Item 14 - Service Recovery, Winter Planning and Supporting the Health and Social Care System
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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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.