Minute
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 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 16th November 2022 2pm-3.30pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Gerry Brennan North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Ayeshah Khan 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 In Attendance: Stacey Connor (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Nicola Lynch Finance Manager NLC Dr Lucy Munro Medical Director North HSCP Elizabeth Seaton Partnership for Change User Rep Apologies 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 Councillor Paul Kelly North Lanarkshire Council Nominated Councillor John Watson Unison Rep
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2 ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. It was noted Neil Findlay has resigned from his position and a replacement will be appointed in due course. Welcome was extended to Cllr Brennan and Cllr Burgess as new voting members of the committee. 2. Declaration of Interests There were no declarations of interest raised. 3. Minutes 31st August 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. All items were either complete or on todays agenda with the exception of items 9-13 for which Ross provided an update 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. 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. 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 These risks were reviewed on 2nd November 2022 and will be subject to further review with the Chief Finance Officer as part of the financial planning exercise for 2022/23.
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3 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 Ross McGuffie noted reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute. Ally Boyle queried for the CAMHS risk how long will this stay at rated as high. It was previous rated at very high due to Health Board scrutiny process; particularly due to recruitment concerns and length of waiting times. Starting to see improvement in both areas so this is why risk has been reduced from very high to high. Dr Lucy Munro noted this was reviewed yesterday at CAMHS programme board and the risk will be reviewed next week, where it is hoped it will be further reduced. Cllr Khan requested abbreviations are not used in future reports; this was noted. Brian Moore noted different rating for staff well-being on both registers and requested that this be reviewed to ensure consistency of approach. Ross McGuffie will review. Recommendation agreed by the IJB PFA: 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. RMcG RMcG 6. Analogue to Digital Telecare Transition The report shared 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. 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.
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4 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) A business case around the analogue to digital telecare transition has been agreed and signed off at the Enterprise Architecture Govern Group and CORE. North Currently have purchased around 1000 digital devices and working at replacing roughly 20 alarms a day. Keen to now progress and purchase an additional 5500 alarms to move the work along at pace. North HSCP have secured £2m of capital funding from North Lanarkshire Council to support this. Although it is noted there is an on-going revenue cost with use of digital sim cards which is rough £347,000k per year. Cllr Brennan queried will this be a digital version of life lines and will it mean more peripheral be able to be used with the device. Ross McGuffie advised later in the meeting that 8 peripherals can be used. Ally Boyle queried does this new equipment meet the new fire standards and the paper says the alarm doesn’t cover the peripherals, is this correct. Ross McGuffie advised the capital obtained is enough to cover the proposal and the peripherals. The equipment does meet the new fire standards. Brian Moore asked what is the timescales for the devices to be available to the community. Ross McGuffie noted the initial 1000 devices went through the national framework so this was pretty quick. Morag Dendy added digital group is meeting after this so can provide exact timescales in due course. Ross McGuffie to provide the group with an update on the work when appropriate. Going to council committee in February so will link to same timescale. The IJB PFA committee agreed the following: a) Noted the progress of the project to date b) Noted the risk of early telephone migration by telephone providers c) Approved the purchase of 5500 alarm devices to support the transition to digital telecare. RMcG 7. Primary Care Improvement Plan Update A paper which has already been prepared and approved by South Lanarkshire IJB was tabled update members on the progress of Primary Care Improvement Plan implementation.
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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) RAG Rated-Green Community Treatment and Care (CTAC) RAG Rated-Amber Pharmacotherapy RAG Rated-Red Dr Lucy Munro advised there have been a number of updates to the work from Scottish Government which includes mandatory legislation in place to cover the 3 services listed above. It was noted North HSCP is involved in the work streams and part of any test of change work being undertaken in tandem with South HSCP. Ally Boyle queried should RAG ratings be split down further as a number of different factors can progress but still not change the overall rating. Dr Lucy Munro advised more detail can be provided if required to offer the committee assurance. Cllr Burgess noted a lot of changes for patients how do they feel about this. Dr Lucy Munro advised this has not all happened at once but been delivered over a period of time, patients seeing different types of practitioners have reported to being greatly satisfied. Cllr Burgess also asked will work move from GPs to pharmacists going forward. PCIP covers pharmacist based in GP practices and those in community have a separate contract. There is also prescribing optometrists now, independent contractors are all working to the top of their license. GPs are experts in holistic care to manage complexity and risk and other contractors can specialist in certain areas. Brian Moore queried if there is any sense from GPs themselves that the contract has made improvements, has there been tangible benefits captured. Dr Lucy Munro noted after the pandemic when the programme was picked up this was in a changed environment. Have undertaken some surveys for example around urgent care which has provided some positive data. GPs are over whelmed with current work pressures so difficult to get a clear impact view. Cllr Brennan asked has the pandemic helped to propel some of the work indirectly. Dr Lucy Munro advised it is challenging to pin down what is better beyond digital access for patients being a positive improvement. The IJB PFA noted the following recommendations: 1) That the report and progress is noted; and
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6 2) That the proposed revitalised reporting regime be approved. 8. Integration Review 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. The review consisted of three main elements: themed work streams; self- assessment exercise and structural review. 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. 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. Ross McGuffie noted in the action plan there was an action around digital upgrades to support joint working, this was overtaken due to roll out of 365 across Scotland. As part of COSLA and Scottish Government collaboration work this has been undertaken to allow access to diaries and contact in teams; the cost has been covered by the national work. The IJB PFA noted the completion of all outstanding actions from the Integration Review process. 9. Financial Monitoring Report 2022/2023 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). 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 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.
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7 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. Brian Moore noted the projected underspend is £14m for end of year which will become part of reserves going forward. Ross McGuffie advised there is a lot of work under going nationally, Scottish Government may not release additional funding until reserves have been utilised which would change the position but this has not been confirmed. Brian Moore also asked is there any update on covid 19 reserves being recovered. Amanda Kilburn advised Scottish Government have requested a return at period 6 for covid costs; any claw back would be based on this report but nothing has been confirmed as yet. The IJB PFA Committee agreed following recommendations: Note the contents of the report; and 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. 10. Progress Report on Agreed Actions 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. 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. The report totals 20 actions where 11 have been completed with 9 still outstanding. Ross McGuffie advised even though there are a number of actions outstanding they are near completion. The IJB PFA Committee agreed the following recommendations: That the content of the report is noted; and That further progress reports will be presented to future meetings of the PFA Committee in respect of any ongoing actions. 11. IJB Reserves Strategy 2022/2023 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves and seeks endorsement to establish
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8 new reserves in line with the planned commitments and Scottish Government guidance. 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). 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. A total of £8.335m has been drawn down from reserves during 2021/2022 (NHSL - £7.564m; NLC - £0.771m). 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. 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. 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. 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. Amanda Kilburn noted there is on-going work to review all commitments within the reserves strategy. If there are any areas of funding which can be re-routed this can support pressure areas within the strategic commissioning plan. Ross McGuffie noted will review all ring fenced reserves linked to SCP. Ally Boyle asked what would the principles around the spend be for the funding would it be for short term gain or to maximise funds available over a longer period. Amanda Kilburn noted some funds are temporary so funding would be drawn down from reserves going forward.
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9 Cllr Khan noted be would be helpful to have list of areas within the SCP in priority order; this was noted. The IJB PFA Committee agreed: Note the 2021/2022 closing balance on the IJB reserves at 31 March 2022; Endorse the allocation of the Scottish Government funding to the ring-fenced reserves as outlined at section 8.1; Endorse the allocation of funding to the risk based, earmarked and contingency reserves as detailed at sections 8.2, 8.3 and 8.4; Endorse the re-allocation of reserves as detailed at section 9.1; Note the update from Scottish Government with regards to reclaiming surplus Covid-19 reserves at section 6.4; and 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. 12. Covid Update 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. As of today got 60 covid positive inpatients, 9 patients off site and 9 in intensive care. 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. On 27th July 2022, NHS Lanarkshire moved from red to black status due to escalating staff and bed shortages across the system. There are 4 care home outbreaks 17 resident and 5 staff are effected. Uptake of vaccinations has been very positive within care homes. Delayed discharge demand is incredibly high at present, got 85 delays with 13 discharges planned. The NHS non-executive directors have a session
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10 today around winter planning which will includes discussions around delayed discharges. The IJB PFA: (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. 13. ADP Self-Assessment 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. 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. Morag Dendy noted main area for improvement is ability to evidence sustainable. Noted a number of people with lived experience are involved in the work. Brian Moore asked when will the external evaluation be available and form this may take. Morag Dendy advised there is some direct involvement with HIS particularly around homeless work but nothing else. He also requested that we align IJB reporting timetable with that of the ADP. He also observed that the final page of the report helpfully set out the governance relationship between the IJB and the ADP. Morag Dendy noted as the SCP is developed this will help to align the reporting work. The IJB PFA noted the report. 14. Service Recovery, Winter Planning and Supporting the Health and Social Care System 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. 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.
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11 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. Brian Moore noted the report is helpful to give the wider picture and asked how we capture improvements going forward. Morag Dendy confirmed updates will be brought to the committee in due course. The IJB PFA committee: 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. 15. Risk Ross McGuffie will review CAMHS and staff well-being to ensure the risks match on each register. 16. Date of Next Meeting TBC