0.346 NHSL Children and Adolescent Mental Health Services - Waiting List Co-ordinator (Band 5) 0.038 0.038 NHSL Childrens Services - Childrens Inspection Senior Nurse (3 months) 0.017 0.017 NHSL Childrens Services - Manager Post (1WTE) 0.040 0.040 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.645 (0.645) - NHSL CLAN Funding 0.095 0.095 NHSL Clinical Fellow Funding 0.080 0.080 NHSL Clinical Guidelines Post 0.023 0.023 NHSL Clinical Pharmacist - Additions 0.035 0.035 NHSL Community Assessment and Rehabilitation Service - Rehabilitation Pilot 0.023 0.023 NHSL Dietetics Services 0.046 0.046 NHSL Dietetics Services - Band 6 0.114 0.114 NHSL Dietetics Services - Double Running Costs 0.110 0.110 NHSL Dietetics Services - Oral Nutrition 0.038 0.038 NHSL Dietetics Services - Weight Management 0.049 0.049 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.694 0.694 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 3.776 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.566 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.107 NLC Financial Strategy - Changes to LA Services Muirpark 2.973 2.973 NHSL Forensic Band 3 x 5 WTE 0.147 0.147 NHSL GPIT Reprovisioning Gap 0.181 0.181 NHSL Health Visiting Students/Trainees 0.840 0.840 NHSL High Resource User Posts 0.025 (0.025) - NLC Home Support Development 0.217 (0.217) - NHSL Hospital at Home Services - Shortfall 0.110 0.110 EARMARKED RESERVESLEAD 2022/23
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10 Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC Impact of Covid-19 Pandemic Review 0.100 0.100 NHSL Integrated Support Worker 0.153 0.153 NHSL IT Federated Trust Environment Strategy 0.214 0.214 NHSL Joint Equipment Store 0.054 0.054 NHSL Kings Fund Organisational Development 0.014 0.014 NHSL Kylepark Works 1.000 1.000 NHSL LD Band 3 x 4 WTE 0.118 0.118 NHSL LTC Lead Clinician 0.010 0.010 NHSL Medical Director - Associate Medical Director (MR) 0.074 0.074 NHSL Mental Health PDN 0.2wte for 20/21 spend previously approved 0.011 0.011 NLC Mental Health Practice Assessor 0.006 0.006 NHSL Mental Health Practice Development (HF) 0.047 0.047 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.107 0.107 NHSL Minor Capital Works 1.387 1.387 NHSL Motherwell Rehabilitation Team Leadership 0.058 0.058 NHSL NA Band 7 x 0.2 WTE 0.011 0.011 NHSL Neurodevelopmental Pathway OT 0.095 0.095 NHSL Nursing Appointments 0.119 0.119 NHSL Nursing Services 0.125 0.125 NHSL Nursing Services - Extend Health Improvement Unit posts to March 2020 0.075 0.075 NHSL Nursing Services - Quest Patient Safety Posts 0.003 0.003 NHSL Nursing Services - Solihull Training 0.018 0.018 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.908 0.908 NLC Payment to Voluntary Org - Glenboig 0.006 0.006 NLC Planned Date of Discharge - Discharge To Assess 0.200 0.241 0.441 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.055 0.096 0.151 NHSL Podiatry Services - Foot Screening 0.459 0.459 NHSL Pre School Screening Exclusion Incident Audit 0.025 0.025 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.070 NHSL Project Manager - Adverse Events 0.036 0.036 NHSL Promise Funding (2 years) 0.052 0.052 NHSL Public Projection Joint Resourcing 0.075 0.075 NHSL Regrading Band 4 x 5 WTE to Band 5 Backpay 0.125 0.125 NHSL Return to Nursing Students 0.107 0.107 NHSL Scottish Clinical Leadership Fellowship 0.045 0.045 NLC SDS Transformational Team 0.025 0.025 NHSL Sexual Health Services 0.109 (0.011) 0.098 NHSL Sexual Health Services - LARC (2 clinics for 2 years) 0.386 (0.004) 0.382 NHSL Sexual Health Services - STI 0.122 (0.025) 0.097 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 0.075 NHSL Speech, Language and Therapy Services 0.807 0.807 NHSL Speech, Language and Therapy Services - Contract 0.250 0.250 NHSL Supervisor Training 0.077 0.077 NHSL Test of Change - High Intensity Service Users 0.027 0.027 NHSL Training Fund 0.246 0.246 NLC Unmet Saving 21/22 - IDS/LSS (merging building Coatbridge & Cumbernauld) 0.086 0.086 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.030 NLC Winter Plan 0.300 0.300 NHSL Winter Plan - Discharge To Assess 0.010 0.010 26.802 3.075 (0.812) 29.065TOTAL EARMARKED RESERVES LEAD EARMARKED RESERVES Appendix 2 (CONT.)
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11 Appendix 3 Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC IJB Financial Plan Contingency - Allocated to NLC 3.000 (3.000) - NLC Financial & Strategic Planning 2023/2026 5.416 5.416 NLC Long Covid Contingency 3.000 3.000 NHSL Prescribing Fund 4.361 4.361 NLC Social Care Demand 6.117 (0.075) 6.042 21.894 (3.075) 0.000 18.819 Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Contingency Balance Held By NHSL 4.167 4.167 4.167 0.000 0.000 4.167TOTAL CONTINGENCY FUND RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES
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12 IJB RESERVES POLICY – EXTRACT APPENDIX 4 As the North Lanarkshire Integration Joint Board (IJB) has the same legal status as a local authority, i.e. a section 106 body under the Local Government (Scotland) 1973 Act, and is classified as a local government body for accounts purposes by the Office of National Statistics, it is able to hold a General Fund and this General Fund will be accounted for in the financial accounts and records of the IJB. The North Lanarkshire IJB Reserves Policy allocates funding to a ring-fenced, earmarked, risk-based or contingency reserve. Extracts of the IJB Reserves Policy is noted below for background information. For each reserve there should be a clear protocol setting out the reason/purpose of the reserves, how and when the reserve can be used, procedures for the reserves management and control and the review timescale to ensure continuing relevance and adequacy. IJB Reserves will be held for four specific purposes as follows: RING-FENCED RESERVES A ring-fenced reserve will be established when funding has been received for a specific purpose. If the funding has been received during the year but has not been spent by the year-end, the funding may be accounted for by the partner as a pre-payment in line with agreed accounting standards. If the funding cannot be accounted for as a pre-payment, the IJB will be asked to establish a ring-fenced reserve to ensure the funding received remains available for the specific purpose intended and to minimise the risk that the partner would be asked to repay funding which has not been spent in line with the conditions of receipt of the funding. EARMARKED RESERVES An earmarked reserve will be established when funding has been allocated by the IJB to the partner to commission services in line with agreed directions however the service has not been delivered by the year-end, but a commitment has already been made under the delegated authority by the Chief Officer, which cannot be accrued at specific times (e.g. at the year-end) due to not being in receipt of the service or goods. RISK-BASED RESERVES A risk-based reserve will be established to provide a contingency to address a specific financial risk. Following consultation with each partner, the IJB Chief Finance Officer will recommend to the IJB the need to establish such a reserve and the amount the reserve should be set at. The amount of such a reserve will be dependent on the professional judgement of the relevant officers and also the constraints of the overall financial envelope within which both the partners and the IJB are operating. CONTINGENCY RESERVES A contingency reserve will be established by the IJB to cushion the impact of unexpected events or emergencies. The contingency reserve would also provide a working cash balance to help cushion the impact of uneven cash flows. It is noted that the amount of the contingency reserve will be constrained by the financial envelope available to the IJB from the partners and the commissioning intentions agreed with the partners in the IJB Strategic Plan to meet need.
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1 REPORT Item No: 12 SUBJECT: Covid-19 Update TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 16th November 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit Committee: For approval For endorsement To note 1.2 This paper sets out the actions taken to date during the pandemic response. 2. ROUTE TO THE PERFORMANCE, FINANCE & AUDIT COMMITTEE 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 COVID-19 was declared a pandemic by the World Health Organisation on 12 March 2020, with spread of COVID-19 within all communities in the UK in the intervening period. 5.1.2 Command structures were immediately put in place in both North Lanarkshire Council and NHS Lanarkshire, with the Health and Social Care Partnership fully participating in both. In addition, the pan Lanarkshire Resilience Partnership has supported cross-agency developments. Yes No N/A
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2 5.1.3 An overview of the current developments around Covid-19 is included below: 5.2 Update on Numbers 5.2.1 As at 31st October, the seven-day case rate within North Lanarkshire is 49.8 per 100k population, which is a small decrease to the figures last presented to the IJB on 30th September when it was 66.8 per 100k. 5.2.2 The inpatient peak of the second wave of Omicron was 322 covid positive inpatients on 28th March 2022, with a further 63 in off-site facilities. As at 31st October, there are 84 covid positive inpatients and a further 9 in offsite facilities, which in total is a small increase of 4 compared to the position on 30th September. 5.2.3 On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. 5.3 Care Homes 5.3.1 One of the greatest areas of focus has been around supporting the Care Home sector, covering key areas of work such as: Testing, outbreak management and ongoing surveillance Infection, prevention and control including PPE and cleaning requirements Education and training Supportive reviews and visits. Workforce requirements and supply of mutual aid 5.3.2 Across Lanarkshire, work began to strengthen the management and oversight of outbreaks in care homes in March 2020, enhancing the supports we had offered routinely up until then. This included: Social Work Quality Assurance Section – existing contact Care home Liaison Team Support – existing weekly contact HPT Management of outbreaks – daily contact during outbreaks Weekly conference calls with sector by HSCP, established March 2020 Established early contact with Care Inspectorate Care home Assurance Group, meets daily, established 23rd April 2020 Bronze care home sub group, meeting twice weekly, established 24th April 2020 Development of Care Home Strategy 23rd April 2020 Access to staff bank to enable sustainable rotas with supporting governance framework Enhanced PPE recommendations that sector move to table 4 on 1st May 2020 Prioritised programme of testing for care homes commenced 5th May 2020 Workforce group established to support screening programme established 14th May 2020 Additional support arrangements for Care Homes confirmed until June 2022, with £1,326,353 allocated as part of the Remobilisation Plan funding in June 2021. 5.3.3 Following communication from the Cabinet Secretary on 17th May 2021, which outlined the additional requirements regarding accountability for provision of nursing leadership; professional oversight; implementation of infection prevention control measures; use of PPE; and quality of care; we have undertaken significant work to
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3 map our current provision of support and ongoing workforce and resource requirements to deliver this new request: Care Home Assurance Group – initially established on 23rd April 2021, group was expanded to include Chief Social Work Officers, Chief Officers and the Medical Directors. The group has also undertaken a thematic analysis of Care Homes, identifying support needs around access to updated HPS guidance; management of outbreaks; standard infection prevention and control measures; and staff support around mental health and wellbeing. Huddle - All 93 care homes in Lanarkshire have registered to use the national safety huddle template hosted on TURAS. There is a daily safety huddle meeting involving social work, care inspectorate, health protection team and nursing staff where they review this information and respond to any escalations or concern’s raised. Work continues with the Care Homes to improve completion rates, particularly at weekends. Enhanced support from Social Work Quality Assurance – including coordinated timetable of audits for each Care Home; supporting action plan development; coordinating links with colleagues in Care Home Liaison, Infection Prevention and Control, Care Inspectorate etc; and support for Homes to claim financial assistance where appropriate. Care Home Liaison – establishment increased by 0.8wte B7 and 3.4wte B6 to move to a 7 day service and enhance contact with each home in Lanarkshire. The team have undertaken visits; managed daily data returns; acted as an escalation point for PPE issues; and participated in the prioritised engagement visits as required. Health Protection Team – To enhance the outbreak management and screening testing in Care Homes, an additional 0.6wte B7, 3wte B5, 1wte B4 and 3wte B2 staff have been brought into the team. Testing – All staff continue have access to weekly asymptomatic PCR staff testing through either the social care portal or NHS laboratory testing. In addition to weekly PCR testing care home staff are now also requested to undertake twice weekly Lateral Flow Testing. Infection, Prevention and Control – In conjunction with Care Home Liaison, the IPC team provide advice and support covering virtual visits, attendance at Care Inspectorate unannounced inspections and providing support to Homes as required. Senior Nursing Leadership – a team is being developed under the leadership of a Deputy Chief Nurse to provide an immediate response during early stages of an outbreak similar to acute care setting where the focus is on early containment. This team would build on the existing care home liaison team and would have additional workforce requirements as detailed below, including IPC expertise. The outbreak testing team would be embedded within the team. 5.3.4 In November 2020 a Care Home Outbreak Oversight Group was established, chaired by a Public Health Consultant, to provide oversight of all active outbreaks. To date, Fifty-six care home outbreaks have been recorded and 37 IPC outbreak supportive visits have been undertaken by IPC specialist nurses. As an outbreak is declared the care home assurance team deploy an IPC nurse to support the care home manager to review practice and identify any immediate issues. This is in addition to routine IPC audits and support visits. Feedback from these outbreak visits is provided to the Oversight Group and common themes recorded. This supports the targeting of messaging, education and support for care homes.
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4 5.3.5 As at 31st October, there are 3 outbreaks in care homes covering 20 residents and 8 members of staff cumulatively. 5.4 Personal Protective Equipment (PPE) 5.4.1 One of the biggest challenges during the early phases of the pandemic was the supply of PPE to frontline staff. The national PPE guidance has evolved over time, but overall the service has been able to maintain supplies to frontline staff in line with guidance. 5.4.2 There are no ongoing issues to report. 5.5 Delayed Discharge/System Pressures/Home Support 5.5.1 Following the first wave of Omicron, delayed discharge performance improved significantly and in early February has gone back down to 50s and 60s, as it had been in October and November. However, the second Omicron wave created significant challenges across the system, with delays returning to the 70s and 80s. 5.5.2 Despite very positive performance in June and through to mid-July, delays have become a greater challenge as acute and service pressures increase, averaging in the low to mid 70s. 5.5.3 As at 31st October, delays are 88, with 25 discharges lined up for the day. Performance has been reasonably consistent in the mid-70s over recent months, but in the second half of October this has spiked into the 80s. 5.5.4 The winter business case was approved at a special meeting of the IJB on 16th February 2022, with recruitment underway to support the development of the new models proposed, including: Home Assessment Teams in each Locality to support early discharge as well as admission prevention Expanded Home Support and Reablement capacity in each Locality New resource in District Nursing teams to proactively support Care Managed patients (those identified as being at the highest risk of admission) Expanded Integrated Rehabilitation Teams to create additional rehabilitation capacity for both discharge support and admission prevention 5.5.5 Home Assessment Team roll out continues, with capacity continuing to increase in Cumbernauld and Wishaw teams. A soft launch will commence in Airdrie and Motherwell Localities later this month. 5.6 Testing 5.6.1 Staff testing has continually evolved in line with the Scottish Government guidance throughout the pandemic. We have seen a gradual reduction in testing requirements over recent months and continue to follow the national guidance in full. 5.7 Covid Vaccination 5.7.1 The Covid vaccination programme continues at pace, with uptake as at 31st October as follows: Total doses administered 1,738,775
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5 Individuals with at least 1 dose 559,027 Partially vaccinated 26,738 Fully vaccinated 94,268 Boosters 438,021 5.7.2 The current autumn/winter vaccination programme is scheduled to provide vaccines to the respective population groups, operating 0800 to 2000 hrs, seven days a week across six sites, delivering c3,000 vaccinations per day commencing on 19 September. 5.7.3 Scottish Government modelling for NHS Lanarkshire to complete the programme by 5th December outlined that there would need to be around 92,000 doses of Covid-19 Autumn/Winter booster and around 97,000 adult flu vaccine doses administered in the first 6wks of the programme, with NHSL being beyond trajectory for both at present. 5.7.4 Strong progress has been made in the Care Home sector, but uptake in staff and 2-5yr olds has been lower than anticipated, though this follows national trends. The current DNA rate is around 17%, which is higher than expected and presents a risk to meeting the 80% uptake rate of all eligible groups by 5th December. That said, recent learning is that some DNA cases are now booking alternative appointments, which could at least partially mitigate the risk. 5.7.5 Of particular note is that all care home residents have now been offered both a covid and flu vaccination and uptake is higher than national average. 6. CONCLUSIONS 6.1 There has been a tremendous effort across the whole system (including third and independent sectors, communities and public partners) in building our response to the pandemic. 6.2 The dedication, bravery and commitment of all of our frontline staff should be commended in supporting us to continue to deliver a strong service to our residents in North Lanarkshire. 6.3 The delivery of the Covid Vaccination campaign is now at an advanced stage, with Lanarkshire comparing very positively against the Scottish averages. 6.4 NHS Lanarkshire moved back into black status on 27th July due to sustained staffing and bed pressures, with command structures proportionately in operation. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance:
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6 Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and is currently rated at very high. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 13 SUBJECT: North Lanarkshire Drug and Alcohol Partnership – Self Assessment TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning Performance and Quality Assurance Author(s) of Report John Holleran, ADP Strategic Lead DATE: 16th November 2022 1. PURPOSE OF REPORT 1.1. This paper is coming to the PFA: For approval For endorsement To note 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: Prepared by the ADP support team, approved by the ADP Board and reported to the IJB on 21 September 2022. 3. RECOMMENDATIONS 3.1. The PFA committee is asked to: a) Note the completed Self-Assessment
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2 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1. A Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. 5.2 The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes 5.3 The self-assessment is designed to ensure key relationships are in place and that the local system is supporting the work of the ADP. The self-assessment has been agreed and signed off with the relevant Chief Officers and stakeholders 5.4 The self-assessment sets out where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic planning 2. Financial arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight 5. The relationship between the ADP and the Integration Authority 5.5 The report presented through the IJB on the 21 September 2022 provided the context and intended content of the Self-Assessment. The report to the PFA provides the completed document. 7. IMPLICATIONS 7. NATIONAL OUTCOMES 7.1. This paper impacts on all of the national outcomes. Yes No N/A
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3 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1 Self-Assessment Toolkit https://mars.northlanarkshire.gov.uk/egenda/images/att98970.pdf CHIEF ACCOUNTABLE OFFICER (or Depute)
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4 Appendix 1 IMPROVING GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS WITHIN ALCOHOL AND DRUG PARTNERSHIPS: SELF ASSESSMENT TOOL Alcohol and Drug Partnerships Partnership Delivery Framework Self-Assessment Tool
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5 June 2022 Introduction to the Self-Assessment Tool This Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. The Scottish Government and COSLA coproduced the Partnership Delivery Framework for Alcohol and Drug Partnerships which was published in 2019. It sets out the expectations for the role of Alcohol and Drug Partnerships (ADPs The purpose of the self-assessment The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery.
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6 Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes ADPs are strategic planning partnerships that set out plans to delivery national and local priorities. To effectively deliver these priorities ADPs undertake strategic planning, formulate delivery plans and report outcomes. They do this on a partnership basis that aims to be inclusive and transparent with representation from stakeholders affected by alcohol and drug harms. Increasingly alcohol and drug harms are seen as a “whole system” issue and not just the realm of specialist drug and alcohol services. ADPs are not Statutory Public Bodies, i.e. they are not “organisations” and therefore rely on the Integration Authority for financial governance and ratification of investment as well as performance oversight. Community Planning Partnerships hold the overall responsibility for population level outcomes set out in the National Outcomes Framework for Scotland and therefore provide ADPs with an overarching forum for reporting achievement of outcomes. Local areas will also have other strategic partnerships which are required in statute such as Children Service Boards, Community Justice Partnerships etc and it is important to ensure that there are strong links between ADPs and these partnerships. The self-assessment is designed to help local stakeholders ensure that these key relationships are in place and that the local system is supporting the work of the ADP and vice versa. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders.
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7 The Scottish Government use of the Self-Assessment reports As stated, the self-assessment tool is for local stakeholders to ensure that they are creating the right conditions and operating environments for ADPs to function effectively. The Scottish Government will have oversight of the self- assessment reports and the information will be used to help develop programmes of support for local areas when required and will help facilitate peer discussions with ADPs about best practice and achievements. Where an ADP signals it would like further discussion or support in responding to local barriers, this will initially be provided through discussion with the ADP Liaison leads within the ADP Support Team in the Scottish Government. External Validation ADPs are asked to assess their own ability to deliver against the Quality Standards and highlight any issues. At a future point the Scottish Government will seek to validate the self-assessment through a third-party organisation such as the Care Inspectorate or Health Improvement Scotland. On that basis, ADPs should complete the self-assessment from the perspective of “if an external person reviewed our approach would they find the same evidence we are presenting?” How to complete the Self-Assessment Tool The self-assessment should tell a story about where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic planning 2. Financial arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight
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8 5. The relationship between the ADP and the Integration Authority A representative national working group agreed the following five standards in relation to the Partnership Delivery Framework. The five quality standards are: Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Structure of the Self-Assessment Tool
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9 The Self-Assessment Tool should be completed in conjunction with the Self-Assessment Criteria (Appendix 1 page 25- 34). The criteria outline the minimum supporting evidence required to demonstrate the ADP is delivering and working in line with the Partnership Delivery Framework. The first part of the Self-Assessment asks ADPs to assess themselves against the Self-Assessment Criteria and to map themselves again the Criteria using the definitions Maintain, Explore, Develop outlined in the table below. Definition Maintain We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. To meet this definition, the ADP needs to be confident that it has policies and practice in place. ADP member’s and senior stakeholders support this statement. The ADP has feedback processes in place and is confident that an external process could independently gather similar feedback locally. The ADP is confident in maintaining this standard as core practice. Explore We currently partly demonstrate this standard and may need further development The ADP feels it has some evidence to support the standard but isn’t confident it is consistently maintained. The ADP and stakeholders feel there is room for improvement on some elements of the standard. Develop We do not fully demonstrate this standard currently and need to develop / discuss this further. The ADP is not confident it is achieving the standard. Further work is required to generate support for improvement or progress
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10 The self-assessment then asks the ADP to demonstrate their assessment with narrative in line with the headings of: 1. How effective is the ADP in respect of this area? 2. How do you know this? 3. How will you do it and by when? For each of the elements described above, please outline in no more than 250 each what you need to maintain, improve or do differently and provide a timeframe for these to be implemented. Please be open and honest in your response and consider the self-assessment in collaboration with relevant stakeholders, including local communities, children, young people and families. This will provide opportunities to: review what progress has been made and what development and learning has happened provide assurance about the quality of delivery highlight areas of good practice for sharing highlight areas for improvement and levels of priority Those completing the self-assessment are encouraged to use information from different sources to triangulate evidence of the quality of service delivery. The completed Self-Assessment should focus on outcomes rather than activities. This could include a description of the impact of changes or improvement activities on the delivery or information on how potential impact is being monitored.
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11 The Self-Assessment Tool ADP area: Please use the box below to highlight relevant contextual and background information about the ADP including: -Population data for context -Outlining Governance and accountability arrangements (particularly in relation to ADP, Community Planning Partnership, Integration Joint Boards and Chief Officer Groups) -Links to other local statutory plans/partnerships (and how they link to local delivery) e.g. what links / role does the ADP have in relation to delivery of outcomes against their Local Outcome Improvement Plan / Children’s Services Plan Drugs North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 80 people dying from drug- related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire. There were 2,812 drug related crimes in North Lanarkshire in 2019/20 [latest figure available]. This is a rate of 82.4 per 10,000 population share, contrasting with a rate of 64.6 across Scotland.
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12 Alcohol In 2020, 101 people died from alcohol-related causes in North Lanarkshire. Alcohol related hospital admissions were 3270 in 2019/20 [latest available figures]. There were 36,135 Alcohol related hospital admissions across Scotland. Age-sex standardised rate per 100,000 for North Lanarkshire in 2019/20 was 982.36 and 673.27 for Scotland. The age-standardised death rates for alcohol-specific deaths in the most deprived 20% of areas in Scotland has been consistently higher than the rest. The death rate in the most deprived areas is 4.3 times the rate in the least deprived areas in 2020 (41 deaths per 100,000 compared to 10). Since 2001 the death rate in the most deprived areas has remained the highest of all five SIMD quintiles although the gap has narrowed slightly. *1 Not from the full sample of 94 deaths as at the time of analysis we did not have the toxicology reports for all 94 deaths therefore this percentage is from the available data set (61 of 94 deaths) SIMD and DRD Across Scotland in 2020, 1339 drug-related deaths occurred. Seven hundred and seven (53%) were in SIMD quintile 1 and three hundred and sixteen were in quintile 2 (24%) therefore 77% in quintiles 1 and 2. This is most significant if we consider the population of North Lanarkshire where 59% (32% SIMD 1; 27% SIMD 2) of the population is in SIMD quintile 1 or 2*. The strong links between drug and alcohol related harms and poverty1, inequality and trauma are widely acknowledged. Deprivation has been linked as a significant factor2 in drug and alcohol problems developing. 1 Hard Edges Scotland | The Robertson Trust 2 Staying-Alive-in-Scotland-Digital.pdf (sdf.org.uk) * See appendix 1 for fuller data
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13 What we see in North Lanarkshire is not unique and reflects a national picture where data trends are synonymous with the wider evidence base on substance-related harms3 . It is vital we have the most relevant data and evidence available to us to target the response needed to tackle the root causes of problematic substance in a holistic way. This includes using tried and tested approaches and targeting specialist responses across key localities. This will help to improve links to universal services and support the right investment in initiatives that can influence change and prevent deaths at the earliest opportunity. Support for Families In the Scottish Families report ‘Hidden in Plain Sight’ commissioned by NLADP in 2020, the vast majority of community survey respondents (9 in 10 people) felt their community had an issue with alcohol or drug use, with just 7% believing this not to be the case. NLADP strategy does not exist in isolation and is intended to link with other strategic plans focussed on identifying and protecting those at risk of harm from substance use. This includes but is not limited to: North Lanarkshire Children’s services plan Mental Health and Wellbeing Strategy Community Justice Improvement Plan Strategic Commissioning Plan VANL strategic plan North Lanarkshire Town Visions 3 Problem drug use in Scotland (parliament.uk)
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14 NL Housing Strategy & Rapid Rehousing Plan NLADP Structures Section 1: Strategic Planning Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes ADP Board Prevention Treatment ROSC Whole Family App/FIP Justice & Health Alcohol Harms Finance Sub Group
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15 Maintain Explore Develop We are confident that we are demonstrating this standard; we have evidence to support this, including stakeholder confirmation and need to maintain this focus overtime. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 1.1 Transparency and Effectiveness Further work is required to develop as part of ADP communications plan, web-site and app to share minutes/documents 1.2 Inclusion Confident this is fulfilled via ADP structures/Commissioned services 1.3 Planning Cycle Further work is required – ADP is relatively new in terms of governance.. 1.4 Needs Assessment Confident this is fulfilled via ADP structures/Commissioned services 1.5 Whole System Approach Further work is required – ADP is relatively new in terms of governance. 1.6 Resources and Delivery Further work is required – ADP is relatively new in terms of governance. 1.7 Outcomes Further work is required – ADP is relatively new in terms of governance. Q. How effective is your approach to Quality Standard 1?
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16 1.1 Transparency and Effectiveness The ADP has board representation from statutory and community sector representatives including people with lived and living experience. More work is required to develop as part of ADP communications plan, web-site and app to share key documents and development via minutes’/update documents. Currently all papers from NLADP to the IJB are shared via the North Lanarkshire MARS system. 1.2 Inclusion Confident this is fulfilled via ADP structures/Commissioned services. NLADP commissioned services regularly support direct feedback from those with lived and living experience, community representatives and the wider workforce. NLADP Board have approved a permanent lived experience project worker post to strengthen and maintain out inclusion focus. Work is ongoing to strengthen and sustain our approach. This currently includes: Barnardos, Phoenix Futures, North Lanarkshire Recovery Community, We Are with you, Equal Say Advocacy, Scottish Drugs Forum, Scottish Families Affected by Alcohol and Drugs, SAMH, Turning Point Scotland, Al-Anon in addition to statutory services engagement. 1.3 Planning Cycle The ADP is still in the process of defining our planning cycle following a great deal of work being carried out this year to finalise a new strategy, establish robust governance structures and formalise delivery and commissioning plans. The current planning cycle will take NLADP up until April 2023 when a new annual planning cycle will be put in place in keeping with the national guidance from the Scottish Government including the following elements: Assessing needs Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes
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17 1.4 Needs Assessment The partnership has undertaken extensive needs assessment via the Scottish Drugs Forum peer research programme; a recent rapid review research project carried out by Iconic Consulting; and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. NLADP Information and Research Officer supports ongoing analysis of NRS data with commissioned services monitoring reports to allow NLADP to assess need and target responses on an ongoing basis. All work carried out is now being drawn on to inform commissioning priorities into 2023. 1.5 Whole System Approach NLADP Board, finance and 5 sub-groups have broad representation from key stakeholders/partners and people with lived and living experience in taking a whole-systems approach. This includes; Police Scotland/NHS/Education/Housing/Justice/Community sector and a number of community representatives with lived and living experience. More work will be undertaken as part of our workforce development agenda and training needs analysis, launched in September 2022, to strengthen the Whole System Approach. The ADP support team is widely represented via a number of existing partnerships and networks including but not limited to: Adult protection committee Child protection committee Community Justice Partnership
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18 Violence against Women partnership NL housing partnerships Mental Health Partnership Improving Child Services group NLADP Commissioned services delivery group 1.6 Resources and Delivery Currently under review to inform commissioning priorities and resource allocation into 2023 and beyond. NLADP has a clear understanding of the resource available, the needs that exist and a clear plan. 2022 has been a transitory year for NLADP to review and move towards a more sustainable commissioning model and planning/evaluation cycle. 1.7 Outcomes NLADP Strategy clearly sets out the ADP priorities. Delivery outcomes to demonstrate progress and impact are currently under review to inform commissioning priorities and resource allocation into 2023. The support team continues to work closely with commissioned services during this transition to ensure local needs are met. The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework. Q. How do you know this?
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19 NLADP has undertaken extensive needs assessment via SDF peer research, rapid review research carried out by Iconic Consulting and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. This include the view and experience of those who have used services locally including families. NRS data with Commissioned services monitoring reports also supports NLADP assess need on an ongoing basis. Q. What do you want to maintain, improve or change, how will you do it and by when? April 2023 and beyond – NLADP commissioning plan and delivery plans will be published setting out funding priorities with spend and review arrangements. NLADP will work more closely with community solutions and the community sector via VANL to co-produce more of the responses that are required to tackle the root causes of problem substance use beyond 2023. Any further comments?
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20 Section 2: Financial Governance Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of its Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 2.1 Investment Confident this is fulfilled via ADP structures/Commissioned services 2.2 Governance Confident this is fulfilled via ADP structures/Commissioned services 2.3 Accountability Confident this is fulfilled via ADP structures/Commissioned services 2.4 Reporting Confident this is fulfilled via ADP structures/Commissioned services 2.5 Financial Planning We currently partly demonstrate this standard and may need further development. Work underway to set out commission plan for 2023.
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22 Q. How effective is your approach to Quality Standard 2? 2.1 Investment NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements. The finance group currently meets every 6 weeks with updates at ADP Board level also on a 6-weekly basis. Investment decisions from each sub-group are reviewed by the finance group before final approval by the NLADP board. 2.2 Governance NLADP has a clear reporting mechanism for monitoring and reviewing the investment arrangements. The finance group currently meets every 6 weeks with updates at ADP Board level on a 6-weekly basis. 2.4 Accountability NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – finance group currently meets every 6 weeks with updates at Board level also on a 6 weekly basis. Accountability beyond the North Lanarkshire ADP Finance Group is to the NHS Lanarkshire Board and to the Council Committees covering Adult Health and Social Care and Education and Families. The Chief Officer of the Health & Social Care Partnerships (North) is accountable for:
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23 The Scottish Government Direct Funding allocation services The Local Improvement Fund investment in services to reduce problem alcohol and drug Drug Deaths Taskforce Funding Additional Funding allocation to NLADP from Scottish Government 2.5 Reporting NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – finance group currently meets every 6 weeks with updates at Board level also on a 6 weekly basis. 2.6 Financial Planning NLADP has a clear reporting mechanism monitoring and reviewing the investment arrangements – We currently partly demonstrate this standard and may need further development. Work underway to set out commission plan for 2023. Most recently NLADP brought together the board, finance group and key stakeholders for a development day to agree priorities for investment. This will form that basis of the final delivery and commissioning plans. More work is required here to ensure Lived/Living experience panel are established and have a more active role in financial planning review processes. This currently happens at IJB level. Q. How do you know this? NLADP finance group meeting minutes/draft commissioning plan and regular spending/variation review and monitoring at this forum and updates to the NLADP board.
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24 Q. What do you want to maintain, improve or change, how will you do it and by when? Further work required to finalise and publish NLADP delivery and commissioning plan by April 2023. Any further comments? Section 3: Quality Improvement Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes
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25 Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 3.1 Methodology We currently partly demonstrate this standard and may need further development. 3.2 Reporting We currently partly demonstrate this standard and may need further development. 3.3 Sustainability We do not fully demonstrate this standard currently and need to develop / discuss this further.
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26 Q. How effective is your approach to Quality Standard 3? 3.1 Methodology QI methodology applies across all NHSL improvement projects – more work is to be done to train staff and stakeholders to support relevant Test of Change initiatives. Three members of the NLADP support team have undertaken Quality Improvement training which underpins our approach. 3.2 Reporting Currently commissioned services are required to provide regular monitoring reportswith the next 6-month review due in October 2022. From April 2023, all commissioned services will report to the ADP support team on a quarterly basis, with 6 month/Annual reviews taking place. More work is required to offer support and improve performance monitoring processes. NLADP Lead and Information Research Officer carried out a review of data and evidence in 2022 to understand gaps and improve the quality and consistency of data to the ADP. Work continues with Health Improvement/Public Health colleagues to strengthen links and QI data to help inform and target future initiatives. Work of each sub-group is underpinned by QI principles including the Drug Deaths Prevention Group/Reducing Alcohol Harms group and existing test of change initiatives proposed. This includes investment from DTTF and Corra funded initiatives such as prison Link worker, naloxone, Family learning centres and Breakthrough housing support initiatives.
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27 3.3 Sustainability NLADP has more work to do to support more sustainable quality measures in keeping with planning and commissioning cycles as these are reviewed for implementation beyond 2023. This will be built into future commissioning processes more routinely and robustly via SLAs/ongoing monitoring and performance review processes. Q. How do you know this? NLADP has undertaken extensive needs assessment via SDF peer research, rapid review research carried out by Iconic Consulting and ongoing needs assessment via the ADP sub-group structures/drug-deaths prevention group. PHS/NRS data with Commissioned services monitoring reports also supports NLADP assess need on an ongoing basis. All work carried out is now being drawn on to inform commissioning priorities into 2023. Q. What do you want to maintain, improve or change? NLADP has more work to do to support more routine and sustainable quality measures in keeping with planning and commissioning cycles - these are to be reviewed for implementation beyond 2023. More work is required to support all partners and stakeholders to understand and apply QI principles. New Staff to the ADP support team will complete QI training. Improve access to information and data around alcohol harms working closely with PH and HI colleagues.
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28 Any further comments?
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29 Section 4: Governance and Oversight Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 4.1 Oversight We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. 4.2 Governance We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. 4.3 Risk Management We currently partly demonstrate this standard and may need further development. 4.4 Accountability We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time.
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31 Q. How effective is your approach to Quality Standard 4? 4.1 Oversight NLADP structures are clearly set out with each group directed with a specific Terms of reference setting out meeting frequency, governance arrangements and review processes. There are clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. The draft ADP strategy was shared with all stakeholders and partners for feedback and review. NLADP hosted a number of consultation meetings as part of the strategy development including an online stakeholder event and a follow up consensus event. 4.2 Governance NLADP structures are clearly set out with clear Terms of reference for each group setting out meeting frequency, governance arrangement and review processes with clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. 4.3 Risk Management Further work is required to define and embed risk management processes and to review arrangements moving forward. 4.4 Accountability
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32 NLADP structures are clearly set out with clear Terms of reference for each group setting out meeting frequency, governance arrangement and review processes with clear lines of accountability to NLADP Board/HSCP and IJB. NLADP group membership has broad representation. Q. How do you know this? NLADP structure, strategy, draft commissioning plan/delivery plan/Group terms of reference, membership lists, meeting minutes, decision making/action logs. Q. What do you want to maintain, improve or change, how will you do it and by when? Improve the transparency of the processes and decision making arrangement making details more widely available as the ADP website develops to be able to host information. NLADP will establish lived experience panels in 2023 to review and feedback on future proposals/investment as part of our governance and oversight arrangements
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33 Any further comments?
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34 Section 5: The relationship between the ADP and the Integration Authority Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 5.1 Alignment and Governance We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time.
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35 Q. How effective is your approach to Quality Standard 5? 5.1 Alignment and Governance The ADP Chair is a member of the HSCP Senior Leadership Team and IJB. The progress and performance of the ADP is regularly reviewed at these forums with ongoing feedback. All activities linked to NLADP strategy, delivery and commissioning plans and ongoing performance is scrutinised, reviewed and adjusted via the Integration Joint Board Planning, Performance and Audit (PF&A) committee and approved at IJB level. Q. How do you know this? The integrated authority already has robust mechanisms in place. Full details are open and transparent via NLC with all papers and minutes publically available. The role, function and performance of the ADP is well understood across the HSCP and IJB. Q. What do you want to maintain, improve or change, how will you do it and by when? NLADP will continue to approve spend/adjustments via ADP structures and sub-groups subject to ongoing monitoring at IJB PF&A committee and IJB. Increase the profile and understanding of the ADP and the work we do to encourage more participation achieving our outcomes. This includes ensuring the MAT standards are implemented effectively with the full support of the senior leadership team to influence the change required to fully embed the standards across all localities.
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36 Any further comments?
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37 This Self-Assessment of Partnership Delivery Framework is agreed and ratified by: Senior System Stakeholders ADP Lived Experience Stakeholder/s / Representative Kerry Anne Clarke – NL Recovery Chair of the Alcohol and Drug Partnership Morag Dendy Chair of the Community Planning Partnership The Chief Executive of the Local Authority Des Murray The Chief Executive of the NHS Board Heather Knox Director of Public Health Professor Josephine Pravinkumar The Chair of the Integration Joint Board The Chair of the Chief Officers Group Divisional Commander for Police Scotland Stephen Dolan Chief Executive of Third Sector Interface Maddie Halliday The Chief Officer of the Health and Social Care Partnership Ross McGuffie
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38 APPENDIX 1 Self-Assessment Criteria
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39 1 Quality Standard 1 : The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans 1.1 Transparency and Effectiveness X The strategic plan is agreed by the ADP X The strategic plan is published and publically available X The ADP can demonstrate effective strategic linkage with other local partnership groups and local communities X The ADP can demonstrate examples of improvement activities and positive outcomes for the local population X The ADP can demonstrate evidence that Strategic Planning is safe, effective, compassionate and person-centred 1.2 Inclusion X The ADP can describe how they engage with local communities X The ADP can demonstrate how any potential barriers to involvement or engagement are removed X The ADP strategic planning is inclusive of people affected by drug and alcohol harms and their family members, those who use services, those who deliver services, and the local population X The ADP embeds equality impact assessment processes to understand the diverse needs of local populations and uses this information to inform pathways and provision in its strategic planning and ensure human rights are met
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40 X The ADP Strategy effectively aligns to other statutory plans / priorities on delivery in support to families in crisis or at risk of being in crisis as a result of drug / alcohol use (e.g. Child Protection, Adult Protection) 1.3 Planning Cycle X The ADP can demonstrate that it delivers in line with a strategic cycle for planning which includes: needs assessment, delivery, commissioning, review and reporting of outcomes / progress X ADP Strategic Planning is based on population health approaches and includes primary, secondary and tertiary prevention 1.4 Needs Assessment X The ADP has a local assessment of the needs of people who use alcohol / drugs led by NHS Public Health and involving partners 1.5 Whole System Approach X The ADP can demonstrate that their strategic planning is based on national and local priorities, is evidence based and aligns with delivery of local supports and services X The ADP has representatives of: X Health and Social Care Partnership: mental health, primary care, adult services X Specialist drug / alcohol services X Health (e.g. emergency department, relevant acute wards, health improvement / public health)
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41 X Children’s services X Police X Justice services X Housing / accommodation / homelessness services X Employment services X Community X Lived experience X Education X Third Sector Interface X The ADP can demonstrate that other local planning partnerships and services incorporate and complement ADP activity to reduce alcohol and drug harms 1.6 Resources and Delivery The ADP has an annual delivery plan agreed by member organisations that details resources aligned in support of delivery, including the following: direct resource, local financial investments and “in kind” resources. It details cross-system prioritisation and responsibilities within, for example, Health and Social Care Partnerships, Children’s Services Planning Partnerships, Community Justice Partnerships and Community Planning Partnerships to be deployed to implement the Annual Delivery Plan and the outcomes to be achieved
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42 1.7 Outcomes X The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework X The ADP outcomes are measureable and reportable X The ADP routinely reports on progress against strategic outcomes 2 Quality Standard 2 : The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans 2.1 Investment X The ADP is able to demonstrate that investment in the delivery of outcomes comes from a range of sources, including the Local Authority, Health Board and the Integration Authority, as well as outside of the public sector X The ADP can demonstrate investment is in line with Scottish Government priorities X The ADP can demonstrate that investment is based on evidence of effectiveness and outcomes X The ADP can demonstrate ability to disinvest based on evidence of effectiveness and outcomes and in line with changing priorities articulated though formal needs assessment
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43 2.2 Governance X The ADP has clear policies and procedures for aligning resources for investment with strategic planning X The ADP seeks authorisation for investment from the Integration Authority and local scheme of delegation X The ADP has a clear policy agreed with members and the Integration Authority on the treatment of underspends / overspends X The ADP can demonstrate effective and transparent governance arrangements are in place X The ADP can relate investments in third sector and public sector to performance and outcomes 2.3 Accountability X The ADP and the Integration Authority can demonstrate all funding allocated to NHS Boards for onward delegation to ADPs is available to the ADP X The ADP has full accountability for the totality of funding allocated for drugs / alcohol from its NHS Board and Local Authority 2.4 Reporting X The Health and Social Care Partnership Chief Finance Officer is a member (or formally represented) on the ADP X There is regular routine financial reporting to the ADP on the total spend on alcohol and drug services The ADP and Integration Authority provide an quarterly and annual financial report to the Scottish Government X The ADP reports to local governance structures on investments
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44 2.5 Financial Planning X The ADP strategy includes investment to increase activity over time in relation to prevention and early intervention aligned with other such preventative spend across local partners / partnerships 3 Quality Standard 3 : The ADP can demonstrate quality improvement in delivery of outcomes 3.1 Methodology X The ADP has or uses an underpinning quality improvement methodology X ADP staff and members are supported to use improvement methodologies through training and other workforce development activities 3.2 Reporting X The ADP can demonstrate examples of where improvement methods have had a positive impact X The ADP can demonstrate links with outcome reporting, needs assessment and financial investment / disinvestment
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45 3.3 Sustainability The ADP can demonstrate how achieved improvements are embedded and sustained X The ADP benchmarks performance with other areas (e.g. other ADPs, other partnership groups) 4 Quality Standard 4 : The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan 4.1 Oversight X ADP Members can demonstrate effective oversight arrangements are in place to deliver the local strategy X The ADP can demonstrate processes to ensure oversight, coordination and alignment of ADP activity with other relevant local partnerships and strategies 4.2 Governance X The ADP has published the roles and remit for members setting out how decisions are made, issues and disputes are resolved, conflicts of interest are managed X There is a organogram that sets out the relationship of the ADP with the Integration Authority, with other planning boards (e.g. Children’s Partnership and the Community Justice partnership), and with areas of statutory responsibility (e.g. Child Protection and Adult Protection)
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46 X The ADP can demonstrate how they know governance structures provide appropriate assurance of safe, effective, compassionate and person- centred delivery X There are process in place for the ADP Chair to escalate and progress discussions with local partners / responsible officers when a priority is not being delivered and a process in place to ensure ADP contribution to aligned plans is being progressed X The ADP strategic plan forms part of the overall Community Planning Partnership (CPP) offer, is ratified via CPPs, and aligns with the priorities of other key statutory plans 4.3 Risk Management X There is a clear process for identifying and managing risk in relation to delivery of national and local priorities X There are clear controls in place to reduce impact of identified risks X The ADP can demonstrate how failure is reported, analysed and learning facilitated 4.4 Accountability X The ADP can describe clear accountability to appropriate Chief Officer(s) responsible for the delivery of relevant policy, system or targets X The ADP can demonstrate clear articulation of the relationship with senior accountable officers, and specifically, the relationship between the ADP and Public Protection that sit with the local Chief Officers Group and can demonstrates that processes are in place to ensure learning from drug deaths and responsibility for reducing substance use mortality and harm
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47 5 Quality Standard 5 : The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan X The ADP has a clear policy on taking investment plans and business cases to the Integration Authority Joint Board for ratification X The ADP provides performance and financial reporting to enable support the development of the Integration Authority’s Annual Performance Report X The ADP regularly reports to the Integration Authority on performance X The work of the ADP is reflected in the objectives of the Integration Authority Strategic Plan X Governance and oversight arrangements for ADP business are supported by the Integration Authority X Adult treatment services are delivered in line with ADP strategy X The ADP and the Integration Authority have a clear policy on how decisions and directions are managed for services out-with the scope of the Integration Authority (e.g. children’s services, police, housing will be issued) X The Integration Authority ensures governance arrangements support the deployment of resources at pace to support the Mission
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1 REPORT Item No: 14 SUBJECT: Service recovery, winter planning and supporting the health and social care system TO: Integration Joint Board Performance, Finance and Audit Lead Officer for Report: Ross McGuffie, Chief Officer, North HSCP Author(s) of Report Morag Dendy, Head of Planning Performance and Quality Assurance DATE: 16th November 2022 1. PURPOSE OF REPORT 1.1. This paper is coming to the IJB for: For approval For endorsement To note 1.2. The current and projected demand for health and social care services is significant with pressures experienced across NHS, Social Work and Social Care systems locally and nationally. To respond effectively to this demand through winter 2022 and beyond, key developments and actions have sought to increase capacity, strengthen response and maintain safe and effective services in North Lanarkshire. 1.3. In September 2021 the Integration Joint Board approved the creation of a Change Fund to support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire Health and Social Care Partnership, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan. 1.4. Subsequently, the Scottish Government allocated additional funding in 2021/2022 and has committed to further recurring investment from 2022/2023
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2 to increase capacity across health and social care services with immediate effect. 1.5. In February 2022, the Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target non-recurring reserves to implement a series of proposals, including the development of a Home First model in North Lanarkshire, additional community nursing capacity, enhanced care at home capacity, and additional infrastructure supports. 1.6. This report provides an update on the significant progress made on implementing the proposals and affecting change. 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: Prepared with key members of the Strategic Leadership Team and leads from the areas of development 3. RECOMMENDATIONS 3.1. The PFA committee is asked to: a) Note the content of the Report b) Endorse the approach to service recovery, winter planning and change programme c) Require future reporting reflecting a whole system data set. 4. VARIATIONS TO DIRECTIONS? 5. SUMMARY OF KEY DEVELOPEMNT 5.1 Discharge Without Delay Improvement Work 5.1.1 There are several improvement areas that the sites are working on. Yes No N/A
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3 PDD refresh across all three sites is already showing some improvement in terms of PDDs set, reduction in unplanned. Work is underway to test this in acute receiving and see if PDDs could be set from the front door. Overnight checking of social care issues in the FNC (starts mid-week next week). This will hopefully head off any back log in social care issues as the social care/ work can address discharges first thing in the morning. Testing UHH first and then will come to the other 2 sites. PDD implementation checklist / Discharge Checklist Home First/ Home Assessment Teams expanding South and North. Including end of life pathways and third sector discharge support. Band 3 staff supporting discharge Review of S.A.F.E.R (DDD) across all three sites – starting with UHH and UHW with a focus on planning for discharge on the day and next day preparation. Discussion with each site/ senior nurse/ medical staff- how many patients can be discharged based on staffing capacity – what would we expect? Readmissions review and actions. Delays continue to be managed through daily scrutiny calls. Local improvement plans are in place in relation to care at home/ home support. 5.1.2 Overall and across the three acute sites, 47% of patients have a PDD set, but some wards have been able to set PDDs in over 70% of patients. The day and time of discharge is also important to flow and response, with only 10% of patients discharged over the weekend. Overall, 70% of patients with a PDD set are discharged with no delay, highlighting the success and importance of this area of work. 5.1.3 A key focus of improvement work is to address the number of unplanned social care referrals (i.e., those with no PDD or less than 24 hours and 48 hours from referral. 5.1.4 As we continue to expand the use of PDD across inpatient wards, and particularly within care of the elderly wards, we anticipate the proportion of patients currently aged 65 and over with a PDD will increase (currently just over 50%). 5.2 Home Assessment Team 5.2.1 The cornerstone of a Home First approach is the development of a Home Assessment Team (HAT), putting resources heavily into capacity to undertake assessment at home, at the time it is needed, to shape the responses more effectively thereafter. The focus of the HAT is assessing at home, developing on good conversations with the person and their family to build on strengths, maximise independence through rehabilitation and reablement, clearly articulate outcomes and what is most important to the person. The approach is underpinned by principles of realistic medicine and promoting a human rights approach to care and support dovetail any support arrangements identified by the HAT with Reablement, Integrated Rehabilitation Teams, the resources of the wider community as well as through ongoing supports such as home support and integrated day services.
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4 5.2.2 The HAT has created ring-fenced teams to enable: A designated workforce whose focus is enabling discharge and maximising function in the home environment by increasing the number of timely post- discharge assessments and providing a rapid community response to prevent hospital admission A robust discharge pathway for those who require home assessment following discharge from both front door and downstream wards Flexibility to deploy the workforce across the sectors Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?) Clear leadership within discharge services An approach to avoiding admission to be developed with the IRT and locality teams Wide-ranging strong links with discharge facilitators within the hospital discharge hub Close links with Planned Date of Discharge Team to identify appropriate patients for the pathway. Close working relationship with IRT, District Nurses, Acute Allied Health Professionals, Hospital at Home and Hospital Discharge Support Programme (3rd sector) with access to equipment stores. 5.2.3 Home Assessment Team – Current Position (as at 8/11/22) 144 people have been supported by HAT since 26/4/22 5.2.4 Of those with an outcome recorded, 60% required no further support; 15% were readmitted to hospital; and 25% required further support 5.2.5 Of those requiring further support, roughly half moved into the reablement service and half have moved into long-term home support. 5.2.6 We are closely monitoring the time of response and time spent with the Home Assessment Team: Average time from referral to assessment start is 1.6 days Average time from assessment start to completion is 9.9 days Average time from referral to HAT to discharge is 1 day 5.2.7 Acceleration Plans Increased focus on in-reach – identifying potential patients from MiLan Support service users who require assistance of two to mobilise Support service users who have existing home support to better understand needs once home
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5 5.2.8 Recruitment Position Funded In post Appointed Vacancies Home Support 118 22 26 70 Social Work 6 4 1 1 AHP 24 6.8 3 14.2 Admin 1 1 5.3 Hospital at Home 5.3.1 The Business Case investment in Hospital at Home services extends the service offered to adults under 65 years of age and to the working hours of the service. Introduction of Advanced Nurse Practitioners (Band 7) allows the service hours and patient admission to service to continue until 10pm. 5.3.2 To allow 2 Band 7 ANPs to be rostered on 7 days a week (one from 8am-6pm, and one from 2pm-10pm) would require 4.58 WTE (including 22.5% planned leave allowance). There is a current national shortfall in the availability of qualified Advanced Practitioners, therefore a training programme will need to be offered and supported, this requires up to 2 years to complete (although some potential internal Hospital @ Home candidates have already been supported through the advanced clinical care and Non-Medical Prescribing programmes, so may require less support before becoming fully qualified). 5.3.3 During the Covid pandemic to assist with anticipated hospital flow and to increase ability to serve GPs with hospital admission a “step down” hub was created to ring fence staff and create a designated flow for Acute inpatients to be discharged into the Hospital @ Home service. This service improvement contributed to the increased referral activity and has admitted an average of 38 patients per month in 2021. Due to the clinical presentation of the patients at admission to Hospital @ Home the model could be slightly adapted to allow the patients to be managed by a Junior doctor (with Consultant in-reach when necessary) and band 5 nurses. 5.3.4 Junior doctors have been difficult to recruit on a continuing basis, however an ANP band 7 nurse could provide clinical management to these patients. 5.3.5 The Hospital @ Home team routinely support more than 200 patients per month. Whilst GPs remain the largest source of referral at just short of 70%, 24.6% of referrals are now received from inpatients wards as the service moves to supports more patient discharges from hospital. 5.4 Community Nursing 5.4.1 The HCSW resource is being used to support a refresh of the existing care management approach. Care Management uses early warning indicator tools such as SPARRA to identify those people in our communities who are at highest risk of admission to hospital. These individuals are allocated a district nurse to undertake focused work with them to care plan and minimise the risk,
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6 but their social care needs are provided separately. The testing of a new approach involves the additional HCSW being placed in existing community nursing teams supporting them to meet all care needs whilst they are being care managed. This supports a very person-centred approach focusing on what matters most to people and their families but also on stabilising their conditions and reducing their risk of admission. Some of this funding has also been skilled mixed to ensure that we have enough of a registrant workforce to supervise the HCSW. The home first approach will ensure that people can return to their own home whilst assessment of future needs is undertaken. Any nursing needs during this time would have previously been provided within acute services therefore this is new work for community nurses. The allocation of funding to this proposal will support this new development. The additional registered nurses are required to support new developments including the administration of IV antibiotics whilst we undertake a full community nursing review. 5.4.2 This approach encompasses anticipatory care planning using the principles of realistic medicine. This has support over 100 families to remain at home together for end-of-life care. An average of 7 hours of direct nursing care is being provided to these patients per week. It has reduced footfall into people’s homes during this time and ensured that the team providing care were able to meet all of the care needs. Of these cases only two required admissions to hospital and two were transferred to hospice care as per the patients plan. 5.4.3 Recruitment challenges have impacted on the progress of this work at the desired scale. However, 30.6 WTE band 3 are in post, and 6 WTE band 5 are in post. It should also be noted that due to difficulties in recruiting we have recruited people with no previous health and social care experience therefore extensive training and development is required. 5.5 North Lanarkshire Home Support Service 5.5.1 The Home Support Service is a large and complex service that is responsible for the safety, health and wellbeing of the most vulnerable in our communities. The Service supports around 3,000 people (2,200 in house) at any one time, deploying an inhouse workforce of 979.5 FTE home support workers (headcount = 1,430 workers) (excluding Home Assessment Team) with additional commissioned support provided by independent sector providers. Across both inhouse and commissioned services, we provide 36,000 hours of support per week (72/28 inhouse/independent sector split). An additional 190 older adults direct their own support through individual budgets. 5.5.2 Recruitment Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. Home Support Worker, Support Officer and Service Delivery Coordinators are particularly difficult to recruit and retain. The tasks and skill set needs to be reviewed for a number of posts, including administration and management roles which are critical to supporting our staff. Nevertheless, the home support service continues to expand, and we have
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7 identified an additional 78 FTE posts for permanent appointment and 78FTE fixed term posts to support the service through the winter and into 2023. 5.5.3 Reablement Reablement and rehabilitation are integral to supporting people and will be offered to everyone unless there is no reablement potential due to complex health and/or palliative care needs. Reablement capacity suffered throughout the C-19 pandemic as the immediacy of our home support response took priority. The number of people commencing support through our reablement service has started to recover and we continue to face the challenge of protecting our approach in the face of ongoing daily challenges in supporting people’s discharge from hospital. The percentage of people with a new or increased package of care who commence support with our reablement service, previously stood at approximately 70-75% before the onset of the C- 19 pandemic. This dropped below 60% during 2021 and has started to recover gradually. Similarly, the percentage of people who require a reduced level of support or no further support following reablement previously stood at 70-75% pre-pandemic and we anticipate this to improve from current levels (50-55%) as capacity increases. As we seek to protect our reablement resource, we anticipate that pre-pandemic levels of reablement will be re-established. 5.5.4 Reviews (Home Support) While significant progress has been achieved in working through the backlog of outstanding reviews for people receiving a home support service (see below), the number has very recently started to trend upwards. 5.5.5 Unmet need The number of people waiting for a home support service (following assessment) both in hospital and community settings has shown a general decline since weekly monitoring was introduced in 2021. This trend has also been reflected in the number of hours of support. However, we are aware of the increase in more recent weeks and our response outlined elsewhere will seek to address this increased demand.
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8 5.5.6 The number of people waiting for an assessment in the community remains high and while not having a direct impact or influence on our delayed discharge performance, we are concerned that this level of unmet need in the community will eventually impact on the wider health and social care system if we don’t address this need at the earliest opportunity. 5.6 Interim Beds 5.6.1 Interim placements, and the use of care home facilities for shorter term use will be needed for specific reasons, particularly where the care home of choice is not available immediately. To date, we have used a spot purchased beds in the area of the patient’s choice, but this is becoming increasingly difficult as Care Home providers experience staffing challenges against an uncertain service demand. 5.6.2 A procurement exercise is being undertaken to secure resources for people who: are medically fit for discharge from hospital have been assessed as requiring nursing care in a care home facility are unable to be discharged as their care home(s) of choice has no availability
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9 5.6.3 The procurement exercise will set an increased maintenance rate for such circumstances, covering a clear minimum to maximum number of days and weeks. Part of the procurement exercise will be a Q&A session with all providers to answer any questions and or concerns and hopefully create further interest in this way of working going forwards. 5.6.4 For a small number of people, an interim placement may also be needed when it is not possible to return home immediately: Person’s home requires repairs/adaptations Person’s home needs cleaned to bring it to a habitable condition (though this should be identified at admission to hospital and actioned immediately) Person’s ongoing support cannot immediately be met by in house Home Support services or independent sector contractors (though this should be minimally required as the impact on independence and levels of ability will be impacted by being in a nursing home) 5.6.5 To date, the partnership has spot purchased care home places for individuals requiring interim care, but this is proving difficult. In early November, 18 patients in hospital had an onward plan of nursing care home, with the care home of their choice not being available. The 18 patients were been identified as suitable for interim care, but despite extensive efforts, only 3 placements have been possible. 5.7 Independent Sector 5.7.1 Funding to support sustainability within the independent sector has been offered over two opportunities to bid for resources. Funding application and details were distributed to approximately 45 Providers on the SDS Framework. Submissions from 15 providers were received with a total of 21 payments made. 5.7.2 Proposals for funding reflected several creative ideas responding to the priorities now around recruitment, retention, training, and staff wellbeing. 5.8 Third Sector 5.8.1 Community Solutions, hosted by VANL, is highly successful in strengthening local communities through investment against clear strategic drivers to focus on connection. To make that local response, with a real emphasis on prevention and early intervention, an increased focus, monies from the Winter planning Business Case were identified to add to the community capacity building work already well embedded to enhance: First Point of Contact and 3 conversations Develop the response to frailty Promoting active health Further developing social prescribing Increasing the response to wellbeing Address digital exclusion
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10 5.9 Future Workforce 5.9.1 Health and Social Care was the largest employment sector within North Lanarkshire in 2020 and it accounted for around 25,000 jobs or 20% of all employment. It is also an area of job growth with significant additional replacement demand. 5.9.2 The increased complexity and volume of demand and ongoing supply shortages in critical health and care roles including Nursing, Allied Health Professionals, Mental Health Officers and Home Support Workers requires the strengths of the existing care academy model to be built upon and the range of offers across the authority area for people in our communities increased. 5.9.3 The Care Academy is an essential partnership which will work to achieve the ambition to build a workforce for the future, developing an integrated single academy model that meets immediate employment demands within the sector, as well as building progression and career pathways for young people, residents of working age and targeting those who may consider a career change or return into the sector. 5.9.4 To enhance resilience within the sector in preparation for winter and beyond, we will continue to maximise our existing workforce through contacting recent retirees across a range of roles to return to the workforce; utilise Allied Health Professionals on staff bank; and continue to work with the Higher and Further Education institutions to offer placements and other opportunities to current students and newly qualified individuals. 5.10 Support to unpaid carers 5.10.1 Unpaid Carers of all ages play a vital role in the lives of the people they care for and the Council is committed to supporting Carers to ensure they can continue to provide that care for as long as they wish. 5.10.1 Key services were commissioned in March 2019, to undertake the following functions: • Direct support for adult Carers: Lanarkshire Carers • Carer’s campaigning, information and representation services: North Lanarkshire Carers Together • Young Carers Support Services: Action for Children Young Carers Service • Community Solutions Programme: Voluntary Action North Lanarkshire to support community responses to carers and specifically target people who would not necessarily identify as being a carer. 5.10.2 The commissioned Carer Support Organisations were awarded contracts in March 2019, are now nearing the end of the original contract period. An extension of the contracts for a period of 2 years is being sought to maintain consistency and confidence in local services through this challenging time.
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11 5.10.3 The Carer Breather pilot over a period of 18 months is due to end in March 23. Early feedback on the success of the pilot has been very positive, particularly from those who were able to have a break together and for those providing care but who did not necessarily wish to identify with a carer’s organisation. 5.10.4 North Lanarkshire participated in the national Care Inspectorate Inquiry into Carers experiences of adult social work and social care through Covid. North Lanarkshire were one of the 5 Health & Social Care Partnership areas participating in a more in-depth inquiry. The Inquiry has now been completed and we await feedback on the outcome. 5.11 Anticipatory Care Plans 5.11.1 Considering what is important to you, thinking about the implications for future actions and interventions and recording views so that they can be shared and understood is essential to maintaining choice and control. In December 2019 a multi-disciplinary team (MDT) approach was set up in North Lanarkshire to develop a preventative approach to reduce the unscheduled care demand on both primary and secondary care for older people in the community. The work focused initially on one General Practice with the overall goal to develop, test and spread primary care multi-disciplinary team (MDT) team meetings. 5.11.2 The model initially involved home frailty assessments completed by nurses. During Covid 19 with the MDT work paused a third sector provider tested this extending their role to supporting frailty assessments. This work assisted: • with a focus on reaching people at an earlier stage of their condition • assisting in increasing independence and self-management by encouraging people to plan ahead and take control of their own future care needs • improving and supporting people with frailty & urgent care needs to be assessed sooner and have their views and wishes respected • ensuring the person is being supported to access preventative support in the community when living with frailty • ensuring that the person is at the centre at all times 5.11.3 The third sector provider have supported the Primary Care Frailty preventative approach and have supported 119 patients between Feb 21 to Sept 22 to the MDT for discussion: 5.11.4 The patients who were brought to the MDT had the following conditions identified Depression 29% Incontinence 59% Care Needs 25% Unsteadiness 21% Falls Risk 21%
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12 5.11.5 Frailty assessment • 119 older adults living in the community were identified as being at high risk of deterioration • 119 have person centred outcomes including supported frailty self- assessments and ‘what matters to them’ • 90% have had a falls/frailty assessment • 43 multidisciplinary meetings held 5.11.6 Pharmacy • 100% of people had a polypharmacy review 5.11.7 Anticipatory Care Plans (ACP) • In one practice the number of ACPs completed for the severely frail category rose from 10% to 25% within the period of April 2021 to September 2021 • All patients are offered an ACP by Equals Advocacy. In total 69% have an updated ACP and the remaining 31% will continue to be offered it at the appropriate opportunity. 5.11.8 Work is being undertaken to embed the learning and approach across all localities on North Lanarkshire. 5.12 Care Home residents 5.12.1 An improvement project is currently underway to support care home staff to complete high quality Anticipatory Care Plans and ensure it is shared with GP’s to upload onto eKIS thus enabling residents wishes to be visible both and prevent unwanted admissions. Preliminary data gained from 4 care homes showed between 24 and 72 % of residents had ACP’s in place however the quality of ACP’s was often not of a good standard with many pieces of vital information missing and a lack of transfer onto eKIS. A training package, based on EC4H model of ACP communication is currently being developed and due to commence in December. 5.12.2 A further trial of ReSPECT which documents personalised clinical care based on the residents wishes in case of emergency situations is also underway in 5 care homes. 5.13 Discharge Coordination 5.13.1 We are working to improve discharge coordination from the Emergency Department. 5.13.2 We have already introduced the Discharge Support Worker role within the Frailty Assessment Unit which has improved the coordination of discharge both in terms of patient safety and in relation to multidisciplinary team communication, the timing of discharge and has also allowed early analysis of the delays to the discharge process. Early feedback from patients and their
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13 families has been positive noting the benefit of a single point of contact, especially when there are complex discharge planning issues. 5.14 Expansion of Assessment & Review Capacity 4.13.1 We’re progressing our plans to enhance local social work capacity utilising the new funding provided. This will allow for an enhanced focus on assessment and review activity across hospital and community setting to ensure people receive the right level of support at the right time. This will include MHO roles to ensure a focus on AWI/guardianship processes and will be supplemented with the additional posts we have already been able to recruit to in our Home Assessment Team (including Occupational Therapists) and our Integrated Rehabilitation Teams (including Occupational Therapists, Physiotherapist, OT Assistants and There is an urgent need to focus on assessments and reviews in order to ensure people are receiving the right level of support and release potential capacity in the care system. This includes the wider MDT and key staff such as OTs and OT assistants, and MHO roles to focus on AWI / guardianship processes. 5.15 Support for Care Homes 5.15.1 Robust supports exist around the support to nursing care homes, involving key partners from across health and social care and covering key areas of work such as: • Care Home Assurance Group – initially established in April 2021, group was expanded to include Chief Social Work Officers, Chief Officers and the Medical Directors. The group has also undertaken a thematic analysis of Care Homes, identifying support needs around access to updated HPS guidance; management of outbreaks; standard infection prevention and control measures; and staff support around mental health and wellbeing. • Huddle - All 89 care homes in Lanarkshire have registered to use the national safety huddle template hosted on TURAS. The data is reviewed daily, and any issues highlighted are escalated. There is also a weekly safety huddle meeting involving social work, care inspectorate, health protection team and nursing staff where they review and respond to any escalations or concerns raised. There is a consistently good completion rate with the Care Home Liaison Nurses supporting homes where necessary. • Enhanced support from Social Work Quality Assurance – including coordinated timetable of audits for each Care Home; supporting action plan development; coordinating links with colleagues in Care Home Liaison, Infection Prevention and Control, Care Inspectorate etc; and support for Homes to claim financial assistance where appropriate. • Care Home Liaison – establishment increased by 7.0 FTE B6 with plans to move to a 7-day service and enhance contact with each home in Lanarkshire. The team have undertaken visits; managed daily data
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14 returns; acted as an escalation point for PPE issues; and participated in the prioritised engagement visits as required. • Health Protection Team – To enhance the outbreak management and screening testing in Care Homes, an additional 0.6wte B7, 3wte B5, 1wte B4 and 3wte B2 staff have been brought into the team. • Care Home Assurance Infection, Prevention and Control Nurses provide education, advice, and support for care homes. This includes outbreak management support and visits, collaborative support visits, support to embed the National Infection Control Standards and IPC improvement projects to improve and maintain IPC standards. • Workforce requirements and supply of mutual aid A Care Home Liaison Nurse has been working collaboratively in the acute sites to assist with a reduction in discharge delays. This has involved attending the PDD daily, highlighting any delays due to outbreaks and liaising with Health Protection to risk assess to aid discharge, gaining accurate care home bed occupancy figures via the TURAS Daily Safety Huddle Tool, which is now sent to all interested parties daily, assist Social Work to discuss choices with patients/ families, ensuring community care assessments are completed timeously, improve communication and roll out the transfer document trial with the acute setting, Point of contact for patients, relatives, ward, SW and care home staff to improve communication and prevent duplication of effort. • The Care Home Assurance Team have formed a group for all stakeholders to work collaboratively to create a transfer document for care home residents. This is in response to clinical incidents where poor communication has been highlighted via Datix and SAERs. The document will be used for both care homes transferring residents into hospital and hospitals transferring out to care homes. The draft document has been agreed and testing commence in acute sites coordinated by a CHL nurse and in 5 care homes. • An MDT project to improve proactive, anticipatory, person centred care in line with The Healthcare Framework- My Health, My Care, My Home (Scot Gov 2022) is underway. The project currently involves 5 care homes however the team are engaging with other GP practices and care homes to roll it out further. Data collection is ongoing as the project expands to show the impact on improving the residents care journey using the principals of realistic medicine and ensuring ACP and ReSPECT data is shared. Examples of results seen so far is an average of 30% reduction in medications which are linked to increased falls risk and a £96 reduction in medication costs. 5.16 AWI 5.16.1 Work is ongoing in our aim of a maximum 13 weeks period for guardianship applications. There are currently 18 AWI patients in North Lanarkshire delayed in hospital with 1,699 bed days cumulatively – this accounts for 51% of total current delayed discharge bed days
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15 6. CONCLUSIONS 6.1 The developments and actions described in this report seek to respond effectively to demand through winter 2022 and beyond, key developments and actions are creating increase capacity, strengthen response and maintain safe and effective services in North Lanarkshire 7. IMPLICATIONS 7. NATIONAL OUTCOMES 7.1. Service recovery, winter planning and supporting the health and social care system impacts on all of the national outcomes. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 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 None. ..................... .................................................... CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.