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